Evaluating the Impact of Rural Water Interventions

Project Overview:
Two million children in poor countries die from diarrheal diseases every year. While the underlying biological relationships between water and health are well understood, there is little consensus on the relative cost-effectiveness of different water and sanitation interventions. In countries where rural households are widely dispersed and piped water is expensive to provide, it is unclear whether the priority should be sanitation or water. Within the water sector, some argue for prioritizing point-of-use systems such as chemical disinfectants; others for deep boreholes; and still others for building many cheap shallow wells that trade off a rapid increase in the supply of water (thus allowing people to more frequently wash dishes, clothes, and themselves) for a water source more easily subject to contamination. Rural water facilities can be long-lived if properly maintained, but they often fall into disrepair quickly due to poor maintenance. While many different approaches to the organization of maintenance have been advocated, there is little hard evidence on their effectiveness. Systematic, controlled comparisons of different approaches are lacking.

This project involves a randomized evaluation in rural Kenya that will examine four questions:

• How does improving water quality at the source (e.g. a spring or well) compare to improving water quality at the point of use (in people's homes) as a means of reducing diarrheal disease incidence among young children?
• To what extent does pre-existing sanitation infrastructure magnify the health benefits associated with the provision of improved water supply?
• How do the child health impacts of investments that increase the quality of drinking water alone compare to the impacts of investments that increase both the quantity available for all uses and the quality of drinking water?
• How can infrastructure maintenance be structured to make water investments financially sustainable? How do community-based maintenance models compare to public funding of privately-provided maintenance services in practice?

This research will provide needed evidence to policymakers on "what works" and the most effective ways of spending the $30 billion annually spent in the water sector in developing countries. Research results can be expected to translate into policy that will allow for more cost-effective investments, and ultimately into more lives saved, because of plans for:

• Successful communication of research results to key policy circles, building on existing contacts and relationships in Kenya and at the World Bank.
• Dissemination of results through a major conference organized in Nairobi, funded by the World Bank with its significant convening power in development policy circles.

Main Results:
Analysis ongoing; data available

Principal Investigators:
Alix Zwane, Michael Kremer (Harvard), and Edward Miguel

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