Safe Water 

In 2010, the United Nations General Assembly explicitly recognised water and sanitation to be a human right. One aspect that defines this right is that water must be ‘safe’- free from microorganisms and other substances that can threaten one’s health.

Chlorine has been used for over a century to disinfect water. It has contributed substantially to the increase in access to safe drinking water for millions of people around the world as it can be incorporated on varying scales- ranging from piped networks in urban areas, to household treatments in rural settings. Chlorination is regarded as the most affordable, reliable and effective method of water purification, especially because of its ability to kill the majority of pathogens responsible for diarrheal diseases in children (GEMS, 2018); thus being an approach endorsed by the WHO to improve water quality (2003).

There is a plethora of epidemiology and economics literature that has concluded the wide-reaching benefits, particularly in access to water and public health, that the use of chlorine can contribute to. Yet this remains dependant on its continual use, which is often determined by the method of chlorine provision. In rural communities that are not connected to piped water supplies and are instead reliant on open water sources, individually packaged chlorine is typically purchased. However, the willingness to pay for water treatment is often low (Blum et al. 2014: Kremer et al. 2009), which essentially means that people are reluctant to buy chlorine- regardless of them understanding the health benefits that cleaner water can have. This clearly suggest the need for public provision in order to guarantee access, and ensure the population’s rights to safe water is met.

The following post will now review the ‘Dispenser for Safe Water’ initiative, a program implemented by Evidence Action across East Africa, including Kenya.

The case of Kenya

The majority of the population in Kenya live in rural territories, where there is an absence of a sufficient distribution systems and so water disinfection occurs at a household level. Chlorine is a favourable approach at such small scale, with the key advantage being is its residual potential; in which the chemical remains active for 2-3 days and prevents recontamination when the water is stored (The Chlorine Dilemma, 2011). Ultimately, this can reduce the need to allocate time every day to fetch water. However, the limitation that arises in local-scale chlorine use is that the responsibility of purchasing and correctly dosing the water falls on to individuals- which can potentially discourage use as chlorine take-up is highly sensitive to price change (Kremer et al., 2011)

To tackle this, ‘point-of- collection’ (POC) chlorine dispensers can be installed next to a water source and therefore allows people to treat their water on the spot. This free, pre- measured dosage scheme provides a convenient and economically attractive alternative to bottled chlorine from retailers- which is often imported. Dispensers encourage sustained household use of chlorine- the public location and bright blue colour is a visual reminder, and further facilitates norm formation as potential users can see others using it and be incentivised to also use it too (Ahuja et al. 2010). This human-centric design fosters the practice of chlorinating water when collecting and ultimately extends access to safe water in rural communities. So far, there are over 18,000 dispensers across Kenya, and the evidence of the success has been closely evaluated by Evidence Action.

One reason underpinning the success of this ‘point-of-collection’ model is that the provision is based upon community partnership and engagement. A trusted member is trained, and then delegated the task of encouraging locals to make use of the dispenser, as well as reporting when it needs repairing or refilling. This feature layers upon the human-centric design discussed earlier and reiterates the emphasis on inclusion to promote safe water access. Furthermore, from an economics standpoint, a POC system is very cost- effective as it requires bulk supplies of chlorine for the water sources (ibid); bypassing the delivery and marketing costs associated with the traditional retail approach. The lower supply costs make free provision of the chlorine feasible and thereby transcends the barriers that the ‘low willingness to pay’ posed.

Overall, the existing evidence confirms that chlorine dispenser models are favoured to other water treatment options, and their use tends to be sustained. POC approaches have addressed many of the concerns that were attributed to chlorine, particularly with correct dosing and costs, and have made huge strides with ensuring rural populations have had their rights to water and sanitation met. But what still remains a challenge is the fact that chlorine does not kill all pathogens, namely Giardia lamblia and Cryptosporidium, which can cause diarrhoea. This can render the appropriateness of using chlorine entirely futile for water sources that breed such pathogens, and would prompt the use of alternative treatment methods.

 

 

References

Ahuja, A., Kremer, M. and Zwane, A.P., 2010. Providing safe water: Evidence from randomized evaluations. Annu. Rev. Resour. Econ., 2(1), pp.237-256.

Blum, A.G., Null, C. and Hoffmann, V., 2014. Marketing household water treatment: willingness to pay results from an experiment in rural Kenya. Water, 6(7), pp.1873-1886.

Kotloff, K.L., Nataro, J.P., Blackwelder, W.C., Nasrin, D., Farag, T.H., Panchalingam, S., Wu, Y., Sow, S.O., Sur, D., Breiman, R.F. and Faruque, A.S., 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. The Lancet, 382(9888), pp.209-222.

Kremer M, Miguel E, Mullainathan S, Null C, Zwane A. 2009c. Making water safe: Price, persuasion, peers, promoters, or product design? Work. Pap., Harv. Univ., Cambridge, MA

Kremer, M., Miguel, E., Mullainathan, S., Null, C. and Zwane, A.P., 2011. Social engineering: Evidence from a suite of take-up experiments in Kenya. Work. Pap., Univ. Calif., Berkeley.

WHO (2003) Chlorine in Drinking-water: Background document for development of WHO Guidelines for Drinking-water Quality https://www.who.int/water_sanitation_health/dwq/chlorine.pdf

TUE (2011) The Chlorine Dilemma: Final Report https://sswm.info/sites/default/files/reference_attachments/TUE%202011%20The%20Chlorine%20Dilemma.pdf