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Scaling up dispensers for safe water to reach millions of people

Continuing with our series of blogs to mark the 2019 Nobel Prize in Economic Sciences, awarded to founding GIF Board members: Michael Kremer and Esther Duflo (who share the prize with Abhijit Banerjee), GIF Investment Director Lalit Kumar reflects on his time as Evidence Action’s Regional Director for Africa and a program that scaled up dispensers for safe water. The approach towards this program was based on randomised controlled trials by researchers including Michael Kremer and GIF CEO Alix Zwane.

Unsafe drinking water, inadequate sanitation facilities and poor hygiene are responsible for four billion cases of diarrhoea each year, resulting in 1.65 million deaths, mainly among children under five.

Traditional approaches to water focused on access to water, often by building a large number of wells. But access alone is not enough and functionality needs to be maintained. Water may be relatively safe to drink when it is collected at that source, but does not stay safe in transit or when it is stored in homes, particularly in areas of low sanitation.

There has been debate around which interventions, including market solutions and pay-for-water schemes, are effective. However, research has provided strong evidence that installing chlorine dispensers next to water sources is a highly effective method of ensuring the chlorination of unsafe water.

I had the pleasure of serving as Evidence Action‘s Regional Director for Africa as they scaled up dispensers for safe water – a program providing access to safe water for rural communities in sub-Saharan Africa by installing chlorine dispensers next to communal water points; and promoting community-wide water treatment that prevents water-borne diseases.

Chlorine dispensers installed directly at the water source represent an important innovation in the rural water sector. They solve a number of challenges that have hindered sustainable, quality services for cleaner water to date – despite the billions that have been spent on water and sanitation projects. Community members can go to their water source to fetch water, place their bucket or jerrican under a chlorine dispenser, turn the valve to dispense a pre-measured dose of diluted chlorine, and fill the bucket with water. The chlorine disinfects the water as they are walking home, and by the time they arrive, much of the chlorine smell has dissipated and they are left with water that stays safe for up to three days.

Our approach towards this program was based on a randomised controlled trials by researchers, including Michael Kremer and Alix Zwane, who tested chlorine dispensers in Kenya against a variety of other water treatment options. They found that: chlorine dispensers had a much higher usage rate than comparable treatments; and use stayed high over time.

Now reaching approximately four million individuals in Kenya, Uganda, and Malawi, the program’s success lies in its high and sustained adoption rates, which are typically above  50% (in 2018, the organisation’s average adoption rate was 58%).

The fundamentals that supported the notion that this model could be scaled effectively included rigorous evaluation and monitoring: before expanding into new regions, the program carried out research in order to determine where would be a suitable destination for the chlorine dispenser system.

Secondly, we ran the program like a business. We leveraged the proportionate saving in costs that could be gained by an increased level of production. We ensured that 95% of over 27,500 dispensers were functional at any given point of time, breakages were responded to within 48 hours and there was heavy upfront community engagement and education. The program’s scaling model of area saturation is such that as it expands, average costs increasingly fall. This is because chlorine supply chain costs and maintenance costs will be lower if several can be attended to in one round. As a result, if the program expanded into an area with lower rates of diarrhoea, meaning potentially fewer lives saved for a set amount of money, the reduced costs overall offset the risk.

Another provision for the scalability of the program was the ability to create revenue through carbon credits. Carbon credits were generated because chlorine dispensers avert carbon emissions – people do not need to boil water to disinfect it. During my tenure, we worked with carbon experts and became certified to generate credits in all three countries where the program operates. The revenue earned from these carbon sales was reinvested in the program.

Today, over 150 staff are employed on the ground to serve Evidence Action’s footprint of over 27,000 dispensers, and a network of over 50,000 community volunteers help to refill each dispenser and consistently engage their communities on the importance of safe drinking water.

Image courtesy of Evidence Action.