摘要：In November 1999, CARE Madagascar, Population Services International (PSI), and the Centers for Disease Control and Prevention (CDC) selected 30 poor communities in urban Antananarivo as the target population for launch of the Safe Water System. The system consists of behavior change techniques along with point-of-use treatment and safe storage of water. The project was launched in March 2000, ahead of schedule, because a cholera epidemic struck Madagascar in January. Because of the enormous demand created by the cholera epidemic and by 3 cyclones that followed in the next 3 months, the project grew to national scale in less than a year. The combination of community mobilization and social marketing resulted in increased demand for and use of the Safe Water System. POOR WATER QUALITY AND sanitation infrastructure are major contributing factors to high rates of diarrhea and vulnerability to cholera in Madagascar. In March 1999, cholera was detected in the country for the first time in decades and, spreading rapidly, by January 2000 reached the capital, Antananarivo. In November 1999, some of the poorest communities in urban Antananarivo, where Community Assistance for Relief Everywhere (CARE) had been working, were chosen as the target population for piloting the Safe Water System 1 in Madagascar. The implementation approach combined community mobilization by CARE Madagascar, social marketing by Population Services International (PSI), and program evaluation by the US Centers for Disease Control and Prevention (CDC). CARE's Program Mahavita had a well-established community mobilization process in 30 impoverished neighborhoods in Antananarivo. PSI had a national sales and distribution network for its other products, such as condoms. CDC drew on CARE's human and logistical resources to conduct evaluations. In December 1999, CARE contracted PSI to socially market the Safe Water System in the areas where Mahavita was already operating. This involved local production of a 0.5% sodium hypochlorite solution packaged in a 500-mL bottle, an amount sufficient to treat approximately 2000 L of water. PSI contracted a local company to produce 20-L narrow-mouthed plastic jerry cans. The partners designed a brand name (Sûr'Eau, French for “safe water”), a logo, a label, packaging, usage instructions, and information, education, and communication materials. In response to a major cholera epidemic that struck Antananarivo in January 2000, CARE and PSI launched the program in March 2000, 4 months ahead of schedule.
