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Water Quality Case Study Kenya R

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					Water Quality Case Study:
Kenya Rural Water Project
   Michael Kremer, Harvard University and NBER
      Edward Miguel, U.C. Berkeley and NBER
             Jessica Leino, World Bank
 Sendhil Mullainathan, Harvard University and NBER
             Clair Null, Emory University
   Alix Zwane, Bill and Melinda Gates Foundation

Presented by Vivian Hoffmann, University of Maryland

              DIME-AADAPT SAR
              December 19, 2009
                     Motivation
• 2 million children die of diarrheal diseases annually,
  contaminated water is important pathway of transmission
• Domestic water is a common demand in CDD initiatives
  (especially by women)
• Impact evaluations can help identify effective
  technologies for improving water quality
• Same methodologies can also help identify which
  technologies are valued by beneficiaries
• Essential to understand willingness-to-pay for scale-up
  and long-run sustainability

                                                            2
                                Setting
• Rural Western Kenya
• Demographics
   – Mothers have 6 years of education
   – 4 children under age 12; 1 or 2 children under age 3 per
     compound

• Water
   –   Nearest source is 8 minute walk from compound
   –   Most households get water from unprotected springs
   –   < 20% of HH’s meet US drinking water standard
   –   < 30% boiled yesterday’s drinking water

• Hygiene & Sanitation
   – > 80% have a pit latrine
   – > 90% have a soap                                          3
October 2008 - CAS   Trickle Down   4
October 2008 - CAS   Trickle Down   5
             The Project (Phase I)
• Multiple interventions to improve water quality

• Researchers worked with a local NGO

• 652 springs were identified for protection to
  improve water quality and convenience

• Due to capacity constraints, able to protect only
  one quarter of total springs each year

• Randomized order of phase-in
• Compared with household water treatment
  intervention (chlorine)                             6
         Household Water Treatment
• Point-of-use treatment with dilute chlorine reduces
  diarrheal disease by around 40%, yet relatively few
  households use chlorine even in areas exposed to
  several years of vigorous social marketing

• In Kenyan study area:
   – 70-90% of households familiar with local brand of
     chlorine
   – About as many volunteer that “dirty” water is a cause
     of diarrhea
   – Only 5-10% of households regularly use chlorine to
     treat their water

                                                             7
• Dilute chlorine (similar to chlorination in
  centralized water supplies in rich countries)
• Safe: developed by US CDC & PAHO,
  distributed and marketed by Population
  Services International in over 20 countries
• Chlorine smell and taste is strong at first
  (prevents overdosing / kids drinking straight
  from bottle), fades after a few hours
• One capful disinfects 20L of water, with
  residual protection against recontamination
• 150 mL bottle treats a household’s water
  supply for roughly one month
• Costs 20 KSh (US$0.30), a quarter of the daily
  agricultural wage


                                                  8
                                                       Study Design (Phase I)
                                              Spring Protection vs. Chlorine Distribution

                                                                                      Identify Springs

                                                                                       randomize

  Protect in years 1-2                                                                                      Protect in years 2-4
                                                                                    Baseline HH survey,
                                                                                     water quality tests,
                randomize                                                                                                     randomize
                                                                                         GPS data




                                                                                                                               6 mo chlorine + persuasion

                                                                                                                                                            6 mo chlorine + coupons
                 6 mo chlorine + persuasion

                                               6 mo chlorine + coupons




                                                                                                              6 mo chlorine
6 mo chlorine




                                                                                                                                                                                      control
                                                                         control




                                                                                       Interventions



                                                                                   Follow-up HH survey &
                                                                                     water quality tests
                          Data
• Distance to main source of drinking water (GPS)
• Water quality (fecal coliform) at the spring
• Water quality in the home
• Residual of chlorine in drinking water
   – for study households and social contacts

• Coupon redemption
   – from shopkeepers

• Child diarrhea
   – reported by mother
11
    Summary of Spring Protection Results

• Protecting springs led to 66% less source contamination,
  moderate gains at home; child diarrhea fell by a 25%

• Households value spring protection at 12.7 work days
  ($4.52-$9.02) per year

• Policy implications: comparing this to the cost of spring
  protection, it appears socially optimal to only protect
  springs with large numbers of household users.
                  (does not include health benefits)
Household Water Quality Impacts
Child Health Impacts
            Price and WaterGuard Use
100
  80
  60
  40
  20
      0




              Price=0              Price=10            Price=20
          (Household visit)       (Coupons)        (Social marketing)

               Self-reported   Positive test   Coupon redemption
        Can price serve as a screening
                 mechanism?
• Some argue that price will help to screen out those who
  aren’t likely to value or use the product
   – Ashraf, Berry, and Shapiro (2008) in peri-urban Zambia

• Present study found no evidence that households who
  stand to benefit most from cleaner water (i.e. those with
  young children) have higher willingness to pay

• Draws into question appropriateness of retail model




                                                              16
               Study Design (Phase II)
Alternative Approaches to Promoting HH Chlorine Use


                        Sample of Springs


                           randomize

                          Flat fee      Incentive      Chlorine
  Control
             Social     promoter +         pay       dispenser +
            Marketing   coupon for     promoter +   incentive pay
                         one free      coupon for      promoter
                           bottle        one free
                                          bottle
Point-of-collection Chlorine Dispenser




                                         18
   Point-of-collection Chlorine Dispenser
• Drastically cuts the cost of supplying chlorine
   – Approximately 25% of current individually-packaged retail cost
• Salience
• Convenience
   – Walk home provides agitation and some of wait time
   – Dose is more precise; doesn’t get on hands
• Habit formation
   – Links water treatment to existing habits associated with water
     collection
• Harnesses social network effects
   – Makes decision public


                                                                      19
               Take-up by Treatment Arm
100
  80
  60
  40
  20
      0

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                   Short-run (~3 weeks):                Medium-run (3-6 months):
                   Self-report                          Self-report
                   Positive test                        Positive test
                   Persuasion and Peers
• More intensive marketing messages had no effect on take-up

• Rich relationship data on all pair-wise combinations of
  sampled households in each spring community

• Intervention drastically increased frequency of conversations
  about WaterGuard

• Mixed evidence of take-up effects depending on outcome
   – On basis of self-reported chlorine, comparison household twice as likely
     to use chlorine if all of her close friends were members of treatment
     group (sig. at 90% confidence)
   – On basis of positive chlorine tests, no effect of social networks

• Members of the same tribe and community leaders are
  especially influential on the basis of either measure
                                                                       21
100
          Take-up of Free Chlorine
  80
  60
  40
  20
      0




          Indiv. Bottles +          Dispenser +           Dispenser +
              HH visit               Promoter               Promoter
                                  (Baseline HH's)      (Non-Baseline HH's)

                             Self-report    Positive test
 Conclusions: Household Water Treatment
• Very high take-up rates of chlorine for point-of-use water
  treatment when it is provided for free
   – But demand is very sensitive to price

• Persuasive messages don’t seem to make much difference
  beyond short-run; mixed evidence on peer effects, but
  community leaders do seem important
• Local chlorine promoters were very influential, even when price
  discounts ran out

• Changing the way the product is delivered could be the solution:
  Point-of-collection chlorine dispensers hold the most promise for
  a sustainable strategy for increasing take-up at scale
   – Drastically reduces cost (mainly through packaging)
   – Harnesses peer effects by making use decision public
   – Helps to build habits of consistent use (more convenient)
 Lessons for Impact Evaluation
• Possible to learn a lot by trying multiple
  strategies
  – varied technology, price, message

• Iterative design allows development of
  effective new approaches
  – e.g. free delivery works (but is expensive)  chlorine
    dispenser makes free delivery much cheaper
  – next step: how to manage and finance dispensers?

                                                         24
Thank you!

             25

				
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