## 6 Policy and Management Implications with Recommendations
It may prove a simple but effective way to inform local people about the potential dangers of each water point and allow them to make informed decisions about water consumption on their own. Decommissioning water points based on elevated fluoride is an expensive venture as a replacement water supply must be provided. In a country with water scarcity problems and low-income, this is a considerable investment planning issue. Revision of rural water quality standards that allow 'yes/no' information on water quality at the water point and information on the negative health effects of fluoride ingestion may prove much more realistic across the country. * A wider study of varied lithologies should be sampled in the same manner for hydrochemistry to determine their fluoride-lithology relationships. Both perthitic syenite and limestone (marble in this case) lithologies have been linked to high fluoride and are present in the study area but do not currently have corresponding hydrochemical data. National coverage of lithology types is required. * Collaboration with dental studies in Malawi would be beneficial to corroborating occurrences of fluoride with definitive and documented incidences of dental fluorosis. This will be achieved by working together at the planning stage to ensure both disciplines are conducting their respective research in the same geographical areas. Sharing of data afterwards and working together on cross-discipline publications would ensure the impact of the research to a wider audience of both scientists and policy makers. * An investigation into piped water supply networks should be undertaken. Piped groundwater from reticulated wells (high-yielding boreholes) drilled to support a network of pipes, powered by solar panels, to numerous kiosks where users can collect groundwater from the same source should be evaluated for fluoride. If a reticulated well is drilled into augen gneiss where fluoride potential concentrations are high, a larger number of people across a wider area will be at risk. The MoIWD or local government (or NGOs) should test for fluoride at kiosks and if found, water cycling with nearby, low fluoride water points should be advised in the first instance. If such methods are not possible at kiosks, those kiosks should be decommissioned, and replacement water supplies installed. If elevated fluoride is found in numerous kiosks fed from the same well, decommissioning of the full system and replacement of the water supply is advised. Future plans for similar piped supplies should incorporate some level of fluoride risk assessment as described by this study. Simply avoiding target (high geological fluoride risk) lithologies may be enough and should be implemented. **Supplementary Materials:** The following are available online at [[http://www.mdpi.com/2076-3417/10/14/5006/s1](http://www.mdpi.com/2076-3417/10/14/5006/s1)]([http://www.mdpi.com/2076-3417/10/14/5006/s1](http://www.mdpi.com/2076-3417/10/14/5006/s1)), Table S1: summary statistics for fluoride data in the study area, Table S2: geochemical data from TA Mazengera samples. **Author Contributions:** Conceptualization, M.J.A. ; data curation, M.J.A. ; formal analysis, M.J.A. ; funding acquisition, R.M.K. ; investigation, M.J.A. ; methodology, M.J.A. ; project administration, R.M.K. ; resources, M.J.A., O.P. and W.L. ; software, M.J.A. ; supervision, M.J.A., M.O.R. and R.M.K. ; validation, M.J.A., M.O.R., P.P., P.M., E.M. and M.B. ; visualization, M.J.A. ; writing--original draft, M.J.A. ; writing--review and editing, M.J.A., M.O.R., P.P., P.M., E.M., M.B., O.P., W.L. and R.M.K. All authors have read and agreed to the published version of the manuscript. **Funding:** This research was funded by The Scottish Government, via the 'Climate Justice Fund: Water Futures Programme', grant number HN-CJF-03 awarded to the University of Strathclyde ([PERSON]). **Acknowledgments:** The authors gratefully acknowledge the Scottish Government for funding this research.