Sustainability of Long-Term Take-Up of Point-of- Collection Chlorine Dispensers Provided Free of Charge in Rural Western Kenya

Transcription

1 Sustainability of Long-Term Take-Up of Point-of- Collection Chlorine Dispensers Provided Free of Charge in Rural Western Kenya Presented by: Clair Null Disinfection 2011 Joint work with: Michael Kremer, Harvard University Edward Miguel, U.C. Berkeley Sendhil Mullainathan, Harvard University Alix Zwane, The Bill & Melinda Gates Foundation Exceptional field assistance provided by: Innovations for Poverty Action (special thanks to Jeff Berens and Leonard Bukeke) Generous financial support from: The Bill & Melinda Gates Foundation

2 Overview Take-up of point-of-use chlorine remains low in rural Western Kenya (<20% of households), despite years of social marketing and a good distribution network (kudos, PSI!) In an iterative research process we tested a variety of strategies to increase take-up using randomized evaluations 2

3 Overview Low demand for socially-marketed chlorine persists despite high levels of awareness of water-borne disease & chlorination, positive perceptions of the product, evidence of health effects, and even when the price of the product is greatly reduced. We identify the combination of low cost (both monetary and convenience) along with a social norm of use as the most promising approach to boosting chlorine take-up. Achieved via the chlorine dispenser system Cost-effective and sustainable 3

4 Setting Demographics Mothers have 6 years of education 4 children under age 12; 1 or 2 children under age 3 Water Nearest source is 8 minute walk from compound < 20% of HH s meet E.P.A. drinking water standard < 30% boiled yesterday s drinking water Hygiene & Sanitation > 80% have a pit latrine > 90% have a soap 4

5 Price and WaterGuard Use % of Households with chlorinated drinking water Price=0 (Household visit) Price=10 (Coupons) Price=20 (Social marketing) Self-reported Positive test Coupon redemption

6 Alternative Strategies to Promote Take-up Group 0 Pure comparison Group 1 Persuasive scripts: Group 1A Household script only Group 1B Community script only Group 1C Household + community scripts Group 2 Promoters + coupon for 1 free bottle / household: Group 2A Flat-fee promoter Group 2B Incentivized promoter (paid per positive test) Group 3 Incentivized promoters + dispenser 6

7 Point-of-collection Chlorine Dispenser Jan. 4, 2010

8 Point-of-collection Chlorine Dispenser Drastically cuts the cost of supplying chlorine Approximately ¼ - ⅓ 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 8

9 Study Design 88 springs randomized into community-level interventions Household-level script randomization at comparison & community script springs Baseline surveys, interventions ~20 sampled household s per spring Short-run follow-up (~3 weeks) increase sample by ~5 household s per spring Medium-run follow-up (3-6 months) Long-term follow-up I (18 months) Long-term follow-up II (30 months) 9

10 Take-up by Treatment Arm

11 Take-up by Treatment Arm

12 Take-up by Treatment Arm

13 Take-up by Treatment Arm

14 Take-up by Treatment Arm

15 Take-up by Treatment Arm

16 Take-up by Treatment Arm

17 Take-up by Treatment Arm

18 Community Diversity & Dynamics

19 Community Diversity & Dynamics Wide ranges within communities across rounds Wide ranges across communities

20 Community Diversity & Dynamics Lowest rates typically short-run while learning Long-term has held up pretty well (not universal) sustainability

21 Community Diversity & Dynamics A problem was corrected There was a problem

22 Community Diversity & Dynamics This is amazing! What is going on and how can we replicate it in other communities?

23 Promoter or Dispenser?

24 Conclusions 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 (awareness already high) Local chlorine promoters were influential while paid (even when price discounts ran out), but did not create self-sustaining social norm of use without on-going subsidies Combine potential of persuasive messages and peer effects Incentivized payments did not increase take-up 24

25 Conclusions 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 takeup 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) 25

26 Next Steps Long-term sustainability (18-month follow-up) at dispensers with volunteer promoters Additional analysis of social effects Off-shoot research projects Community financing for chlorine refills Refinements to promoter program Health impact of dispensers specifically Scale-up efforts Fine-tuning engineering & mass production Partnerships with government in Kenya Exploring suitability of dispensers in other contexts 26

27 Thank you! 27