Beyond broken pumps and promises: Rethinking intent and impact in environmental health

Global environmental health efforts are motivated by a sense of common responsibility. These programs take forms small and large, from community churches to the World Bank. The methods likewise take varying, and sometimes competing forms, from watershed restoration to road building to community engagement, with funding provided by charities, bilateral aid, loans, microfinance and big business. Once these projects are installed, typically the implementers are their own evaluators. Under the best of circumstances, sometimes funding is available to run a randomized controlled trial to rigorously evaluate if the projects are improving the intended environmental, economic, health or other metrics. But, usually sooner rather than later, the funding runs out for that particular project, and everyone moves on. This has resulted in sad statistics. For example, half of the water pumps installed in some African countries are broken a few years after they're installed. In a recent volume, Broken Pumps and Promises - Incentivizing Impact in Environmental Health [1] my co-authors and I review alternatives. Instead of pushing money toward projects based on promises, pay interventions for successfully demonstrating impact that meets this intent. We propose moving from intent to impact via a combination of aligned standards, metrics and evidence.