<p>Naogaon District of Bangladesh, situated in the Barind tract, is well known for its severe water scarcity and exotic climate. This study examines the relationship between groundwater quality, operational performance of sources, and public health outcomes in rural areas. In this locale, the community's major reliance on groundwater is crucial for drinking and domestic purposes. This survey was conducted for all functional water sources of the studied area and recorded well depths with water quality measures, pH values, total dissolved solids, and conductivity. Pearson correlation, logistic regression, cluster analysis, principal component analysis, and structural equation modeling were employed, along with spatial autocorrelation tests, to delineate the relationships among water quality variables, operational reliability, and public health risks. Only 50% of the water sources consistently met demand, with a notable proportion facing seasonal supply disruptions, and 64.3% of sources were located within proximity of unlined sanitary facilities. Although inherent water quality parameters fell within acceptable ranges, bacterial contamination was detected in stored household water. The results underscore that water sources in proximity to sanitary hazards and revealing prolonged service intervals were significantly associated with higher maintenance needs and elevated health risks.</p> Graphical Abstract <p></p>