When urban taps run dry: Drinking water patterns in low income neighborhoods of Accra, Ghana

Intraurban differentials in access to safe drinking water in developing cities have been exacerbated by population growth that exceeds expansion of municipal water infrastructure. In Accra, Ghana, municipal water is rationed to fulfill demand that far exceeds production, and water delivery is ultimately influenced by both geography and income. The gap in water services is increasingly being filled by entrepreneurial water vendors selling packaged, or “sachet” water. While the booming sachet industry effectively extends water coverage deeper into informal settlements and slums, higher unit prices may perpetuate poverty. Contrarily, sachets alleviate the need for safe storage of drinking water and may introduce an inadvertent health benefit over variable-quality tap water. We explore factors associated with using sachets as the primary source of drinking water in 1,276 low-income households in Accra; we use data from a Housing and Welfare Study (HAWS) administered in 37 census areas classified as slums according to UN-HABITAT criteria. Using a multilevel framework, we find that neighborhood rationing exerts a strong effect on a household's likeliness to buy sachet water, even after adjusting for socioeconomic and demographic factors at the household and individual level, and that sachet customers tend to be the poorest of the poor. The relationship between sachet use and recent incidence of diarrhea in children is less clear, but remains an important research question given increasing dependence on sachets by low-income neighborhoods. We conclude with implications for sachet regulation in Accra and other rapidly developing sub-Saharan cities facing drinking water shortages.