Lessons Learned Implementing Household Water Treatment in Developing Countries

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1 Lessons Learned Implementing Household Water Treatment in Developing Countries Daniele Lantagne, CDC Megan Wilson, PSI Susan Mitchell, Abt Associates June 2008

2 About PSI International NGO founded in 1970 Programs in over 60 countries Uses social marketing of products and services to promote health Family planning HIV Malaria Water / Child Survival Focused on achieving measurable health impact at scale

3 PSI, CDC, and the SWS Why the partnership: CDC: Provides technical assistance, experience PSI: Marketing / distribution, ability for scale Countries Bolivia (marketing ) Zambia (1998) Steady growth in programs and impact Currently: 19 countries Over 12 billion liters treated in 2007 Over 45 billion liters treated total

4 PSI Safe Water Solution Programs Haiti

5 PSI SWSʹsLiters of Treated Water Liters Treated per Year 14,000,000,000 12,000,000,000 Liters Treated 10,000,000,000 8,000,000,000 6,000,000,000 4,000,000,000 2,000,000,

6 Why Safe Water Solution? Child-focused, evidence-based Reduces diarrhea incidence by 22-84% Low cost Costs <1 US cent per family per day Benefits the poor Often last in line for water supply Scalable In 2007, over 12 million bottles sold Provides safe water to 16.5 million

7 Lessons Learned Outline Commissioned by POUZN Project - USAID funded partnership with PSI/Abt - Promote point-of-use and zinc Key lessons areas - Project Design - Product - Marketing & Communications - Sales & Distribution - Partnerships

8 Project Design Select target areas appropriately Diarrhea incidence and income Begin with medium-to-long term funding Obtain a range of technical expertise Involve government from outset Involve relevant agencies Respond immediately to concerns Prepare program staff as technical experts

9 The Product Local production difficult but crucial Sustainability Cost-effectiveness Quality control Internal, external Technical barriers to scale Dosage, expiry, THM, clarification

10 Marketing & Communications Launch: rural, seasonally timed Focus behavior constructs - Diarrhea not natural - Unsafe water causes diarrhea - There is something I can do Complementary messaging Channels depend on context Focus positive, aspirational Not health Standardization

11 Marketing & Communications

12 Sales and Distribution HWTS is a new product category: - Distributors/retailers conservative - Commercial sector incentives - Marketing and distribution push from the project Goal: market creation Market establishment has elicited commercial product(s) True aim of social marketing

13 Importance of Partnerships Trusted spokespeople Key to reach rural / high-risk Key to uptake How to reach NGO s, CBOs, clinics, schools Nurses, health care, gov t The PSI product made my job so much easier HIV/AIDS Link Care & treatment Avoid stigmitization

14 Key Lessons Learned 1. Involve key stakeholders from inception 2. Maintain due diligence with high-quality product 3. Address unique marketing, communications, and distribution challenges and opportunities 4. Work with partners to reach target populations with product and messages

15 Next steps after Lessons Learned After quality product is present: Consumer demand Product uptake Barriers to use Product differentiation Emergency Response

16 Further Research - Madagascar Emory (Rheingans) Product awareness Availability Desire / demand Ability to pay

17 Further Research Haiti SWS

18 At least one purchase N = 199 Rate of use 1) Bottles / months 2) % quarters purchased Non-users N = 170 Users N = 357 Never purchased N = 158

19 KEY Summary construct PSI Bubbles determinant Opportunity Stage of change Behavior change objective Social Norms Availability / Transport costs Quality of care Precontemplation: Non-user Create awareness and trial Contemplation: User never purchased Create trial Action: Inconsistent purchaser Create repeat purchases Maintenance: Consistent purchaser Ability to pay for bucket Attitudes Outcome Expectations Knowledge Social Support Motivation Ability

20 Product Selection Selection SWS / Tabs / PuR Benefits / drawbacks of each Cost, usage, treatment, shelf-life User preference Mali/Niger/Benin Characteristics of countries Tabs: Emergency, weak manufacturing SWS: Development, cost-recovery Differentiation Uganda, Tanzania, Ethiopia Reach additional users

21 Emergency Response Cholera Initially, spurred Zambia sales 12 countries responded in bottles - >2 million bottles All in partnership Disaster Response Initially, spurred Madagascar sales Myanmar/Burma Locally-made, available product for emergency NGOs to utilize

22 Thank You! We are happy to take questions. Daniele Lantagne, PE Susan Mitchell PSI Staff