The GiveWell Blog

A major initiative to scale up water chlorination in India

We recommended a $38.8 million grant to Evidence Action to support the Indian government in providing clean water by setting up in-line chlorination in two states, Andhra Pradesh and Madhya Pradesh.

This isn’t a grant designed to directly deliver a service or commodity; instead, Evidence Action will use the funding to work in close partnership with state and local governments, providing technical assistance to support the delivery of the program. Providing all rural households with access to clean, piped water is a major priority for the Indian government. In-line chlorination, which uses a device to automatically disinfect water by adding chlorine as the water passes through a pipe, is a way to make drinking water safe.

We believe this grant may not only increase access to chlorinated water in the states it directly supports, but also inspire other states to adopt similar practices. A core part of the program’s theory of change is that governments in locations outside the grant area may take up a program they might not otherwise adopt. This is the first very large grant we’ve made where that’s been an important consideration. We think the upside is unusually high—if successful, this grant could eventually lead to tens or even hundreds of millions of additional people receiving safe water—but it’s also riskier than most of our grants, as there are a number of ways the program could fail to have the desired impact. Our hope is that this grant will reduce mortality and improve health at a very large scale.

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Answering some questions about water quality programs

On June 22, we held a virtual event on research into water quality interventions, featuring presentations from Michael Kremer of the University of Chicago’s Development Innovation Lab; Brett Sedgewick from Evidence Action, the parent organization of Dispensers for Safe Water; and Stephan Guyenet, Elie Hassenfeld, and Catherine Hollander of GiveWell. (If you weren’t able to attend, we’ve published a video recording, audio recording, and transcript here.)

We hosted the event to provide some additional background for our recommendation of up to $64.7 million to Dispensers for Safe Water, which installs chlorine dispensers to treat water at rural collection sites in Kenya, Malawi, and Uganda. This grant was the result of a lengthy investigation and a significant update in our views on the cost-effectiveness of water treatment, which we’ve written about here.

Several attendees wrote in with a range of thoughtful questions—about our analysis of the effects of chlorination interventions, about the particulars of Dispensers for Safe Water’s program, or more generally about our work. We covered as many as we could during the event and followed up on others by email. Below, we’re sharing a selection of the questions we responded to in writing, along with other questions we’ve gotten about this work outside of the event, in the hope that they’ll be of interest to a broader audience. Questions and answers have been anonymized; some have been edited slightly for brevity, or to fill in important context that was missing.

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A major update in our assessment of water quality interventions

As we continue to grow, GiveWell seeks to maximize both the cost-effectiveness of the funding we direct and the likely room for more funding of the programs we support. We think we’ve identified a category of interventions that rates really well on both: water treatment, such as chlorination.

This is a major update for us. Before 2020, based on the available evidence, we didn’t believe that water quality interventions had a large enough effect on mortality to make them a competitive target for funding. We’ve since seen new evidence that has led us to significantly increase our estimate of the mortality reduction in young children that’s attributable to these interventions: a 14% reduction in mortality from any cause, up from around 3%.

Though we have remaining uncertainties about these numbers, we’ve substantially updated our view of the promisingness of water treatment. Where we previously found that Evidence Action’s Dispensers for Safe Water program was about as cost-effective as unconditional cash transfers, we now believe it’s about four to eight times as cost-effective, depending on the location. That was a primary factor in our decision to recommend a grant of up to $64.7 million to Dispensers for Safe Water in January 2022.

We’re sharing this news in brief form before we’ve published a grant page, because we’re excited about the potential of this grant and what it represents. It’s an area of work we haven’t supported to a significant degree in the past, but one that we now think could absorb hundreds of millions of dollars in funding for cost-effective programming.

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