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Scaling What Works


 

 

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Scaling What Works


 

 

 

Evidence Action scales proven development solutions to benefit millions of people around the world. We fill the gap between knowing “what works” and having impact at scale. 

We implement cost-effective interventions whose efficacy is backed by substantial rigorous evidence. We identify innovative, appropriate financing mechanisms and build best practice operational models. We voraciously self-evaluate, learn, and improve our models for scaling with a commitment to transparency on progress, impact, and value for money.

 
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Dispensers for Safe Water


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Dispensers for Safe Water


The Problem: Unsafe Drinking Water and Disease

More than 780 million people worldwide lack access to safe drinking water.

More than 3.4 million people die each year from water, sanitation, and hygiene-related causes. Unsafe drinking water is also a leading cause of diarrheal disease with nearly two billion cases each year globally.

An estimated 760,000 children under the age of five die from diarrhea each year, making childhood diarrhea caused by unsafe water and poor sanitation one of the leading causes of childhood mortality. 

The Solution: Dispensers for Safe Water

Dispensers for Safe Water are a proven, innovative, and low-cost approach to increase rates of household chlorination.  

Chlorine disinfects drinking water against most bacteria including those causing cholera while protecting water from recontamination. Chlorinating water also means that people do not need to boil their water to disinfect it, saving time and natural resources.

The dispenser is installed with community input directly at the water source. It is fitted with a valve that consistently delivers a precise 3 ml dose of chlorine (sodium hypochlorite solution).  Community members go to their water source, place their bucket or jerrican under the dispenser, turn the valve to dispense the correct amount of chlorine, and then fill the bucket with water.

Dispensers for Safe Water at a Glance 

  • Currently serves  more than 2 million people. 
  • Aims to reach 25 million by 2018.
  • Active in Kenya, Malawi, and Uganda.
  • Includes the dispenser hardware, community education, and a regular supply of chlorine.
  • Ongoing maintenance is provided by an elected community ‘promoter’ who encourages use of the dispenser, reports any problems, and refills the dispenser with chlorine.
  • Usage and functionality of all dispensers is closely monitored by Evidence Action field workers who deliver chlorine on motor bikes, and track issues with mobile phones. 
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Deworm the World Initiative


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Deworm the World Initiative


The Problem

Over 600 million school-age children are at risk of parasitic worm infection. Over 400 million of these children remain untreated.

Worm infections interfere with nutrient uptake; can lead to anemia, malnourishment and impaired mental and physical development; and pose a serious threat to children’s health, education, and productivity. Infected children are often too sick or tired to concentrate at school, or to attend at all.

Worm infections are estimated to cause a loss of 200 to 524 million years of primary schooling. Parasitic worms exact a clear toll on human capital, hindering economic development in parts of the world that can least afford it.

The Solution

Treatment with a simple pill is universally recognized as a safe, cost-effective and scaleable solution. Side effects are very rare.

School-based deworming programs leverage existing infrastructure, result in treatment coverage of over 80% of at-risk children, and reduce costs to less than USD 50 cents per child per year. 

Deworm the World Initiative: A "Best Buy" in Development

The Jameel Poverty Action Lab at MIT lists mass school-based deworming as a “best buy" in both education and health. 

GiveWell named the Deworm the World Initiative at Evidence Action one of its top-rated charities for a second year in a row, stating that it “offers donors an outstanding opportunity to accomplish good with their donations.”

  • Deworm the World Initiative treated 37 million children in the 2013/14 school year in India and Kenya.
  • We support the world's largest school-based deworming program in Bihar.
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Evidence Action Beta


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Evidence Action Beta


What is Evidence Action Beta?

We are thrilled to introduce Evidence Action Beta. Evidence Action Beta investigates what interventions might be suitable for massive scale up – finding the next thing that works.

Borrowing from software development where ‘beta’ connotes software prior to commercial release that is still being tested to find any bugs, Evidence Action Beta explores what program with proven impact might work for millions of people. Similar to beta testing for software, we want to ensure that we maximize benefit while reducing any unintended consequences of massive scale up of an intervention.

Our flagship programs, Deworm the World and Dispensers for Safe Water, now reach close to 40 million people per year and are growing fast. But Evidence Action, since its inception a year ago, has always intended to be more than worms and water.

Our mission is to scale global development programs that have proven to be effective in their ‘alpha’ phase, that are cost-effective relative to their impact, and for which we can develop sound business and financing models so that millions of people benefit.

Our 6 Criteria for Choosing What to Work on Next: 

  1. Scale: Can the project impact tens of millions of people?
  2. Sustainability: Does the project have the potential for sound business models? 
  3. Cost-effectiveness: What is the cost relative to the impact?
  4. Partners: Is there demand and interest from potential partners?
  5. Research Experts: Is there interest in collaboration by experts? 
  6. The Counterfactual: If we do not invest in this program or business model, what will happen? 

 

What Are We Working On? 

So what are we working on? As is true for many beta projects, we fully expect that some of these programs will not progress beyond the current stage as we learn more about them. We aim for one or two new programs at Evidence Action to be identified over the next few years that meet our rigorous filters on the “path to scale.”

Young 1ove: Innovative HIV Education

In Botswana 21 percent of adults (aged 15-49) are living with HIV/AIDS.  Similarly high rates of infection are seen throughout Southern Africa. Teenage girls that engage in sex with older men are more susceptible to infection, since 25-year-old men are more likely to already have HIV than 16 year olds. Programs aimed at addressing risky sexual behavior have the potential to protect against the spread of HIV and reduce rates of adolescent pregnancy.

In a rigorous evaluation in Kenya, youth were given information on the increased risk of HIV/AIDS disaggregated by age and gender, resulting in a 28 percent reduction in adolescent pregnancy rates.  Do these results hold up in Botswana and elsewhere in the region where infection rates are the highest? Evidence Action is exploring partnering with Young 1ove, a non-profit based in Botswana, to implement an advocacy program aimed at reducing the spread of HIV/AIDS among youth. The Young 1ove program targets youth through primary school visits to promote curriculum on HIV/AIDS risk disaggregated by age and gender, with emphasis on the increased risk of infection from cross-generational sex. The pilot’s implementation will be accompanied by a rigorous evaluation in conjunction with the Baylor International Pediatric AIDS Initiative in Botswana and J-PAL Africa. The evaluation will test information delivery methods for program effectiveness and cost efficiency to inform the potential for a nationwide scale-up.

No Lean Season: Seasonal Income Support to Avert Famine

Seasonal hunger is a problem in many regions of the world for the very poor during the period between planting food crops and harvest time. For example, northern Bangladesh is at risk of widespread famine during three months leading to the winter harvest. Researchers working in this region identified a simple and effective solution that took advantage of the relative abundance of employment opportunities outside of the famine-prone north during this lean season.They provided households a travel subsidy for work-migration during the lean season, allowing them to send a member away to generate income that would otherwise not have been possible. This resulted in significant improvements in household welfare (including consumption and nutrition) during the lean season, an effect that held even in subsequent years. Based on this evidence, providing these travel subsidies is a promising way to avert seasonal famine risk.

We are investigating several critical questions to pressure test the hypothesis that alternative strategies to food aid may be effective and cost effective means of providing seasonal income support in Bangladesh and elsewhere. In collaboration with Innovations for Poverty Action and the original research team, we will test alternative strategies to allocate people to different destinations, local price effects of worker inflow to migration destinations; impacts on household well-being (marital harmony, intra-household allocation, possible introduction of disease by migrant member); and welfare impacts of the program on non-participating households. This work will help us explore unintended consequences that could arise if the program were implemented at a large scale, and understand how to develop a business model for this program.

 

PROJECT SAWA: SAFE WATER FOR HOUSEHOLDS THAT DON’T USE DISPENSERS

Evidence Action has an interest in understanding how to effectively target water treatment products to low-income households at scale, in order to expand our reach and impact beyond the current/planned catchment area of the Dispensers for Safe Water program. This could include operation in other countries where potential partner organizations work, or new strategies in areas where Evidence Action operates but where certain districts are not good candidates for chlorine dispensers (for instance due to population sizes). In 2007-08, a team of researchers found that requiring rural households to exert the effort of traveling to a nearby clinic or shop to redeem coupons in exchange for free bottles of dilute chlorine did effectively target the product to those who would use it for drinking water treatment.

To investigate this idea in more detail, we are developing a series of strategies for allocating and redeeming coupons at scale. This involves thinking through how to transfer funds to shopkeepers, detect cheating, and monitor usage of chlorine. We are also exploring how to transfer our model of carbon crediting from dispensers to this alternative model.

COMMUNITY HEALTH PROMOTERS: SIMPLE NUTRITION MESSAGING

We are exploring the potential to use Dispensers for Safe Water’s existing rural delivery system to deliver nutrition information to targeted groups at a low marginal cost in order to reduce the impact of undernutrition and malnutrition on child health. The nutrition messaging program is modeled on the MaiMwana infant feeding intervention from Malawi.

A randomized controlled trial found that the MaiMwana program led to significant reductions in infant mortality as well as improvements in height-for-age among young children. The nutrition information provided in the program was simple and non-technical; it’s possible that our promoters could be effective as information providers.

Evidence Action is collaborating with evaluators to explore whether the initial results found in the Malawi context can be sustained at a larger scale with less intensive quality control. We will do this by using dispenser promoters for nutrition message delivery.

VOLUNTEER MENTORING FOR REMEDIAL EDUCATION

Evidence Action is working with the Government of Kenya on a pilot program for post-university volunteers that aims to increase social cohesion, improve student literacy outcomes, and provide unemployed college graduates with professional skills.

Rigorous evaluations conducted in India, Ghana, and Kenya have shown that an additional lightly trained volunteer working with remedial students can be a low-cost method of improving literacy and raising standardized test scores.

Working closely with the Government of Kenya, we are supporting the development of a program intended to achieve these educational outcomes, as well as other important goals, with university graduates. The initial pilot that we are supporting will focus on strategies for recruiting a quality cohort of volunteers, creating compelling incentives for volunteers to engage consistently with the most vulnerable children, and measuring learning and other outcomes.