Outcomes.

A quarter of the world’s population lacks access to safely managed water. In Accra, Ghana, where less than half the population has a piped connection on premises, improving access is a government priority. This study used a quasi-experimental design to explore benefits of on-premise piped connections among direct (connected) and indirect (neighbors of connected households) users. Among 2,521 households surveyed, 720 (29%) had access to piped water on premises. Piped water was primarily available intermittently, with only 17% of connected households reporting that piped water was available every day. Most connected and unconnected households (90%) reported using packaged water for drinking. Households with a piped connection on premises experienced greater convenience and time savings: they were less likely to report cost barriers (Odds ratio (OR) 0.26; 95% confidence interval (CI): 0.14 to 0.48), less reliant on supplementary water sources (OR 0.45; 95% CI: 0.34 to 0.59), and collectors saved an hour fetching water per week (95% CI: 38–84 minutes). However, these households were less likely to have their domestic water source available every day (OR 0.13; 95% CI: 0.09 to 0.18) and equally likely to store water (OR 1.04; 95% CI: 0.69 to 1.56). Indirect users were less likely to be dissatisfied with their primary domestic water source (OR 0.45; 95% CI: 0.31 to 0.67), but otherwise benefits were less pronounced. We found no differences in perceived water security or income-generating activities associated with piped connections. These findings provide nuanced insights into the benefits of increasing piped water access in Accra’s underserved communities. In this setting, the benefits of piped water services will not fully materialize until all households have access to a connection on premises and issues of intermittent supply are addressed.