Impact of safe drinking water and clean fuels on health and wellbeing in Pakistan: A spatial analysis

Abstract

Access to safe drinking water and clean fuels remains a setback for low- and middle-income countries. It has substantially impacted people's health and wellbeing worldwide and its improvement would enhance the economic development of any country. In this study, we constructed four versions of the District Health Index (DHI) each with a different set of indicators by adopting the Urban Health Index (UHI) framework and Geographic Information System (GIS) tools to (i) determine the effect of safe drinking water and clean fuels on districts wellbeing, (ii) measure the impact of safe drinking water and clean fuels on disparities/inequalities (disparity ratios and disparity slopes) concerning DHI scores and, (iii) examine the role of safe drinking water and clean fuels in the spatial relationship among contiguous districts in terms of DHI scores. Results of the study indicated that on average, only 17.72 and 18.29 percent of people in each district had access to safe water and clean fuel respectively. Less accessibility towards these indicators reduced the mean score of the Pakistan district's health from 0.37 to 0.25. The inclusion of safe water widened the disparity ratio and diminished the disparity slope. Spatial analysis revealed that Pakistan's district health status was spatially correlated with contiguous districts. Global Moran's I scores confirmed the declined spatial dependence, when safe drinking water indicator was included in composite index. Most of the districts were concentrated in high-high (HH) and low-low (LL) quadrants. A spatial cluster of low-low (deprived/unhealthy) districts in Baluchistan confirmed that comparatively, Baluchistan is the most deprived province which needs government attention and policy maker's prioritizations.