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Abstract
Background and objective Access to clean drinking water is essential for health and development. Despite global and national initiatives, many regions in India continue to face inadequate water access. This study assesses progress, sociodemographic determinants and geographic disparities in access to drinking water in India, aligning with Sustainable Development Goal (SDG) 6.1.
Design This study used secondary data from five rounds of the National Family Health Survey (NFHS-1 to NFHS-5; 1992–2021), nationally representative surveys conducted across India. Logistic regression was employed to examine the association between household sociodemographic characteristics and access to improved drinking water. A Water Access Index (WAI) was constructed using Principal Component Analysis (PCA) based on four indicators: access to improved sources, on-premises availability, 5-minute round-trip access and household water treatment. The scores were normalised to a 0–100 scale.
Setting and participants The study used household data from NFHS-1 (88 562 households), NFHS-2 (92 477), NFHS-3 (109 041), NFHS-4 (601 506) and NFHS-5 (636 699), covering all 36 states/union territories in India.
Results There has been a notable improvement in access to improved sources, on-premises water and timely availability. Factors such as higher educational attainment, pucca housing and the absence of a below poverty line card were positively associated with better access. Based on WAI scores, 343 districts (49%) were categorised as front runners (65–99%), 142 districts (20%) as performers (50–64%) and 221 districts (31%) as aspirants (0–49%). Only one district (0.1%) achieved universal access. Many districts in West Bengal, Bihar, Odisha, Jharkhand and other states still exhibit low-to-moderate water access.
Conclusion While access to improved drinking water has advanced, regional and socioeconomic disparities remain stark. Targeted, multisectoral policies are essential to ensure equitable progress towards SDG 6.1 across all districts and population groups in India.
- Social Interaction
- Health
- Health Services
- Health Services Accessibility
- Vulnerable Populations
Data availability statement
Data are available in a public, open access repository. The dataset analysed during the current study are available in the Demographic and Health Surveys (DHS) repository, https://www.dhsprogram.com/data/available-datasets.cfm.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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STRENGTHS AND LIMITATIONS OF THIS STUDY
This study uses the most recent and nationally representative National Family Health Survey-5 (NFHS-5) (2019–2021) data, allowing for robust, population-level insights into household water access across Indian districts.
The Water Access Index offered a multidimensional and data-driven approach to assess district-level disparities in water access.
Integrating geospatial mapping and district-level classification provides valuable policy-relevant insights aligned with the Jal Jeevan Mission and Sustainable Development Goal 6 targets.
The study highlights sociodemographic associations with water access using multivariable logistic regression; however, due to the cross-sectional nature of the data, causal relationships cannot be established.
The analysis relies on NFHS sample data, which, although nationally representative, does not capture the entire population like the census; however, the most recent census data is from 2011, limiting the use of fully up-to-date population-level information.
Introduction
Access to clean water and adequate sanitation is essential for public health and sustainable development. In 2010, the United Nations (UN) General Assembly recognised the significance of access to clean drinking water as a fundamental human right.1 It has a major effect on a household’s life expectancy, living conditions and social standing as well. Nonetheless, it continues to be a significant developmental barrier, particularly in underdeveloped nations. Approximately 25–50% of the world’s population lacked access to sanitary facilities and appropriately regulated drinking water until 2020.2 3 However, the governments of developing nations are working diligently to achieve Sustainable Development Goal 6 (SDG 6), which was endorsed by the UN in 2015. By 2030, everyone should have access to safer water, according to SDG 6.1. Basic water, as per the Joint Monitoring Programme (JMP) ladder, includes access to better sources of water, and round-trip collection time, including queuing, does not exceed 30 min.4 These sources include piped water, public taps, stand pipes, tube wells, bore wells, protected dug wells, rainwater and community reverse osmosis (RO) plants.
With 17.76% of the world’s population living in India, it is the most populous country in the world. Approximately 91 million people in India do not have access to clean water sources, and over 746 million do not have access to household sanitation facilities that are safe.5 The inadequate water and sanitation facilities in India are impacting health, resulting in dysentery, cholera and typhoid diseases. According to a study by Mallick et al, the majority of diarrhoeal deaths in India are caused by contaminated water and inadequate sanitation.6 A World Bank study estimates that 21% of infectious diseases in the world are due to the consumption of unsafe water and the lack of sanitation facilities.7 Another study estimates that polluted water is responsible for approximately 502,000 deaths annually, most of which occur among children.8 Thus, to achieve the target 6.1 ‘universal and equitable access to safe and affordable drinking water for all by 2030’ is the aim of SDG, UN.9 Despite significant advancements in this area, in 2020 one in three people, or approximately two billion people worldwide, still do not have access to safe, clean drinking water.10 While high-income countries have largely addressed this challenge, low-income nations continue to struggle, with only 29% of the population in third-world nations having access to clean water. Moreover, global population growth has slowed the progress of providing safe drinking water in recent years.4
However, the Indian government has taken a number of actions, that is, launch of Jal Jeevan Mission (2019), which seeks to provide every household access to piped water by 2024.11 The programme has focused on water-stressed areas and underprivileged populations, and set an ambitious goal of providing 55 L of water per person each day.12 According to a recent study, most Indian states will soon have universal access to better drinking water sources.13 However, providing access to clean drinking water and adequate sanitation is still a major issue in India. A number of studies globally investigated the variables which are impacting access to clean water and proper sanitation.14–17 However, research is limited in India on the availability of better drinking water sources. Few studies, that is, state-level analysis,18 urban households and rural households19 are included in the existing literature.
It is important to keep in mind that any policy change intended to address issues regarding drinking water irregularities should first identify people who are at risk from substandard water facilities.20 Thus, it is vital to comprehend the critical elements impacting the availability of clean water and better sanitation. Therefore, this study employs the National Family Health Survey (NFHS) to assess drinking water availability across India. While several international efforts have examined household-level access to drinking water—such as community-based models in Brazil and Colombia,21 22 or equitable water distribution policies in South Africa23— there remains limited comparative evidence from India that integrates spatial analysis and composite indexing to capture multidimensional disparities at the subnational level. This study addresses this gap by analysing the coverage of household access to improved drinking water facilities across Indian states and districts. We also examine how key water access indicators have evolved from NFHS-1 (1992–1993) to NFHS-5 (2019–2021), and identify the sociodemographic determinants influencing access. To advance this assessment, we construct a Water Access Index (WAI) using Principal Component Analysis (PCA), which integrates multiple indicators into a single composite measure. The WAI enables the identification of districts most in need of policy intervention, aligning with the objectives of SDG 6.1 to ensure universal and equitable access to safe and affordable drinking water for all.
Materials and methods
Study setting
The study focuses on India, the world’s most populous country, with a population exceeding 1.42 billion. Administratively, India comprises 28 states and 8 union territories, which are further divided into districts, and subsequently into census enumeration blocks in rural areas and wards in urban areas. Over the years, the Government of India has implemented several initiatives to ensure universal access to safe drinking water, including the Jal Jeevan Mission, which aims to provide a piped water supply to every rural household by 2024 in alignment with SDG 6.1. While national-level progress in water access has been commendable, considerable disparities persist due to the country’s vast geographic diversity, sociocultural heterogeneity and varied infrastructural development across regions.
Data
The data for this study were drawn from the household information collected in all rounds of the NFHS,24 spanning NFHS-1 to NFHS-5. A multistage stratified sampling method was employed, consisting of two stages for urban areas and three stages for rural areas. The sample households varied for each survey round, with distinct sample sizes. Specifically, the study used data from 88 562 households in NFHS-1 (1992–1993), 92 477 households in NFHS-2 (1998–1999), 109 041 households in NFHS-3 (2005–2006), 601 506 households in NFHS-4 (2015–2016) and 636 699 households in NFHS-5 (2019–2021). The analysis in this study was conducted based on this diverse and comprehensive dataset.
Variable description
To assess household-level access to drinking water across districts in India, a WAI was developed using four key indicators: (1) the percentage of households with access to improved sources of drinking water, (2) the percentage of households that require less than 5 min to access drinking water, (3) the percentage of households with access to water treatment facilities and (4) the percentage of households with on-premises drinking water access. These indicators reflect the dimensions of availability, proximity, safety and convenience of water access. The WAI was developed using PCA, a statistical technique that reduces dimensionality and identifies latent patterns in multivariate data. Each variable was first standardised to z-scores to ensure comparability. The PCA-derived scores were normalised to a scale of 0–100, using the formula:
where higher WAI values indicate better access to drinking water. This data-driven approach assigns statistical weights to each indicator based on its contribution to the overall variance, allowing for an objective and comprehensive assessment of district-level disparities in household water access. In addition to the WAI, all four individual indicators were also spatially visualised through district-level maps to offer a disaggregated understanding of each dimension. Each map, including the WAI, was classified according to National Institution for Transforming India (NITI) Aayog’s SDG localisation framework: achiever (100%), front runner (65–99%), performer (50–64%) and aspirant (0–49%).25 This classification and spatial visualisation approach provides a data-driven, comparative and geographically nuanced assessment of disparities in drinking water access across Indian districts.
Outcome variable
In this study, we focused on four outcome variables. The first one is ‘household access to improved sources of drinking water’, which is divided into two groups: ‘improved sources’ include piped water into dwelling, piped to yard/plot, public tap/standpipe, tube well or borehole, protected well, protected spring, rainwater, tanker truck, cart with a small tank, bottled water and community RO plant. ‘Unimproved sources’ include unprotected well, unprotected spring, river/dam/lake/pond/stream/canal. The second variable is ‘on-premises drinking water access’, categorised into ‘household on-premises drinking water access’ and ‘household outside premises drinking water access’. The third variable is ‘5-minute access to drinking water’, with categories ‘≤5 min to access drinking water’ and ‘>5 min to access drinking water’. The fourth variable is ‘households having access to water treatment facilities’, classified into ‘households having access’ and ‘no access to water treatment facilities’.
Explanatory variables
We selected key explanatory variables for our analysis based on existing literature and their relevance to household-level access to drinking water. These variables include: sex, categorised as male and female; education level, classified as no education, primary, secondary and higher; family structure, divided into nuclear and non-nuclear households; house type, categorised as kachha, semipucca and pucca; below poverty line (BPL) cardholder status, distinguished between cardholders and non-cardholders; place of residence, classified as urban and rural and geographic region, segmented into north, central, east, northeast, west and south.
Statistical analysis
To achieve the study objectives, we conducted descriptive statistics, bivariate analyses and multivariable logistic regression models. The primary aim was to examine the association between sociodemographic factors and access to drinking water facilities. We employed four separate adjusted logistic regression models corresponding to the four outcome variables: (1) household access to improved sources of drinking water, (2) on-premises drinking water access, (3) 5-minute access to drinking water and (4) access to water treatment facilities. Each of these binary outcome variables was modelled independently using logistic regression to estimate adjusted ORs (AORs) along with 95% CIs. The threshold for statistical significance was set at p<0.05. Given the complex sampling design of the NFHS, all analyses applied appropriate sampling weights and accounted for the stratified two-stage cluster sampling design using the ‘svyset’ command in Stata. This approach ensures unbiased and nationally representative estimates, as the NFHS does not follow a simple probability proportional to size sampling strategy. All statistical analyses were carried out using Excel and StataSE V.16 software. Mapping and spatial analysis were conducted using QGIS V.3.18.1 software. Figure 1 shows the methodological framework of the study.
Methodological framework of the study.
Patient and public involvement
Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Results
Participants
The study used data from five rounds of the NFHS, comprising a total sample of 1 528 285 households across India: 88 562 households in NFHS-1 (1992–1993), 92 477 households in NFHS-2 (1998–1999), 109 041 households in NFHS-3 (2005–2006), 601 506 households in NFHS-4 (2015–2016) and 636 699 households in NFHS-5 (2019–2021). These surveys employed a stratified two-stage sampling design and were nationally representative. For the current analysis, we focused primarily on NFHS-5 data to examine household-level access to improved drinking water and its determinants. Out of 636 699 households interviewed in NFHS-5, all were potentially eligible for inclusion based on the availability of key variables related to water access. There were no significant exclusions due to missing data on the primary outcome variable. Most household heads were male and had attained secondary-level education among the included households. A substantial proportion of households resided in rural areas (74.8%), identified with the Hindu religion (75.7%) and fell within the poorest wealth quintile (23.4%). Regarding household structure, 54.8% lived in pucca (permanent) houses. Importantly, 94.9% of households reported access to an improved source of drinking water.
Access and coverage of drinking water facilities in India
Household access to improved sources of drinking water
India has made remarkable progress in achieving its goal of ensuring 100% access to improved sources of drinking water by 2030. Our analysis (table 1) reveals that 30 states/union territories (states/UTs) have already achieved more than 90% coverage of household access to improved sources of drinking water. Puducherry, National Capital Territory of Delhi, Chandigarh, Uttar Pradesh and Bihar stand out as the top five states that have shown the most significant progress in providing access to improved sources of drinking water. Conversely, Manipur, Meghalaya, Assam, Jharkhand and Tripura are the bottom five states, performing less satisfactorily in providing access to improved sources of drinking water. Notably, most states with the lowest performance are located in the northeastern region of India. When we consider the states that have shown the most improvement in access to improved sources of drinking water from 1992–1993 to 2019–2021, Himachal Pradesh leads the way with an impressive increase of 38.12%. Mizoram, Rajasthan, Jammu and Kashmir, and Odisha also demonstrate substantial progress, increasing 37.20%, 34.55%, 33.35% and 29.38%, respectively.
State-wise distribution of household access to improved sources of water: NFHS-1 to NFHS-5
Time to access water source for households
Online supplemental table 1, shows the time required to access water sources for households within 5 min in India, spanning from NFHS-1 to NFHS-5, reveals the following significant trends: the study observed that 12 states/UTs have achieved an impressive coverage of more than 90% of households with access to drinking water sources within a 5-minute radius. Additionally, 12 states/UTs fall within the 80–90% coverage range. The top-performing states where households can readily access drinking water sources within a 5-minute window are Goa, Sikkim, Kerala, Chandigarh and Punjab. These states have made remarkable progress in ensuring quick access to clean water. Conversely, Andhra Pradesh, Jharkhand, Madhya Pradesh, Odisha and Chhattisgarh are the bottom five states with less satisfactory performance in providing access to drinking water sources within 5 min. States that have made significant progress in improving access to household drinking water sources within a 5-minute timeframe from 1992–1993 to 2019–2021. Punjab leads the way with a substantial increase of 75.98%, followed closely by Bihar, which achieved a remarkable increase of 74.82%. Haryana, Gujarat and Jammu and Kashmir have also made impressive gains, with increases of 72.34%, 72.16% and 69.44%, respectively.
Supplemental material
Households having access to water treatment
Online supplemental table 2, shows access to water treatment facilities in India from NFHS-2 to NFHS-5, reveals a spectrum of findings: a mere four states have successfully achieved more than 90% coverage of households with access to water treatment facilities, represented by Nagaland, Kerala, Sikkim and Goa, while only two states/UTs fall within the 80–90% coverage range, namely Lakshadweep and Arunachal Pradesh. Alarmingly, 15 states/UTs report coverage levels below 50% for households with access to water treatment facilities, signifying significant challenges in delivering this essential service, with Bihar (7.98%), Uttar Pradesh (11.80%), West Bengal (13.21%), Andhra Pradesh (21.17%) and Telangana (26.39%) emerging as the bottom five worst-performing states. Encouragingly, several states, including Punjab (36.18%), Kerala (33.99%), Arunachal Pradesh (31.54%), Tamil Nadu (31.53%) and Goa (25.37%), have made notable strides in improving access to water treatment facilities from 1998–1999 to 2019–2021.
Household on-premises water access
In online supplemental table 3, the result of household access to on-premises drinking water supply in India, spanning from NFHS-3 to NFHS-5, reveals notable trends: a total of eight states/UTs have achieved more than 90% coverage of households with access to on-premises drinking water supply, while an additional 14 states/UTs fall within the 80–90% coverage range. Goa, Sikkim, Chandigarh, Punjab and Arunachal Pradesh emerged as the top five states, showcasing the best performance in providing on-premises drinking water supply. Conversely, Andhra Pradesh, Manipur, Odisha, Jharkhand and Telangana are the bottom five states, facing challenges in ensuring access to on-premises drinking water supply. Notably, the top five states that have made significant progress in increasing access to on-premises drinking water supply from 2005 to 2006 to 2019–2021 include Chhattisgarh (36.87%), Nagaland (34.55%), Mizoram (34.51%), Tripura (34.14%) and Karnataka (32.37%).
Determinants of drinking water facilities in India
To comprehend the key determinants associated with access and coverage of drinking water facilities in India, this study employed a binary logistic regression model. The outputs of the logit model are presented in table 2. The results highlight that sex, education level, family structure, house type, poverty status, place of residence and geographic region play significant roles in access to improved drinking water, on-premises drinking water, 5-minute access to drinking water and water treatment. Women had higher odds of accessing improved drinking water sources (AOR: 1.24; CI: 1.18 to 1.31), on-premises drinking water (AOR: 1.23; CI: 1.21 to 1.26), 5-minute access to drinking water (AOR: 1.28; CI: 1.24 to 1.31) and water treatment (AOR: 1.13; CI: 1.11 to 1.16) compared with men. Education level showed a strong positive association, where individuals with higher education had the highest odds of accessing improved drinking water (AOR: 1.51; CI: 1.36 to 1.67), on-premises drinking water (AOR: 1.94; CI: 1.85 to 2.04), 5-minute access (AOR: 2.09; CI: 1.98 to 2.21) and water treatment (AOR: 2.81; CI: 2.70 to 2.92) compared with those with no education. Non-nuclear families had lower odds of using improved drinking water (AOR: 0.96; CI: 0.92 to 0.99), but higher odds of on-premises drinking water (AOR: 1.10; CI: 1.08 to 1.13), 5-minute access (AOR: 1.09; CI: 1.07 to 1.12) and water treatment (AOR: 1.28; CI: 1.26 to 1.31) compared with nuclear families. People belonging to pucca houses had consistently higher odds across all outcomes: improved drinking water (AOR: 1.74; CI: 1.59 to 1.89), on-premises access (AOR: 1.51; CI: 1.44 to 1.59), 5-minute access (AOR: 1.57; CI: 1.49 to 1.65) and water treatment (AOR: 1.35; CI: 1.28 to 1.41) compared with those in kachha houses. Non-BPL cardholders had higher odds of using improved drinking water (AOR: 1.30; CI: 1.24 to 1.36), on-premises access (AOR: 1.31; CI: 1.27 to 1.34), 5-minute access (AOR: 1.37; CI: 1.34 to 1.41) and water treatment (AOR: 1.06; CI: 1.04 to 1.09) compared with BPL cardholders. Rural residents consistently had lower odds across all outcomes: improved drinking water (AOR: 0.30; CI: 0.27 to 0.33), on-premises access (AOR: 0.52; CI: 0.49 to 0.54), 5-minute access (AOR: 0.46; CI: 0.43 to 0.48) and water treatment (AOR: 0.61; CI: 0.59 to 0.63) compared with urban residents. Geographic variations in the northeast had higher odds across all outcomes, whereas those in the east and central regions had significantly lower odds than the north. The west had lower odds for improved drinking water (AOR: 0.52; CI: 0.46 to 0.60) but higher odds for water treatment (AOR: 3.39; CI: 3.21 to 3.58), while the south had lower odds for on-premises access (AOR: 0.48; CI: 0.45 to 0.50) and 5-minute access (AOR: 0.64; CI: 0.60 to 0.68) but slightly higher odds for water treatment (AOR: 1.22; CI: 1.18 to 1.27) compared with the north.
Determinants of households’ access to improved sources of drinking water, on-premises drinking water access, 5-minute access to drinking water and access to water treatment: National Family Health Survey-5 (2019–2021)
Policy attention and intervention for drinking water facilities in India
Figures 2–6 are pivotal in identifying specific districts and regions requiring targeted attention and policy interventions to enhance drinking water facilities. Based on NITI Aayog’s classification, districts are categorised into achiever (100%), front runner (65–99%), performer (50–64%) and aspirant (0–49%).
District-wise coverage (%) of improved sources of drinking water—National Family Health Survey-5 (2019–2021).
District-wise coverage (%) of on-premises drinking water access—National Family Health Survey-5 (2019–2021).
District-wise coverage (%) of less than 5-minute access to drinking water—National Family Health Survey-5 (2019–2021).
Households with access (%) to water treatment—National Family Health Survey-5 (2019–2021).
Comprehensive Water Access Index—National Family Health Survey-5 (2019–2021).
Figure 2 illustrates the access to improved sources of drinking water across districts in India. Of 707 districts, 148 (21%) have achieved 100% access, earning them the ‘achiever’ status, while 547 districts (77%) fall into the ‘front runner’ category with 65–99% access. However, challenges remain in 12 districts, with eight classified as ‘performers’ (50–64% access) and four as ‘aspirants’ (0–49% access), primarily located in northeastern states like Meghalaya, Assam and Manipur, where drinking water accessibility continues to be a pressing issue. With 98% of districts categorised as front runners or achievers, India appears to be well-positioned to meet the SDG 6 target of universal access to improved drinking water sources.
Access to on-premises drinking water supply presents a more challenging landscape across India’s 707 districts, as revealed in figure 3. While 457 districts (65%) have made substantial progress with 65–99% access, earning them ‘front runner’ status, only six districts (1%) have achieved universal access, qualifying as ‘achievers’. The data expose significant gaps, with 116 districts (16%) classified as ‘performers’ (50–64% access) and a concerning 128 districts (18%) falling into the ‘aspirant’ category with less than 50% access. Unlike the overall improved water source accessibility pattern, the districts struggling with on-premises water supply are predominantly located in India’s central, eastern and southeastern regions.
Examining the accessibility of drinking water within a 5-minute reach across India’s districts, figure 4 reveals a nuanced pattern of persistent challenges. Only 16 districts (2%) have reached the pinnacle of 100% coverage, earning ‘achiever’ status. Moreover, 553 districts (78%) qualify as ‘front runners’ with 65–99% coverage. About 101 districts (14%) are categorised as ‘performers’ with moderate coverage between 50% and 64%, and concerning gaps persist in 37 districts (5%), which are classified as ‘aspirants’ with less than 50% coverage. These struggling districts are not randomly distributed but form distinct geographical clusters predominantly in central, eastern and southeastern India.
Access to water treatment remains a major challenge across India’s 707 districts, as shown in figure 5. A total of 367 districts (52%) fall into the aspirant category, with less than 50% access to water treatment. A total of 138 districts (20%) are in the performer category (50–64%), while 201 districts (28%) are classified as front runners (65–99%). Only one district (0.1%) has achieved 100% access, placing it in the achiever category. Critical districts are concentrated in north, central, eastern and southeastern India.
Figure 6 presents the WAI, an overview of drinking water facilities across Indian districts. PCA was applied to reduce the dimensionality of the data and construct the index. The first principal component (PC1), which explained the highest variance among the indicators (0.5814 or approximately 58.14%), was retained as the composite score for the WAI. The scree plot (online supplemental figure 1) further validates this choice, showing that only the first component has an Eigenvalue greater than 2—thus justifying its selection as PC1 for index construction. The PCA scores are normalised to a scale of 0–100, where higher values indicate better access to drinking water. Based on the WAI, 343 districts (49%) are classified as front runners (65–99%). A total of 142 districts (20% are in the performer category (50–64%). While 221 districts (31%) fall into the aspirant category (0–49%). Only one district (0.1%) has reached 100% access, placing it in the achiever category. A large number of districts in West Bengal, Bihar, Odisha, Jharkhand, Madhya Pradesh, Chhattisgarh, Telangana, Andhra Pradesh, Tamil Nadu, Meghalaya and Manipur have lower values in the index and continue to experience low to moderate access to drinking water facilities.
Supplemental material
Discussion
The Government of India is making a significant effort to eradicate barriers for achieving Water, Sanitation, and Hygiene (WASH) targets as it is a crucial step towards achieving many interconnected SDGs and has a direct link with households. Even though the country is progressively moving closer to the SDG targets for sanitation and water, the JMP ladder is showing various gradients in achieving the concerned targets.26 This study showed that India has made remarkable progress in achieving its goal of ensuring 100% access to improved sources of drinking water by 2030. Although some criteria need crucial attention in order to achieve 100% accessibility of water. For instance, access to improved sources of drinking water remains a concern in northeastern states such as Manipur, Meghalaya and parts of Assam, where several districts fall in the aspirant category. Meanwhile, several districts classified as ‘performers’ are concentrated in eastern Indian states like Jharkhand, Odisha and Chhattisgarh. In terms of access to on-premises drinking water supply, most districts in central, eastern, and southeastern India fall into the aspirant category, whereas Goa, Sikkim, and Kerala enjoy better access to on-premises water services. According to the study, Uttar Pradesh, West Bengal and Andhra Pradesh still lack water treatment facilities. In the study, it was also found that in terms of coverage of drinking water in 5-minute access, most of the central, east and southeast districts fall into the front runner to aspirant category. Moreover, education level showed a strong positive association with access to drinking water services, where higher education had significantly greater odds of accessing improved drinking water (AOR: 1.51), on-premises drinking water (AOR: 1.94), 5-minute access (AOR: 2.09) and water treatment facilities (AOR: 2.81) compared with those with no education. It also found that, as per the WAI, 221 districts—accounting for 31% of all districts—fall into the aspirant category and are in dire need of attention.
Our research confirms that a household’s ability to obtain adequate clean drinking water is influenced by multiple factors, including accessibility, availability, reliability and the effectiveness of government policies. Monitoring water availability and quality must extend beyond the timelines of existing national frameworks, including those outlined by the WHO and UNICEF JMP, which, while emphasising global standards, often face challenges in localisation and long-term sustainability.27 Achieving SDG 6 and upholding the fundamental human right to water require collaborative governance across national and local levels. Efforts to improve water access must be integrated with broader goals of sanitation, hygiene and environmental sustainability, such as enhancing infrastructure, ensuring the availability of treated water and promoting the use of recyclable and reusable materials.28 Persistent barriers exist on both the supply and demand sides, with a major constraint being the lack of disaggregated, real-time data in smaller urban centres and rural areas—hindering effective policy evaluation and resource allocation for WASH programmes.29 In response, India has launched initiatives like the National Rural Drinking Water Programme and its successor, the Jal Jeevan Mission, aiming to deliver universal and sustainable access to safe drinking water.30 These initiatives resonate with international best practices. For instance, South Africa’s Free Basic Water Policy guarantees a minimum supply of 6000 L of water per household per month to ensure equity and basic access,23 while Brazil and Colombia have demonstrated success through decentralised, community-led water governance models.21 22 In the developed world, Scandinavian countries like Finland and Denmark offer effective models through strong policy coherence, robust infrastructure investments and active citizen engagement, achieving near-universal water access and quality.31 32 The Indian experience, though distinct in scale and diversity, reflects common challenges faced by other low and middle income countries—particularly regional disparities, urban–rural gaps and the need for localised, context-sensitive solutions. India’s successes and ongoing challenges contribute valuable lessons to the broader global WASH discourse. Moving forward, international collaboration through knowledge exchange, technical assistance and capacity building remains vital to achieve SDG 6 targets, and strengthening the global–local dialogue will be essential to developing inclusive, equitable and sustainable drinking water systems worldwide.33 34
Nevertheless, between 1962 and 2014, there has been a 3.07% increase in total water withdrawal. The overall amount of internal renewable water resources has declined by 64.29% per person. There was an 18.4% rise in water stress between 1979 and 2011. Contrary to that, from 2014 to 2015 to 2017–2018, the Indian government increased funding for the drinking water and sanitation departments from 12 107 to 24 011 and 11 013 to 40 754 crore rupees, respectively, for rural and urban areas.29 Furthermore, providing homes with infrastructure for drinking water, sanitation and hygiene promotes social dignity, which can support social sustainability. States and union territories that have not yet met SDG 6’s overall target of 100% should use a particular regional development strategy to catch up.
To accelerate progress towards SDG 6 and ensure equitable access to safe drinking water, actionable and region-specific strategies must be implemented, particularly in underperforming districts. These strategies should include the development of piped water infrastructure, installation of community-based purification systems and promotion of safe water handling through behaviour change communication campaigns. Strengthening the technical and administrative capacities of local governing bodies is crucial for effective planning, implementation and monitoring of water supply schemes. Public–private partnerships and community-driven models should be leveraged to enhance sustainability, while the use of geospatial tools can support real-time monitoring and planning at the district level. Furthermore, national and state governments must prioritise vulnerable districts by adopting differentiated policy approaches, tailored funding mechanisms and integration with health, education and rural development programmes. If these interventions succeed at the local level, they will significantly contribute to the overall advancement of the nation. India and other developing and impoverished nations must accomplish the SDG 6 objectives to improve public health and reduce regional disparities.12 Developed countries should also support these efforts by providing technical and financial assistance,35 and UN agencies must work in close collaboration with national governments by using region-specific strategies that reflect local needs and priorities, thereby accelerating comprehensive and inclusive global development.36
Limitations
The study presents valuable empirical evidence on the progress and spatial disparities in household access to improved drinking water in India and its associated sociodemographic determinants. However, certain methodological limitations inherent to the study design must be acknowledged. First, using cross-sectional data from the NFHSs (NFHS-1 to NFHS-5) restricts the ability to establish causality between explanatory variables and access to drinking water. As such, while associations can be identified, inferences regarding cause and effect should be made with caution. Second, the NFHS relies primarily on self-reported household responses, which may be subject to reporting biases—either underestimation or overestimation—particularly for indicators such as water source usage or household treatment practices. This could affect the precision of the access estimates reported. Moreover, while the NFHS is a nationally representative and methodologically robust sample survey, it does not cover the entire population of India. In the absence of recent census data—the last census conducted in 2011—NFHS remains the most up-to-date and comprehensive source for population-level estimates. Nonetheless, the lack of complete enumeration data does impose limitations on concluding the entire population with complete certainty. Future research could benefit from integrating complementary administrative or geospatial datasets to enhance the granularity and representativeness of findings. Acknowledging these limitations, the study underscores the need for cautious interpretation and highlights the importance of continued data collection efforts to monitor equitable progress towards SDG 6.1.
Conclusion
This study provides compelling evidence of India’s significant progress towards universal access to improved drinking water. Improved sources show impressive coverage (21% of districts at 100% access, 77% at 65–99%), while on-premises access presents significant hurdles (only 1% achieving universal coverage with 18% below 50% access). Similarly, 5-minute accessibility reveals persistent gaps (5% of districts below 50% coverage despite 78% classified as front runners), and water treatment infrastructure remains severely inadequate (52% of districts in the aspirant category with just one district achieving 100% coverage). The WAI framework, integrating these four key metrics, provides policymakers with a robust, evidence-based tool to inform resource allocation and address water inequality. The geospatial clustering of low-performing districts—primarily in northeastern states for improved sources and in central, eastern and southeastern regions for on-premises access—offers actionable insights for targeted interventions. Notably, 409 districts remain in the aspirant category, with critical-to-adequate conditions concentrated in West Bengal, Bihar, Odisha, Jharkhand, Uttar Pradesh, Jammu and Kashmir, Himachal Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Telangana, Andhra Pradesh, Tamil Nadu, Assam and Manipur. To drive meaningful progress towards equitable water access, future initiatives should leverage the WAI framework to develop region-specific solutions, prioritise investments in water treatment infrastructure, expand on-premises water supply, strengthen local governance, foster public–private partnerships and improve cross-sectoral coordination. At the same time, further research is needed to understand micro-level disparities in water access, assess the impact of climate change on water security and examine the link between water quality and health risks. Advancements in technology, such as Artificial Intelligence driven water monitoring and decentralised treatment systems, should also be explored to enhance efficiency and sustainability. Comparative studies with other developing nations can provide valuable insights and help adapt successful strategies to India’s unique challenges. Addressing these future research gaps and policy needs, India can ensure no community is left behind while establishing a global benchmark for evidence-based water policy.
Data availability statement
Data are available in a public, open access repository. The dataset analysed during the current study are available in the Demographic and Health Surveys (DHS) repository, https://www.dhsprogram.com/data/available-datasets.cfm.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Acknowledgments
The authors are thankful to the reviewers for their excellent comments and constructive suggestions that helped improve the quality of this manuscript. We also extend our sincere thanks to the editor for their consistent communication and guidance throughout the review process.
Footnotes
Contributors SB is the guarantor of this work. SB: conceptualisation, methodology, formal analysis, resource acquisition, preparation of maps and tables, writing—original draft, writing—review and editing, and correspondence. ZK: writing—original draft, writing—review and editing. AA: writing—original draft, writing—review and editing, and supervision. LS: writing—original draft, writing—review and editing, and supervision. For this submission, we used ChatGPT, an AI language model developed by OpenAI, to correct grammatical errors and improve the language. The AI technology was used to ensure clarity, coherence and overall quality of the writing. Specifically, ChatGPT was employed to identify and rectify any grammatical mistakes, as well as to enhance the flow and readability of the text. This helped in making the content more polished and professional.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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Competing interests None declared.
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