Household Water Treatment working to save lives in Rwanda. Population Services International

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1 Household Water Treatment working to save lives in Rwanda Population Services International

2 Outline of the presentation 1. Context 2. Challenges 3. Policies & Programs 4. Role of Household Water Treatment 5. Lessons learned page 2

3 Rwanda- Context in the Le pays de Milles Collines Rwanda, a small country with over 10 million people, is located in central East Africa. Over 80% of the population lives in rural areas* 60 % of the population lives below the poverty line* 50% close to half of all children under age five suffer from chronic malnutrition* *According to 2007 DHS page 3

4 2. Challenges Only 30 % of the rural population has access to an improved source of water. 1 in 10 children die before reaching his /her fifth birthday 13.7% of children under the age of five had diarrhea in the two weeks preceding the survey Diarrhea is second major cause mortality in kids under five Epidemics of cholera occur periodically including in 2009 page 4

5 3. Rwandan Government W&S Policies 2004 Water and Sanitation Policy seeks to Increase the rate of potable water coverage by 2.5 % annually in order to achieve 2020 Vision of universal access to water and 80% sanitation coverage. Currently the Water and Sanitation policy is being revised. Economic Development and Poverty Reduction Strategy During the EDPRS period, the sector aims to increase the proportion of the population accessing safe water in a reasonable distance from household to 86%, and the proportion with sanitation services to 65%. In addition the proportion of schools with latrines complying with health norms will rise from 80%. page 5

6 3. A Sample of W&S Programs UNICEF WASH: improve hygiene and sanitation for 800,000 people in 4 districts towards reaching Rwanda s MDG targets. ( ). Word Bank: To assist in meeting the EDPRS, MDG and Vision 2020 targets for access to clean water supply and hygienic sanitation facilities in rural areas. EU: Increased provision (with at least 20%) of sustainable potable water supply and Sanitation within three years in the rural areas of Nyamagabe and Nyaruguru Districts JICA: Construction of medium scale water supply facilities and extension and rehabilitation of the existing facilities and training for water users associations and local governments to improve their operation page 6

7 4. How does HWT fit in? WASH program initiated in 4 districts: Burera, Rubavu, Nyabihu, Musanze Water treatment and safety at the household level identified as one of the major considerations of the water supply interventions to ensure safe water supply up to the point of use. WASH project therefore supports demonstration of appropriate home-based water treatment methodologies such as using sodium hypochlorite and other safe water treatment and storage practices.

8 So what does PSI do to support the government in its efforts? a. Who is our target audience? b. What did we do? c. How did we distribute the product & encourage behavior change? d. What impact did it have?

9 A. Who is our target audience? Woman of 29 years, married with 4 kids, primary school education, with a small revenue Leads a very busy life, needs assistance Is aware the water she uses is contaminated but is too busy to take any actions Is afraid that her kids might get diarrhea page 9

10 B. What to did we do we help? Product: Developed and introduced the chlorinebased water treatment solution Sûr Eau with support of US CDC. Price: Sold Sûr Eau for 200RF which is the equivalent of $0.37 Promoted HWT, handwashing at key times, and use of the latrines. Placement: Launched this through public, the private sectors & community based distribution. page 10

11 Timeline Sur Eau introduced Promotion to PWHLA via World Bank USAID s Point of Use Zinc (POUZN) Project launched with mutli-sectoral approach Baseline Research completed 2008 Mutuelles Health insurance pilot implemented Follow up research completed page 11

12 Principal Partners Government of Rwanda: Ministry of Health, Ministry of Infrastructure Local authorities National Women Network Rwanda local NGOs Producer of Sur Eau, Sulfo US Centers for Disease Control page 12

13 Communications + Product = Healthy Behavior

14 PSI Private Sector Distribution network page 14

15 Drivers of HWT Knowledge about the importance of water treatment Diarrhea can be caused by drinking water that looks clear Positive social norms Most of the people I know take some action to treat their water to make it safer to drink Self-efficacy for water treatment I feel capable of using Sur Eau correctly Perceived availability I can always find Sur eau around where I live Perceived threat My child is at high risk for getting diarrhea

16 Promotion Mass Media The Good Life campaign, targeting caregivers of children under five, positioned Sûr Eau as a water treatment product that offers a caregiver comfort and peace of mind designed to: rapidly build awareness and knowledge, promote availability at wholesalers and semi wholesalers, and improve point of sale presence and visibility. page 16

17 Promotion to people in Rural Areas Building on the mass media messages, PSI reached out to people in Rural area through: Clinic and School based chats with Women & Kids Clinic based demonstrations while women were waiting to access services Village chats held by Community Health workers and RPO team members Women s Associations page 17

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19 D. So what impact did we have? 1. Improving access to and sustained provision of Sûr Eau in both public and private sectors 2. Increasing consistent use of the water treatment solution Sûr Eau 3. Empowering the private sector by engaging local companies in the supply chain (production, promotion and distribution) 4. Improving knowledge of Sûr Eau effectiveness and use. page 19

20 Almost half of people survey lived in an area selling Sur Eau. SurEau Availability Western Region Eastern Southern Northern Living in a cell with SE (%) Kigali % page 20

21 Exposure to messages lead to Increased Use SurEau Usage % Not Exposed Exposed 0 Ever Used SurEau Currently Uses SurEau Correct Use page 21

22 Knowledge of Sur Eau Percentage Ever Heard of Sur Eau* Knows where to Buy Sur Eau* Not Exposed Exposed *p<.05 page 22

23 5. Taking HWT to Scale: Lesson Learned Working through multiple channel better enables behavior change and increases product update, especially for rural areas. Government leadership helps ensure program success. To increase use HWT programs should focus on determinants of behavior, awareness is not enough. Social norms, risk perception, & self-efficacy are a key to increasing use of HWT. Continue to sustain use through constant communication of culturally-relevant aspirational messages Partnerships are critical to success. (Quality, Distribution, and Communication).

24 Thanks! In 2010 PSI commits to reaching over 19 million people in 30 countries with safe water programs so that women and their children can live, learn and achieve their full potential for years to come. To learn more about PSI's safe drinking water efforts visit

25 Links to Selected HWT Websites WHO Household Water Treatment and Safe Storage Network (HWTS)- Centers for Disease Control (CDC) - UNICEF/Water, Environment and Sanitation - Environmental Health at USAID Hygiene Improvement Project - Population Services International (PSI) -

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