We have been in Jeremie, Haiti for two weeks, and without running water for a week. In the afternoons I often meet children fetching water, which might be contaminated . . . Access to clean water remains a key problem for development in the country.
IPA reports on an effective way to improve water quality:
The Chlorine Dispenser System (CDS) offers an innovative approach to increasing the adoption of water treatment by rural populations, thereby reducing diarrheal diseases among children. A point-of-collection dispenser system in combination with community promoters was successful at increasing adoption of chlorinating drinking water via the dispenser, and sustaining this behavior change even two years after payments to the promoters ended.
The approach was designed to take advantage of insights from behavioral economics, helping people overcome barriers to chlorine adoption: The dispenser hardware provides a visual reminder to treat water when it is most salient—at the time of collection. The source-based approach makes drinking water treatment convenient because the dispenser valve delivers an accurate dose of chlorine to treat the most common transport container, while the public nature of the dispenser system also contributes to learning and habit formation. The promoters also provide frequent reminders and encouragement to use the product. As promoters are members of the community, their local knowledge, trust, and social influence may have contributed to their success in driving adoption.
At scale, the cost of the CDS could be as low as $0.50 per person per year, 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.
The dispenser has been installed in some parts of Kenya and Haiti. An evaluation of the program by IPA concludes:
While three quarters of households have heard of point-of-use water chlorination and 70 percent admit that drinking dirty water causes diarrhea, only 5 percent of households report that their main drinking water supply is chlorinated.
The promoter (nudge) is key:
Hiring local community members at a low wage to promote chlorine use among their neighbors is highly effective at increasing use. Chlorine was detected in 40 percent of households visited by a promoter, compared to only 4 percent in those who weren’t visited. Incentivizing these promoters had only modest effects. Communities with point-of-collection chlorine dispensers in combination with promoters saw 61 percent of households chlorinate their water, up from only 2 percent prior to the study, suggesting that this is a highly cost-effective way to promote take up.
I kept thinking however in the long term effects of the dispenser/promoter. Will the positive effects last say 3 or 4 years from now? What is the best way to make a transition towards self-management of clean water in countries like Haiti? Ideally one would like to see a market developed, where local providers supply the dispensers and their businesses are sustainable because people are willing to pay for it. One hopes that at the beginning when international organizations pay for dispensers and promoters communities see the benefits of clean water, and developed the will to pay for it. But what if this does not happen? These questions call our attention for the need of long term evaluations of interventions and to think deeply about ways in which we can move towards a self-sustanable and self-organized way of providing clean water. This is an importunity for researchers and evaluators: to look at long term effects. Granted, some interventions are still so "young" that it is not possible to do this, but it will be in the following years.
Nudges might not be enough, other means might be required. That is where probably movies, documentaries, etc., that provide information, can be valuable to promote long term behavioral changes. But still, I wonder how effective nudges are in the long run.