摘要：Rural populations disproportionately lack access to improved water supplies. We evaluated a novel scheme that employed community-based sales agents to disseminate the Safe Water System (SWS)—a household-level water chlorination and safe storage intervention—in rural Madagascar. Respondents from 242 households in 4 villages were interviewed; all used surface water for drinking water. Respondents from 239 households (99%) had heard of Sûr’Eau, the SWS disinfectant; 226 (95%) reported having ever used Sûr’Eau, and 166 (73%) reported current use. Current Sûr’Eau use was confirmed in 54% of households. Community sales agents effectively motivated their neighbors to adopt a new health behavior that prevents diarrhea. Future work should focus on strategies for sustaining SWS use, factors that motivate community-based sales agents to promote SWS, and the feasibility of scaling up this approach. AMONG THE 1 BILLION persons estimated to lack access to improved water sources worldwide, rural populations are disproportionately underserved. The World Health Organization estimated that in 2000, 94% of the world’s urban population had access to improved water sources compared with just 71% of rural populations 1 ; that year, only 34% of Madagascar’s rural population was estimated to have access to improved water sources. 2 The low population density, remoteness of the population, difficult terrain, and relative political disenfranchisement of rural areas have resulted in a much lower investment in improved water sources despite greater need. 1 In 2000, Population Services International initiated a social marketing campaign to promote the Safe Water System (SWS; see the box on the next page)—a household water quality intervention for diarrhea prevention—in Madagascar. Many isolated rural communities that lacked access to mass media were not reached by the campaign. In August 2001, CARE Madagascar launched a project to increase access to the SWS in the remote rural communities of eastern Madagascar by motivating community-based sales agents to sell both the diluted chlorine solution, which bears the brand name Sûr’Eau , and jerry cans with taps (Figure 1 ▶ ). Open in a separate window FIGURE 1— Sûr’Eau water disinfectant, Madagascar, 2002.
