INTRODUCTION:
Water treatment is one of the most cost-effective ways to reduce child mortality, preventing up to 1 in 4 child deaths.1 Despite this, water treatment has been relatively neglected by governments and donors. Evaluations have shown providing free dilute chlorine solution through a targeted voucher program can be cost-effective.2-3 J-PAL Africa is supporting government partners across sub-Saharan Africa to adapt, pilot, and scale a chlorine voucher integration with their existing health systems. The presentation will share lessons from the partnership development, program adaptation, and initial pilot implementation in two countries.

METHODS:
In the basic model, pregnant women and mothers of young children visiting clinics for routine care are given a voucher by health workers for free chlorine solution. Women can then use the voucher to receive a free supply of chlorine on a regular basis at local health points until the child turns 5 years old. Through deep engagements with policymakers and iterative pilot testing, this model is adapted to integrate seamlessly into existing health services. Household surveys are conducted approximately eight weeks after the program roll-out to track critical implementation elements, including voucher redemption rates and verified chlorine tests.

RESULTS:
In 2025, J-PAL Africa began formalizing partnerships with the Ministries of Health in several African countries. Phased pilot programs in at least two countries are scheduled for 2026. The pilots test assumptions about the most effective way to adapt the program in each context while building greater internal support for the government to scale up the intervention. Results from the initial pilot phases in two countries will be compiled prior to the conference.

CONCLUSIONS:
Findings from the initial pilot programs will focus on design adaptations, feasibility within routine health service delivery, and policy-relevant insights to inform scale-up of household water treatment programs.