Note: This page summarizes the rationale behind a GiveWell grant to Evidence Action. It reflects our understanding at the time we recommended the grant in March 2023. Evidence Action staff reviewed this page prior to publication.
In a nutshell
In March 2023, GiveWell recommended a 4-year, $6,319,756 grant to Evidence Action to identify, scope, and pilot opportunities to improve and expand its safe water interventions to new geographies and types of settings.
We recommended this grant because we believe it will enable Evidence Action to reach more people with safe water. We expect Evidence Action to accomplish this by improving the cost-effectiveness, scalability, and reach of its existing chlorination interventions, chlorine dispensers and in-line chlorination, and by identifying new technologies and delivery methods to provide water chlorination in more settings.
We have several important reservations about this grant.
Published: January 2025
Table of Contents
Summary
What we think this grant will do
We think water chlorination is an effective way to reduce deaths from waterborne disease. There is strong evidence that water chlorination reduces the concentration of pathogens in water and reduces diarrhea risk, likely leading to reductions in mortality, especially in children under five.1
Evidence Action's chlorine dispensers program increases chlorination coverage by installing chlorine dispensers at communal water points.2 In-line chlorination delivers chlorine to water sources that have a tank fed by a pipe. The in-line chlorination device automatically adds chlorine as the water runs through the pipe.3
With this grant, Evidence Action will conduct three main workstreams:
- India pilot: Conducting a three-state pilot of in-line chlorination in India ($1.5m) (more);
- New country expansion: Scoping new countries for potential introduction of chlorine dispensers and in-line chlorination ($0.9m) (more);
- Innovating program design: Improving program models for chlorine dispensers and in-line chlorination to reduce cost, increase coverage, or improve scalability; and testing other types of chlorination technologies and delivery models ($2.2m) (more);.
Why we recommended this grant
We think this grant could improve the cost-effectiveness of the safe water grants we've already funded, and could potentially open up additional highly cost-effective funding opportunities for us.
At the time of recommending this grant, we had supported a number of water quality programs:
- Evidence Action's chlorine dispensers program in Uganda, Kenya, and Malawi
- Evidence Action's in-line chlorination in Malawi
- One Acre Fund's scoping for in-line chlorination in Rwanda, and
- Development Innovation Lab's randomized control trial of water quality interventions in Kenya and scoping of additional research on chlorination in India and Nigeria.
This grant could improve the cost-effectiveness of the safe water grants we've already funded, especially Evidence Action's chlorine dispensers and in-line chlorination programs. For instance, we expect Evidence Action will test cost-recovery models and higher capacity chlorination devices that could reach more people.4 Even modest improvements to coverage or cost of chlorine dispensers and in-line chlorination could have high impact when applied across the over 9 million people Evidence Action is currently reaching and the millions more it may reach in the future.
This grant could also lead to more opportunities to scale up safe water interventions. This could happen by:
- Identifying new areas in which scaling up safe water interventions is highly cost-effective. By piloting in-line chlorination in new geographies (rural India) and new contexts (peri-urban locations), Evidence Action will get valuable data to inform how promising future work in these locations would be, as well as how to adapt and scale up the interventions in new areas. (more).
- Developing a scalable safe water program model that other implementers could use. Evidence Action's program may serve as a model for implementers who want to roll out safe water programs. (more).
Main reservations
Our primary reservations are:
- We only have limited information on the specific activities Evidence Action will conduct with our support. We're particularly uncertain about its concrete plans for improving program models and testing other types of chlorination technologies. We only have limited information now because Evidence Action expects to develop its plans based on what looks promising in the initial scoping period of the grant. Because water quality is a promising intervention area and we have confidence in Evidence Action as an implementer, we do not think that specifying all grant activities is needed to give us confidence in the expected value of this grant. (more).
- The pilot won’t inform some of our biggest uncertainties about the potential scale-up opportunity in India. For example, our cost-effectiveness analysis is very sensitive to baseline water treatment rates in the states where we might fund scale-up. However, we don't expect to get information from the pilot that will meaningfully inform our estimates of baseline treatment because baseline water treatment data will only be collected at the pilot sites, which are not representative of the states as a whole. (more).
- We expect to get additional operational data from Evidence Action's DSW and ILC programs as well as information on chlorination's impact on mortality from the research we supported DIL to conduct. It’s possible we should wait to receive these results prior to making additional investments in this space. (more)
This grant was funded by the Weiss Asset Management Foundation, Open Philanthropy, and an anonymous donor.
The organization
Evidence Action is an organization with which we have a long-standing relationship and to which we have provided significant support for various programs, including deworming, iron and folic acid supplementation, and maternal syphilis screening and treatment.5 As of the time we recommended this grant, Evidence Action was operating two water chlorination programs, chlorine dispensers in Uganda, Kenya, and Malawi and in-line chlorination in Malawi.
Background
Evidence Action’s chlorine dispensers program began in 2012.6 In-line chlorination is a newer program for Evidence Action, incubated as part of the Evidence Action Accelerator. Evidence Action estimates that these two programs reach over 9 million people with safe water.7
The grant
This grant supports Evidence Action to identify, scope, and pilot opportunities to innovate on and expand its safe water interventions to new geographies and settings. This work consists of three main workstreams over 4 years:8
- A three-state pilot of in-line chlorination in India ($1.5 million),
- Scoping new countries for potential expansion of Evidence Action’s chlorine dispensers and in-line chlorination programs ($0.9 million),
- Improving program design for chlorine dispensers and in-line chlorination to reduce cost, increase coverage and adoption, or improve scalability; and testing other types of chlorination technologies and delivery models ($2.2 million)
In-line chlorination pilot in India
The Government of India has allocated approximately $50 billion from 2019 to 2024 to its Jal Jeevan Mission (JJM) to bring safe water access to all rural households in India by 2024.9 JJM is currently focused on water access. The majority of its budget is allocated to building the infrastructure (piping) to connect households to the water system.10
The Government of India has asked Evidence Action to provide support identifying safe water solutions.11 Evidence Action conducted an infrastructure assessment in India and concluded that in-line chlorination devices, similar to the ones Evidence Action is using in Malawi, could be compatible with JJM's piped water infrastructure and suitable across rural India's most common water schemes.12
With this grant, Evidence Action plans to run a pilot to assess the operational feasibility of different in-line chlorination devices across various settings in three states in India: Andhra Pradesh, Madhya Pradesh, and Rajasthan. By piloting these devices, Evidence Action expects to learn about the costs of installing and operating ILC devices in these locations, how to identify suitable third-party contractors to install and maintain devices, whether the devices provide correct and consistent doses of chlorine in the water, and which suppliers can produce devices at scale.13 Evidence Action also plans to test which ILC devices work best in which contexts. (There are several different types of ILC devices. For example, some use liquid chlorine and others rely on tablets.14 )
Evidence Action believes that demonstrating the feasibility of installing ILC devices in these contexts and their efficacy once installed could increase the government’s confidence to explore a larger ILC program.15 If the government is interested in Evidence Action's support for launching such a program, that could be an opportunity for us to direct significant funding to a cost-effective program.
At the time we recommended this grant, we were also considering funding the larger grant to support scale-up of ILC in India. Although we think it is plausible that the operational learnings from this pilot will improve the efficacy of any later scale-up of ILC, we didn't expect the pilot to be informative about some of our largest sources of uncertainty regarding the cost-effectiveness of the program at scale. These include:
- State-level data on baseline water quality. Our cost-effectiveness analysis of chlorination interventions is very sensitive to baseline water treatment rates.16 If baseline water treatment in these states is higher than we expect, it could diminish the potential impact of the scale up. This pilot will only collect water quality data at the pilot sites, which are not a statistically representative portion of any of the three states.17
- Longer-term maintenance feasibility. The impact of the scaled-up program over time will depend on the devices being properly maintained, likely by third-party contractors selected through government processes.18 The one-year pilot won't provide much information about the likelihood that maintenance is conducted well over the long run.
- The most likely challenges associated with scale-up.
- At scale, we expect the government would contract with vendors, who may differ from those involved in the pilot. However, there is uncertainty around whether this government process will happen, and, if it does, around the ability of vendors to oversee high-quality installation, operations, and maintenance of ILC devices
- Longer-term issues with community acceptance of chlorination. In the long run, responsibility for the regular upkeep of the ILC devices (e.g. chlorine refills) will likely fall to communities.19 The impact of the program also depends on communities using the chlorinated tap as their primary source of drinking water. The one-year pilot will not test the transition to community upkeep or the long-run community acceptance of chlorine.
We think the pilot is likely a necessary (even if not sufficient) step in building a foundation for successful scale-up, as Evidence Action will use the results of the pilot to explore scale-up opportunities with the government.20
In July 2023, we recommended a grant of $1.03 million to expand this pilot from 18 sites to 50 sites to allow Evidence Action to test in-line chlorination's applicability across a wider range of scenarios. In September 2023, we recommended a $38.8M grant to Evidence Action to support scale-up of ILC in India.
Expanding to new countries
In January 2022, GiveWell recommended a grant of $0.8 million to Evidence Action to scope new countries for potential introduction of chlorine dispensers and in-line chlorination.21 This funding is to cover Evidence Action staff travel, government engagement, water point surveys, and operational evaluations in different contexts.22
Evidence Action subsequently told us that it did not account for sufficient funding in its original $0.8 million budget for scoping new countries.23 It requested additional funding to:
- Extend the timeline for staffing and scoping operations to mid-2024 to provide enough runway to complete the deliverables.24 The previous scoping grant covered until the end of 2023.
- Cover the higher-than-expected costs of water point surveys.
- When Evidence Action conducted water point surveys to prepare for rolling out in-line chlorination in Malawi, it found that it needed to (a) survey more locations than it expected and (b) collect additional information about the water infrastructure in order to find the target number of water points eligible for the program.25
- The previous scoping grant included funding for two water point surveys. Now, Evidence Action plans to consider a third country, depending on the outcomes of these initial surveys.26
We think that the likelihood of opening up significant room for more funding through these scoping activities is worth the additional cost, and we plan to retrospectively evaluate how well Evidence Action keeps to these updated budgets, timelines, and outputs.
At the time of recommending this grant, Evidence Action had shortlisted five countries that it believed had high potential to be cost-effective based on high disease burden and operational feasibility.27 We expect that the scoping work will result in Evidence Action’s ability and readiness to expand chlorine dispensers and/or in-line chlorination to at least two highly cost-effective countries in 2024, and to additional countries in subsequent years.
Innovation and optimization of technology and implementation
This workstream will consist of testing alternative technologies and delivery models for Evidence Action’s safe water programs. The goal is to improve the cost-effectiveness and reach of these interventions. It may also include developing a scalable safe water program model that is adaptable to different contexts.
We expect Evidence Action to accomplish this by:
- Establishing a team within Evidence Action focused on improving its safe water programs. This team will likely conduct A/B testing of potential improvements as Evidence Action scales up chlorine dispensers in Malawi and Uganda and in-line chlorination in Malawi.28
- Conducting two pilots of in-line chlorination in peri-urban areas and developing a delivery model for this type of location.29 Evidence Action currently focuses on reaching rural populations. A delivery model for peri-urban contexts would open the opportunity to provide water treatment to a large population of people globally who live in peri-urban settings. These densely populated areas may also be more cost-effective than rural areas because the intervention would reach more people per water point.30
- Systematically assessing and piloting approaches to reaching more people in different settings with safe water programs, including:31
- New delivery models, including chlorine vouchers, different cost recovery models, and working with utilities to improve water treatment systems
- Technological innovations, including sensors, filtration, and larger-scale chlorination devices
Evidence Action’s goal is to identify two new approaches or technologies that can either increase cost-effectiveness or reach new markets cost-effectively.32
Additionally, Evidence Action thinks that this work to scope and pilot innovations on the technology and different delivery models will enable it to develop the “playbook” for scalable safe water solutions that other NGOs can then implement in more places. Evidence Action thinks having a program model that can be taken to large scale and in different settings is a major bottleneck (in addition to funding) to other implementers doing work on water quality.33 Evidence Action is interested in supporting other groups to implement the program models it develops, with standard operating procedures, learnings, and simplified models.34
Budget for grant activities
The total budget for the grant is $6,319,756. Of this, Open Philanthropy recommended $4,546,716m on GiveWell’s behalf, while $1,273,040 was provided by the Weiss Asset Management Foundation, and $500,000 by an anonymous donor.
At the time we recommended the grant, we expected the budget to roughly break down as follows. However, we're treating this as a flexible grant; Evidence Action may adjust how it is allocating funds across the workstreams as work begins and it becomes clear which areas are more promising:35
- Pilot of in-line chlorination in India: $1,477,534 (23%)
- Scoping for chlorine dispensers and in-line chlorination implementation in new countries: $880,427 (14%)
- Optimizing and innovating technologies and delivery models: $2,243,584 (36%)
- Global Management, Regional Management, and Cross-Cutting Resources: $664,919 (11%)36
- Indirect costs: $1,053,293 (17%)
The case for the grant
We are recommending this grant because:
- We believe safe water is among the most cost-effective intervention areas. We think water treatment is a highly cost-effective intervention for preventing deaths in young children.37 Our current best guess is that in 18 countries in Africa, chlorine dispensers is more than 8 times as cost-effective as unconditional cash transfers (“8x”), the benchmark we use for comparing opportunities.38 At the time of making this grant, our bar for funding was 10x.
- Optimization of chlorine dispensers and in-line chlorination could improve the cost-effectiveness and scalability of current and future safe water programs. Since DSW already operates across such a large scale, reaching over 9 million people, even small improvements in cost-effectiveness could have a large impact.39 In addition, because water chlorination is an effective intervention, increasing the number of people that could be reached with chlorine dispensers or in-line chlorination could have a significant positive impact.
- This grant could help identify more opportunities to scale up safe water interventions in new geographies and within new types of water access points.40
- If the in-line chlorination pilot in India is successful, it may open a large opportunity for Evidence Action to provide technical assistance to Indian states to scale-up chlorination programs.41
- Innovating on the technology and delivery model could open up opportunities to expand safe water interventions to new contexts, such as urban or peri-urban settings. These areas could be even more cost-effective, or this work could open up more room for more funding than we’ve currently estimated.
- This grant could enable Evidence Action to develop a scalable water program model that other implementers could use. Evidence Action thinks having a program model that can be taken to large scale and in different settings is a major bottleneck to other implementers doing work on water quality. It thinks that its work to scope and pilot innovations on the technology and different delivery models will enable it to develop the “playbook” for scalable safe water solutions that other NGOs can then implement in more places (more). We think this is a plausible model for facilitating the adoption of effective water programs by other implementers.
- There is a funding gap for this work. Our impression is that there is a large funding gap for household water treatment programs.42 This is based on research we have done for our previous safe water grants and what Evidence Action has told us.43 We believe that in the absence of GiveWell support, this grant would likely go unfunded.
- We view Evidence Action as a strong partner. We have previously recommended funding for Evidence Action to implement chlorine dispensers and in-line chlorination. We think there is a strong chance that funding for optimizing and innovating on its program will allow Evidence Action to improve its delivery model and ability to reach different populations for household water treatment.
Risks and reservations
Our main reservations about this grant are:
- We don’t have details on specific grant activities for a large portion of the work, so it’s hard to assess the value of the outcomes of this grant.
- We have discussed plans for the grant activities in detail with Evidence Action and our understanding of Evidence Action's plans is reflected above.44
However, some of the specific grant activities are still being developed, especially around optimization and innovation (see above). This is because Evidence Action needs flexibility to focus its efforts around what looks promising after scoping activities have begun.45
Since water quality is a promising intervention area and we have confidence in Evidence Action as an implementer, we do not think that specifying all grant activities is needed to give us enough confidence that the impact of this grant will likely be above our bar.
- We see this as similar to our case for a grant we recommended in 2018 to support Evidence Action to develop an "Accelerator" for highly promising programs. Despite its initial uncertainty, that grant has resulted in several new program areas that we have funded.46
- Evidence Action has discretion over how much of its grant budget) to allocate to various grant activities. It could end up allocating more resources to an area we think is less cost-effective, which could lead to less impact than we project.
- To mitigate this concern, we plan to have regular check-ins with Evidence Action to align on how promising scoping opportunities are and to suggest areas where Evidence Action should invest more resources for scoping and piloting. We also plan to retrospectively evaluate the impact of this grant, so that we will learn how Evidence Action's activities ultimately compare to the expectations we had at the time we recommended the grant. We will use this to inform future grantmaking decisions. See our plans for follow up for more.
- We have discussed plans for the grant activities in detail with Evidence Action and our understanding of Evidence Action's plans is reflected above.44
However, some of the specific grant activities are still being developed, especially around optimization and innovation (see above). This is because Evidence Action needs flexibility to focus its efforts around what looks promising after scoping activities have begun.45
Since water quality is a promising intervention area and we have confidence in Evidence Action as an implementer, we do not think that specifying all grant activities is needed to give us enough confidence that the impact of this grant will likely be above our bar.
- While the pilot for in-line chlorination in India is an important step towards Evidence Action successfully launching the program at scale in India, it won’t inform some of our biggest uncertainties about the potential scale-up opportunity. We discuss this in more detail above.
- It’s possible we should wait until we see results from ongoing chlorine dispensers and in-line chlorination programs first, before recommending additional funding to continue to scope and improve this work.
- At the time of recommending this grant, Evidence Action has not yet finished installing chlorine dispensers or ILC devices. We thus have a limited track record from Evidence Action's past work.
- We also have open questions about water chlorination's effect on mortality, as discussed in our water quality report. We expect to learn more about chlorination's effect on mortality via a recent grant we recommended to the Development Innovation Lab to scope a study on the effect of chlorination on mortality.
Plans for follow up
We plan to engage closely with Evidence Action on the progress of this work through:
- Monthly calls with Evidence Action's safe water leadership
- Quarterly calls to discuss how the safe water team is prioritizing work
- Annual updates on Evidence Action's high-level progress against the goals of this grant, including assessment of expected room for more funding in Evidence Action’s safe water pipeline.
- More frequent check-ins and written updates for activities that advance to the field (such as pilot work) to ensure alignment.
Although we have substantial uncertainty upfront about the outcomes of this work and how much room for more funding Evidence Action will be able to successfully identify, we’ll be able to retrospectively evaluate this grant. The results of that retrospective will inform our future funding for Evidence Action.
Internal forecasts
For this grant, we are recording the following forecasts:
| Confidence | Prediction | By time |
|---|---|---|
| 80% | Evidence Action will have finished 2 pilots (either of new technologies or variations of chlorine dispensers or in-line chlorination) that can either a) cost effectively reach significant new markets or b) significantly increase the cost-effectiveness of safe water programs work in current markets | End of 2024 |
| 50% | We will make at least one grant >$10M to Evidence Action to provide technical assistance in India for safe water expansion | End of 2023 |
| 50% | Evidence Action will identify 2 new countries to expand chlorine dispensers or in-line chlorination to that are above >11x cash. | End of 2024 |
| 60% | We will have directed at least $10M in funding to an opportunity that was identified out of the scoping/piloting work from this grant (excluding technical assistance in India) | End of 2025 |
| 50% | Evidence Action will identify >$30M in annual room for more funding at >11x cash by 2025 | End of 2025 |
Our process
- We had three calls with Evidence Action about the general scoping and piloting work it intends to do for this grant.
- We had an additional call focused on Evidence Action's plans for its in-line chlorination pilot in India.
- We reviewed a proposal and budget for this work provided by Evidence Action.
- We spoke with an expert in water chlorination to learn more about the promisingness of in-line chlorination in the contexts Evidence Action was proposing to work in.
Sources
- 1
GiveWell, Water quality intervention report.
- 2
GiveWell, Water quality intervention report.
- 3
GiveWell, Evidence Action's In-Line Chlorination Program — General Support (July 2022)
- 4
“We seek to systematically assess these through research, tech assessments and infrastructure assessments, and then pilot the most promising ones. This may include things like (but not limited to):
- Delivery models:
- Vouchers
- Cost-recovery/fee for service models
- Supporting utilities to improve existing treatment systems (which may open up opportunities in urban areas as well)
- Technologies:
- Larger scale chlorination devices which can reach many more people per waterpoint than DSW or ILC and have different regulatory and ownership models
- ‘Top-up’ chlorination tools, for larger water systems where water may get recontaminated en route to the water point
- Internet of Things- sensors (for dosing, water pressure, amount of water in a tank, etc) that can add efficiency
- Filtration and other non-chlorine technologies
- Delivery models:
- 5
Evidence Action’s Deworm the World Initiative was one of GiveWell’s top charities from 2013 to 2022. We have also supported the Evidence Action Accelerator, as well as programs such as syphilis screening and treatment during pregnancy in Liberia, Zambia, and Cameroon.
- 6
GiveWell, chlorine dispensers Organization basics, based on field notes, 2022
- 7
Evidence Action confirmed this during review of a draft of this page, 10 July 2024.
- 8
See Evidence Action, ‘Budget summary by workstream’.
The three scoping workstreams account for $4.6 million of the $6.3 million grant. The remaining costs are management and indirect costs (28% of the budget). - 9
- “To address challenges of water crisis, a new dedicated Ministry of Jal Shakti has been created. In coming days, Centre and States will together take forward the Jal-Jeevan Mission and an amount of more than Rs. 3.5 lakh crores has been earmarked for this.” Indian Prime Minister Narendra Modi, Independence Day Speech, August 15, 2019.
- 3.5 lakh crores = 3.5 trillion Indian rupees. On August 15, 2019, at the time of this speech, this was equal to $49 billion USD. ($1 USD = 71.46 Indian rupees) https://www.xe.com/currencytables/?from=INR&date=2019-08-15#table-section
- “States/ UTs for creation of water supply infrastructure so that every rural household has Functional Tap Connection (FHTC) by 2024 and water in adequate quantity of prescribed quality is made available on regular basis.” Jal Jeevan Mission: “About JJM”
- 10
“Up to 2% of the total annual JJM allocation to the States/ UTs is meant for activities related to water quality monitoring and surveillance.” Government of India, Jal Jeevan Mission, “Drinking Water Quality Monitoring & Surveillance Framework”, p. 77.
- 11
"In 2022, Evidence Action was approached to support Jal Jeevan Mission (JJM) in their intention
to ensure appropriate drinking water quality through households taps through their goal to
provide universal access to water to all of India by 2024." Evidence Action, India safe water pilot MLE overview, 2023. - 12
"Evidence Action first supported JJM to conduct a landscape assessment of water source infrastructure in November and December 2022, surveying 152 sites across ten states to better understand common types of water points in India. Simultaneously JJM conducted a technology assessment to shortlist to determine the best-fit water quality technologies. Based on this assessment, Evidence Action is planning an operational pilot of in-line chlorination technologies to assess the feasibility of various technologies in several already-existing water system/source contexts. These contexts include single-village water
schemes (SVS), multi-village schemes (MVS) at the village level, and MVS at the intermediary
level (upstream from multiple villages), all of which serve water collection points (WCPs) in
villages." Evidence Action, India safe water pilot MLE overview, 2023. - 13
“The pilot aims to identify the following for each device tested:
- Installation Feasibility – Complexity and amount of effort and time required for the installation
- Operational Feasibility – Operating, refilling, and basic operator-level maintenance of the technology
- Efficacy – In terms of conducting the device’s designated task, e.g. is the dosage correct and consistent
- Financial and Economic Implications – Understanding the full costs of installing and operating the device and costs per person served per year
- Scalability – Understanding the firms’ ability to scale production and programmatic ability to replicate technologies across multiple infrastructures
Given that the proposed pilot is designed to measure operational findings in the short-term, this pilot will not be able to evaluate:
- Seriousness of operational and maintenance issues – Frequency and degree e.g. equipment breakdown due to the multi-year life cycle of some of the technologies
- Community buy-in – Long term community buy-in and commitment to operating and maintaining the device. Evidence Action will look to state-level government support to assess community engagement.” Evidence Action, Piloting Water Treatment Devices in conjunction with Jal Jeevan Mission, 2023.
- 14
- "Evidence Action proposes installing selected chlorine-based water treatment directly on currently in-use water infrastructure as directed by state departments of water. The pilot would test the technologies’ ability to provide safe water directly to the water infrastructures’ population." Evidence Action, Piloting Water Treatment Devices in conjunction with Jal Jeevan Mission, 2023.
- "Tablet-based passive in-line chlorination devices: Provide a low cost, low operationally intensive, and low maintenance solution to dose dry chlorine tablets at the village level. Dry chlorine tablets are more stable and less volatile across climates, but are still easy to source across India." Evidence Action, Piloting Water Treatment Devices in conjunction with Jal Jeevan Mission, 2023.
- "Sensor-based in-line liquid chlorine dosing pumps: Provide all of the benefits of a mechanically-based in-line liquid chlorine dosing pump, but also include sensors at the dosing pump inlet, outlet, or both to test the free chlorine concentration in the water. " Evidence Action, Piloting Water Treatment Devices in conjunction with Jal Jeevan Mission, 2023.
- Electrochlorinators: Electrochlorinators enable water treatment facilities to input a sodium chloride (NaCl) and water solution into the device and in as little as eight hours produce the required Sodium Hypochlorite (NaOCl). Electrochlorinator’s tradeoff generally includes a higher upfront capital expenditure to purchase the device, but lower operating and supply chain costs due to only requiring standard salt. Evidence Action, Piloting Water Treatment Devices in conjunction with Jal Jeevan Mission, 2023.
- 15
Evidence Action confirmed this during review of a draft of this page, 10 July 2024.
- 16
GiveWell, Water quality intervention report.
- 17
"Similarly, the data collected through various mechanisms in this pilot will not provide state-level or broadly representative data for indicators such as baseline water treatment, but will be representative only of the water sources included in the pilot and the communities that they serve." Evidence Action, India safe water pilot, MLE overview, 2023.
- 18
- This is different from Evidence Action's ILC program in Malawi, where Evidence Action manages the maintenance directly. See this section of our grant page for Evidence Action's ILC program in Malawi.
- 19
Evidence Action confirmed this during review of a draft of this page, 10 July 2024.
- 20
Evidence Action confirmed this during review of a draft of this page, 10 July 2024.
- 21
“Scoping grant: This grant covers two years of costs associated with scoping new countries for potential introduction of chlorine dispensers and in-line chlorination, for a total of $0.8 million.” Evidence Action's chlorine dispensers program – General Support (January 2022) | GiveWell
- 22
Evidence Action, Email to GiveWell, November 16, 2021 (unpublished).
- 23
“As we’ve begun this work and developed a well-informed plan, we’ve identified gaps in our plan, which was highly notional. To do sufficient due diligence in promising countries, including robust water point surveys (where needed), and to have a sufficient runway to complete those activities, we will need some funding beyond what was included in the DSW budget. This is based on our learnings from ongoing expansion in existing geographies and uncertain access to accurate data about waterpoints in new countries.” Evidence Action, Water scoping proposal, 2023, p. 5.
- 24
"Part of GiveWell’s January 2022 grant to Evidence Action for chlorine dispensers included $0.8 million for scoping opportunities to implement chlorine dispensers and in-line chlorination in new countries. Evidence Action estimates that additional funding will be needed to complete these activities due to its increased timeline and the number and cost of water point surveys (data collection to better understand target users, stakeholders, and existing infrastructure). Evidence Action plans to complete 3-4 water point surveys by mid-2024, with the aim of identifying two new countries where these water quality interventions would be cost-effective at scale. " GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- 25
Call with Evidence Action, Feb 2, 2023 (unpublished).
- 26
A water point survey is completed to identify and learn about potential water access locations where chlorine dispensers or an in-line chlorination program could be implemented. An example water point survey report for in-line chlorination in Kenya is here.
- 27
Evidence Action, Country Prioritization narrative document, 2022 (unpublished).
- 28
“Optimizing cost-effectiveness and scalability of existing programs. Evidence Action plans to have a small focused team dedicated to high-level improvements to its core safe water programs, chlorine dispensers and in-line chlorination. chlorine dispensers is a longstanding program already well-optimized for cost-effectiveness, but it operates at such a large scale (across tens of thousands of water points) that even a small cost reduction or increase in coverage could have high impact. Because in-line chlorination is a newer program, Evidence Action expects to find more significant opportunities to improve program design in a way that would increase cost-effectiveness. It plans to conduct A/B testing on a list of optimization ideas for both programs over the next year.” GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- 29
“Adapting programs to reach peri-urban areas on the outskirts of cities, a massive underserved market. Evidence Action is designing two peri-urban in-line chlorination pilots that it plans to conduct in Kenya and one other location.” GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023
“We want to conduct two ILC pilots focused on peri-urban markets. The primary goal will be to develop a delivery model appropriate to peri-urban areas, which are massive, largely underserved, and population dense (and thus potentially more CE than rural areas). In addition, this work will a) help refine the ILC delivery model, b) accelerate our ability to scale the model to new geographies efficiently, and c) generate lessons for the sector and models that can be more easily handed off to partners and country governments.
Evidence Action has never worked in peri-urban areas for safe water. We see this as one of the most promising geographies for ILC, but there are a number of unknowns of how the delivery model will need to be adapted.
For instance, the pilots will help us understand: 1) the best ILC technologies to serve these areas, given existing water systems and infrastructure, 2) current water quality and treatment practices, 3) how to adapt to different regulatory environments and ownership models, and 4) differences in chlorine supply chain and device repair and maintenance.
Given the operational differences between countries, conducting pilots in two countries will allow us to build a more replicable model faster, de-risking and accelerating entry into new countries for both rural and peri-urban.- We believe this could open up an important new global market segment for ILC, which is both large (in Nairobi alone, there are 2.5m people living in slums/informal settlements, which may be appropriate for ILC; barely half of Kenya's urban population has access to water) and potentially more CE than rural areas, due to the higher density.”
- 30
"We believe this could open up an important new global market segment for ILC, which is both large (in Nairobi alone, there are 2.5m people living in slums/informal settlements, which may be appropriate for ILC; barely half of Kenya's urban population has access to water) and potentially more CE than rural areas, due to the higher density." Evidence Action, Water scoping proposal, 2023
- 31
- “Finding scalable approaches to improve water treatment within complex systems such as water utilities services and areas with intermittent water supply. Intermittent water supply is a large cause of contamination that affects up to 900 million people globally because periods of stagnation throughout the infrastructure encourage bacteria growth and attract disease-causing insects.
- Adapting programs to reach peri-urban areas on the outskirts of cities, a massive underserved market. Evidence Action is designing two peri-urban in-line chlorination pilots that it plans to conduct in Kenya and one other location.
- Adapting in-line chlorination to serve larger water points (i.e., water points that reach hundreds or thousands of households, rather than 10-100). This would include learning how to work with different types of in-line chlorination devices.
- Connecting in-line chlorination to existing water pipe infrastructure in Africa that is currently providing unsafe water. This would leverage the significant global investment in water pipes across Africa.
- Developing standard operating procedures to share with other actors. The lack of scalable interventions has been a sector-wide bottleneck. Evidence Action could share learnings and successful models (especially simpler models, such as a vouchers for safe water program) with other implementers for replication.
- Improving financial and operational sustainability of the in-line chlorination model by identifying a viable cost recovery approach. This could make in-line chlorination more scalable and more attractive for other actors to replicate.”
GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- “We seek to systematically assess these through research, tech assessments and infrastructure assessments, and then pilot the most promising ones. This may include things like (but not limited to):
- Delivery models:
- Vouchers
- Cost-recovery/fee for service models
- Supporting utilities to improve existing treatment systems (which may open up opportunities in urban areas as well)
- Technologies:
- Larger scale chlorination devices which can reach many more people per waterpoint than DSW or ILC and have different regulatory and ownership models
- ‘Top-up’ chlorination tools, for larger water systems where water may get recontaminated en route to the water point
- Internet of Things- sensors (for dosing, water pressure, amount of water in a tank, etc) that can add efficiency
- Filtration and other non-chlorine technologies"
- Delivery models:
- 32
- “What success looks like:
- Identify two new approaches/technologies that can a) cost effectively reach significant new markets and/or b) significantly increase the CE of safe water work in the types of markets we currently target”
- “What success looks like:
- 33
Call with Evidence Action, Feb 2, 2023 (unpublished).
- 34
“Developing standard operating procedures to share with other actors. The lack of scalable interventions has been a sector-wide bottleneck. Evidence Action could share learnings and successful models (especially simpler models, such as a vouchers for safe water program) with other implementers for replication.” GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- 35
- See the full budget here.
- Call with Evidence Action, January 17, 2023 (unpublished).
- 36
Evidence Action also plans to use funding from its Accelerator program budget to cover Year 1 grant management and cross-cutting costs. "Accelerator grant ($3.1M): Safe Water is one of several program areas we are exploring through the Accelerator grant, and the work being proposed here is similar in kind to that of the Accelerator grant. However, the Safe Water opportunities we are identifying are far greater than we’d initially planned for and will require more dedicated resources to fully explore them. We plan to fully spend the budget earmarked for Safe Water activities in the Accelerator grant, and the budget requested here is for additional costs." Evidence Action, 2023 Safe Water GiveWell Proposal Budget.
- 37
See our report on water quality interventions for more on the cost-effectiveness of water quality interventions.
- 38
For more information about our funding bar, see "How we use cost-effectiveness estimates in our grantmaking."
- 39
"Evidence Action plans to have a small focused team dedicated to high-level improvements to its core safe water programs, chlorine dispensers and in-line chlorination. chlorine dispensers is a longstanding program already well-optimized for cost-effectiveness, but it operates at such a large scale (across tens of thousands of water points) that even a small cost reduction or increase in coverage could have high impact." GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- 40
We currently estimate that there is approximately $437 million in one-off scale-up funding and $157 million in ongoing annual room for more funding at scale for chlorine dispensers and in-line chlorination combined, across all countries where our best guess of cost-effectiveness is greater than 8x.
- 41
See "Jal Jeevan Mission dashboard," accessed 2023.
- 42
Our impression based on discussions with Evidence Action and other funders is that water, sanitation, and health work require large investments, and financing them can be challenging.
- 43
- "Major global health donors and country governments have historically focused on water access due to limited budgets to address water safety." GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023.
- "We understand that most large funders tend to focus on water infrastructure, rather than treatment, leaving an unfilled need." GiveWell, chlorine dispensers grant page, 2022.
- 44
See GiveWell's Non-Verbatim Summary of a Conversation with Evidence Action, February 2, 2023 for more details.
- 45
Evidence Action confirmed this during review of a draft of this page, 10 July 2024.
- 46
We originally recommended funding for the Evidence Action Accelerator (originally called Evidence Action Beta) in July 2018, then renewed this grant for 2022-2025. So far, the Accelerator has resulted in several new program areas, including in-line chlorination, Syphilis screening and treatment, and iron and folic acid supplementation.