The right to water in rural Punjab: Assessing equitable access to water through the Punjab rural water supply and sanitation project

Water Affordability		Percent
Change in price of water over 5-year period, n=193*	More expensive	67.9
	Less expensive	8.3
	Stayed the same	4.3
	Can’t say	17.6
How much do you pay per month for the new connection? n=102**	50-100 Rs	92.2
	100-150 Rs	6.9
	150-200 Rs	0
	200-250 Rs	0.98
If connection was cheaper, would you have gotten it? n=148**	No	21.6
	Yes	78.4
If you think you can’t afford the connection, give reasons why not, n=110**	Very costly	74.6
	You need money for other uses	14.6
	Money spent on medical expenses	3.6
	Money spent on social obligations	7.3
If you can’t pay for the connection, what do you do?  n=129**	Use a hand pump	83.0
	Borrow water from neighbors	15.5
	Take water from rivulet/water channel/etc.	1.6
If water is made available at all times, are you willing to pay more? n=176**	Yes	40.9
	No	59.1

Table 4. Demographic, socioeconomic, and water accessibility characteristics, by program participation

Demographic Information			Participation % or Mean (Range) n=106	Non-Participation              % or Mean (Range) n=137	P-value
Gender of survey respondent, n= 241*	Female		48.1	41.6	0.317
	Male		51.9	58.4
Number of members in the household, n=243			5.7 (5.2, 6.1)	5.7 (5.3, 6.1) 0.87
Gender of the head of household,  n=243	Female		80.2	80.3	0.98
	Male		19.8	19.7
Socioeconomic Information
Materials that make up roof of house, n= 224	Iron or mixed steel/		49	56.4	0.27
	Concrete/
	Thatch/Other		51	43.6
Materials that make up walls of house, n=237	Mud/		57.6	49.6	0.23
	Wood/ Cement/ Bricks/ Steel/ Other		42.4	50.4
Water Accessibility
Sources of water: Where respondents most frequently obtain water	Improved drinking water source, n=229		53.7	11.3	0.0001
	Unimproved drinking water source		46.3	88.7
Has water quantity increased or decreased in past five years? n=173	Increased/same		41.1	22.0	0.0068
	Decreased		58.9	78.0
Water Quality
Has water quality increased or decreased  in past five years? n=233	Increased		70.9	53.9	0.008
	Decreased		29.1	46.1
Reported treating water, n=200	Never		63.0	62.04	0.29
	Sometimes		13.0	21.30
	Often		5.4	6.48
	Don’t know		13.0	8.33
Have access to materials needed to treat water, n=134	Never		53.9	48.8	0.0907
	Sometimes		7.7	20.7
	Often		13.5	4.9
	Don’t know		25.0	25.6
Report of gastrointestinal problems in the past two years n=223	Yes		52.0	66.4	0.0298
	No		48.0	33.6

*Sample size less than n=243 reflects missing data.

Socioeconomic status and water accessibility and quantity
Study participants who reported having walls made of mud or “other” materials were more likely to say that the price of water had increased in the last five years than those who reported having walls made of wood, cement, bricks, or steel (OR: 2.3; 95% CI: 1.4-3.8; p < 0.001). People who had mud or “other” walls were also more likely to report that they would have gotten the PRWSS connection if it were cheaper than respondents who had wood, cement, bricks, or steel walls (OR: 2.3; 95% CI: 1.1 – 5.8; p < 0.05). Respondents who had a toilet in their house were more likely to be willing to pay more if water were available at all times than those who did not have a toilet in their house (OR: 0.78; 95% CI: 0.61-1.02; p = 0.07). In addition, those with toilet facilities in their homes were more likely to know who to approach to make a formal complaint or speak with someone about water (OR: 0.77; 95% CI: 0.61-0.96, p < 0.05).

Socioeconomic status and water quality
Respondents who had walls consisting of mud or “other” materials were also less likely to report sometimes treating water than those who had walls of wood, cement, bricks, or steel (OR: 1.6; 95% CI: 0.93-2.7, p=0.09). Also, respondents who had roofs made of iron, mixed steel, or concrete were more likely to have access to an improved drinking water source compared with those who had roofs made of thatch or “other” (OR: 0.55, 95% CI: 0.36 -0.84, p <0.01). Respondents who did not have a toilet in their house were more likely to report that water quality has decreased in the past five years compared with respondents who had a toilet in their house (OR: 1.4; 95% CI: 1.1-1.7, p < 0.01).

Results from water sample analysis
A sample of water was taken from water tanks associated with the World Bank project, public hand pumps at different depths, and wells in Malsian Bhai Ke, Barsal, Kot Mian Sahib, Mastafapur, Rajoanna Kalan, and Babel Khurd. In Malsian Bhai Ke, the water tank associated with the World Bank Project was potable, defined as being devoid of coliform and assayed microbiological contamination, while a household hand pump that was ten feet from the latrine with a reported depth of 80 feet was not potable, containing traces of coliform and Listeria sp. Water from sampled private taps in Malsian Bhai Ke was found to be potable. In Barsal, two of four sampled household hand pumps were not potable, with both containing coliform and one contaminated with both Listeria sp. and Y. Enterocolitica. Additionally, a public water source using a submersible pump was found to be non-potable. Submersible pumps are used to actively pump water from depths greater than those accessible by hand pumps. Unlike publicly funded hand pumps, the submersible pumps are generally purchased by the household. In Rajoanna Kalan, two of the four sources—a water tap and a public hand pump—were not potable due to Y. Enterocolitica contamination and traces of coliform, respectively. The other two, a tap pit and a source from the World Bank project, were potable. In Kot Mian Sahib, two of three household hand pumps and two out of two submersible water pumps were not potable and were positive for traces of coliform. In Mastafapur, all five tested water sources—including a submersible pump and hand pumps—were not potable and tested positive for coliform. These descriptive results indicate that while nearly all of the World Bank-associated water sources were potable, other sources of water, including the commonly used household hand pump, are frequently not fit for consumption.

Discussion

The findings from this study indicated that the World Bank program in Punjab, India did not fulfill the right to water for all citizens in participating villages. Although the PRWSS project has generally demonstrated an ability to improve access to improved water sources for those who enroll, there was a substantial number of non-participants. This group was more likely to be poor—as indicated by not having toilets in their homes. Thus, for PRWSS to ensure that everyone in the target areas fully realizes their right to water, increased emphasis should be placed on expanding coverage of the program for households that are more impoverished to recognize and address existing structural inequalities that may impede prospective participants’ right to water.

Water quality
While still in its early stages of implementation, the water supplied by the PRWSS project appeared to be of good quality. PRWSS members regularly inspected the water tanks in each village for quality. However, the quality of the publicly available water was compromised, with the majority of samples being non-potable. Specific chemicals such as arsenic were not included in this study, but there was a significant presence of coliform and other bacteria. In addition, all five water sources from Mastafapur—including submersible water pumps—tested positive for coliform. The findings of poor water quality from hand pumps in these towns were consistent with other studies that have also found pollutants in water throughout India.³⁰ Furthermore, these findings were consistent with participants’ self-reported assessment of water quality, where participants in the program reported an improvement in water quality over the past five years compared to respondents not participating in the program.

There was one case where a private water connection established by the PRWSS project was found to be non-potable. This sample was taken from a household in Babhel Kurd, a village where many residents voiced frustration with a local company contracted to construct the water supply system. In interviews, several households that had bought into the program and were located on the opposite end of the village from the central water supply complained that there was little to no water flow, and when water did flow it appeared to be discolored and filled with soil. In addition, residents did not know who to go to in order to voice their concerns. Unlike past water supply projects, which were provided through state or national bodies, PRWSS contracted construction out to local companies. However, given the geographic variability in industry, wealth, and population density across Punjab, the new construction format may have permitted village-level disparities in access to the new water supply projects based on the local economic and social inequalities across rural Punjab. These local disparities may also reflect the long-term structural inequities experienced by different social classes in India, that is, those who were living in poverty or had less socioeconomic resources historically were also less able to buy into the demand-focused design of the PRWSS.

The self-reported improvement in water quality appeared to be consistent across several World Bank projects. In Karnataka and Maharashtra, respondents self-reported that their health improved, although this varied by province—Karnataka reported an average improvement of 45% while Maharashtra reported an improvement of 54%.³¹ These self-reported health improvements were also reflected in a decrease in the number of reported diarrhea cases. Additional research on World Bank projects in Karnataka and Uttar Pradesh comprised of 1,523 households found that 68% of households in Karnataka and 70% in Uttar Pradesh reported being satisfied with the new water provision scheme.³²

Water access, availability, and quantity
Over 57% of respondents reported that the water quantity had decreased in the past five years, suggesting that the general accessibility of water may be at risk in future years. This decrease is likely to continue, as 103 of the 137 geographically defined blocks of groundwater in Punjab (out of the total 839 blocks in India) were declared over-exploited and nine were declared critical or semi-critical.³³ This lack of groundwater availability will be important when implementing current programs or planning future water projects to ensure adequate access to water in India.

Evidence from this study suggests that the PRWSS project had been successful in expanding clean water supply into rural villages. Of the households surveyed in villages covered by a PRWSS project, approximately 40% had contributed money. This substantial enrollment rate is indicative of the demand for clean water access, despite the fact that water supply was only made accessible for less than three hours a day. In Karnataka and Uttar Pradesh, 48% and 81% of the households in the respective villages had contributed to the project.³⁴ When including those households that did not buy into the project for financial reasons, approximately 99% of households in towns covered by PRWSS demonstrated interest in an upgraded water supply.

For those households that did not buy into the upgraded water supply, high costs appeared to be the predominate barrier to enrollment. Approximately 78% of eligible households that did not enroll stated that they would have joined if obtaining a connection were less expensive. Thus, not surprisingly, disparities in access to the upgraded water supply seemed to fall along socioeconomic lines. Using existence of a household toilet as a proxy for socioeconomic status, the non-enrolled group was disproportionately composed of poorer households. For households to enroll into the upgraded water supply, they were expected to pay a security deposit that is generally less than Rs. 1000 (US$22.50), a monthly payment of less than Rs.100 (US$2.25), and a highly variable cost for actually constructing a tap and a connection to the central water tank that may exceed Rs. 2000 (US$45). While subsidies that reduced security fees by half were in place for underserved villages and scheduled caste populations, there were no such subsidies in place for monthly fees or construction expenses. The combination of a security deposit and construction fees could have resulted in a significant upfront financial burden that may have served to deter poorer households from accessing the program.

Water supply programs: Where do we go from here?
Enrollment fees for rural water supply services have been shown to be inversely related to the financial sustainability of a project.³⁵ In the context of Punjab, these findings may suggest that the cost of enrollment, which may have prohibited some individuals from accessing the program, may be detrimental toward the project’s long-term sustainability. While few respondents complained about the monthly charges, several commented that construction fees were unaffordable. Given the potentially high up-front fees faced by poor households, subsidies targeted toward construction costs may be warranted.

Previous work has suggested that households’ contribution toward the capital costs of water services is positively related to equity of access within the village.³⁶ An increased sense of ownership and capacity to promote access to water by underserved populations may result in equity improvements. The gains in equity may be accounted for by an increased sense of ownership over the water service and stronger grounding to oppose curtailment in services amongst underserved groups.³⁷ An alternative strategy may involve village water committees paying the upfront construction costs and recovering the costs through interest-free repayments with a monthly service charge. Through this arrangement, villages may adjust payments to a locally appropriate rate and promote a sense of ownership over the water service. The committee would have an incentive to help households overcome enrollment fees so that membership in the project can be expanded. Increased enrollment would improve monthly cost-recovery and promote the financial sustainability of the project. The current evaluation rubric for PWRSS projects does not assess the number or percentage of households in a village that have received taps, providing little incentive for villages to create innovative mechanisms to maximize coverage.³⁸ An addendum of metrics or incentives that promote full coverage of households within a village may foster innovative thinking on how to help all households gain access to an upgraded water supply.

Given these findings, water quality may be a significant concern for households that are unable to buy into an upgraded water supply. Based on the survey data, poorer households were more likely to be dependent on hand pumps or unprotected wells for their water usage. Unlike higher-income households that may elect to defer joining the project based on satisfaction with water drawn from costly submersible pumps, poorer households were largely dependent on free water sources most at risk for poor quality, susceptibility to depletion, or contamination with pesticides or pathogens. Given the descriptive data about the poor water quality provided by hand pumps, submersibles, and wells, households that were unable to buy into the PRWSS water supply were left dependent on a potentially unsafe water supply.

While operations and maintenance responsibilities were decentralized to the village level, it is unclear whether the PRWSS project adequately engaged local communities in decision making. One of the potential benefits of decentralization was to promote participatory development by transferring responsibility and accountability to the village Gram Panchayat, and the GPWSC. The localization of control to the village level potentially made water supplies more responsive to village needs and increased accountability for sustainable water supply.³⁹ Despite these potential benefits, 60.3% of those surveyed in all villages did not know who to go to in order to issue a formal complaint regarding water supply. These data suggest that households may not be adequately informed about local operations and means of voicing their concerns. Non-enrolled households were found to be less likely to know where to go with a formal complaint regarding the water supply than enrolled households. While the directionality of this association is difficult to discern, it is concerning that households dependent on the non-upgraded water supply were less likely to know where to go to voice their concerns.

This potential disparity in awareness raises the question of whether the model of decentralization currently employed in the PRWSS project is sufficient to promote participatory development. While Punjab is among the most affluent states in India, significant disparities in land ownership and income do exist within rural villages. The 2005 GINI coefficient for rural Punjab was .253, with the lowest 40% of rural households spending Rs. 441 per month, as compared to Rs. 1295 per month by the richest 20%.⁴⁰ The combination of disparities in income and information regarding the water supply system may place the projects at increased risk for capture by local elites.⁴¹ While participatory development is a key component of PRWSS projects, the evaluation criteria for individual projects do not directly assess community education or awareness.⁴²

There are several limitations of the present study. First, the results are based on a cross-sectional survey due to resource constraints. A longitudinal assessment of the introduction of the PRWSS program and the right to water outcomes would yield a more rigorous analysis. Second, the recall period for gastrointestinal problems of two years is long and would possibly result in random misclassification, since it may be difficult to remember brief periods of gastrointestinal illness during that time frame. However, this type of misclassification biases the results towards the null, when a significant association was observed between self-report of gastrointestinal problems and program participation. Third, although the selection of water samples for microbiological analysis was not representative of the water supply for the six villages and only involved 30 samples, the finding that nearly all World Bank program sources of water supply were potable, provides preliminary findings that the World Bank program was generally able to achieve the goal of safe water quality, a key concern of the target area prior to the project. Finally, it is important to note that this is not a formal evaluation of the PRWSS project. Rather, we intended to examine to what extent the right to water was achieved in a target area of the project.

In summary, the program in the Punjab region improved water quality but did not ensure that everyone had an equal realization of the right to water. Future programs in Punjab should take into account the specific barriers poor populations face in accessing the upgraded water supply and support community-devised solutions to maximize access. Assessing outcomes related to the economic sustainability as well as equal access to the program among the targeted participants may result in improving water quality as well as ensuring the right to water for the most vulnerable communities.

Acknowledgements

Many people contributed to this study. Foremost, we would like to extend our gratitude to the study participants for their time and insight. We are grateful for the contributions made by Dr. Pardeep Sharma in the local planning and coordination of the study, Param Sahota and Gulab Pandove for assistance with water sample analysis, Amanda Klasing for her insight into study design and editing, and Elena Chopyak for revising and editing the final manuscript.

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Shamsher Samra, MPhil, is an MD candidate at Harvard Medical School, Boston, MA, USA.

Julia Crowley, MSc, was a research assistant in the Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.

Mary C. Smith Fawzi, ScD, is an instructor in the Department of Global Health and Social Medicine, Harvard Medical School, and epidemiologist for Partners In Health, Boston, MA, USA.

Please address correspondence to the authors c/o Mary C. Smith Fawzi, ScD, Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Ave., Boston, MA, USA; email: mary_smith-fawzi@hms.harvard.edu; telephone: (617)432-2574; fax: (617)432-2565.

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26. Ibid.

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29. See note 9.

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31. See note 17.

32. L.S. Prokopy, “The relationship between participation and project outcomes: Evidence from rural water supply projects in India,” World Development 33/11 (2005), pp. 1801-1819.

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34. See note 32.

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36. See note 32.

37. See note 19.

38. For additional information on the Punjab Rural Water Supply and Sanitation Project, see its homepage at: http://wbprwssproject.org/.

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40. A. Sen, “Poverty and Inequality in India,” Economics and Political Weekly 39/38 (2004), pp. 4247-4263.

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