Experiencing modular adaptive decentralized water security systems in southern Pakistan and implications for public health and nutrition: a qualitative exploratory study

Introduction This study attempted to explore the perception and experiences of facilitators and challenges in the implementation of modular, adaptive, and decentralized water infrastructure in the community. It also aimed to explore the association between social justice in the implementation of MAD water infrastructure and its potential in improving health and nutrition outcomes in vulnerable communities. Methods This exploratory study was conducted in two water-insecure regions in South Punjab, Pakistan. These regions include: (1) Cholistan Desert in Bahawalpur Division, and (2) Western foothill region in Rajanpur District in D.G. Khan Division. The qualitative data were gathered through semi-structured interviews with 20 key individuals, group discussions involving 27 participants, and direct observations. These methods were used to gather data from key stakeholders in water management, communities, and experts in public health. Results Overall, five themes and 10 sub-themes were identified. The results showed that inequality in water distribution and accessibility among different socioeconomic groups and genders, as well as private water vendors, hinder water accessibility. Water governance is also marred by elite capture and politics, which has led to a lack of equity in water distribution. Large-scale water infrastructure has also led to a lack of trust in how water is managed. While decentralized, local solutions like small dams, rainwater harvesting, solar technologies, wastewater reuse, and ponds were seen as good options, their success depended on maintaining local capacity and ownership. Where better solutions, such as rainwater harvesting, exist, there are no waterborne diseases and healthy children. While the benefits of the MAD water solutions are high, there are structural barriers to affordability and technical expertise. Many of these solutions prove to be short-lived without external financial and training support. Conclusion The study argues that new solutions for the MAD water system need to be ethical, approachable, participatory, gender-sensitive, and politically unbiased.