When urban taps run dry: Sachet water consumption and health effects in low income neighborhoods of Accra, Ghana

Abstract

Intraurban differentials in safe drinking water in developing cities have been exacerbated by rapid population growth that exceeds expansion of local water infrastructure. In Accra, Ghana, municipal water is rationed to meet demand, and the gap in water services is increasingly being filled by private water vendors selling packaged “sachet” water. Sachets extend drinking water coverage deeper into low-income areas and alleviate the need for safe water storage, potentially introducing a health benefit over stored tap water. We explore correlates of using sachets as the primary drinking water source for 2,093 women in 37 census areas classified as slums by UN-Habitat, and links between sachet water and reported diarrhea episodes in a subset of 810 children under five. We find that neighborhood rationing exerts a strong effect on a household's likelihood of buying sachet water, and that sachet customers tend to be the poorest of the poor. Sachet use is also associated with higher levels of self-reported overall health in women, and lower likelihood of diarrhea in children. We conclude with implications for sachet regulation in Accra and other sub-Saharan cities facing drinking water shortages.

Intermittent Domestic Water Supply: A Critical Review and Analysis of Causal-Consequential Pathways

“…Each condition is placed in one of five categories, discussed below. Broadest network distribution prioritized Local Governance -Low prices [15] -Water rationing by utility [107] -Network stretched beyond capacity to deliver continuous supply [5,81] -Intermittent supply [2,43,111,113] Consumers overdraw Consumer Response -Water losses/less water in system [32,48] Coping mechanisms among the most impoverished are not observed or understood Local Governance -Politicians do not believe the poor are willing to pay for water [94,127] Demand-supply gap widens Large-Scale Trend -Water rationing by utility [7] We identified a total of 106 cause-consequence pathways between 47 conditions of water intermittency. Table 2 lists each condition in alphabetical order, and the conditions that arise consequentially according to the literature, with citations provided.…”

“…Each condition is placed in one of five categories, discussed below. Local Governance -Politicians do not believe the poor are willing to pay for water [94,127] Demand-supply gap widens Large-Scale Trend -Water rationing by utility [7] Development Large-Scale Trend -Increased water demand [37] Electricity blackouts Capacity Constraint -Intermittent supply [33,87,107,111] Funders prefer new construction over improvements Local Governance -Water utility has insufficient funds to perform job [28] Government corruption/power structures that prioritize privilege Local Governance -Low consumer confidence/satisfaction [128] -Policies do not address intermittency [26,88] Higher costs to run system Capacity Constraint -Poor water utility service [87,107] Hydrological regime changes (e.g., climate change, anthropomorphic change) Large-Scale Trend -Demand-supply gap widens [6,7,37,114] Inadequate water delivered to households Capacity Constraint -Suffering/interpersonal conflict [62,127] Increased -Water utility has insufficient funds to perform job [20,120] -Access inequality [26,28,96,107] Political misjudgments of progress indicators Local Governance -Broadest network distribution prioritized [19] -Funders prefer new construction over improvements [28] Politicians do not believe the poor are willing to pay Local Governance -Low prices [15,33,129] -Intermittent supply [15] Poor utility data management Capacity Constraint -Policies do not address intermittency [6,37] -Coping mechanisms among the most impoverished are not observed or understood …”

“…"Serving the last mile" can be complicated by socio-political issues such as secure land tenure or steady income [130], but has its basis in equity when planners choose to provide water to as many people at the lowest prices possible [2,5,113]. However, researchers have found that prioritizing broad distribution can cause water rationing [107], low prices [15], network stretch [81] and, generally, intermittent supply [2,43,111,113]. Unfortunately, the priority of broad delivery compromises service to individual households and produces consequences, such as household water storage, which in turn help to further entrench the intermittent water supply regime.…”

Self-supply and accountability: to govern or not to govern groundwater for the (peri-) urban poor in Accra, Ghana

“…In a 2013 survey in a poor community with "paradoxical" good piped water access, convenience was given as the top reason for buying sachets (43 %), followed by "better quality" [than GWCL water, presumably] (23 %) (Stoler et al 2012b(Stoler et al , 2015b. The Food and Drugs Authority registers sachet producers and monitors the raw water treatment; use of sachets has been associated with higher levels of self-reported overall health in women and lower likelihood of diarrhoea in children, meaning that the urban poor may reap an unintended health advantage as sachets replace the consumption of stored water that is often cross-contaminated in the home (Stoler et al 2012a). Highly reputed brands have been found to be generally coliform-free, but the sachet water production is prone to development of bio-film and emergence of potentially pathogenic microorganisms such as Pseudomonas Aeruginosa, which presents a risk to immune-compromised populations (Stoler et al 2015a).…”

“…Besides, not all water used in the household needs to be of potable standard. Taking into account how sachet water permeates the low-income West African market and has been found to be healthier for residents of water-stressed communities to use sachets in place of poorly stored household drinking water (Stoler et al 2012a), there are numerous benefits not least to vulnerable groups such as children, women and elderly from the easy access to water that self-supply can provide.…”