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Expanding Access to Clean Water for the Rural Poor: Experimental Evidence from Malawi

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  • Dupas, Pascaline
  • Nhlema, Basimenye
  • Wagner, Zachary
  • Wolf, Aaron
  • Wroe, Emily

Abstract

Using data from an 18-month randomized trial, we estimate large and sustained impacts on water purification and child health of a program providing monthly coupons for free water treatment solution (diluted chlorine) to households with young children. The program is more effective and much more cost-effective than asking Community Health Workers (CHWs) to distribute free chlorine to households during routine monthly visits. That is because only 40% of households make use of free chlorine, targeting through CHWs is worse than self-targeting through coupon redemption, and water treatment promotion by CHWs does not increase chlorine use among free chlorine beneficiaries. Non- use of free chlorine is driven by households who have a protected water source and those who report that chlorine makes water taste bad.

Suggested Citation

  • Dupas, Pascaline & Nhlema, Basimenye & Wagner, Zachary & Wolf, Aaron & Wroe, Emily, 2020. "Expanding Access to Clean Water for the Rural Poor: Experimental Evidence from Malawi," CEPR Discussion Papers 15095, Centre for Economic Policy Research.
    • Handle: RePEc:cpr:ceprdp:15095
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    References listed on IDEAS

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    1. Anderson, Michael L., 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Journal of the American Statistical Association, American Statistical Association, vol. 103(484), pages 1481-1495.
    2. Wagner, Zachary & Asiimwe, John Bosco & Levine, David I., 2020. "When financial incentives backfire: Evidence from a community health worker experiment in Uganda," Journal of Development Economics, Elsevier, vol. 144(C).
    3. Martina Björkman Nyqvist & Andrea Guariso & Jakob Svensson & David Yanagizawa-Drott, 2019. "Reducing Child Mortality in the Last Mile: Experimental Evidence on Community Health Promoters in Uganda," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 155-192, July.
    4. Dizon-Ross, Rebecca & Dupas, Pascaline & Robinson, Jonathan, 2017. "Governance and the effectiveness of public health subsidies: Evidence from Ghana, Kenya and Uganda," Journal of Public Economics, Elsevier, vol. 156(C), pages 150-169.
    5. Katherine L. Milkman & John Beshears & James J. Choi & David Laibson & Brigitte C. Madrian, 2011. "Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates," NBER Working Papers 17183, National Bureau of Economic Research, Inc.
    6. Zachary Wagner & John Bosco Asiimwe & William H Dow & David I Levine, 2019. "The role of price and convenience in use of oral rehydration salts to treat child diarrhea: A cluster randomized trial in Uganda," PLOS Medicine, Public Library of Science, vol. 16(1), pages 1-18, January.
    7. Anett John & Kate Orkin, 2022. "Can Simple Psychological Interventions Increase Preventive Health Investment?," Journal of the European Economic Association, European Economic Association, vol. 20(3), pages 1001-1047.
    8. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
    9. Florencia Devoto & Esther Duflo & Pascaline Dupas & William Parienté & Vincent Pons, 2012. "Happiness on Tap: Piped Water Adoption in Urban Morocco," American Economic Journal: Economic Policy, American Economic Association, vol. 4(4), pages 68-99, November.
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    Cited by:

    1. Sun, Yucheng & Li, Jiaolong & Shen, Xiuheng & Pan, Zhewen, 2025. "Early-life access to primary healthcare and educational attainment: Evidence from community health centers in China," Social Science & Medicine, Elsevier, vol. 380(C).
    2. Angelucci, Manuela & Bennett, Daniel M, 2022. "Depression, Pharmacotherapy, and the Demand for a Novel Health Product," IZA Discussion Papers 15832, IZA Network @ LISER.
    3. Wagner, Zachary & Asiimwe, John Bosco & Levine, David I., 2020. "When financial incentives backfire: Evidence from a community health worker experiment in Uganda," Journal of Development Economics, Elsevier, vol. 144(C).
    4. Martín Rossi & Giulia Buccione, 2023. "Familiar Taste, Safer Choices: Sensory Heuristics and the Adoption of Clean Water," Working Papers 167, Universidad de San Andres, Departamento de Economia, revised Oct 2025.
    5. Pakhtigian, Emily L. & Aziz, Sonia & Boyle, Kevin J. & Akanda, Ali S. & Hanifi, S.M.A., 2024. "Early warning systems, mobile technology, and cholera aversion: Evidence from rural Bangladesh," Journal of Environmental Economics and Management, Elsevier, vol. 125(C).
    6. Agha A. Akram & Gabriella Fleischman & Reshmaan N. Hussam & Akib Khan, 2026. "Experiential and Social Learning," NBER Working Papers 35410, National Bureau of Economic Research, Inc.
    7. Rafi Amir‐ud‐Din & Muhammad Khan & Zahra Murad & Irene Mussio, 2025. "Clear Waters, Bright Futures: Do Low‐Cost Information Interventions Increase Health Preventive Behaviors," Health Economics, John Wiley & Sons, Ltd., vol. 34(9), pages 1578-1594, September.
    8. Aisha Aziz & Kashif Akram & Muhammad Abrar ul Haq & Iqbal Thonse Hawaldar & Mustafa Raza Rabbani, 2022. "Examining the Role of Clean Drinking Water Plants in Mitigating Drinking Water-Induced Morbidity," Sustainability, MDPI, vol. 14(15), pages 1-21, August.

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    Keywords

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    JEL classification:

    • D10 - Microeconomics - - Household Behavior - - - General
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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