BACKGROUND:
South Africa faces ongoing water and sanitation challenges, with millions lacking reliable services amid climate change, population growth, and aging infrastructure. Water quality degradation, inadequate wastewater treatment, flooding, drought, and unsafe household water storage increase risks of waterborne and zoonotic diseases, including diarrhoeal illnesses and schistosomiasis, particularly in low-income communities. Municipalities in the Eastern and Western Cape illustrate these intersecting challenges, experiencing recurrent droughts, compromised water quality, and persistent disease transmission despite relatively high sanitation coverage. This panel convenes multidisciplinary research addressing water-related health vulnerabilities through behavioural, environmental, and One Health approaches.

METHODS:
The panel synthesises evidence from multiple integrated studies: a randomised field experiment testing behavioural nudges to improve household water storage; a One Health surveillance framework for early detection of waterborne zoonoses in Eastern Cape municipalities; participatory ethnographic research on flooding-related health vulnerability; and multidisciplinary investigations of waterborne diseases. Mixed methods included molecular diagnostics, water quality and snail host assessments, epidemiological surveys among schoolchildren, microbial analyses of water sources, hygiene education interventions for municipal workers, and community workshops co-designing nature-based and water-sensitive solutions.

RESULTS:
Findings reveal substantial under-detection of schistosomiasis with conventional diagnostics, while molecular tools uncovered hidden infections even in low-transmission areas. Environmental assessments showed widespread microbial contamination and water bodies conducive to snail survival. Behavioural and WASH-related risk factors were prominent, but hygiene education and behavioural nudges led to measurable improvements in knowledge and practices. Integrated analyses informed a drought-related waterborne infection prediction tool linking environmental conditions, water quality, and human behaviour to disease risk.

CONCLUSIONS:
These studies highlight the need for integrated surveillance, climate-resilient water management, molecular diagnostics, and community-centred interventions. By bridging One Health, behavioural science, and participatory adaptation, the panel identifies scalable, evidence-informed strategies to reduce waterborne disease transmission and strengthen public health resilience in water-stressed settings.