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Evidence to PolicyAdapting and scaling a program, Scaling up an evaluated pilot › Installing chlorine dispensers at community water sources for better health

Installing chlorine dispensers at community water sources for better health

Innovative technology is used by an estimated 3.86 million people.

Installed directly at community water sources, chlorine dispensers provide a visual reminder to use chlorine and are calibrated to deliver a precise dose of chlorine solution to treat the most commonly used water transport containers.

Chlorine dispensers installed at community water sources are a low-cost technology used to treat water for consumption. They deliver a precise dose of chlorine solution and are easy to use by community members who can keep using their regular water containers. Research in rural Kenya by J-PAL affiliated professors Michael Kremer, Edward Miguel, and Sendhil Mullainathan, along with Clair Null, Jessica Leino, and Alix Zwane, has shown  that point-of-collection water chlorination systems, in combination with encouragement from community promoters, dramatically increased access to safe water compared to bottled chlorine sold in stores. The Dispensers for Safe Water Program is now one of the flagship initiatives of the nonprofit Evidence Action, which works closely with local authorities and trained staff to manufacture, install, and maintain chlorine dispensers in rural districts of Kenya, Malawi, and Uganda. In each community, a local promoter is selected to take care of the dispenser, educate families on its use, and monitor usage.

The Scale-Up: Dispensers for Safe Water program is a now sustainable model

According to Evidence Action, more than 4.65 million people now have access to chlorine dispensers in their communities, with over 27,000 dispensers installed to date across Kenya, Malawi, and Uganda. We estimate that 2.25 million people actively use chlorine dispensers to treat their drinking water, based on an average adoption rate in the community of 48.4 percent. Preliminary estimates suggest that, at scale, the full cost of the chlorine dispensers system could be as low as $0.50 per person per year, which is much cheaper than home delivery (or retail sale) of individual chlorine bottles. This cost includes both hardware and the recurring costs of chlorine refills, dispenser management, and maintenance, making the dispenser highly cost-effective. Furthermore, Evidence Action has put in place an innovative carbon credit financing scheme to ensure the sustained free delivery of the chlorine supply.

The Problem: Access to safe water is key to improving health

In 2012, the United Nations estimated that 783 million people, or 11 percent of the global population, had no access to an improved source of drinking water. Safe drinking water could prevent 1.4 million child deaths from diarrhea and 860,000 deaths from malnutrition annually (World Health Organization. 2008). Chlorine disinfects drinking water against most bacteria and protects it from recontamination. Additionally, chlorinated water does not need to be boiled, which saves time and resources like firewood.

The current standard approach is to encourage populations to use chlorine via promotional campaigns and the use of chlorine bottles bought in stores, but take-up is low under this model. In Kenya, for example, where chlorine is relatively cheap ($0.30 for a family of five for a month),1 less than 10 percent of the population purchases chlorine each month despite2 extensive promotion. To date, there is little evidence explaining why people do not use chlorine… do they just forget to do it at least 30 minutes before drinking water?

The Research: Source-based chlorine dispensers significantly increased the share of households using chlorine

“[…] Two years after installing the dispenser, 61 percent of sampled households had chlorine in their water, compared to less than 15 percent of households in the control group.” The New York Times. May 14, 2014

From to 2004 to 2008, J-PAL affiliated researchers and colleagues conducted a suite of randomized evaluations to investigate households’ use of chlorine in rural Kenya. They measured how variations in price, marketing, and packaging of bottles of chlorine affected demand for chlorine in retail outlets and when sold door-to-door. They found that the use of chlorine was not sustained over time. In a second phase, researchers designed and tested a point-of-collection chlorine dispenser system that provided a free supply of chlorine at local water sources. The dispenser system was designed to boost take-up by making water treatment convenient, providing a visual reminder, and encouraging peer learning and habit formation by making the decision to use chlorine public. Chlorine dispensers, in combination with paid community promoters, increased take-up by 53 percentage points. Take-up was sustained 30 months into the program, even after payments to promoters had ended.

1Kremer, Miguel, Null, and Zwane. “Water Technologies case study: what works best in poor countries.” Boston Review, September/October 2008. http://bostonreview.net/world/water-technologies

2Internal analysis based on: Abt Associates. 2007. "Best practices in social marketing safe water solution for household water treatment." https://www.abtassociates.com/reports/pouzn_2.pdf