Nonprofit Chronicles

Journalism about foundations, nonprofits and their impact

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Dispensers for Safe Water saves lives in east Africa

Of the countless well-meaning efforts to help the world’s poor, only sixteen are currently endorsed by GiveWell, a meta-charity that rigorously investigates nonprofits. Three of those are run by a little-known nonprofit called Evidence Action.

This is no accident. While GiveWell evaluates programs and Evidence Action operates them, their values are aligned: Both seek to alleviate poverty with interventions that are supported by evidence, thoroughly vetted and cost effective. These are the kinds of programs that merit support from donors, particularly institutional donors, although they don’t necessarily get it.

Evidence Action got started just five years ago when it was spun out of Innovations for Poverty Action (IPA), a network of university researchers focused on global poverty. Evidence Action identifies anti-poverty interventions that have been tested in the field by economists, usually on a small scale, and then looks for ways to help them grow, evaluating them at each stage. All of its programs — pills to protect children from parasitic worms, chlorine dispensers to treat contaminated water, travel subsidies to enable labor mobility in Bangladesh, and remedial education for kids — began as academic research.

Put simply, and true to its name, Evidence Action takes evidence and turns it into action.

“The biggest impact at the lowest cost is what we are after,” the group says on its website.

To learn more, I went to see Arjun Pant, Evidence Action’s chief of staff, in downtown Washington DC, where the organization rents space from WeWork. (It is looking for new offices because it is adding staff.) Pant, who is 31, is a Wharton MBA and former Bain & Co. consultant who has been interested in global development since spending a good part of his childhood and adolescence in India.

Lots of aid dollars, he told me, go to programs that may or may not work, and where impact is hard to pin down. “We place a huge emphasis on measuring impact,” Pant says. You’d think this would appeal to the big, staffed foundations that support global development, but it’s not that simple, as we’ll see.

In November, GiveWell recognized three Evidence Action programs. It named Deworm the World Initiative and No Lean Season as “top charities,” and chose Dispensers for Safe Water as a “standout charity,” a tier just below.

Worm wars

Deworming as an intervention is controversial. Deworm the World is one of several charities that were formed after a 2004 paper by economists Michael Kremer and Ted Miguel found that regular treatment with a low-cost pill prevents worm infections in kids and generates long-term benefits. Their findings have been disputed  by others, including Cochrane, a respected network of health experts. (Here’s a lively summary, via Chris Blattman, of what came to be known as the worm wars.) GiveWell, which commissioned a deep rethink of deworming by David Roodman, a brainy public-policy consultant, still believes that that school-based deworming improves long-term productivity at an average cost of less than $1 per child per year; Evidence Action also points to rigorous evidence support deworming. Deworm the World was the first program operated by Evidence Action, which works with governments in India, Kenya, Ethiopia, Vietnam and Nigeria. They treated nearly 200 million children in 2016. That’s real scale.

No Lean Season is a newer initiative. It’s part of Evidence Action Beta, which tests, prototypes and expands promising interventions. Based on research by Ahmed Mushfiq Mobarak, a Yale economist who grew up in Bangladesh, No Lean Season provides travel subsidies of $8 to $19 to poor farmers in rural areas of Bangladesh so they can travel to cities to find work after crops are planted and before they are harvested. Here’s a good feature story from NPR’s Goats & Soda about No Lean Season.

The “top charity” designations for Deworm the World and No Lean Season are expected to bring a substantial infusion of cash to Evidence Action from Good Ventures, the philanthropic foundation of Facebook billionaire Dustin Moskovitz and his wife Cari Tuna, a former Wall Street Journal reporter. GiveWell, which advises Good Ventures, has recommended that the foundation make multi-year grants of $15.2m to Deworm the World and $11.5m to No Lean Season. Good Ventures and the Children’s Investment Fund Foundation, a British donor, were already the biggest donors to Evidence Action, which spent about $20m last year.

As a “standout charity,” Dispensers for Safe Water gets a $100,000 grant from Good Ventures–a nice boost but not enough to sustain it for long. The program delivers, monitors and maintains chlorine dispensers at wells, boreholes and open water sources in Kenya, Malawi and Uganda. It currently serves about 4.7m people. You can track the operations of Dispensers for Safe Water on this live dashboard; few water charities match that degree of transparency.

Dispensers for Safe Water grew out of research by Kremer, Miguel, Sendil Mullainathan, Alix Zwane (who later became the first CEO of Evidence Action) and Clair Null that found that the dispensers, which provide free and convenient chlorine, are the best way to persuade people to treat their water. (Mullainathan is a well-known behavioral economist.) The Gates Foundation and the Hewlett Foundation, two of the US’s biggest grantmakers, with ambitious initiatives to fight global poverty, were among the funders of the research.

Interestingly, though, neither Gates nor Hewlett currently fund Dispensers for Safe Water or Evidence Action. (Gates no longer funds water programs; its focus has shifted to sanitation.) Nor do the Ford or Rockefeller foundation, which support global health and anti-poverty programs, or the Conrad R. Hilton Foundation, which has an initiative devoted to safe water.

A fundraising challenge

“Safe water is a difficult intervention to fundraise for,” Pant told me, saying more money flows to building wells or pipes. Some foundations prefer to fund new ideas and would rather not pay to maintain existing programs. Others want programs they support to be able to demonstrate a path towards financial sustainability.

As Evidence Action notes in a blogpost:

Traditional donor financing usually comes in the form of time-limited project-specific grants that are disbursed with the expectation of project completion or project sustainability at the end of the grant period. In reality, the end of donor financing often leads to a search for more short-term donor financing or – when donor financing dries up, the demise of a project.

Financial sustainability will be a challenger for Dispensers for Safe Water. Asking poor people to pay for chlorine treatment would sharply reduce usage, research shows, leading to more illness and death. Even when chlorine treatments are free and convenient, sustained adopted rates of Dispensers for Safe Water in Kenya and Uganda are not quite 50 % — rates that Evidence Action says are nonetheless higher than other methods of water purification.

Supporters of Dispensers for Safe Water have included the Stone Family Foundation, the Skoll Foundation, the Isenberg Family Charitable Foundation, Mercy Corps and charity: water. An unnamed European foundation is buying carbon credits to support the program; chlorine dispensers are believed to avert carbon emissions because users do not need to boil water to disinfect it. But carbon credits have not so far been a reliable funding stream for anti-poverty work, as best as I can tell.

Evidence Action says that, to maintain existing operations across its 28,000 dispensers in Kenya, Uganda and Malawi, it will need about $5m per year. Expanding the program, of course, will cost more. To reach scale, Evidence Action may have to look to development agencies or host governments to take over and fund the program. In the meantime, why won’t more funders step up?*

*The WHO says that diarrhoeal disease, which is preventable and treatable, kills an estimated 525 000 children under five each year. Safe drinking-water and adequate sanitation and hygiene could prevent many of those deaths. Few water charities are as evidence-based or transparent as Dispensers for Safe Water. See my 2015 blogpost, Water taps and information gaps

One thought on “Turning evidence into action

  1. Adam Creighton says:

    Hi Marc,
    It was a great insight to me traveling to Ghana, a middle-income and stable country, to learn that many people living in rural areas didn’t boil their water. In my wife’s old Peace Corps village, not only did they not boil the water, they preferred it to the safer well water because it tasted better. Adoption of change is hard. But your line, “Neither Gates nor Hewlett currently fund Dispensers for Safe Water or Evidence Action. (Gates no longer funds water programs; its focus has shifted to sanitation.) Nor do the Ford or Rockefeller foundation, which support global health and anti-poverty programs, or the Conrad R. Hilton Foundation, which has an initiative devoted to safe water” puts a fine point on it.

    Everyone wants to invent the best wheel; no one wants to pay for busses (or trains). Can’t there be some happy mixed strategy of partial funding for innovation to find the best strategy, and partial for just doing the work as best we know how, right now? Is 50/50 too much to hope?

    Like

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