Gobernanza, acceso al agua segura y su efecto en enfermedades asociadas en la parroquia de manglaralto

Abstract

CONDITION FOR PUBLICATION OF PROJECT. governance, understood as the interaction between public, private, and community actors in resource management, is key to preventing diseases and promoting sustainable development. This study evaluates the effect of water service governance on health in the Manglaralto parish, Santa Elena province, Ecuador—a territory characterized by high aridity and dependence on coastal aquifers. The research integrates data from the Drinking Water Access Survey (applied to 1,150 households across six communities) and from the Statistical Registry of Hospital Beds and Discharges. Governance, access, and health indicators were constructed, and probabilistic econometric models and two-stage models with robustness tests were applied. The results revealed territorial inequalities in institutional trust and safe access, as well as significant associations between limited access and longer hospital stays due to genitourinary diseases. The analysis confirms that the impact of governance on health is mediated by real improvements in coverage, quality, and affordability, supporting public policies aimed at sanitation and equitable water management as a cornerstone of rural health. Keywords: Public health, Rural sanitation, Econometric models, Sustainable development, Community management.