Promoting Adoption of Household Promoting Adoption of Household Chlorination in Rural HaitiChlorination in Rural Haiti

Michael Ritter, Deep Springs InternationalMichael Ritter, Deep Springs InternationalDaniele Lantagne, CDCDaniele Lantagne, CDC

Jolivert Safe Water for Families Project

• Began 2002 by CDC and FBO in rural Haiti

• MIT evaluation (2003) with 200 households after 60 weeks showed 68% correct use

• USAID / CDC (2005) showed 71% correct use and detailed records

• Emory / CDC (2007) study on adoption

• Deep Springs International now managing and replicating Jolivert project

ProductsProducts

• Locally produced sodium hypochlorite

• Refillable 240 ml bottles = 48 uses

• Locally available buckets modified with tap and lid

Rural Reseller

Urban Pharmacy

25 Resellers104 communities

Production Technicians at

Missions of Love Clinic

HHs in program

HHs in catchment

Coverage

Town 310 865 35.8%

Rural 899 12,290 7.3%

TOTAL 1,209 13,155 9.2%

Methods

• Analyzed longitudinal sales data for 1,709 member households

• Cross-sectional randomized household questionnaire– 527 total

• 357 members• 170 non-members

•Avg. 76% positive Cl residual

•Avg. 0.96 visits per HH per yr. (range = 0 - 7, std. dev. = 0.99)

•Avg. 5.9 bottles per HH per yr.

ResultsHaving a system

Having made >1 purchase

Consistent purchase

SES **

Knowledge ** **

Distance to sales point ** **

Household visits ** **

Social support ** ** **

Social norms ** **

Self-efficacy **

**Significance p < 0.05 (mix of Chi-square, Cochran-Armitage, and Mantel-Haenzel Chi-square tests)

Conclusions and Program Recommendations

• Program entry should be subsidized

• Additional sales points should be established to increase convenience

• Self-efficacy and social norms messages should be disseminated

• Annual household visits should continue

Comparison with Filtration- Chlorination Program in Rural Haiti

• Technicians visit weekly– Sell chlorine– Provide replacement parts– Test chlorine residual

• 1 tech : 200 households

• Tech salary paid by US parish

Summary of Program Models

NGO A JSWF

Years in operation 12 7

Current households (n) 25,000 4,000

Correct use (+ Cl resid) 85% 76%

Household visits Weekly Annually

Annual BCC cost per HH (current volume & price)

$6 <$1

Annual cost to family $11 – 16 $1 - 3

What Has Been Demonstratedand Future Potential

• With annual visits, high use (>75%) of consumable can be sustained over time

• Potential exists to recover costs of visits and BCC through sales margin

• Durable good must be sold below cost

• Chlorine refills can be sold above cost with high use

• Cost recovery is volume-dependent

Mesi anpil!Mesi anpil!

Thank you!Thank you!

Acknowledgements• Dr. Gene Gangarosa, Emory• Dr. Bill Gallo, JSWF Project Director• Dr. Rochelle Rainey, USAID• Madame Eveline and JSWF staff

Jolivert Safe Water Jolivert Safe Water for Families Projectfor Families Project

Production and distribution ofCDC’s Safe Water System

Donate space and electricity

Technical assistance & evaluation

$20,000 grant from June 2006 - May 2008

Program Director, June 2008

Non-member

Non-purchaser

Inconsistent purchaser

Consistent purchaser

Purchased bucket

No Yes Yes Yes

Purchased soln. >0

No No Yes Yes

Purchased soln.

frequentlyNo No No Yes

MaintenanceContemp-

lationAction

Pre-contemp-

lation

Create trial

Maintenance: Consistent purchaser

Contemp-lation:

Non-purchaser

Action:Inconsistent purchaser

Create aware- ness

and trial

Create repeat

purchases

Pre-contemp-

lation:Non-member

Knowledge Social Support

Ability to pay for bucket

Social Norms

Availability / Transport costs

Attitudes

Outcome Expectations

Quality of care

Summary construct

PSI “Bubbles” determinant

Stage of change

Behavior change objective

KEY

Opportunity

Motivation Ability