1. Promoting Adoption of Household Chlorination in Rural Haiti Michael Ritter, Deep Springs International Daniele Lantagne, CDC

2. 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

3. Products Locally produced sodium hypochlorite Refillable 240 ml bottles = 48 uses Locally available buckets modified with tap and lid

4. Rural Reseller Urban Pharmacy 25 Resellers104 communities Production Technicians at Missions of Love Clinic HHs in program HHs in catchment Coverage Town31086535.8% Rural89912,2907.3% TOTAL1,20913,1559.2%

5. Methods Analyzed longitudinal sales data for 1,709 member households Cross-sectional randomized household questionnaire –527 total 357 members 170 non-members

6. 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.

7. Results Having 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)

8. 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

9. 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

10. Summary of Program Models NGO AJSWF Years in operation127 Current households (n)25,0004,000 Correct use (+ Cl resid)85%76% Household visitsWeeklyAnnually Annual BCC cost per HH (current volume & price) $6<$1 Annual cost to family$11 – 16$1 - 3

11. What Has Been Demonstrated and 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

12. Mesi anpil! Thank you! Acknowledgements Dr. Gene Gangarosa, Emory Dr. Bill Gallo, JSWF Project Director Dr. Rochelle Rainey, USAID Madame Eveline and JSWF staff

13. Jolivert Safe Water for Families Project Production and distribution of CDC’s Safe Water System Donate space and electricity Technical assistance & evaluation $20,000 grant from June 2006 - May 2008 Program Director, June 2008

14. Non- member Non- purchaser Inconsistent purchaser Consistent purchaser Purchased bucket NoYes Purchased soln. >0 No Yes Purchased soln. frequently No Yes Maintenance Contemp- lation Action Pre- contemp- lation

15. 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