In 2012 and 2013, as part of relief-to-recovery programming, Child Relief International partnered with Haiti Philanthropy to install automatic tablet-based chlorinators in 79 gravity-fed water distribution systems in Southeast Department, Haiti. We carried out a mixed methods evaluation to assess sustained effectiveness of chlorinators approximately two years after installation, including 18 site assessments of chlorinators and distribution systems, 180 surveys of households served by those systems and 17 key informant interviews. We tested for free chlorine residual and Escherichia coli in samples collected from sources, reservoirs, water access points, and treated and untreated household stored water. We found: 83% of chlorinators were in operational condition, although water pressure was sufficient to operate chlorinators at only 56% of sites; 0% of chlorinator sites had tablet stock; and, while 86% of households reported using water from distribution systems with a chlorinator, 0% of household drinking water was safe to drink because of chlorinators. Reasons why the chlorinator project did not achieve intended sustained effectiveness included: lack of accountability for infrastructure maintenance; lack of tablet access; and lack of effective community management systems. We recommend future implementers of centralized water treatment systems in relief-to-recovery contexts consider these three components necessary for sustainability.

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