One of the millennium development goals by 2015 is to decrease the population who have no access to both quality and quality for safe drinking water and sanitation by half. The aim of this study is to investigate the existing water supply and sanitation service provision, its access and equity in distribution among different income groups in different geographic areas of Mekelle city in north Ethiopia. Specifically, the physical, social and economic factors are the main elements that are affecting the smooth run of accessing improved water supply and sanitation services. Both open and closed ended Questionnaires were distributed to 268 households. The outcome of the study revealed that the spatial location, inability to pay, and the illegality of their tenure and others are the main reasons for access and equity problems of the lowest level standard, particularly the disadvantaged and low income sector of society. It was also found that the majority of the people are not served according to the access parameters in terms of quantity, quality and proximity. Only 18% of the surveyed residents are used more than the recommended WHO standard which is 20 l/c/day. Other residents have been suffering either in quantity, quality or proximity of the service. The existing limited amount of water is not distributed with equity among different income groups and geographic areas.
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