Clean Water in Northern Ghana

This study assesses the willingness of households in Northern Ghana to purchase a ceramic water filter. The Kosim filter is sold by Pure Home Water (PHW), a Ghana-based NGO, and has been demonstrated to be highly effective at improving water quality without needing electricity. We will also measure the health effects of household-level water treatment in areas with high waterborne disease loads.  

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Policy Issue: 

Diarrheal diseases, which result poor water quality, are a leading cause of death in the developing world, killing approximately 1.8 million people per year.1  Achieving the Millennium Development Goals of reducing the proportion of people without sustainable access to safe drinking water is especially difficult for the rural poor. Delivering treated water through pipes has resulted in sustained health gains in developed countries and urban areas in developing countries, but is not considered feasible in rural areas with dispersed populations and weak institutions for maintenance. Community interventions, such as spring improvement or communal wells, have not produced strong results, and policy makers are increasingly interested in household and point of use treatments. However, the effectiveness of such treatments in rural environments, the role of education and marketing to encourage use, and how to expand access with limited resources remain largely unknown.

Context of the Evaluation: 

Diarrheal diseases account for 12% of childhood deaths in Ghana, and are the third largest cause of death for children under the age of 5.2  These diseases are caused by the ingestion of water contaminated by fecal matter, and 20% of Ghana’s population does not use an improved water source.3  The sparsely populated northern region of Ghana is one of the least developed parts of the country, and has even less access to clean water than the national statistics would suggest. The majority of its residents make their living in agriculture, living far away from one another. This low population density makes any state- or community-wide water treatment intervention costly and impractical.

Details of the Intervention: 

This study will evaluate the demand, use, and impacts of one household level water treatment technology. The Kosim filter is a ceramic filter marketed and sold by Pure Home Water, a Ghana-based NGO. This simple product has been proven to be highly effective at improving water quality and is appropriate for the region, since it removes particles and pathogens from water without the use of chemicals or electricity which require some form of delivery.

Researchers are measuring the willingness to pay of households for the Kosim filter by offering a random selection of households the opportunity to purchase the filter through door-to-door sales. Households will also be offered a randomized price for the filter, to determine price effects and willingness to pay for preventive health technologies.

Researchers will collect data from 1,500 households on water quality, education, income, consumption, health, diarrhea disease knowledge and water treatment and storage practices to see how these variables affect the willingness to pay for a filter. The randomized offer price provides a means to estimate the filter’s health impact and health spillovers among neighbors, without letting a set price screen out households who have a lower value for clean water. Thus, researchers can evaluate different techniques for creating behavioral change, such as the adoption of new water treatment technologies and storage techniques, and the propensity of individuals to drink treated water and provide treated water to their children.

Results and Policy Lessons: 

Forthcoming

[1] As of 2004. WHO, “The Top Ten Leading Causes of Death” (accessed Nov. 6, 2009)

[2] WHO, “Mortality Country Fact Sheet 2006, Ghana.” (accessed Nov. 6 2009)

[3] United Nations, Human Development Report 2009 "Ghana" (accessed Nov. 6, 2009)

Greg Fischer

Cleaning Natural Springs in Kenya

Diarrheal diseases are a leading cause of morbidity and mortality in the developing world, killing an estimated 2.6 million people per year between 1990 and 2000. Diarrheal diseases are often transmitted when a water supply is contaminated and may be endemic in places where the water supply is irregular. Diarrhea is widespread in rural Kenya, where 43% of the population gets their drinking water from nearby springs, usually transported in 10 to 20 liter jerry-cans. Landowners have no incentive to improve the sanitation of water sources on their property and villagers are often reluctant to change their habits to include behaviors that may reduce diarrhea incidence such as hand washing or daily chlorination of water.

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Researchers sought to find an inexpensive way to improve water quality at the source, and thereby reduce the burden of diarrhea by making improvements to springs. Working with a local NGO, they identified 200 springs in the Busia district of Kenya, and persuaded each local community to contribute 10% of the costs to improving the springs. At a cost of about $1,000 per site, half of these springs had their sources encased in concrete, forcing water to flow through a pipe rather than seeping from the ground, thus preventing contamination from groundwater.

Results:

The simple infrastructure investment of “spring cleaning” significantly reduced both water contamination and the incidence of diarrhea. There was 66% less E-coli contamination in treated springs than in untreated ones, and diarrheal incidence in children under 3 years old fell by 4.7 percentage points, or 25%, though there was no significant effect on children ages 5 to 12.

Michael Kremer, Edward Miguel

Experiments to Improve Participation in a Recycling Program in Northern Peru

Economic growth in Latin America has come at the cost of increasingly acute environmental pressures. Expanding trade and consumption has led to increased waste generation and pollution requiring more developed solid waste disposal systems. Markets lack a price mechanism to internalize the environmental cost of this growth.  Policy makers often apply taxes, subsides or other mechanisms to attempt to align private incentives with public environmental preservation. Aside from altering financial incentives, growing evidence from psychology and behavioral economics research shows that behavior can successfully be influenced by leveraging social norms and emotions. 

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Policy Issue:

Economic growth in Latin America has come at the cost of increasingly acute environmental pressures. Expanding trade and consumption has led to increased waste generation and pollution requiring more developed solid waste disposal systems. Markets lack a price mechanism to internalize the environmental cost of this growth.  Policy makers often apply taxes, subsides or other mechanisms to attempt to align private incentives with public environmental preservation. Aside from altering financial incentives, growing evidence from psychology and behavioral economics research shows that behavior can successfully be influenced by leveraging social norms and emotions.  

 

Context:

Over 20,000 tons of solid waste are produced every day in Peru, most of which is dumped in waterways or informal trash heaps, making solid waste management an area of increasing concern for the country. PRISMA, a local NGO, operates a recycling program in Northern Peru whereby it trains and supports workers in forming associations that collect recyclables door to door from participating households. In addition to providing the informal workers with some initial tools and training, PRISMA further assists workers by canvassing the areas of operation to introduce the recyclers to the community and encourage the residents to segregate recyclable and take part in the recycling program. PRISMA was interested in identifying viable strategies to increase program uptake (34% at baseline), and reduce attrition of participating households from the program.

 

Description of Intervention:

Researchers worked with PRISMA to test a series of information messages aiming to improve take-up and participation its recycling program.

To improve take-up of households in communities where PRISMA planned to expand the program, researchers conducted a randomized evaluation to test the impact of different messages in eliciting program participation.  One week before the first PRISMA canvasser’s visit, a paper flyer was delivered with the a generic message about PRISMA’s program and one of nine specific messages eliciting pressures such as, social norm, peer comparison, conformity, authority, environmental or social benefits to increase participation. Households that owned a cell phone and were willing to share their number (about 35% of the sample) received text messages once a week with the specific message in addition to the flyers. 

With a sample of 1,785 existing participants, researchers tested strategies to reduce program dropout and increase the amount and quality of the recyclables collected. Plastic bins were randomly distributed to households participating in the study. Some bins had a sticker specifying which items could be recycled.  Household that provided cell phone numbers were randomly assigned to receive either a generic or personalized SMS reminders to recycle or to serve as a comparison group without SMS reminders. SMS messages were sent the day before the weekly visit by the recycler, for a period of six weeks. Data collection for this component of the study lasted for eight weeks and included a careful accounting of the quantity and quality of recyclables received.

 

Results

Results of treatments on program enrollment

The results reveal no statistically significant effects from the different treatment messages. No significant impact on program take-up for the information campaign conducted through flyers alone or through flyers with text messages were found. Messages conveying social norms and applying social pressure were not successful in leveraging behavioral change. Two interpretations for this outcome are proposed by the researchers: a) these messages and norms were not relevant in this context, b) the large presence of informal recyclers operating outside of the program rendered separation of recyclables at the household level a non-issue.

Results of treatments on compliance

Households who received plastic bins turned in recyclables 3-8 percent more of the times and produced on average more (about 0.2 kg) and more valuable recyclables (about 0.1 pesos).  This finding suggests that convenience of storing recyclables is a barrier to greater program participation. 

The SMS reminders had no significant impact on the level and quality of participation of households in the program, suggesting that forgetfulness is not a serious constraints among households enrolled in the program. There was no clear difference in recycling compliance between households who received plain bins and those who received bins with explanatory stickers.

Dean Karlan, Jeremy Shapiro, Jonathan Zinman

Harvesting Rainfall: Cistern Deployment in Northeast Brazil

What is the impact and cost-effectiveness of rain-fed water cisterns as a main source of water access in rural areas lacking other water sources? This project studies a 16,000 liter cistern for residential use which is filled during the rainy season, and – in theory – should provide families enough water for cooking and drinking during the dry season.

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The technology is well developed, and the Brazilian government has been providing thousands of these cisterns to a target population of millions in northeast Brazil for the last 8 years. However, a rigorous randomized control trial of the adequacy of this technology and its impacts at the household level has not been performed up to now.

We have partnered with the local NGO building the cisterns (ASA) and the Brazilian Government (MDS), and obtained their support for a randomized control trial of their program. Funding for cistern-building has been obtained from the Spanish Development Agency in Brazil and the Brazilian Government.

Paul Gertler, Marco González-Navarro

Source Dispensers and Home Delivery of Chlorine in Kenya

Diarrheal diseases are a leading cause of morbidity and mortality in the developing world, killing an estimated 2.6 million per year between 1990 and 2000. Despite widespread awareness of the dangers of drinking unsafe water, there is extremely low adoption of sanitation or clean water practices in rural Western Kenya. 70% of households admit that drinking dirty water causes diarrhea, only 5% of households report that their main drinking water supply is chlorinated.

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Researchers sought to examine how varying the price, distribution, and promotion of the chlorination products affected a household’s willingness to pay and rate of use. Households were given seven WaterGuard bottles, an individual water treatment product, each sufficient for one month’s supply of clean water. One third of this group received coupons for a 50% discount on future purchases of WaterGuard bottles, one third received additional verbal persuasion messages beyond the basic WaterGuard instructions, and another third received no additional coupons or messages. To estimate social networking effects, the free WaterGuard bottles were distributed in different percentages in each community.

Results:

After receiving a free 7-month supply, chlorine was detected in 58% of households, much more than the 2% starting level but only 10% of the distributed coupons were redeemed. Dispensing free chlorination dispensed at water sources along with community promoters provided the most effective strategy to improve water cleanliness, suggesting that similar programs may help prevent diarrheal incidence in areas such as rural Kenya.

Michael Kremer, Edward Miguel

Chlorine Dispensers for Safe Water in Kenya

Two million children die of diarrheal disease each year and contaminated water is often to blame. Treating water with chlorine could substantially reduce this toll. The most common approach to chlorination in areas without piped water infrastructure is to offer small bottles of chlorine for sale to consumers.

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However, chlorine use has been slow to catch on in this system. In this Kenyan study area, for example, less than 10% of households regularly use chlorine at a monthly cost of approximately US$0.30, despite several years of vigorous social marketing that has raised awareness about the product.

Based on this finding, the research team has developed a way to drastically cut the cost of chlorinating water by reducing packaging and distribution costs -- which account for the majority of the price of chlorine sold in individually-packaged bottles -- by installing chlorine dispensers at communal water sources. Users turn a knob on the dispenser to release a pre-measured dose of chlorine appropriate to treat the volume of water typically collected. The presence of a dispenser provides a reminder to treat water and harnesses peer effects to help increase take-up.

A randomized evaluation, in which provision of chlorine dispensers is phased in over time, is demonstrating the impact of the intervention on child health outcomes and will shed light on how the technology can be sustainably managed in a variety of settings. So far dispensers have been provided to 5,000 people at 20 rural water points.

Results:

 

During an unannounced visit three to six months after the installation of the dispensers, 61% of households in communities with a dispenser had detectable chlorine in their drinking water, compared to 8% of households in a comparison group. The percentage of households who use the dispensers was rising over time.

A second round of pilots is underway, with dispensers at a variety of settings, including schools, unprotected springs, and several urban sites. Work is underway to refine the dispenser hardware to further lower costs and develop strategies for marketing, cost recovery, and sustainable scale-up. The second round of the study will be completed in 2010, and further work to understand how to finance and maintain dispensers will be ongoing until the end of 2011.

Efforts are also underway to expand the program in Kenya and throughout the world. Chlorine dispensers could be appropriate for up to 2 billion people globally. Scaling up this approach globally could drastically alter the rural water landscape and save the lives of 100,000 – 250,000 children each year.

Do you want to help support IPA's work in providing safe water to people in Kenya?  Donate here and select the "Chlorine Dispensers for Safe Water" fund.

Michael Kremer, Edward Miguel

Household Water Connections in Morocco

Many people in the developing world lack access to clean water.  Can providing clean water make kids healthier? Will children attend school more often? Will adults be able to work more regularly? We worked with the Government of Morocco to evaluate the impact of offering piped water connections at a subsidized price, and on credit. It turned out that there were no major health or educational benefits as most households already had access to free public taps, but people were willing to pay for a private tap at home, and the time saved walking to the tap made for more free time and higher self-reported happiness.

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Policy Issue: 

Households in developing countries spend considerable amount of time fetching water. The time-burden of water collection does not typically spare anyone in the household, but in many countries it is borne primarily by women and girls. Most interventions to connect poor households to the drinking water network are primarily concerned with improving physical health. Yet, over and beyond its direct effect on physical health, improved water access could have important effects on the household well-being. By reducing the time burden of water collection, improved water access not only frees up time that could be spent on additional leisure or production (paid labor or schooling), but also removes an important source of stress and tension. But it might also be welfare-reducing as women face restricted mobility outside of excursions to collect water. An in-home water connection could cut off an important opportunity to socialize.

Context of the Evaluation: 

In urban Morocco, the setting of this study, households that rely on public taps spend more than seven hours a week collecting water, despite a relatively high density of water taps. In our sample, 65% of households without a water connection report that water is a major source of concern: 15% have had a water-related conflict within the family and 12% with their neighbors. Thus, both within the family and between families, water seems to be the primary source of stress and tension.

Details of the Intervention: 

J-PAL worked in collaboration with Amendis, the local affiliate of an international private utility company, which operates the electrical and wastewater collection networks as well as the drinking water distribution in Tangiers, Morocco. In 2007, Amendis launched a social program to increase access to piped water and sanitation. As of the end of 2007, approximately 845 low-income households living in “on-the-grid neighborhoods” of Tangiers (i.e. in principle easily connectable) did not have a household water connection because they could not afford the connection fee. These households had free access to public taps in their neighborhood, however, and they also all had sanitation facilities at home.

The program provided a subsidized interest-free loan to install a water connection. The loan was to be repaid in regular installments with the water bill over three to seven years. The subsidy did not cover the cost of installing the connection or the cost of water consumed. To pilot-test the program, a door-to-door awareness campaign was conducted in early 2008 among 434 households, randomly chosen from the 845 that needed a connection. Those households received information about the credit offer as well as help with the administrative procedures needed to apply for the credit. The remaining households (the comparison group) were eligible to apply for a connection on credit if they wanted to, but they received neither individualized information nor procedural assistance until 2009.

Results and Policy Lessons: 

Since the participating households already had access to the water grid through free public taps, no improvements in the quality of water consumed by households have been found. Despite significant improvement in water quantity, no change in the incidence of waterborne illnesses was found. Nevertheless, households are willing to pay a substantial amount of money to have a private tap at home. Getting connected generates important time gains, but does not lead to increases in labor market participation, income, or schooling attainment. The spared time seems to be used for leisure and social activities.  Because water is often a source of tension between households, home connections appear to improve social integration. Overall, despite the financial cost, households’ self-reported happiness improves substantially when they are connected to the water system at home.

Esther Duflo, Pascaline Dupas
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