Evidence Action, a U.S. based nonprofit organization, is fighting high rates of Diarrheal Disease in Sub-Saharan Africa by installing free chlorine dispensers at community water sources. Their solution is effective, scaleable, and, per the organization’s mission, founded upon a base of solid empirical evidence.
According to the UN, 40% of the population in Sub-Saharan Africa does not have access to clean, reliable sources of drinking water, and is succeptible to diseases related to contaminated water and poor sanitation. Research from the World Health Organization suggests that diarrheal diseases are among the most prolific and deadly of these diseases. Every year, 525,000 children under the age of five die as a result of diarrheal diseases, making them the second leading cause of death in children under 5 years old.
There are dozens of organizations working to provide communities in Africa with potable drinking water using a variety of methodologies such as filters, dilute chlorine solution, and solar disinfection. However, studies have shown that, of these technologies, adoption remains low. In one study, for example, mothers of young children were given coupons that could be exchanged for free chlorine at stores. Adoption was 60 percent initially, but dropped to only 20 percent by six months, suggesting that even the small inconvenience of going to a store and redeeming a coupon could be a barrier to adoption. When chlorine was distributed directly to homes, adoption rates remained high for up to 6 months after distribution, although this was too a costly solution to scale.
In 2003, Researchers at Harvard, Stanford, and the University of California, Berkeley, in collaboration with Innovations for Poverty Action (IPA), set out to determine the most effective ways to improve water quality in rural Kenya. Their research focused on the most effective technologies, as well as structuring a program to promote long-term use.
Seven years, and several studies, later, one program stood out as the most effective and cost-efficient way to improve water quality. The team placed free chlorine dispensers in the immediate vicinity of local water sources, and paid community members to promote the dispensers and educate their neighbors on the importance of having clean water. The dispensers, in combination with paid community promotors, showed an initial adoption rate of 53% that lasted 31 months into the program- even after the payment to promotors had ended.
Dispensers for Safe Water is Born
Inspired by the program’s efficacy and high adoption rates, the researchers handed the project off to Evidence Action, an organization dedicated to scaling up proven interventions to improve the lives of the poor in Africa and Asia. Between 2009 and 2011, Evidence Action tested various operational models for service delivery and conducted additional research on how best to engage local promoters to boost adoption. The organization installed 2,500 dispensers in Kenya during this period, serving approximately half a million people. Having refined the business model in Kenya, Evidence Action successfully replicated and scaled the program in Uganda and Malawi, demonstrating successful implementation of the program at scale.
The Business Model
Evidence Action installs dispensers directly at a community water source. Community members go to their water source, place their bucket under the dispenser, turn the valve to dispense a precise amount of chlorine, then fill the bucket with water. The chlorine disinfects the water as they are walking home and they are left with clean, safe water that stays safe for 2-3 days.
Importantly, the project focuses on providing chlorine dispensers as a service, and not just a one-time hardware installation. Evidence Acton elects a community member to be the dispenser ‘promoter,’ who encourages use of the dispenser, reports any problems, and refills the dispenser with chlorine when needed.
Finally, the organization operates a supply chain that brings chlorine refills to local promoters at each dispenser every two to three months. Evidence Action operates hotlines for promoters to reach out with any issues and request repairs of dispenser hardware as needed.
To date, the Dispensers for Safe Water program has installed over 26,000 dispensers serving 4.5 million people across Kenya, Malawi, and Uganda.
Does it Work?
Randomized controlled trials have shown that the dispenser system dramatically increased water treatment compared to the traditional retail model. During unannounced visits 30 months after dispenser installation, two years after payments to the local promoter terminated, 55-60% of household drinking water samples tested positive for chlorine. These test results represent a conservative estimate for the adoption of dispensers, since self-reports of use were closer to 75 percent.
In comparison, only 5-10% of samples with access to the traditional retail model of chlorine distribution tested positive. Bacteriological testing showed that those reporting chlorine use had less contaminated water than those who said they had not used chlorine.
Furthermore, Evidence Action field officers riggorously evaluate the adoption rates and performance of their dispensers. Every month, officers visit 1.5% of dispenser sites and test randomely selected households for traces of chlorinated water. Additionally, a random selection of eight households are interviewed at each dispenser site by Evidence Action’s Monitoring and Learning Team for qualititative information about adoption and usage in that particular village.
Below is a snapshot of the Total Dispenser Adoption Rates taken from the live dashboard on Evidence Action’s website. Evidence Action has maintained 60% adoption rate on average across Kenya, Uganda and Malawi, as measured by the presence of residual chlorine in stored household drinking water, at scale.
Snapshot of Total Dispenser Adoption Rates (http://dispenserdata.evidenceaction.org)
Similarly, EA monitors their dispensers to ensure that they are dispensing the correct amount of chlorine and are otherwise in working order. Data is gathered on each trip that chlorine is delivered to the dispenser and uploaded to the online dashboard.
Snapshot of Dispenser Reliability (http://dispenserdata.evidenceaction.org)
Provide Clean Water with the Change in Your Pocket
Your everyday change might not seem like enough to tackle huge issues like this, but the beauty of scalable models like Dispensers for Safe Water is that they allow small donations to have a huge impact.
Data from Evidence Action’s website indicates that a donation of less than $2 can provide a person with clean water for an entire year.
This means that the average GiveTide donor:
-Rounds up enough spare change every month to provide 14 people with water for a year
-Can fund the yearly maintenance of one dispenser every 10 months, providing 144 people with clean water for a year
So if you're looking for an organization worthy of your spare change, consider the impact Evidence Action can make with a few dollars.