Why Worry About Water, Sanitation, and Hygiene?

Unsafe Water: More than 884 million people worldwide lack access to improved water sources

No Sanitation: 2.5 billion don’t have access to a latrine or toilet

So What?: Every 15 seconds child dies from dehydration due to diarrhea.

Goal: Reduce Global Burden of Diarrhea

Graphic Citation: worldmapper.org

• Every Year: 1.5 M children die from diarrheal diseases; 4,000 every day• 90% children under 5• 80% transmission from consumption of unsafe drinking water

Proportion of Worldwide Cases of Diarrhea (0 – 4 years of age)*

Ensuring the Water is Clean…

When You Drink it

4

• Even when water is delivered by wells to a community, water often becomes contaminated while being transported from the well to the home or while it is being stored in the household.

• Low additional cost and widespread applicability make them a viable complement to infrastructure development

• Enables households to manage their water quality

Household Water Treatment (HWT): One Family at a Time

CDC’s Safe Water Solution (Sodium hypochlorite solution)

• Low Cost: Less than a penny a day for a family of 6;• Builds Local Capacity: Produced locally; thereby reducing

production costs and improving sustainability.

NaDCC Aquatabs (NaDCC tabs)

• Facilitates distribution: Light and easy to transport• Long Product Life: Five year expiration date• Individual sale possible: Facilitating purchase by consumers with

little disposable cash

Flocculant – Disinfectant (PUR Purifier of Water®)

• Facilitates distribution: Light and easy to transport• Long Product Life: Three year expiration date• Added Effectiveness: Also removes turbidity, other micro-

organisms (i.e. giardia) and arsenic• Visual Cue: Enhances demand, especially rural audiences

PSI’s current HWT Options: Ensuring household drinking water quality

Social • marketing(so shel • mar kit ing) n. 1.The application of marketing concepts and techniques to influence behavior among a target audi-ence in order to benefit themselves and society.

Communications + Product = Healthy Behavior

PSI’s Child Survival programs are in over 30 countries

Liters of water treated since PSI Safe Water programs began:

over 60 billion

A Case Study: Enabling People in Madagascar to treat their drinking water

Applying Evidence to Improve HWT Uptake: MadagascarSur’Eau use: 2004 and 2006

Lack of developed commercial sector – limited reach of wholesalers

Lack of rural coverage

Low profit margins compared to other FMCG

Increased costs

Limited funding leading to modest A&P Budgets

“Water treatment culture” is harder to create than thought

Challenges Encountered

Hotely Sûr’e

Sekoly Sûr’e

Community-Based Distribution Agents

Using key determinants to drive behavior change: • Self efficacy :

– Simply Instructions– More product demonstrations via CHWs

and other

• Social norms:– Develop a “Women Network” and

revise packaging to promote Sûr’Eau use

• Risk of diarrhea:– Implement concentrated IPC/ mass

media campaign on negative effects of diarrhea

– used radio spots, mobile video units, and interpersonal communication activities to educate about the dangers of diarrhea; implemented intensive IPC in high prevalence zones

MadagascarSur’Eau use: 2004, 2006, 2008

0

5

10

15

20

25

30

35

40

Ever Used Used in thelast month

Used in thelast 24 hours

2004

2006

2008

Primary CS Indicators

• Water treatment:– % of households with children under five ever using a

PSI point of use treatment product to treat drinking water

– % of households with children under five consistently treating drinking water using promoted method

– % of households with children under five treating drinking water using promoted methods in the last 24 hours

• Verified with chlorine residual testing – % of households with children under five correctly

treating drinking water using promoted method • Water storage

– % of households with children under five correctly storing treated drinking water

Primary CS Indicators

• Handwashing– % of caregivers with children under five who wash

their hands at critical times:• before preparing food• before feeding a child• before eating• after defecation• after changing a child

– % of households with children under five who have soap present in the home

• Hygiene– % of caregivers who used a toilet or latrine the last

time they defecated– % of caregivers who always use a toilet or latrine for

disposing of children’s feces

Taking HWT to Scale: Lesson Learned

• Focus on key determinants

• Constant communication of culturally-relevant aspirational messages

• Partnerships are critical to success

• Work through multiple channels to enable behavior change and increase product update

• Monitoring and Evaluation of standard indicators is essential

• Emergency Relief can serve as a launching pad and be leveraged for behavior change

Conclusion: These interventions are…

Effective:

Offer measurable reduction in diarrheal disease prevalence

Offer measurable increase in good hygiene practices and beliefs

Affordable

From a penny a day to $0.20 a day for a family of 6

Scalable:

Allow PSI to ensure that millions of people can drink a glass of clean, safe water every day.