Promoting Adoption of Household Promoting Adoption of Household Chlorination in Rural HaitiChlorination in Rural Haiti
Michael Ritter, Deep Springs InternationalMichael Ritter, Deep Springs InternationalDaniele Lantagne, CDCDaniele Lantagne, CDC
Jolivert Safe Water for Families Project
• Began 2002 by CDC and FBO in rural Haiti
• MIT evaluation (2003) with 200 households after 60 weeks showed 68% correct use
• USAID / CDC (2005) showed 71% correct use and detailed records
• Emory / CDC (2007) study on adoption
• Deep Springs International now managing and replicating Jolivert project
ProductsProducts
• Locally produced sodium hypochlorite
• Refillable 240 ml bottles = 48 uses
• Locally available buckets modified with tap and lid
Rural Reseller
Urban Pharmacy
25 Resellers104 communities
Production Technicians at
Missions of Love Clinic
HHs in program
HHs in catchment
Coverage
Town 310 865 35.8%
Rural 899 12,290 7.3%
TOTAL 1,209 13,155 9.2%
Methods
• Analyzed longitudinal sales data for 1,709 member households
• Cross-sectional randomized household questionnaire– 527 total
• 357 members• 170 non-members
•Avg. 76% positive Cl residual
•Avg. 0.96 visits per HH per yr. (range = 0 - 7, std. dev. = 0.99)
•Avg. 5.9 bottles per HH per yr.
ResultsHaving a system
Having made >1 purchase
Consistent purchase
SES **
Knowledge ** **
Distance to sales point ** **
Household visits ** **
Social support ** ** **
Social norms ** **
Self-efficacy **
**Significance p < 0.05 (mix of Chi-square, Cochran-Armitage, and Mantel-Haenzel Chi-square tests)
Conclusions and Program Recommendations
• Program entry should be subsidized
• Additional sales points should be established to increase convenience
• Self-efficacy and social norms messages should be disseminated
• Annual household visits should continue
Comparison with Filtration- Chlorination Program in Rural Haiti
• Technicians visit weekly– Sell chlorine– Provide replacement parts– Test chlorine residual
• 1 tech : 200 households
• Tech salary paid by US parish
Summary of Program Models
NGO A JSWF
Years in operation 12 7
Current households (n) 25,000 4,000
Correct use (+ Cl resid) 85% 76%
Household visits Weekly Annually
Annual BCC cost per HH (current volume & price)
$6 <$1
Annual cost to family $11 – 16 $1 - 3
What Has Been Demonstratedand Future Potential
• With annual visits, high use (>75%) of consumable can be sustained over time
• Potential exists to recover costs of visits and BCC through sales margin
• Durable good must be sold below cost
• Chlorine refills can be sold above cost with high use
• Cost recovery is volume-dependent
Mesi anpil!Mesi anpil!
Thank you!Thank you!
Acknowledgements• Dr. Gene Gangarosa, Emory• Dr. Bill Gallo, JSWF Project Director• Dr. Rochelle Rainey, USAID• Madame Eveline and JSWF staff
Jolivert Safe Water Jolivert Safe Water for Families Projectfor Families Project
Production and distribution ofCDC’s Safe Water System
Donate space and electricity
Technical assistance & evaluation
$20,000 grant from June 2006 - May 2008
Program Director, June 2008
Non-member
Non-purchaser
Inconsistent purchaser
Consistent purchaser
Purchased bucket
No Yes Yes Yes
Purchased soln. >0
No No Yes Yes
Purchased soln.
frequentlyNo No No Yes
MaintenanceContemp-
lationAction
Pre-contemp-
lation
Create trial
Maintenance: Consistent purchaser
Contemp-lation:
Non-purchaser
Action:Inconsistent purchaser
Create aware- ness
and trial
Create repeat
purchases
Pre-contemp-
lation:Non-member
Knowledge Social Support
Ability to pay for bucket
Social Norms
Availability / Transport costs
Attitudes
Outcome Expectations
Quality of care
Summary construct
PSI “Bubbles” determinant
Stage of change
Behavior change objective
KEY
Opportunity
Motivation Ability