Clean Water, Better Health: A cost-effective and sustainable approach to water decontamination in Sierra Leone


Unsafe drinking water is a major cause of diarrhea in children, leading to 760,000 under-5 deaths globally every year. Sierra Leone has one of the highest child mortality rates in the world, where 14.5% of those deaths are due to diarrhea. Consistent with global trends, most Sierra Leonean households do not have reliable access to clean drinking water and 50.4% of rural households receive their drinking water from unimproved sources such as streams and unprotected wells. Treating drinking water with chlorine can reduce diarrhea by up to 50%, yet only 7.8% of rural households in Sierra Leone decontaminate their water with chlorine.

We address the challenge of unsafe drinking water and diarrhea in Sierra Leone by implementing and evaluating a novel program that combines three components. First, chlorine dispensers, proven successful in increasing household water treatment, will be placed at established community water collection points in order to provide communities with a reliable and convenient way to treat their water at the source. Second, Info-Tools, or diarrhea incidence trackers, will be distributed to households to make the incidence of diarrhea salient. By making diarrhea incidence salient, the Info-Tools aim to generate demand, inducing higher and more persistent chlorine usage. Third, two cost-recovery mechanisms will be implemented to inform the scalability of the dispensers: (1) First households will make contributions to a community dispenser. To do this we will leverage local community health promoters, who manage local savings and contribution programs. (2) Second, carbon credits will be operationalized through forward contracts.

Despite the availability of water decontamination methods (i.e. procurement from government clinics or NGOs), the majority of households in Sierra Leone do not buy or use liquid chlorine solution or tablets. Dispensers are an attractive alternative to home-based chlorine solution and tablets. Placing dispensers at the point of collection eliminates barriers associated with access, visibility, and convenience. Thus, by alleviating behavioral barriers to take-up, enabling community level access to chlorine, augmenting demand through the Info-Tool, and the cost-recovery mechanisms, we provide a programmatic innovation that should prove to be more financially stable and sustainable than existing solutions such as chlorine tablet distribution or the promotion of boiling water.

Team Members

Dr Agha Ali Akram
Dr Elif Kubilay, Senior Research Officer, ISER, Essex University
Dr Wameq Azfar Raza, Thematic Research Head, BRAC International
Osman Ghani Siddiqi, Country Director (Sierra Leone & Liberia), IPA