World Water Day 2014

Today Alix Zwane spoke at US Tec H2.0, a US World Water Day event, and reflected on the history of the dispensers program. Here are her remarks.

We are grateful for the support of groups like USAID and individual donors who are essential to growing our impact on World Water Day and every day! I’m Alix Zwane. I’m the Executive Director of a non-profit called Evidence Action that scales up evidence-based development solutions to reach tens of millions of people. This is the chlorine dispenser system. Working with local communities and partners, we use dispensers to provide sustainable safe water services to 1.5 million people in East Africa, and will reach 4 million people by the end of this year. Our business plan, supported by Development Innovation Ventures at USAID, has us reaching 25 million people by 2018, at which time we will be financially self-sustainable,

The story of the development of the dispenser and this unique business model is a story of evaluation for the sake of innovation, rather than accountability, and iteration in stubborn pursuit of scale. The hand-off from researcher to social entrepreneur can’t be expected to be seamless, but passing this baton is exactly what we have to be good at if we are going to meet our safe water service goals that we reflect on for World Water Day.

WaterGuard is the brand name under which bottles of dilute chlorine are marketed in Kenya by Population Services International. Adding a few drops of WaterGuard to water that you are going to drink or store in your home is a very good idea in lots of places: If you get water from a well or a municipal stand pipe it may have bacteria or viruses in it. Or it might not… but by the time you have stored it in your home for a day or two it could become contaminated. Chlorine kills pathogens, and provides residual protection against recontamination. The tap water that we drink here has dilute chlorine in it.

Chlorine can save lives. When basic water treatment was introduced in American cities in the early 20th century, child mortality plunged. Epidemiological studies estimate that chlorine can achieve 40% reductions in child diarrhea. But way too few people use WaterGuard. In 2006, when researchers from Harvard and Berkeley started looking at these questions in rural Western Kenya, about 10% of people used the product. A lot of people knew what it was, and not quite as many, but still a lot, knew that dirty water causes diarrhea, but WaterGuard was just not something that people were using.

Why? The fact is, WaterGuard use has a lot of hurdles to it. To end up with chlorine in your water storage container at home, you have to do the following things:

• Go to the market to get it
• Remember to get it when you are there
• Pay for it, meaning less money for something else
• Understand how to use it
• Use it correctly
• Repeatedly remember to use it, once you have it at home
• Keep going through this cycle

Contrast this to what you had to do this morning to get chlorine in your tap water. Nothing.

The research team that wanted to increase WaterGuard use randomly dividing a large group of households into five groups, and then systematically removed some of these constraints. So, one group got coupons for WaterGuard – this removed the price barrier to adoption. A second group got free WaterGuard; no price barrier, no time cost. A third group got free WaterGuard and extra marketing messages, removing price, time cost, and some of the challenge of remembering to use the product. Finally, group 4 received free chlorine via a dispenser next to their water source along with promotional messages. For this group, there was no price barrier, no time cost, and a much reduced cognitive burden: the activity was literally bundled with water collection. Finally, there was a control group that could buy WaterGuard if they wanted, but received no services as part of the research.

What worked best? At a follow-up visit after some 8 weeks, the dispenser group and the free distribution group both had about 50% adoption. This was a more than 6-fold increase over the control group, where adoption was about 7%. Most importantly, the dispenser adoption rate held steady, for two years, not falling off as the novelty of the product declined or as people learned more about it.

The promise of a robust business model seemed compelling for dispensers as this data came in. And, indeed, that is where the hand-off from research to social enterprise had to come in. There would have to be a real plan for cheap reliable refills and cost recovery without user fees. That is what we have been doing with the support of USAID, to get to the service levels and business plan we have today. This isn’t academic research any more, and it is not particularly glamorous, but in all it is one of the best examples of innovation, evaluation, design, and entrepreneurship coming together that I know about today. I’m proud to be a part of taking it forward to the next level.