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Posts tagged “water”

Towards safe drinking water and clean cooking for all

Isha Ray, writing with and channeling the late Kirk R. Smith, in Lancet Global Health:

In the past 40 decades, there have been many innovations in the development of low-cost and efficacious technologies for WASH and household air pollution, but many of these technologies have been associated with disappointing health outcomes, often because low-income households have either not adopted, or inconsistently adopted, these technologies. In this Viewpoint, we argue that public health researchers (ourselves included) have had an oversimplified understanding of poverty; our work has not focused on insights into the lived experience of poverty, with its uncertainties, stresses from constant scarcity, and attendant fears. Such insights are central to understanding why technologies for safe water or clean cooking are unused by so many households that could benefit from them. We argue that, rather than improved versions of household-scale delivery models, transformative investments in safe water and clean cooking for all require utility-scale service models.

In the months before Kirk passed away, this topic -- the combination of WASH and HAP interventions, the merging of decades of thinking about usage, service delivery, affordability, and quality of interventions -- was a common theme. See also 'Let the "A" in WASH Stand for Air: Integrating Research and Interventions to Improve Household Air Pollution (HAP) and Water, Sanitation and Hygiene (WaSH) in Low-Income Settings.'

an aside: I think they must have meant "the past 40 years" or "past 4 decades" -- but also Kirk worked on these issues with such mental intensity and productive output it may as well have been 40 decades.

Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China

Cohen A, Pillarisetti A, Luo Q, Zhang Q, Li H, Zhong G, Zhu G, Colford JM, Smith KR, Ray I, Tao Y. Boiled or Bottled: Regional and Seasonal Exposures to Drinking Water Contamination and Household Air Pollution in Rural China. Env. Health. Perspect. 2020; 128(12). doi.org/10.1289/EHP7124

India is building millions of toilets, but that's the easy part

Rama Lakshmi, in the Washington Post, on the push for many, many more toilets throughout India:

Modi has made toilet-building and sanitation a rallying cry since October. He has enlisted large companies to help. In the past year, his government has built more than 5.8 million toilets — up from 4.9 million the previous year. But reports show that many of them are unused or that they are being used to store grain, clothes or to tether goats, thwarting Modi’s sanitation revolution.

“Even as we accelerate toilet construction now, much more needs to be done to persuade people to use them,” said Chaudhary Birender Singh, India’s minister for rural development, sanitation and drinking water. “For long, we assumed that if the toilets are built, people will automatically use it. But we have to diligently monitor the use over a period of time and reward them with cash incentives to the village councils at every stage. Only then will it become a daily habit.”

This all sounds really familiar.

Assessing Willingness to Pay for Environmental Health Interventions

Attended a great lecture today by Isha Ray and Jack Colford as part of a new BERC IdeaWorks series. It was a discussion of "Water resources for sustainability and health", focusing mainly on water quality issues in the developing world. A number of interesting studies were described (amazingly clearly, given the complexity of them on the ground) by Dr. Ray and Dr. Colford - both masterful professors. Dr. Colford's undertaking a multi-country assessment of water, sanitation, and hygiene interventions (individually and combined) to see their effects on height, weight, diarrhea. The challenge of doing this kind of randomized trial is not to be underestimated; they plan a year of pilots before the full study begins. A heady undertaking.

Dr. Ray described a couple studies that try to understand how people use these services, how they pay for them, and how they weigh options for water and sanitation. The most striking example she gave is a study kicking off shortly in Tanzania. Her research team is assessing how willing people are to use and pay for six commercially available point-of-use water treatments (like chlorine, a safe-water bucket, a UV filter, a biosand filter, etc). Her approach is novel. As with all studies of this sort, intervention devices will be given to participants. At the end of the study, she'll try one of the following two things: (1) randomly give participants an envelope with a cash amount her team will pay to buy back the point-of-use device or (2) plan the study so that at its conclusion all devices are returned to the researchers; participants are given the option to buy the device back, again at a randomized price. Its an elegant solution to figuring out how much a person would be willing to pay for a technology that is available on the local market.

Our work in the stove world needs to look towards these kinds of assessments to help us frame the issue of poor uptake and compliance of cookstove usage. Both of these types of environmental health interventions often run into the same issues - the technology is poorly designed for the target population, or the population doesn't perceive a need for it. Trying out locally available technologies and helping NGOs and governments figure out which ones people are willing to pay for -- which we hope is a proxy for willing to use -- is one step in the right direction.

This discussion ignores the impact of the devices on the market -- it assumes they work. That's a second, additional wrinkle that plays into the technology adoption.