The cause of “water” is one of the more (initially) emotionally appealing, and probably marketable, causes in developing-world aid. Here are some thoughts on the cause, fresh off of reading the Copenhagen Consensus report on it:

From what I’ve seen – both in terms of water-related literature and in terms of general morbidity data – outright lack of water (i.e., dehydration in otherwise healthy people) is not a widespread problem. If you know of data showing otherwise, even for particular parts of the world, please share. However, I think most water and sanitation projects are instead concerned with:

1. Access to convenient water sources. Some people lose hours to maintaining their filters and/or boiling their water for cleanliness; people who live far from water sources can lose far more time (see Pg 11 of the Copenhagen Consensus report for a stark example). Improving water infrastructure may therefore free up time and make them economically better off. However, when this is the goal, it seems important to consider not only how much time potential beneficiaries would save, but how much this time is worth (i.e., what else they could do with it). Depending on market and/or weather conditions, extra time may not translate into extra money, or into much extra quality of life.

2. Access to clean water. Contaminated water can contribute to a variety of diseases that generally cause severe diarrhea (see Pg 34). However, it’s important to note that:

• Water is not the only source of contamination, and clean water alone – when unaccompanied by other sanitation interventions – can only dent the burden of these diseases (again see Pg 34).
• There are a variety of ways to purify water at the “point of use,” some of which – like boiling – are extremely simple and relatively inexpensive (see Pgs 90-91).
• Communities that suffer from contaminated water may also suffer from a host of other health problems (such as malaria and malnutrition) that can be at least as damaging as waterborne infections, while having solutions (such as supplementation, bednets, etc.) than are far cheaper and simpler than the provision of clean water.

In our first year, we saw no cases of well-documented water-focused projects that address key questions such as whether water quality and use were verified, whether an effect on quality of life was documented, etc. Literature on past programs’ effects also seems relatively thin.

At this point, I think of water projects as being pretty far from the sort of “proven, effective, scalable” programs we are looking for. If I change my mind, it will likely be for a program in the first category – providing water to people who otherwise would be spending inordinate amounts of time retrieving it – rather than for a program focusing exclusively on clean water.