By Alex Harding, Executive Director at Water Ecuador
When I was working in Ecuador to build water treatment systems in small rural communities there, I thought of my job as extremely complex. There was, of course, the actual construction of the water plant and the installation of treatment equipment. But the work of the organization I founded in 2007, Water Ecuador, began long before we broke ground and would continue on for years after we put the finishing touches on the paint job. We had to deal with health education, community organizing, business concerns to ensure financial viability of our model, and scientific questions about efficacy of our treatment methods.
Water Ecuador managed all these complex tasks and for years focused on independently building and running its own water treatment centers. It was exhausting.
And, yet, when thinking about issues related to maternal and child mortality, I realize that the level of complexity is an order of magnitude greater than what we deal with at Water Ecuador. Unlike providing drinking water, which is an end in itself for organizations like Water Ecuador, there are numerous inputs that must be improved in order to have an impact on maternal and child mortality rates.
Cheng et al. showed in 2012 in Environmental Health that with each quartile improvement in water access, odds of maternal mortality rates decreased by 42% and there were 1.17 per 1000 fewer deaths for children under 5 years. The same study showed that improved sanitation is also associated with reduced maternal and child mortality.
But there are many other levers on maternal and child mortality: fertility rates; nutrition; immunizations; access to health facilities; and training for community health workers, nurses, and physicians are a few other examples.
It is an overwhelming number of tasks to manage—too many for any single organization to manage on a large scale.
At Water Ecuador, while we managed our own water treatment centers we also saw that private companies were sprouting up around us, using a similar approach as we were, to provide clean water in the same communities where we worked. As a result, we decided to change course. Rather than compete with the private companies that were providing clean water to those communities, we decided to collaborate with the private sector, working to help improve their practices so that the water they provide is of the highest possible quality.
We have found that this approach—working with organically-developing local industry—has several advantages. For one, Water Ecuador is not responsible for the burdensome day-to-day management of water centers, which are managed instead by local people more familiar with local conditions. Also, by partnering with local industry, we support the development of a local economy rather than creating a culture of dependency upon external aid. Lastly, we are able to utilize our strengths more effectively: our team, with its scientific and public health experience, is able to focus on research and engineering improvements to improve treatment processes of the existing local producers.
A similar approach can be taken with other levers affecting maternal and child health. John Snow, Inc. has taken a market-oriented approach to family planning in countries like Bangladesh, where it has distributed contraceptive methods using savvy branding and slick marketing campaigns. Importantly, John Snow, Inc. utilized the distribution chains that already reached rural communities, selling through the corner stores that also sold common household goods like soap or cooking oil. By doing so, John Snow, Inc. did not need to develop a retail distribution network of its own.
Can the private sector be harnessed to have an impact on any of the other levers on maternal or child health? It will take creativity to find ways to use existing local industry to improve maternal and child health, but I feel confident that this approach can yield great rewards in terms of magnitude and scale of impact on these measures.