Short Summary
This nonprofit will reach high-risk households by identifying diarrhoea patients in hospitals and providing simple WASH support.
The intervention package combines bedside education, low-cost supplies like chlorine tablets, and follow-up via mobile messaging.
Evidence from RCTs shows sustained improvements in WASH practices and reduced diarrhoeal burden for up to 12 months.
The Problem
What’s the problem?
Diarrhoeal diseases remain a major cause of preventable death in many countries across Sub-Saharan Africa and South Asia, particularly where poverty and poor healthcare access create barriers to prevention. The literature strongly suggests that household contacts of an index case of diarrhoea are at significantly higher risk of contracting diarrhoeal illness than the general population, making them a key group for intervention.
Why does it matter?
Diarrhoeal-related mortality is almost entirely preventable. Proven WASH practices—such as handwashing with soap and using chlorine-treated water—are highly effective, low-cost prevention measures.
Neglectedness:
While there is substantial ongoing work in the broader WASH space, this approach, using hospital case identification to deliver targeted, household-level interventions, is relatively novel. To date, it has mostly been tested in small-scale academic settings.
The Solution
What’s the proposed solution?
A new charity will partner with hospitals to identify patients admitted with diarrhoeal illness and deliver targeted WASH interventions to households at high risk of contracting diarrhoeal illnesses. The intervention package will likely include bedside education, essential WASH supplies, and post-discharge follow-up via mobile messaging (SMS/IVR) or household visits. The charity will have to iterate through different combinations of these services to identify optimal combinations that maximize cost-effectiveness.
Why do we trust this solution?
The idea was suggested to us by GiveWell as a potential area of research. While this targeted, hospital-linked approach is somewhat novel, it builds on a robust body of evidence supporting general WASH interventions, and we believe that salience for the adoption of WASH measures will be higher amongst households that have had a recent family member admitted to hospital for diarrhoeal illness.
How robust is the evidence?
Variations of this intervention have been evaluated in high-quality field RCTs in Bangladesh and the DRC, demonstrating promising 12-month follow-up results in both improved adoption of WASH behaviors and reductions in diarrhoeal disease incidence and child stunting.
The Impact
Estimated cost-effectiveness:
GiveWell has previously estimated this intervention to be between 5x and 13x relative to GiveDirectly. This range is influenced largely by geography and intervention design (i.e, the specific combination of services provided). We anticipate cost-effectiveness to be on the higher side of this range in the DRC.
Ideal Founder Profile
Who is best suited to do this? *
It would be beneficial for the founding team to have experience in Monitoring, Evaluation, and Learning (MEL) and a healthcare or medical background.
Prior experience in designing messaging campaigns and an ability to manage complex partnerships with many stakeholders would also be of great benefit.
We think it is key that co-founders are comfortable with uncertainty and are committed to iteratively adapting the exact program of services provided based on MEL data.
*We think candidates with the following skills will have a comparative advantage/be especially promising for founding this idea, but we would like to still encourage applicants from people who do not match this criteria who are enthusiastic about this idea and believe they may be well-suited for reasons not captured here
