The Impact on Health and the Willingness to Pay for Piped Water in Punjab, Pakistan

Every year some 3.4 million people worldwide, mostly children, die from diseases associated with poor water quality, sanitation and hygiene. In Pakistan, it is estimated that about 200,000 children die every year of water-related diarrheal diseases. Piped water is commonly thought to mitigate the public health consequences of water borne diseases; however, the empirical evidence on the health effects of piped water is mixed at best.;This study measures the health effect of piped water in the Punjab, where most Pakistanis reside, by analyzing the impact of piped water on the incidence of diarrhea in children under the age of 5. The results show that piped water has no significant effect---positive or negative---on diarrhea in children in rural areas; that piped water has an adverse health effect in urban areas, and is associated with increasing the probability of diarrhea in children by an average of 2.2 percentage points; and that in both areas proximity of piped drinking water and wastewater confers additional health risks, presumably due to cross-contamination. At the very least, the empirical findings offer no support to the view held by some that publicly provided water has beneficial health impacts. Indeed, for urban areas they implicate piped water as contributing to negative child health outcomes.;Since poor service of public water systems often leads to customer dissatisfaction and lower collection of water tariffs, this study also analyzes the willingness to pay for piped water at the mean levels of service, and predicts how the willingness to pay may change if services were improved to provide better quality water, and for more duration per day. The results show that piped connections add a positive and significant value to the imputed house rental price in both rural and urban areas; that the value of piped water increases as water table depth, groundwater salinity, and duration of piped water flow per day increases; and that it falls as the percentage of households in a district with bacteria present in their piped water increases.;Taken together, these findings suggest that improving both the quantity (i.e., increasing the duration of flow daily) and water quality have a significant effect in increasing the willingness to pay for piped water. The results also indicate that households are willing to pay more for an improvement in quality of piped water than for an increase in the duration of flow, and that the response is higher in areas where alternatives to piped water are harder or more costly to find.