Preventive Measure Initiative

Global statistics: 

Over 1.7 billion people still do not have basic sanitation services, such as private toilets or latrines. Of these, 494 million still defecate in the open, for example in street gutters, behind bushes or into open bodies of water. (Source: WHO)

Access to hygienic toilets and sanitation facilities in Bangladesh:  The rate of sanitation coverage is only 61 percent, growing at 1.1 percent annually. More than 40 percent of all latrines in Bangladesh is still unimproved, and the sanitation facilities for children with disabilities are still lacking. (Source: The Borgen Project) 

A global report on health status of 188 countries based on the health related Sustainability Development Goals (SDG) indicators found Bangladesh to be one of the poorest performing countries in South Asia, lagged by only Nepal and Afghanistan. This report clearly shows that no country can make sustainable progress on the global health goals without addressing the critical components of water, sanitation and hygiene (WASH). In this context,

Bangladesh has made a number of commitments to mobilize urgent action towards SDG 6 and related targets.

The action plan proposed by the Government of Bangladesh considering SDG 6 includes the following outcomes and targets:

• Bangladesh would ensure access to safe, adequate and equitable water supply for all with a target of improving water supply coverage to 100% both (in urban and rural area) by 2020;
• Bangladesh would ensure 90% hygienic sanitation coverage, with special attention to physically challenged and socially excluded population, by 2030.
• Ensuring safe yield from ground water sources of water and their preservation and conservation by 2020 through appropriate actions (The Water Act is already in place) and continuous monitoring up to 2030;
• Percentage of population using a handwashing facility with water and soap, disaggregated by location (home, school, health center). However, there are a number of challenges to achieving Goal 6 which must be acknowledged and prepared for:
• While the Millennium Development Goals dealt more with straightforward issue of expanding access, the SDGs bring in issues of equity, quality and sustainability which will require more nuanced, integrated and multi-sectoral ways of working.
• The ‘Leave No One Behind’ theme of the SDGs requires going beyond broad-brush interventions that raise beneficiary count, to focusing on hard-to-reach areas and populations, which will require innovative, context-specific technology and programmatic solutions.
• Protecting water sources and introducing sustainable management of groundwater and surface water will be a priority given Bangladesh’s extreme reliance on limited groundwater sources.
• Hygiene is perhaps the most lagging area of WASH, and there is evidence of widespread poor practice. Determining effective ways to improve behaviour will be a key challenge of the SDG era.
• Issue of integration with the national planning process is a big concern. Monitoring progress on Goal 6 will require devising appropriate indicator, coordinating among the stakeholders and establishing a feedback mechanism to review the decision and control measures through coordination with concern ministries, including Ministry of Water Resources, Ministry of Local Government, Rural Development and Co-operatives, etc.

Besides, Bangladesh Water Act 2013 (BWA) is a framework Law to integrate and coordinate the water resources management in the country. The Water Act will establish a new, integrated approach to the protection, improvement and sustainable use of country’s rivers, lakes, estuaries, coastal waters and groundwater. Considering this context, the proposed project proposal will contribute to achieve the objectives of the national policy and acts.

Problem description in the local context:  Morrelganj is an upazila of Bagerhat District in the Division of Khulna, Bangladesh. It is located at 22.4500°N 89.8583°E with total population 321153; male 50.48% and female 49.52%.

The water-thrust locals across the Morrelganj upazila are walking mile after mile to collect drinking water from alternative sources of ponds, canals and rivers. The households of the upazila are facing serious drinking water crisis. Most of the tube-wells are either arsenic-contaminated or non-functional and pond sand filter system (PSF) points are also defective.

Villagers are collecting drinking water from distance areas by boats or on foot; many are drinking water from ponds, canals or river. People have been in a compelling situation to drink pond water from nearby ponds; but the ponds have almost dried up with some bottom water only. From morning to night, people from different areas are fetching water from the pond.

As a consequence of this, people of different ages including children to elderly are being affected by various water-borne diseases including food poisoning.

Women and adolescent from marginal community fetch water from ponds moving aside dirt and floating leaves, slowly lowering earthen pitcher into it and fill it with around 20 liter of water. Fetching the water, they carefully climb the muddy, steep stairs of the pond and walk around hours to return home by holding the heavy pitcher against their waist or on head the entire time. Only to fetch water for family, they do this arduous task every day, twice, throughout the year, except for a few months of rainy season. As a result, the women and adolescent girls suffer from back pain frequently.

The ponds are also used for washing and bathing the livestock. There is no management system of the ponds for maintaining and keeping the ponds clean. Lack of awareness on health hygiene and sanitation practices are also making the situation worse in this area.

People also have no access to the public ponds because the government’s relevant department leases the ponds to the local influential elite people for commercial fish farming.

All through the year the coastal area experiences devastated natural disasters such as Cyclone Aila, Sidr, Amphan etc. At this, life and livelihood becomes standstill. Most of the people here are illiterate and live below the poverty line. They depend on the Sundarbans mangrove forest for their livelihood. They make their living by fishing in coastal rivers and canals surrounded by forests. With these entire disadvantage and poverty-stricken circumstances, they have no idea about primary health care.

When the children of these areas get sick, they depend on village quacks. It has been seen that rivers and canals are spread like a net around all the villages of 6 unions.

Most time of the year, boats are the only means of transportation for people as there is no suitable road connection. For this reason, serious patients are unable to get admitted in the sub-district or district level hospitals for proper treatment.  

RUSTIC has been conducting voluntary activities in the area to take initiative to ensure Primary Health Care. Following this, a health survey was conducted at the Household level in the 6 most backward and remote unions of Morelganj Upazilla.

Primary health care is based on a number of principles, including the importance of prevention as well as preventive care, equity, appropriate technology, community participation, inter-sector coordination and decentralization. RUSTIC have identified major problem in the intervention area are lack of health education, malnutrition, unsafe water and poor sanitation, poor hygiene, lack of arrangements to address environmental health risks due to climate change, deprivation of maternal and child health service including family planning, vaccination, prevention and treatment of local diseases, treatment of common diseases and injuries, and essential medicines to prevent existing diseases. There are also inequalities in terms of socio-economical condition; out of pocket payment at the moment of receiving health care, lack of proper arrangements for non-communicable diseases, services for the elderly and disabled, treatment of mental illness, lack of suitable health care providers, dissatisfaction with the quality of service. In order of priority, the specific problem within the Challenge that RUSTIC is trying to solve are, poor sanitation and hygiene practice and lack of health education. 

The proposed project will provide clean and safe sanitation facilities i.e. septic tank pit latrines including health education among the target beneficiaries. First of all, a survey has already been conducted in the targeted area. Through the survey, RUSTIC determined 1200 underserved rural Households. The proposed project will install Septic tank pit latrines and provide Rain water harvesting tank among the selected Households. Women beneficiaries group will be formed. Each group will be formed consisting of 20 Households members. All of the members of the group will be female. Training, workshop, courtyard meeting will be organized. Female village quack doctors will be engaged as community organizer. They will be trained on safe water, Primary health education, disaster management, environment, gender parity and women leadership for providing training among the beneficiaries group in every month. The community organizer will have the job responsibility of 10 households groups.  The community organizer will collect the primary health care data from the beneficiaries’ households. The collected data will be compiled time to time to get update of the household beneficiaries’ health status. With the update health status report, the project will take necessary steps for further improvement in case of serious issues. Besides, the project will take initiatives to ensure government health facilities for advance health support for the household beneficiaries. 

A supervisor will be responsible for supervising the field activities of the community volunteers.  The safe drinking water solution will be ensured through providing Rain water harvesting Tank. The followings are the solution to the safe drinking water crisis:

• Access to safe drinking water for the targeted households
• Decrease the rate of waterborne diseases like arsenic, diarrhea etc.
• Address the gender inequality at marginalized community.
• Improved health and hygiene practices in the community
• Rights and social inclusion will be ensured

The proposed project area is a natural disaster prone area in the south-western coastal region of Bangladesh. There are local government initiatives for ensuring sanitary latrines and health hygiene which is insufficient in comparison with the needs and necessity of the households of this area. The proposed project will contribute in improving the living standards of disadvantaged household of 6 unions in Morelganj Upazilla (sub-district) of Bagerhat district. About 29654 households live here. The population is about 148269 people. Of these, 30% of households use sanitary latrines. The remaining 70% use unhygienic latrines. In the proposed project, 1200 families have been selected from 70% of the households who are in the worst condition and at the highest health risk.   

The proposed project area has sanitation facilities for only 8896 households. On the other hand 12862 households use semi-concrete unhygienic latrines. In addition, 7896 households use unhygienic latrines out of which 1200 households have been identified through the survey of RUSTIC. 

The proposed project will install Septic tank pit latrines and Rain water harvesting tank for the selected household beneficiaries. Awareness building training support will be provided so that their health hygiene practice can be improved. The beneficiaries’ group formation and regular group meeting will contribute to ensure sustainability after the phase out of the project.  

The proposed project is designed to take initiative for sanitation, health hygiene because it is the root cause of deterioration of overall health status in the area. 

 The south-west coastal Bangladesh faces a crisis of fresh drinking water due to water salinity resulting from climate change. This region is more vulnerable to safe drinking water shortage than elsewhere in the country because both surface and ground water suffer from acute and high salinity intrusion. It is evident that diarrhea, dysentery, and skin diseases as the prime waterborne health risks that occur through climate-related safe water scarcity. Therefore, RUSTIC works for safe drinking water solution through providing rain water harvesting system to the vulnerable community.

In the past, we conducted sanitation program with the support of Bangladesh NGO Foundation, a financial institution of the People's Republic of Bangladesh. We have an experienced and skilled management team on this issue. We currently have an office in the proposed project area. Here we are continuing our activities on Climate change adaptation of the marginal people of the area to increase adaptability to climate change impact. Our Climate volunteer team is regularly working to reach out to disadvantaged people and implement various programs. With the support of Bangladesh NGO Foundation, RUSTIC provided rain water harvesting with sanitation to 30 households in the Moralganj Upazilla. We have been conducting activities in this area for 12 years. As a result, it has been possible to identify the needs of the residents here. During the project, the beneficiaries will be able to share their needs through regular yard meetings, monthly meetings, workshops, etc. As a result, the project will be able to get update information and take appropriate initiatives and implement the project according to their needs.

Targeted population are in below the poverty line with no advantage of basic services in the community especially sanitation and primary health care services. This becomes as primary challenge for their socio-economic development. RUSTIC designed the project to address the challenge through providing primary health care services and health education to overcome the barrier. Besides, the project will also develop capacity for the community through leadership training with community group development. Thus their behavioral change will help to overcome the cultural barrier.   

Due to ignorance and lack of awareness, they do not have proper idea about safe water, sanitation and health hygiene. We will work to remove ignorance. Awareness will increase. We will install sanitary latrine for them. We will form a group consisting of 20 households.

Our community organizers are experienced and skilled in these matters. Each community organizer will be engaged with 10 groups for conducting meetings, training and data collection. Besides they will collect installment money of sanitary latrine and select new beneficiaries through data collection. Through these activities, there will be a positive impact on primary health education among the people out of the project as well.

After starting the project we will meet our target in the next year and will be able to implement this program with additional 3600 households in the next five years. Further activities will be conducted through monthly installments payment and data collection. 

The quality of life of the targeted households will improve. Doctors and medical expenses will decrease. Health of mother and child will be good. As a result of implementing this project, people outside the project including government and non-government organizations will be interested in joining these activities. 

Community organizers of the project will regularly monitor the following issues and take appropriate action by verifying these data:

• Beneficiary will collect information regarding members' participation in training.
• Whether sanitary latrines are being used will also be monitored.
• Information on cleanliness of toilets will be collected.
• Data will be collected on whether the health status of project beneficiaries has improved.
• Data will be collected on whether medical costs are reduced.
By collecting these data, it can be measured whether the goals and objectives of the project are being properly achieved.

Theory of Change

Activities

Health Education/Awareness

Installation Septic tank pit latrines

Setup Rain water harvesting tank

Provide Healthcare (prescriptions, first aid,) support

Outputs

• Trained on Primary health education, disaster management, environment, gender parity and women leadership

• Fully functional to use sanitary latrine  

• Fully functional to use Rain water harvesting tank
• Ensure Safe drinking water supply
• Developed fully functional management for Primary health care  

Short term Outcomes

• Increase health hygiene practice
• Increased community participation specially women in sanitation and health hygiene practice  
• Decreased illness
• Decreased medical cost

• Receive regular primary health care support from the project
• Reduce the incident of Water borne disease  
• Received regular basis health support from the Community Volunteers

Long Term Outcomes

• Decreased child mortality in the community
• Improved overall health and hygiene status

• Improved and uninterrupted use of Septic tank pit latrines

• Ensure Disease control in the communities out of the project beneficiaries
• Increased the health hygiene coverage among the communities out of the project beneficiaries
• Achieved Safe drinking Water sufficiency

• Increased the health status of mother and child
• Improved the overall health status of the community
• Developed fully functional sustainable Primary health care system through introducing Social business model  

SMS technology will be used to deliver all necessary and urgent services of the project. Mobile number of each beneficiary will be saved at project and head office. Community organizers and supervisors will ensure emergency information services by providing SMS.

Mobile apps will be introduced to collect Primary health care data from the beneficiaries. The community organizers will use the mobile application and update all data directly from the beneficiary’s households. By following appropriate procedure, all data and information will be accessible to the relevant individual, institution or government agencies from anywhere of the world.   

The community organizer will collect the primary health care data from the beneficiaries’ households. The collected data will be compiled time to time to get update of the household beneficiaries’ health status. With the update health status report, the project will take necessary steps for further improvement in case of serious issues. Besides, the project will take initiatives to ensure government health facilities for advance health support for the household beneficiaries. 

A supervisor will be responsible for supervising the field activities of the community volunteers.          

Diversity, equity and inclusion have a clear basis in human rights. In generally, women are lagging behind in terms of social and economic progress. Our targeted people and community are also remained in the same situation. For this reason, the project will promote diversity, equity, and inclusion in the project workplace as well as community level. The supervisor and community organizers promote pay attention equally to all beneficiaries. The project will provide Training on social, cultural coherence for diversity, equity, and inclusion. Besides, data collection will also reflect the existing situation as a regular basis. With the collected data, necessary measures will be taken to address the findings accordingly.    

Business Model: First of all, the proposed project will seek a primary donation and grants to start the process and social business model. A factory including sales center will be setup for production of Septic tank pit latrines. This sales center will be open for all in a subsidized price or in installment for the low income families.  With this fund, the project will start the business model as given below:

Business model

As a result of the disease, their performance decreases. As a result, livelihood and income are affected. They are deprived of health hygiene practices because of lack of awareness and poor income.                   

 This initiative will reduce the incidence of the disease and disease costs among them. Physical and mental well-being will return. As a result, they will be able to do their daily work. Above all, they will develop healthy habits and become financially self-sufficient. The implementation of this project will have a positive impact on other people in the work area and they will be motivated to take similar initiatives.

The sustainability of the project will be achieved through the following steps.

• A survey has already been conducted in the project area
• Women beneficiaries group will be formed.
• Provide training, workshop, courtyard meeting.
• Provide training among the beneficiaries group in every month on Primary health education, disaster management, environment, gender parity and women leadership
• Septic tank pit latrines and Rain water harvesting tank  will be Installed among the selected Households
• Septic tank pit latrines and Rain water harvesting tank will be provided with a monthly payment installment facility for three years with a minimum service charge to the target beneficiaries. The recovery fund will be reinvested to the social business model.  
• The community organizer will collect the primary health care data from the beneficiaries’ households. The collected data will be compiled time to time to get update of the household beneficiaries’ health status.
• Primary health care data sharing with concerning government and non government organizations.  
• Factory and sales center will be setup to produce Septic tank pit latrines. It will enable regular income generating option for the project. It will activate and make it sustainable as social business model.  

Last 12 years, RUSTIC has been serving the marginal community with VGD (Vulnerable Group Development) program with the support of Ministry of Women & Children affairs of Bangladesh government. Besides, Bangladesh NGO foundation, a financial institution of Bangladesh government supported Water & Sanitation program of RUSTIC. At present, RUSTIC has been working for 2116 Households as the direct existing beneficiaries. In this piloting phase, RUSTIC selected 1200 households to continue the project. But, project initially needs donors or funders support as a primary fund to role the social business model.