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Chris Dunston, MPH, David McAfee, Reinhard Kaiser, MD, MPH, Desire Rakotoarison, MD, Lalah Rambeloson, Anh Thu Hoang, MPH and Robert E. Quick, MD, MPH

Chris Dunston, Desire Rakotoarison, and Anh Thu Hoang are with CARE Madagascar, Antananarivo. David McAfee and Lalah Rambeloson are with Population Services International Madagascar, Antananarivo. Reinhard Kaiser is with the National Center for Environmental Health and Robert E. Quick is with the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to Robert E. Quick, MD, MPH, Foodborne and Diarrheal Diseases Branch, Mail Stop A38, Centers for Disease Control and Prevention, Atlanta, GA 30333 (e-mail: rxq1{at}cdc.gov).

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.

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