Delivering Safe Water to Millions
UNSAFE WATER IS A LEADING CAUSE OF DEATH AMONG CHILDREN UNDER FIVE.
MOST OF THESE DEATHS ARE PREVENTABLE.
Over 2 billion people lack access to water that is safe to drink. The problem is particularly acute in poor rural areas, where a lack of infrastructure leaves people to rely on open springs and shallow wells that are easily contaminated by human and animal waste.
Unsafe water is responsible for more than 1.2 million deaths each year. It’s a leading risk factor for infectious diseases, exacerbates malnutrition, and is the most common cause of diarrhea. Diarrhea is, in turn, the world’s second-leading cause of child mortality, claiming the lives of an estimated 525,000 children under five every year.
It doesn’t have to be this way.
A Low-Cost, Scalable
Solution to this
Child Health Challenge
FOR LESS THAN $1.50 PER PERSON, PER YEAR WE PROVIDE OVER 4 MILLION PEOPLE WITH FREE AND RELIABLE ACCESS TO SAFE WATER.
Chlorination is a WHO-endorsed approach to improving water quality, and is routinely used in water systems around the world. Chlorine is effective at killing pathogens and provides protection for up to three days, ensuring water isn’t recontaminated when stored at home. However, individually packaged chlorine has an adoption rate of just 10%.
Our network of over 28,000 chlorine dispensers provides over 4 million people, including over 570,000 children under five, with access to safe water. Across rural Kenya, Uganda, and Malawi, we consistently provide water treatment in areas that aren’t reached by municipal systems – and at no cost to users or their communities. We leverage human-centric design, behavioral economics, community partnerships (including over 54,000 volunteers!) and an efficient last-mile network to achieve an average adoption rate of over 60%. We estimate that between 2013-2021, the program averted over 1.3 million cases of diarrhea among children under five.
How Dispensers for Safe Water Works
Our model is simple: A community member goes to their usual water source, places their bucket under the dispenser, turns the valve to dispense the correct dose of chlorine, and fills their bucket with water as they normally would. The chlorine disinfects the water during their walk home; by the time they arrive, it is safe to drink. Here’s why it works:
Our bright blue dispensers are installed next to water sources, making it easy for people to remember to use them, and helping them build safe water practices into their routines. Because the water is treated during the walk home, there is little-to-no lag time between treatment and use.
We engage local leaders before a dispenser is installed, and communities elect a volunteer “promoter” who guides and encourages dispenser use, and who lets us know when refills or dispenser repairs are needed.
LAST-MILE SERVICE DELIVERY
Our maintenance and supply chain ensures dispensers are always stocked with chlorine and working. Issues are addressed within 72 hours and local staff use motorcycles to reach remote locations.
Research shows the use of preventative health products declines with even marginal increases in cost. By providing chlorine for free, we make sure those who need it most don’t have to make difficult trade-offs.
Water Treatment Is One of the Most Cost-Effective Ways To Save Children's Lives
Dispensers for Safe Water is built on rigorous research by Michael Kremer, (Nobel Laureate, Economic Sciences, 2019) and colleagues from Harvard University and UC Berkeley. They tested point-of-collection chlorine dispensers against a variety of other water treatment interventions and found that a) dispensers had much higher usage rates and b) usage stayed high over time.
Meanwhile, there is a strong evidence base linking chlorination to health outcomes, as chlorine is effective at killing diarrhea-causing pathogens. Safety concerns with diluted chlorine are minimal, and it is used as a disinfectant in water treatment plants around the world. Chlorine can provide residual protection for up to three days, which means it also prevents recontamination.
We have always had a high degree of confidence in the impact and cost-effectiveness of Dispensers for Safe Water (dig deeper into our 2017 review of the evidence base here). Now, evidence suggests even we were underestimating the program’s ability to save children’s lives.
The impact of water treatment on child survival is difficult and expensive to estimate, so most of the existing evidence is non-experimental or focuses on diarrhea rather than mortality. But new evidence clearly demonstrates the link between water treatment and child mortality. A meta-analysis from Michael Kremer, Stephen Luby, Brandon Tan, Ricardo Maartens and Witold Wiecek uses a novel methodology that enables them to analyze the impact of water treatment on child survival, even if the authors of the original RCTs had originally focused on different cohorts.
The Sustainable Development Goal on Clean Water and Sanitation calls for universal and equitable access to safe and affordable drinking water. The development sector has made enormous strides on increasing access to improved water sources such as taps, boreholes, and protected springs. But untreated groundwater is often contaminated, even if it’s from an improved source. For Evidence Action, ‘safe water’ means safe to drink – on this, we have a way to go.
Their astounding conclusion is that water treatment reduces all-cause under-five mortality by around 25%. They also analyzed cost data from Dispensers for Safe Water and estimate that the number of DALYs averted per dollar is more than 45 times greater than the WHO’s threshold for “highly cost-effective” interventions. This puts water treatment in a similar company to micronutrient interventions, insecticide-treated malaria bed-nets, and routine childhood vaccinations in terms of their impact on child health.
Expanding Access to
Safe Water in Rural Africa
With the evidence backing the role of safe water in improving child survival, we are thrilled to be expanding Dispensers for Safe Water. Starting in 2022, we’re installing 24,000 new dispensers in Uganda and Malawi – doubling our footprint by 2023 to reach a total of 9 million people. This will see us providing over 10% of Uganda’s population, and over 15% of Malawi’s, with access to safe water. We will also continue to serve over 2 million people in rural Kenya.
There is much more to do: hundreds of millions of children worldwide lack access to safe water. We remain committed to rapidly scaling Dispensers for Safe Water, as well as next generation interventions – such as in-line chlorination – to improve the health of families and save the lives of young children.
Learn more by reading our program expansion announcement.
World Health Organization. (2022) Drinking-water. World Health Organization https://www.who.int/news-room/fact-sheets/detail/drinking-water
Ritchie H and Roser M. (2021) Clean Water. Our World in Data https://ourworldindata.org/water-access
World Health Organization. (2022) Diarrhoeal disease. World Health Organization https://www.who.int/news-room/fact-sheets/detail/drinking-water
Kremer M., Miguel E., Mullainathan S., Null C., and Zwane A.P. (2011) Social Engineering: Evidence from a Suite of Take-up Experiments in Kenya. Innovations for Poverty Action https://www.poverty-action.org/sites/default/files/publications/chlorinedispensers.pdf
World Health Organization. (2011) Guidelines for Drinking-water Quality (Fourth Edition). World Health Organization http://apps.who.int/iris/bitstream/10665/44584/1/9789241548151_eng.pdf
Ritchie R, and Mispy, O. (2018) Measuring progress towards the Sustainable Development Goals. Our World in Data https://sdg-tracker.org/water-and-sanitation#6.1
Tompkins L. (2022) Millions More People Got Access to Water. Can They Drink It? The New York Times https://www.nytimes.com/2021/12/02/world/clean-water-to-drink.html
Kremer M., Luby S., Maertens R., Tan B., and Więcek W. (2022) Water Treatment and Child Mortality: A Meta-analysis and Cost-effectiveness Analysis. Becker Friedman Institute for Economics https://bfi.uchicago.edu/working-paper/2022-26/