Innovative service delivery models are attempting to more consistently provide clean water to communities in developing countries. It is imperative that these approaches be evaluated for their performance in these contexts while understating potential consequences. A private service delivery model in Ghana utilizing solar-powered water treatment, circuit rider principles, pre-paid metering, and a district-wide approach was assessed for three years. A quasi-experimental design used key informant surveys, household surveys, and water quality testing to investigate the service received by households under various management schemes. Service indicators were compared using logistic regression analysis. Private customers were shown to have significantly improved quality, annual reliability, and satisfaction ratings (p
< 0.05) compared with control households, while maintaining the quantity of water collected. However, private customers were more reliant upon multiple water sources to meet domestic needs and suffered from lower affordability scores. About 38% of households used private water services, with no significant relationship with socioeconomic class. It is important for policy-makers and implementers to understand that some people will be unwilling or unable to take advantage of this model, and a transition from free improved sources to paid piped schemes will likely require a period of supporting both systems in order to reach everyone.
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