Three in 10 people in the world lack access to safe drinking water, but children are particularly vulnerable to the consequences. Nearly 1,000 children die each day from preventable water and sanitation-related diseases like diarrhea — a condition that’s responsible for the deaths of nearly 900,000 children under five each year.
The situation is dire. The U.N. predicts that if current trends persist, billions of children and families in the least-developed countries (LDCs) will still lack water, sanitation and hygiene services by 2030.
Recently, we spoke with two parties that are working to address this stark and stubborn marker of global inequity. One of them, Evidence Action, created Dispensers for Safe Water, a scalable water treatment solution that costs just $1.50 per person per year. The other is GiveWell, whose rigorous research was the basis of nearly $65 million in funding from Open Philanthropy. The big backing is expected to double the reach of Dispensers for Safe Water in a number of African countries and reduce the water mortality of children under five by up to 25%.
Open Philanthropy and GiveWell’s symbiotic partnership
Open Philanthropy, founded by Facebook co-founder Dustin Moskovitz and his wife, Cari Tuna, got its start in 2014 as a spinoff of Good Ventures, which was also largely funded by the couple. It takes a transparent, evidence-based approach to funding in four focus areas: global health and development, U.S. policy, global catastrophic risks, and scientific research.
GiveWell and Open Philanthropy have a symbiotic relationship. GiveWell, an independent charity evaluator, does the due diligence and then makes funding recommendations. It has long been a key proponent of effective altruism, an approach to giving that seeks to maximize the measurable impact of philanthropic dollars using an evidence-based “rationalist” lens.
Stephanie Stojanovic, Givewell.org’s director of development, said the partnership between GiveWell and Open Philanthropy is especially robust within the area of global health — and that Open Philanthropy “largely” employs GiveWell’s funding recommendations in that field.
GiveWell is a longtime partner of Evidence Action, which develops research-based solutions that it says have measurably improved hundreds of millions of lives. Evidence Action was spun out of Innovations for Poverty Action, another researcher that seeks to help decision-makers make sound, strategic investments to improve the lives of the global poor.
Evidence-based action
Grace Hollister, chief engagement officer of Evidence Action, said the Dispensers for Water initiative was originally based on mid-2000s research on providing safe water in rural communities in Kenya.
Small-scale randomized control trials showed that free, standalone chlorine dispensers installed near accessible water sources were five times more effective than other interventions. When it comes to accessing safe drinking water, uptake hinges on peers and price. Individually packaged chlorine, for example, presents barriers of cost and supply, and means convincing users to adopt the practice one by one. Dispensers for Water are not only free, but benefit from the power of community word of mouth.
A recent meta analysis from Nobel laureate Michael Kremer and his colleagues at UC Berkeley and Harvard confirmed that idea. The research showed that “providing chlorine in a public fashion led to much higher take-up,” and further validated Evidence Action’s model as a cost-effective way to ensure access to safe drinking water.
Kremer’s report included analysis of implementation data from Dispensers for Safe Water that estimated the model is a full 45 times more effective than the WHO’s “highly cost-effective” threshold, putting it in league with leading child health interventions like micronutrients, mosquito nets in bedrooms and early vaccinations.
GiveWell’s Stojanovic said Kremer’s findings made all the difference. Dispensers for Safe Water had been “on its secondary list for a while,” but “evidence wasn’t rising to the bar.” After Kremer’s findings on the correlation between clean water and child mortality became known, Open Philanthropy supported the initiative to the tune of $64.7 million in January on GiveWell’s recommendation.
Why chlorine dispensers work
Chlorination, a practice that kills 99.9% of bacteria and viruses found in water, certainly isn’t new, nor is it limited to low-income countries. It’s been around for more than a century in the U.S., for example, where it’s currently used by more than 98% of all water utilities. But it’s not viable in places without municipal water supplies.
Dispensers for Water locates brightly colored chlorine dispensers near waterholes and public water places, allowing local community members to treat their own water so it’s safe to drink. Rather than relying on local government, dispensers are supported by 200 field staff — “local promoters” that help with training and restock alerts.
Hollister said the dispensers were carefully designed for ease of use. The dispenser valve was developed with an engineering team, and chlorine is measured for use in the most commonly used conveyance, jerry cans, making delivery simple.
To date, the program has provided 28,000 dispensers to more than 4 million people in rural parts of Uganda, Kenya and Malawi that lack municipal systems. Open Philanthropy’s $64.7 million in additional funding is expected to double the size of Dispensers for Water’s footprint by 2023, letting the program reach a total of 9 million people over the next four years. That means safe water for more than 2 million Kenyans, 10% of Uganda’s population, and more than 15% of the people of Malawi.
Stojanovic said the size of the investment took into account the likelihood of additional fundraising by Evidence Action, supporting four years of the program in Kenya, and seven years in Malawi and Uganda, including funds for entry and potential exit.
Municipal water systems are not on the horizon in any of those locations, so Hollister said the hope is to sustain operations through “long-term stopgap” funding, as each country’s government works to build water treatment plants and expand access.
An argument for effective altruism
Evidence Action estimates that its dispensers have averted 1.3 million cases of childhood diarrhea in the eight years between 2013 and 2021.
Besides the “real world” deaths averted through the program, Stojanovic said GiveWell also values the medical costs and treatment time avoided, along with the adverse developmental effects on children who become gravely ill but survive — like long-term health impacts, and income limitations later in life.
That’s real-world progress for the nearly 1 million children under five that are in harm’s way this year and every year. It’s also one point in favor of the effective altruist approach both Open Philanthropy and GiveWell have long championed.
