Despite targeted development efforts, Timor-Leste has some of the poorest water and sanitation performance indicators in Southeast Asia. This cross-sectional study investigated the role of social, economic, and related systematic factors on recently completed water source interventions in the country. A Rapid Assessment Process (RAP), strongly informed by ethnographic/ecologic understandings, was used to gather data in eleven urban, peri-urban, and rural settings on conditions and outcomes of the projects. Extensive information obtained through meetings with government, Inter-Governmental Organization (IGO), and NGO officials complemented these data. Reliable quantitative metrics were scarce, yet most of the communities reported overall perceived improvements in community health and well-being. A general consensus emphasized the importance of local involvement in, and integration among, water, sanitation, and hygiene (WASH) efforts, with four communities effectively demonstrating such integration and four others making strides. Community residents' openness to outside assistance is making a difference, and traditional beliefs and customs have experienced a bit of resurgence, which is likely aiding project integration. Applied ethnography and triangulated methods proved essential in these determinations. We found that user perceptions, health outcomes, and the sustainability of such projects can be improved by emphasizing collaboration and “what-works information diffusion” among all stakeholders through all stages of project design and implementation.

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