Water is Life: interventions to support healthy water practices for most vulnerable communities in Upper Egypt

Background & Context

Water scarcity casts a long shadow across the globe, threatening human health, economic development, and environmental sustainability.  The UN World Water Development Report estimates that by 2050, one in four people will likely live in a region experiencing chronic or periodic freshwater shortages¹. This crisis is particularly acute in the Middle East and North Africa (MENA) region, where 12 out of 18 countries, including Egypt, are classified as water scarce (World Bank, 2023)².

Despite the iconic Nile River, Egypt exemplifies the complex challenges of water scarcity in the MENA region, with an annual per capita water availability of only 570 cubic meters (m3) – far below the UN's water poverty threshold of 1,000 m3 (The Atlantic Council, 2023)³. Egypt faces immense pressure on its limited water resources due to its rapidly growing population, exceeding 100 million (CAPMAS, 2023). The impact of water scarcity transcends mere availability and extends disproportionately to minorities especially in rural communities, constituting nearly 56% of the population (UNICEF Egypt, 2024)⁴.  

However, addressing these challenges requires agile solutions. In partnership with the Abdullatif Jameel Poverty Action Lab (J-PAL MENA) and implemented by Life From Water Foundation (LFW), Sawiris Foundation for Social Development (SFSD) is proud to fund interventions as well as impact evaluations that help identify effective interventions for increasing the uptake of community-based water treatment units in rural Egypt. This evidence-based approach enabled us to move beyond traditional water delivery methods and precisely determine the impact of our efforts to bridge water security rifts that threaten the everyday lives of vulnerable Egyptian communities. 

Water Is Life

"Water is Life" is designed against the challenge of water scarcity in the rural communities of Sohag, Assiut, Minia, and Qena in Upper Egypt. The project involves increasing the capacity and adoption rate of 25 community-based water treatment units and construction of two more making them 27 units dedicated to securing accessible and clean water to beneficiaries. In addition to that, the project delivers infrastructure developments of laying 4,000 meters of main water pipelines and the establishment of tap water connections in 200 households resulting in the access and water security of more than 11,600 families in rural Upper Egypt.

Moreover, the deployment of water taxis—a novel solution that would further ensure purified water is taken to homes that are out of reach from primary infrastructure, so that no family is left without potable water. It also conducts awareness campaigns with the overall objective to reinforce the conservation of water, hygiene practices, and the adoption of behaviors that sustainably use water. Such campaigns are instrumental in the entrenchment of project objectives in the lives of community members for a sustained impact.

At the core of the "Water is Life" project’s strategy is a strong emphasis on technical capacity building and supervision. This Sub-component will implement a system that empowers community members through the skills and knowledge required for the daily operations and maintenance of water treatment units built to be in place, building sustainability and community-based management of natural resources (CBNRM) in this model of water resource management. 

Cultural Context to Safe Drinking Water Practices: Evidence from Egypt

Addressing the challenge of low adoption rates of safe water stands as a primary concern for policy makers and international donors. The usual suspects to explain low adoption rates for chlorinated water include high prices and limited awareness regarding its health benefits prompting necessary innovative approaches to bridge this gap in safe water uptake and drive behavioral change at the household level.

A recent study conducted by Sawiris Foundation, Brown University, and Life from Water investigates the pivotal role of preferences, culture, and habits in the households’ decision-making process to adopt safe water.  The project (intervention) introduced a novel and culturally friendly technology that employs water treatment units to filter local water and generate safe drinking water. In contrast to chlorination, this technology produces water that closely resembles local water, without altering the taste of traditional beverages (tea) that are relevant to locals’ consumption habits and sociality. Furthermore, filtered water is healthier than chlorinated water because, in addition to removing bacteria, the filtration process also eliminates excessive salinity.

The study reveals a clear and strong preference for filtered water over chlorinated water. In a “blind taste test”, 230 participants blindly tasted both filtered and chlorinated water and were asked to state their preferences: 80 percent preferred filtered water to chlorinated water (see Figure 1). 

Second, this preference for filtered water translates into higher adoption rates and higher willingness to pay compared to chlorinated water. 400 women were randomly presented with either a 20-liter bucket of filtered water (treatment group) or chlorinated water (control group), without informing them of the type of water presented. After tasting the water, women were asked to make purchase choices of the tasted water for different, randomly drawn, offer prices (Becker, Degroot, and Marschak (1964) mechanism)⁵.  Women were willing to pay 61 percent more compared to chlorinated water with adoption rates for filtered water reaching up to 91 percent when offered at a zero price (i.e. full subsidy). This rate remarkably exceeds the previously reported ceiling of 50 percent identified by previous studies (Dupas et al. (2016), Haushofer et al. (2021), and Dupas et al. (2023))⁶. 

The study also assessed factors explaining these striking differences in health perception of different water sources.  Conditional on receiving the same health information, findings show that participants considered filtered water to be both tastier and healthier. This difference in health perceptions can be exclusively attributed to differences in the taste of the water, suggesting that taste plays a key role in shaping perceptions regarding the health benefits associated with different water varieties. 

Policy Implications 

These findings carry significant policy implications, the first of which is tailoring interventions to specific cultural contexts enhances local acceptance and boosts long-term sustainability. Secondly, policymakers should reconsider balancing the prevailing strategy of subsidizing chlorine in favor of exploring alternative approaches that account for the culture and preferences of local communities. The research also highlights the constraints of information campaigns in water interventions, particularly in regions with high illiteracy rates. In these areas, taste serves as a crucial indicator of water quality, shaping perceptions of healthiness and safe water uptake, harming the rationalization of scientific information. 

Does the observed increase in safe water adoption translate into improved health? Future research entails conducting an additional experiment to study if differences in adoption rates translate into health benefits. This upcoming project in collaboration with J-PAL MENA and Ministry of Planning & Economic Development’s Egypt Impact Lab will primarily assess effects on health outcomes, such as hygiene, clean water use, stomach, and kidney issues. Secondary outcomes will include the impact on education and productivity, especially for women and girls who bear the burden of fetching water.

Concluding Remarks

Sawiris Foundation supports the Egyptian government's efforts to combat water scarcity, a major contributor to multidimensional poverty, Initiatives like Water is Life exemplify this commitment. However, the unique complexities of Egypt's water crisis, including ingrained household water usage practices, a declining per capita share of clean drinking water, and the need for robust innovation in water-related solutions, demand a comprehensive and strategic approach that furthers existing government efforts. 

Securing the needs of Egypt’s most vulnerable communities with regards to their access to clean drinking water, is crucial to their development and wellbeing. We learned this can best be done in tandem with more vigilant, localized water management practices, and contextualized awareness building on the implications of unhealthy water.

By supporting changemakers like Life From Water foundation to implement evidence-based interventions, offering access to basic services ultimately reducing the dimensions of poverty Egyptians face. Through the Social Empowerment department, SFSD focuses on promoting innovation in water technologies like decentralized desalination and improved resource management, in addition to behavioral change campaigns to raise awareness and encourage sustainable water usage at the household level. Our Foundation is committed and looking forward to contributing to a more comprehensive and sustainable national water management strategy and interventions, ultimately leading to a future where the specter of water scarcity no longer hinders the well-being and prosperity of the Egyptian people.

Sources:

o   Buccione, Giulia, and Martín Rossi. Incorporating Cultural Context into Safe-Water Interventions: Experimental Evidence from Egypt. No. 167. 2023.

o   ومن الماء حياة (lifefromwater.org.eg)

o   UN Water (2020). UN Water - UN-Water. https://www.unwater.org/

o   The Atlantic Council (2023, March 22). Building Resilience for the Water Sector in Egypt - Climate Risks and Hazards.

o   The Atlantic Council, Egypt’s Climate Profile (2023): Climate profile: Egypt - Atlantic Council

o    https://www.aucegypt.edu/climate-change/water-scarcity

o   CAPMAS, 2024

o   USAID definition of Community based natural resource management: What is CBNRM? (usaid.gov)

o   International Food Policy Research Institute (2024). Water. https://www.ifpri.org/topic/water

o   Triple Threat How disease, climate risks, and unsafe water, sanitation and hygiene create a deadly combination for children. New York: United Nations Children’s Fund (UNICEF), 2023.

o   UNICEF (2024). Water, Sanitation and Hygiene. https://www.unicef.org/supply/water-and-sanitation

o   UNICEF Egypt (2024). UNICEF Egypt. https://www.unicef.org/egypt/

o   UN Water (2020). UN Water - UN-Water. https://www.unwater.org/

o   World Bank (2023, March 22). Accelerating Change to Solve the Water Crisis. https://www.worldbank.org/en/news/immersive-story/2023/03/22/accelerating-change-to-solve-the-water-crisis

o   Becker, Gordon M., Morris H. DeGroot, and Jacob Marschak. "Measuring utility by a single‐response sequential method." Behavioral science9.3 (1964): 226-232.

o   Dupas, Pascaline, et al. "Targeting health subsidies through a nonprice mechanism: A randomized controlled trial in Kenya." Science 353.6302 (2016): 889-895.

o   Haushofer, Johannes, et al. Water treatment and child mortality: Evidence from kenya. No. w29447. National Bureau of Economic Research, 2021.

o   Dupas, Pascaline, et al. "Expanding access to clean water for the rural poor: experimental evidence from Malawi." American Economic Journal: Economic Policy 15.1 (2023): 272-305.