Note: This page summarizes the rationale behind a GiveWell grant to Evidence Action's in-line chlorination program. Evidence Action staff reviewed this page prior to publication. The page reflects our rationale at the time the grant was recommended.
Summary
In July 2022, GiveWell recommended a grant of up to $5.6 million to Evidence Action's in-line chlorination program in Malawi.
In-line chlorination is a technology for automatically disinfecting water at shared water collection points. Evidence Action aims to scale in-line chlorination alongside an expansion of its Dispensers for Safe Water program that we supported in January 2022.
We recommended this grant because:
- We believe it is a cost-effective use of funding. We estimate that this grant is 11 times as cost-effective as providing unconditional cash transfers, the benchmark against which we typically compare programs. This is above the cost-effectiveness threshold we're currently using when deciding whether to make grants.
- There is a funding gap that will be filled by this grant. We believe this program is unlikely to be funded in the absence of GiveWell's recommendation, since most large funders tend to focus on water infrastructure rather than treatment.
- There is moderate future room for more funding. Globally, we estimate that in-line chlorination programs could use approximately $30 million per year in recurring costs and approximately $90 million in one-time costs. We expect this grant will improve Evidence Action’s capacity to deliver the program at scale, increasing their ability to fill in this gap.
- We believe that this grant will have high learning value. In-line chlorination has not yet been implemented at scale. As it scales, Evidence Action will gather high-quality data that will improve our understanding of the program and the precision of our cost-effectiveness estimate.
Our main reservations are:
- Whether we should wait until we have more information about the impact of chlorination programs on mortality. There are limitations in the evidence on the effect of chlorination on mortality. We may fund additional research in this area. We're also waiting for the results of a study measuring the effect of dispensers on mortality in Kenya, which may inform our estimate. However, we'd guess that it’s worth continuing to invest in water chlorination before waiting for this research to be completed.
- The cost-effectiveness of an integrated Dispensers for Safe Water/in-line chlorination program is below our current funding threshold. While the cost-effectiveness for this in-line chlorination-only grant is above our current cost-effectiveness threshold for grants, we estimate that an integrated in-line chlorination and Dispensers for Safe Water program is below it. This will become relevant when assessing whether to extend the program in the future, since Dispensers for Safe Water currently shoulders some of the "platform" costs associated with running in-line chlorination. We don't know how cost-effective it would be to run the in-line chlorination program alone.
This grant was funded by Open Philanthropy.
Published: December 2022
Table of Contents
The organization
In-line chlorination is run by Evidence Action, an organization we have a longstanding relationship with and have provided significant support to. For example, in January 2022, we recommended a grant of up to $64.7 million to Evidence Action's Dispensers for Safe Water program.
History and size
The in-line chlorination program was incubated as part of the Evidence Action Accelerator. Evidence Action has piloted in-line chlorination in Kenya with funding from the Accelerator grant.1
Evidence Action plans to leverage its Dispensers for Safe Water program in Malawi to scale in-line chlorination.2
Evidence Action also requested funding to support in-line chlorination implementation in Kenya and Uganda, though we decided against recommending funding to support this work (see below for our reasoning). Based on surveys conducted by Evidence Action and public data, Evidence Action very roughly estimates that it will install around 1,500 devices in Malawi with this grant.3
Staff structure
Evidence Action plans to primarily rely on staff in roles that are integrated across in-line chlorination and Dispensers for Safe Water, rather than hiring staff specific to in-line chlorination work.4
The intervention
Key differences between in-line chlorination and Dispensers for Safe Water
In order to be eligible for an in-line chlorination device, a water point needs to have a tank,5 which is fed by a pipe. In-line chlorination is done by attaching a small device to the pipe; as water passes through the pipe, it is automatically disinfected by the device before entering the tank.6 This automatic chlorination is a key difference from Dispensers for Safe Water’s chlorine dispensers, which require users to add chlorine to water themselves.7
In-line chlorination activities
Evidence Action plans to integrate Dispensers for Safe Water and in-line chlorination activities. At a high level, staff will:8
- Identify eligible water points suitable for Dispensers for Safe Water and/or in-line chlorination;
- Install Dispensers for Safe Water and in-line chlorination devices at those water points;
- Maintain Dispensers for Safe Water and in-line chlorination devices; and
- Conduct community sensitization meetings to introduce community members to the program.
Does in-line chlorination work?
We believe that in-line chlorination is effective at saving and improving lives.
Our full analysis of the benefits of water chlorination on mortality, including in-line chlorination, can be found in our water quality report. In brief, we estimate that the benefits of in-line chlorination derive primarily from three sources:
- Reducing under-5 mortality: 40-50% of benefits9
- Reducing over-5 mortality: 20-40% of benefits10
- Developmental effects: 20-30% of benefits.11
The grant
We recommended a grant of up to $5.6 million to Evidence Action's in-line chlorination program in Malawi.12 This includes $4.4 million to support in-line chlorination scale-up over 15 months ($1.5 million) and 4 years of maintenance ($2.9 million).13 We recommend the additional $1.1 million to be disbursed as an exit grant, conditional on GiveWell terminating its support of the program.14 In addition to the main grant, we recommended $20,395 to support Evidence Action's baseline water quality testing in its next round of surveys.15
Budget for grant activities
Evidence Action has proposed a total budget of $5,680,208 for the activities described above.16 See here for a full breakdown of the proposed budget.17
We expect that Evidence Action will raise revenue from carbon credits totaling $104,000,18 which we subtracted from the recommended amount, for a total grant size of $5,576,208.19
Grant duration
This grant supports the in-line chlorination program over seven years: approximately 1.25 years of scale-up, 4 years of program maintenance, and 1.5 years of exit funding.20 Exit funding is conditional on GiveWell terminating its support of the program, but is not conditional on termination of in-line chlorination programming in the geography.21
We typically recommend three-year grants. The main reason to extend the usual grant timeline in this case is that the program requires setting up physical infrastructures and building strong community relationships, so the cost of entering and exiting communities is high.22 The longer timeline helps ensure the set-up and exit costs are covered and amortized over a sufficiently long time horizon.
The case for the grant
Cost-effectiveness
We estimate the long-term cost-effectiveness of the program supported by this grant is 11.1 to 12.5 times as cost-effective as unconditional cash transfers.23 These estimates involve a number of assumptions, which are detailed in the following footnote.24
There are a number of limitations in the evidence included in our cost-effectiveness estimate (see below).
Funding gap
It's our understanding that most large funders tend to focus on water infrastructure, rather than treatment, and that this program is unlikely to be funded in the absence of GiveWell's recommendation.25 In addition, because in-line chlorination is a new program, it doesn't have established funders and so it seems particularly likely this program would go unfunded without our recommendation.26
Moderate room for more funding
We estimate that Evidence Action could productively use an additional $4.8 million per year beyond the current grant amount to further scale the in-line chlorination program in Malawi.27
Evidence Action also plans to look for expansion opportunities for in-line chlorination and Dispensers for Safe Water in additional countries.28 Globally, we estimate that there is roughly $31 million per year of recurring costs and $86 million in one-off costs in room for more funding for in-line chlorination above a funding bar of 9x cash, our funding bar at the time of assessing the grant.29 We expect this grant will improve Evidence Action’s capacity to deliver in-line chlorination at scale, increasing their ability to fill in this gap.
Ability to measure and evaluate impact
We expect Evidence Action will gather high-quality data that will improve our understanding of the Dispensers for Safe Water and in-line chlorination programs and the precision of our cost-effectiveness estimate. Evidence Action plans to collect the following data:
Data we will use to estimate program cost per person:30
- Average number of devices maintained per year
- Average number of households per water point with in-line chlorination
- Among people using a water point with a device, average number of people and average number of under-five children per household.
Data we will use to estimate program benefit per person:31
- Chlorination rates
- Baseline water treatment rates and baseline diarrhea burden.
Main reservations about the grant
Limitations to our cost-effectiveness estimate
Limitations that apply to multiple water chlorination interventions, including in-line chlorination, are discussed in our water quality report here. Important inputs to our in-line chlorination cost-effectiveness estimate about which we have particular uncertainty include:
- Baseline water treatment practices in the areas served by Evidence Action.32
- The number of people reached by the program, particularly the number of in-line chlorination-eligible water points and the number of people reached per in-line chlorination device.33
- Chlorination rates, or the rates at which the water of people served by the program tests positive for chlorine.34
- Levels of water contamination in water points served by in-line chlorination.35
We expect to learn more about baseline water treatment, the number of people reached by the program, chlorination rates and water contamination through Evidence Action's monitoring during the grant period, as well as through baseline water quality testing (see above).
Not waiting to get more information about mortality evidence
There are limitations in the evidence on the effect of chlorination on mortality, which are discussed in our water quality report. In particular, our approach yields an estimate that is not statistically significant at conventional levels.36 Furthermore, it implies that for each death averted that is directly attributable to enteric infections in children under five, 2.9 deaths are averted from other causes by in-line chlorination in Malawi.37 This seems surprisingly high.
It's possible we should wait for more information about the effect of water chlorination programs on mortality before making additional grants. We're currently exploring funding additional research that could increase our confidence in our estimates. We're also waiting for the results of the Expansion of the Kenya Study of Water Treatment and Child Survival, a follow-up study measuring the effect of dispensers on mortality in Kenya. However, we'd guess the opportunity cost of waiting for this research outweighs the benefit of doing so.
The cost-effectiveness of the integrated Dispensers for Safe Water/in-line chlorination program in Malawi is below our funding bar at the time we recommended this grant
The cost-effectiveness threshold we used for recommending grants (our funding bar) was approximately 10x cash as of the time we recommended this grant. While we estimate that the cost-effectiveness of in-line chlorination alone is above our funding bar, we estimate that the integrated in-line chlorination and Dispensers for Safe Water program falls below it (7.2x).38
This will become relevant when we decide whether to extend the program. Dispensers for Safe Water received a grant at GiveWell's recommendation in January 2022 that funds work in Malawi for seven years. The in-line chlorination program is highly integrated with the Dispensers for Safe Water program, and Evidence Action is leveraging its Dispensers for Safe Water platform to scale up in-line chlorination.39 Dispensers for Safe Water currently shoulders some of the "platform" costs associated with running in-line chlorination.40 If we renewed in-line chlorination without renewing funding for Dispensers for Safe Water in the future, we expect that in-line chlorination program costs, and thus the cost-effectiveness of a future grant to in-line chlorination, would be affected. However, this could be mitigated by a range of things, e.g. if Evidence Action launches other programs in Malawi which help spread shared costs in the future, or if there are improvements to cost structure or implementation design over time.
However, we don't have an estimate of how much the costs would be affected. We consider this an open question, but not one that we could answer well prior to making a grant recommendation.41
Other reservations about the grant
The opportunity cost of not funding Kenya and Uganda
In addition to scaling up in-line chlorination in Malawi, Evidence Action also proposed funding a combination of in-line chlorination and Dispensers for Safe Water in Kenya and Uganda, for up to approximately $37 million in additional funding.42 We decided to not recommend funding the program in these countries because we estimate that the cost-effectiveness of those opportunities falls below our current funding bar at approximately 5-6x cash.43 We also considered recommending a grant to support in-line chlorination in Kenya, which falls below our current funding bar at 7.5x to 8.5x.44
We may lose some of the learning value that we would have gained by scaling the program in multiple countries; for example, better understanding of costs and benefits at scale and learning about context-specific factors that impact cost-effectiveness. There may also be loss of efficiencies that would accompany scaling in-line chlorination and Dispensers for Safe Water at the same time, and scaling in multiple countries at the same time.
Our best guess is that we will have sufficient learning from one country (Malawi) and that Kenya and Uganda are sufficiently far from our expected cost-effectiveness bar that the marginal learning value and efficiency gains are not sufficient for making a grant.
Plans for follow-up
We plan to ask Evidence Action to regularly report on a number of indicators of the program's success. These are listed in the following footnote.45
Internal forecasts
By December 2023, we think there is a 70% chance that in-line chlorination adoption rates in Malawi are within 20% of the adoption rate estimates based on the Kenya pilot. We think there is a 60% chance that in-line chlorination in Malawi will be above 10x cash once the baseline survey and monitoring and evaluation program data from Malawi are incorporated into our cost-effectiveness analysis. We think that by March 2023, there is a 70% chance we will have identified one or more countries where we expect Dispensers for Safe Water and in-line chlorination (combined) would be above our funding bar with total room for more funding at scale of more than $15 million per year. We think that by March 2024, there is a 70% chance we will have identified one or more countries where we expect Dispensers for Safe Water and in-line chlorination (combined) would be above our funding bar with total room for more funding at scale of more than $30 million per year.
Our process
- We recommended a grant to Evidence Action Accelerator to build out a dedicated portfolio focused on scoping and bringing to scale evidence-backed, cost-effective interventions.
- As part of this work, Evidence Action investigated opportunities to scale in-line chlorination in areas where it had an existing footprint, spoke with experts, conducted in-country scoping of water points, and conducted a pilot in the fall/winter of 2021-2022 in Kenya.
- We had several calls and many email exchanges with Evidence Action to understand its proposed activities, programmatic risks, monitoring and evaluation plan, and budget.
- We updated our review of the effectiveness of water quality interventions.
- Using our cost-effectiveness analysis of water quality interventions as a base, we created a program-specific cost-effectiveness analysis of Evidence Action's in-line chlorination program. This cost-effectiveness analysis was based partly on our conversations with Evidence Action and partly on our research.
Sources
- 1
"In order to explore the potential of ILC as a scalable, cost-effective intervention, Evidence Action's Accelerator and Dispensers for Safe Water teams completed a pilot of ILC in late 2021 and early 2022." Evidence Action, ILC Kenya pilot results report, 2022, pg. 1
- 2
"DSW was recently awarded a grant from GiveWell that funds three years of program implementation in Kenya, four years in Uganda and Malawi, as well as significant expansion in Uganda and Malawi. Given the similarities between DSW and ILC, as well as our operational presence in these countries, we envision the ILC program to be built out of and eventually fully integrated with DSW, rather than treating the two programs separately." Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished), p. 1
- 3
"There is no available data on the number of ILC-eligible WPs [water points] across DSW geographies. However, there is limited data available on WP characteristics that may imply ILC eligibility (e.g., type of water source). Using what data is publicly available, data from our WP surveys, and our experience during the ILC pilot in Kenya, we estimated the total number of ILC installations by district across Kenya, Uganda, and Malawi.
Although this estimate represents our best guess given the information currently available, we expect this to be fairly imprecise. Without comprehensively verifying WPs' eligibility on the ground, WP by WP, we have relied on modeling assumptions, so the ultimate figures may vary. Accounting for WP infrastructure, the presence of dispensers, expected rates of refusal, and our threshold for the number of households per WP, we estimate the following number of ILC installations:...Kenya 2,093; Uganda: 2,458; Malawi: 1,518; Total 6,069" Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished), p. 2
- 4
"At the country level, we are not creating new roles for ILC specifically, but instead increasing the number of DSW staff to account for the additional, integrated workload brought on by ILC." Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished), p. 4
- 5
"A water point was determined to be ILC suitable or not based on how it scores on our indicators for chlorination status, number of users, and infrastructure:
- If a total chlorine residual test of the water reads zero, a water point is considered unchlorinated.
- If a water point serves 20 or more households, it is considered communal.
- If a water point has passed the initial infrastructure screening questions and has a storage tank as part of the system, it is considered to have suitable infrastructure.
Any water point that meets all three of these criteria is considered ILC suitable." Evidence Action, ILC water point survey report, 2021, p. 3
- 6
"A small device is attached on a pipe near the point of water collection which dispenses chlorine into the water as
the water is distributed." Evidence Action, ILC Kenya pilot results report, 2022, p. 1
- 7"Our model is simple: A community member goes to their usual water source, places their bucket under the dispenser, turns the valve to dispense the correct dose of chlorine, and fills their bucket with water as they normally would. The chlorine disinfects the water during their walk home; by the time they arrive, it is safe to drink." Evidence Action, "Dispensers for Safe Water"
- 8"ILC implementation will model DSW almost exactly. With a few exceptions, ILC activities and responsibilities will be fully integrated into the DSW program." Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished), p. 3
- 9
- GiveWell, Water quality cost-effectiveness analysis, November 2022, "ILC_long term" tab, row "percent of cost-effectiveness coming from under-5 mortality reduction"
- We discuss how we modeled the impact of water chlorination on mortality in our Water Quality Intervention Report. See the section titled "What is the impact of water quality interventions on mortality?"
- 10
- GiveWell, Water quality cost-effectiveness analysis, November 2022, "ILC_long term" tab, row "percent of cost-effectiveness coming from over-5 mortality reduction"
- We discuss how we modeled the impact of water chlorination on mortality in our Water Quality Intervention Report. See the section titled "What is the impact of water quality interventions on mortality?"
- 11
- We refer to the impact of avoiding serious illness in childhood on beneficiaries' ability to be productive and successful throughout life as "developmental effects." We applied a formal method we developed to estimate the developmental effects of an intervention for which we have no direct evidence. This method uses seasonal malaria chemoprevention (SMC) as its benchmark, since we have both direct and indirect evidence of its developmental effects.
- See our Water Quality Intervention Report, "Development effects" section for more.
- GiveWell, Water quality cost-effectiveness analysis, November 2022, "ILC_long term" tab, row "percent of cost-effectiveness coming from development effects"
- 12
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Grant size" tab, row "Total Malawi grant size"
- 13
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Grant size" tab, rows "Total scale-up and maintenance grant amount (unconditional)," "Total scale-up grant amount (unconditional)," and "Total maintenance grant amount (unconditional)," respectively.
- 14
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Grant size" tab, row "Total exit grant amount (conditional)."
- 15
- Our CEA of water chlorination is sensitive to baseline water quality, and we don’t currently have sufficient data on this. We believe this data will help inform our assessment of the cost-effectiveness of water quality interventions, since our current baseline estimates are limited.
- “Costs: Based on the information that we gathered, we estimate that this will cost us an additional $20,395, above the current funding for ILC Malawi.” Andrew Kitchel, Senior Manager, MLE Strategy, Evidence Action, email to GiveWell, August 29, 2022 (unpublished).
- 16
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Source: ILC Total Budget" tab, cell D6. Note that this does not include the additional $20,395 to support baseline water quality testing.
- 17
The full budget includes funding for Uganda and Kenya, which are out of date. Kenya and Uganda budgets are subject to change as the estimates of program costs and target markets improve.
- 18
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Source: ILC Revenue" tab, row "Total funds, per country," column "Malawi"
- 19
- We described how the carbon credits program worked on a previously-published page describing a grant to Dispensers for Safe Water: "Dispensers for Safe Water is partially funded by revenue the program earns by being awarded, and selling, carbon credits. Dispensers for Safe Water is accredited to generate such carbon credits because the promotion of water chlorination is expected to avert greenhouse gas emissions compared to a counterfactual program that would promote water purification via boiling. Our understanding is that water boiling is not highly prevalent in areas where Dispensers for Safe Water works, and so the carbon credit accreditation is based on displacing possible counterfactual water boiling promotion rather than on converting current water treatment from boiling to chlorination." GiveWell, "Evidence Action's Dispensers for Safe Water program," 2018
- The total grant size can be found at GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Grant size" tab, row "Total Malawi grant size"
- 20
Colin Richardson, Manager, New Program Development, Accelerator, Evidence Action, email to GiveWell, April 25, 2022 (unpublished)
- 21
Colin Richardson, Manager, New Program Development, Accelerator, Evidence Action, email to GiveWell, April 25, 2022 (unpublished)
- 22
"As with DSW, ILC relies heavily on infrastructure investments and extensive local government and community involvement. Both programs involve direct delivery of highly visible services at the community level and require a large number of personnel. Scaling these programs up or down is time and labor intensive. Thus, time and consideration are needed to ensure a successful phasing out period through thoughtful communication and awareness raising with local government and community end-users of DSW and ILC." Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished), p. 4
- 23
- We use GiveDirectly's unconditional cash transfers as a benchmark for comparing the cost-effectiveness of different funding opportunities, which we describe in multiples of "cash." Thus, if we estimate that a funding opportunity is "10x cash," this means we estimate it to be ten times as cost-effective as unconditional cash transfers.
- Note that a) our cost-effectiveness analyses are simplified models that are highly uncertain, and b) our cost-effectiveness threshold for directing funding to particular programs changes periodically. As of the time this grant was made, our bar for directing funding was about 9x as cost-effective as GiveDirectly. See "GiveWell’s Cost-Effectiveness Analyses" for more information about how we use cost-effectiveness estimates in our grantmaking.
- 24
These estimates are for the cost-effectiveness of in-line chlorination only, rather than the in-line chlorination and Dispensers for Safe Water integrated program. However, we assume that Dispensers for Safe Water, which we supported in Malawi via a previous grant, shoulders some of the platform costs associated with the in-line chlorination-only program.
- The program cost-effectiveness estimate assumes a timeline of 13 years, while the grant cost-effectiveness estimate assumes a timeline of 7 years (the period covered by the grant). Both estimates assume medical costs averted make up 6% of total benefits. We focus on our program cost-effectiveness estimate:
- 13-year timeline. Our costing analysis assumes a timeline of 13 years, rather than the seven years covered by this grant. The cost-effectiveness for the latter is lower because the fixed costs are amortized over a shorter period. We assume a 13-year timeline because this assumes 10 years of maintenance, which is the standard length we use for programs where costs need to be amortized over a longer timeline.
- Medical costs averted. We provide a range, rather than a point estimate, due to internal disagreement on how to account for benefits deriving from medical costs averted. The upper bound estimate assumes our best guess, that medical costs averted make up approximately 20% of total benefits. The lower bound estimate assumes medical costs averted make up 6% of total benefits, and while this is not our current best guess, it allows for comparability with top charities, which also currently use this 6% estimate (for example, see our Malaria Consortium cost-effectiveness analysis here). This is important, because our cost-effectiveness estimates for these charities strongly inform our funding bar.
- Tables reporting the cost-effectiveness estimates under different specifications can be found here.
- The program cost-effectiveness estimate assumes a timeline of 13 years, while the grant cost-effectiveness estimate assumes a timeline of 7 years (the period covered by the grant). Both estimates assume medical costs averted make up 6% of total benefits. We focus on our program cost-effectiveness estimate:
- 25
This is based on our research during the investigation of the January 2022 grant to Dispensers for Safe Water. We expect the funding landscape for ILC to be similar to that of DSW, as both are chlorination-based water treatment programs.
- 26
Colin Richardson, Manager, New Program Development, Accelerator, Evidence Action, email to GiveWell, January 27, 2022 (unpublished)
- 27
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "RFMF" tab, row "RFMF per year, per country (after grant)," column "Malawi"
- 28
"If ILC gets approved, we plan to make expansion plans for both ILC and DSW together as an integrated program. While Kenya, Uganda and Malawi are the focus of current ILC planning, Evidence Action hopes to explore the potential of ILC/DSW for other existing Evidence Action countries, including Nigeria, Pakistan, Liberia and India." Evidence Action, ILC room for more funding, 2022, p. 3
- 29
- GiveWell's funding bar at the time we assessed room for more funding for in-line chlorination was 9x cash. At the time the grant was recommended, our funding bar was 10x cash.
- For our calculations of global room for more funding, see GiveWell, Dispensers for Safe Water grant size, costs and room for more funding 2021 (redacted), "Long term RFMF," rows "All countries >9x, RFMF at scale, per year, $" and "All countries >9x, scale-up cost, one-off, $," respectively.
- 30
Roughly, we estimate the cost per person as the budget divided by people served. We estimate the number of people served by multiplying the following:
- average number of devices maintained per year,
- average number of households per water point with in-line chlorination, and
- average people per household using a water point with a device. See here for these calculations.
- 31
Roughly, to calculate the program's benefits, we adjust for the difference in increase in chlorination rates in the studies and rates in the in-line chlorination program. We calculate the increase in chlorination rates in in-line chlorination programs as chlorination rates minus baseline water treatment rates. See here for these calculations.
- 32
See these estimates here.
- 33
See these estimates here.
- 34
See these estimates here.
- 35
Water points eligible for in-line chlorination use tanks. It is possible this means they are less contaminated than average water points in the literature we use to estimate chlorination’s impact.
- 36
"We note that our pooled estimate is imprecise and not statistically significant by conventional standards." GiveWell, "Water Quality Interventions," 2022
- 37
GiveWell, Water quality cost-effectiveness analysis, November 2022, "Internal validity adjustment" tab, row "Estimated non-enteric deaths averted per enteric death averted, for illustration only," column "ILC Malawi"
- 38
GiveWell, Water quality cost-effectiveness analysis, November 2022, "ILC&DSW tab," cell D44. Note that this estimate uses the lower bound assumption for medical costs averted (6%).
- 39
See the table on p. 3, Evidence Action, ILC Additional Information on Scale, Timelines and Staffing Plans, 2022 (unpublished). The in-line chlorination program in Malawi will be scaled up in the DSW expansion footprint.
- 40
Jeff Grosz, Kevin Kelsey, and Colin Richardson, conversation with GiveWell, July 7, 2022 (unpublished)
- 41
This is difficult to estimate because:
- Since in-line chlorination hasn't been scaled yet, data are limited on how platform costs are currently divided between the Dispensers for Safe Water and in-line chlorination programs.
- If in-line chlorination and Dispensers for Safe Water were no longer operating together in the future, Evidence Action may change the in-line chlorination program design, since it was designed to run with Dispensers for Safe Water.
- The Dispensers for Safe Water program in Malawi may continue in the absence of GiveWell support. We're unsure how likely it is that Evidence Action will have sufficient funds to run Dispensers for Safe Water if we stop recommending funding to it, but it seems plausible.
- Evidence Action may expand its non-water programming in Malawi in the future. Other, non-Dispensers for Safe Water programs may then shoulder some in-line chlorination platform costs.
- There are many other factors that could influence our interest in making a follow-on grant to Dispensers for Safe Water and in-line chlorination seven years from now. For example, we're unsure what our funding bar will be at that time.
Our understanding of the above points was informed by Jeff Grosz, Kevin Kelsey, and Colin Richardson, conversation with GiveWell, July 7, 2022 (unpublished)
- 42
GiveWell, Malawi in-line chlorination grant budget and room for more funding, "Source: ILC total budget" tab, row "ILC + DSW total"
- 43
GiveWell, Water quality cost-effectiveness analysis, November 2022, "ILC&DSW" tab, row "CE for this grant, by country" cells B41 and C41. Note that this estimate uses the lower bound assumption for medical costs averted (6%).
- 44
With additional resources, GiveWell would consider recommending funding to Evidence Action’s in-line chlorination program in Kenya. See our blog post for more.
- 45
- Budget spent, yearly
- Baseline surveys
- % of households who report treating water
- % of households who report chlorinating water
- % of households whose water sample tests positive for chlorine (FCR)
- Under 5 diarrhea rates
- Number of eligible water points in expansion areas
- Ongoing M&E data, bi-annaully
- Households per water point with in-line chlorination
- People per household
- Under-five per household
- % of households whose water sample tests positive for chlorine
- % of households whose water sample was positive for chlorine who report using in-line chlorination devices
- 1