Millions of tubewells across South Asia protect from cholera, but many contain poisonous levels of arsenic. Arsenic impairs fetal growth, increases infant mortality, diminishes children’s intellectual and motor functions, reduces adult earnings, and accounts for 6% of adult mortality in Bangladesh. One reason is that most rural residents don’t know the status of their well. Our solution - providing access to safe wells - amplifies our proof of concept and will improve the lives of 40 million people. Our consortium of scientists and local NGOs will test millions of wells for arsenic. Results will be distributed via a smartphone app that indicates which wells to use and will guide the installation of millions of new safe wells. We will rigorously assess the impact of these interventions and adjust procedures accordingly. These activities will provide the Bangladeshi government with the data and methodology to ensure that arsenic exposure remains low in the future.
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In the past 40 years, millions of wells were installed privately by households in South Asia to avoid water-borne diseases, such as cholera. This resulted in the largest mass poisoning in history due to high arsenic levels in many of those wells. Bangladesh has been affected the most, with 40 million people exposed to arsenic levels 10 to 100 times higher than the World Health Organization guideline. Arsenic is an invisible killer that accounts for over 100,000 spontaneous abortions, still births, and infant deaths annually; reduces intellectual and motor function in children; and accounts for 1 of 18 adult deaths, primarily from cardiovascular disease. Economists have demonstrated other health effects of arsenic on wage earners that have reduced annual income of almost 8 million exposed households by an average of US$100. Our main challenge is knowing exactly where the arsenic is in order to avoid it. When the problem was first recognized in the late 1990s, high hopes were placed in solutions such as filters to remove arsenic that, despite extensive media coverage, turned out to be unsustainable. The World Bank supported piped-water supply systems but curtailed its efforts because of insufficient progress. The patterns of arsenic in groundwater are so complex, we need to test every well to locate safe water with confidence. Because households reinstall their well approximately once per decade, a one-time blanket testing of all 10 million existing wells is not sufficient; about 1 million new wells need to be tested each year.
Most rural households in Bangladesh live within walking distance of an existing safe well or potentially safe well that could be installed by local well drillers. Sadly, many of them don’t know this. Our approach relies on underground processes to treat the water naturally instead of trying to remove arsenic from well water above ground, which is logistically much more difficult. Most households in Bangladesh own at least one smartphone. By testing millions of wells for arsenic and delivering a guidance to safe water with a smartphone app, our solution will provide actionable information at the local level. Our research has also shown that knowing that safe water is available is not always sufficient to induce behavior change, especially if switching to a safe well requires extra effort. Building on our previous experience, we will systematically compare the efficacy of different ways to deliver that information and various incentives for encouraging households to respond. Beyond test results, the app will document the impact of new public wells that have been installed by our NGO partners under the project as well as new public wells installed independently by the government. Such public knowledge will create an incentive for selecting better locations for these public sources than in the past. The groundwater arsenic problem is also serious in rural India, Pakistan, Nepal, and Myanmar. Lessons learned will be conveyed to NGOs and relevant government departments in those countries and reach at least as many as the 40 million exposed in Bangladesh.