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 crosscontamination.
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.