Water, Health and Wealth: The Impact of Piped Water Outages on Disease Prevalence and Financial Transactions in Zambia

Providing clean water requires maintenance, as well as the initial connections that are typically measured. Frequently, the water supply fails in the developing world, especially when users do not pay the marginal cost of water. This paper uses the timing of frequent, unexpected water service outages in Lusaka, Zambia to identify the short-term impacts of piped water access on contagious disease, economic activity and time use. We use microdata from the primary water utility in the city on the timing and location of supply complaints to identify outages, matched to extensive administrative data across the city. Conditional on fixed effects for time and water service district within Lusaka, we find that increases in outages are associated with increased incidence of diarrhoeal disease, upper respiratory infections, typhoid fever and measles. We match outages to geolocated microdata on financial transactions from the largest mobile money provider in Zambia, and find that outages cause a reduction in financial transactions. Outages also increase the time that young girls spend at their chores, possibly at the expense of time that they spend doing schoolwork. Imperfect infrastructure appears to burden the poor in ways that go far beyond obvious health consequences.