Satisfaction and willingness-to-pay for water services in rural northern Ghana: Do we need intermediary steps toward safely managed services?

Abstract Universal access to safely managed water, defined as water from an improved source that is accessible on premises, available when needed, and free from contamination, remains far off in many low-resource settings. Progress toward safely managed services may include intermediate steps focused on improving some service attributes over others. However, knowledge surrounding households’ service preferences remains limited. This study explored satisfaction with existing water service characteristics and willingness-to-pay for hypothetical improvements in water supply. We conducted surveys with 1,748 households among 120 rural communities in northern Ghana. While few households (<2%) had safely managed water services, approximately half (52%) had at least basic access (i.e., an improved source where collection time is within 30 minutes). Satisfaction with existing water services was associated with source type, accessibility, availability, and perceived safety. For example, respondents who always had drinking water available in sufficient quantities had almost three times the odds of being satisfied (odds ratio [OR]: 2.66, 95% CI: 1.94-3.66), similar to respondents able to collect water within 30 minutes (OR: 3.09, 95% CI: 2.28-4.19) and those with on-premises water access (OR: 2.90, 95% CI: 1.26-6.66). Accessibility and water quality were particularly high priorities. Using discrete choice experiments, we estimated participants were willing to pay 3.6-4.9 times more for on-premises piped connections (compared with handpumps 30 minutes away) and chlorination (compared with no treatment). To a lesser extent, households were willing to pay for improved reliability, increased availability, and shorter collection times (10 vs. 30 minutes). Accordingly, we considered the possibility of introducing an intermediate service level: “proximate access”, defined as using an improved source where water is collected within 10 minutes, available when needed, and (possibly) free from contamination. Such a category may provide feasible intermediate improvements to advance progress toward more highly valued safely managed services in rural, low-resource settings. Competing Interest Statement The authors have declared no competing interest. Funding Statement This manuscript builds on research initiated under the Enhancing Water, Sanitation, and Hygiene (EnWASH) program, which was supported by a cooperative agreement between the United States Agency for International Development (USAID) and Global Communities. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of USAID or the United States Government. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board for the Council of Scientific and Industrial Research in Ghana gave ethical approval for this work (RPN 022/CSIR-IRB/2022). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors.