Phase I (2006-2011)

The first implementation phase of our program (2006-2011) has focused on:

1. mitigating the arsenic contamination in several highly arsenic-affected and marginalised communities, and
2. learning from these experiences and developing innovative methods that are replicable and capable of producing multiplier effects in the country.

The lesson is that if implemented improperly 30 water supplies will only serve 30 well-to-do families; if done properly 3 water supplies may serve an entire community of 300 families. Activities can be divided into three parts. The first lead to the selection of a working area. Second, we assisted communities with the establishment of drinking water and health care systems. Third, our direct involvement is reduced, and we begin to support activities leading to sustainability of the water and health systems. The details of this process can be seen in the presentation below (start prezi and click on the bottom-right button to view full-screen).

Since 2006, we have worked in 30 unions – involving around 250,000 people. For more information, please click here to download our poster with an overview of the implementation process or our flyer with an evaluation of Phase I.

Phase II (2012-2017)

The second implementation phase of our program (2012-2018) focuses on:

1. strengthening the sustainability of projects initiated under Phase I, and
2. refining the implementation approach in new areas

From the start of Phase I, the deep tube-wells were intended as triggers for a lengthier and broader development process. Phase II further facilitates this process in the existing working areas. Some of the committees have already started undertaking activities beyond deep tube-well operation and maintenance responsibilities. This not only encourages other developments, but it also strengthens the existing drinking water and health support systems set up during Phase I.

At the start of Phase II, we had worked closely in over 30 villages to secure safe drinking water for the community and to provide medical support for arsenicosis patients. This is not enough to counter the problem in the long term. The distribution of medicine needs to be replaced by activities to improve overall health and nutrition. This has become the focus for Phase II. To support this work, we were granted support from the Embassy of Japan in Dhaka to establish a clinic in Munshiganj.

We also continue to refine and develop the approach initiated in Phase I. We have conducted primary field visits to a new district (Shatkhira) and we are further expanding our drinking water activities in the district of Munshiganj. We also aim to continue engaging in lobbying and sharing our experiences at different levels.

Strengthen existing projects: The following activities will take place in existing working areas and will help improve the sustainability of drinking water and health systems set up during Phase I:

1. Initiate a dialogue with communities on the risks of deep tube-wells, uncertainties about their possible contamination in the future, continued maintenance issues, how to monitor water quality, and alternative water supply technologies if they become needed.
2. Although the signals are promising, the committees still require facilitation and motivation. Community meetings will focus on the monitoring of the maintenance committees, the replacement of inactive members, the role of the community to take on this responsibility in the long-term.
3. Train and support households for setting up homestead fruit and vegetable gardens, and producing herbal medicine to gradually replace the need for external medical treatment.
4. At this point, the community-based organisations are still mostly maintenance committees for the deep tube-wells. They will be encouraged to take on new activities in education, sanitation, primary health care, food security, village infrastructure, and so on.
5. Provide medical health care facilities through the establishment of a clinic in Munshiganj. The infrastructure will be built on the land that is currently owned by AMRF. It will provide health care services, especially for women and children in the project area.

Refine the approach: The following activities aim to expand our work and learn from the implementation process in new areas with new socioeconomic, geographic and cultural characteristics. The following activities are part of the broader aim of the program to develop an approach that can be replicable elsewhere:

1. Set up a pilot project in a new area (Shatkhira), adapt our approach to the new situation, implement safe drinking water and health systems appropriate to the new conditions.
2. Record the learning experience in reports and research publications. Lobby at the national and international level and dissemination results.

Phase III (2018 onwards)

The second implementation phase of our program (2018 onwards) focuses on:

1. strengthening the sustainability of projects initiated under Phase I and II, and
2. refining the implementation approach in new areas, by adopting a broader public health and integrated WASH approach.

As explained, arsenic contamination was declared as a national environmental health crisis in the mid-90s. Naturally occurring arsenic was discovered in shallow groundwater, which is the source of water for virtually every household. Groundwater tube-wells were put in place in the 1970s and 1980s with the aim to cast aside polluted and irregular sources of surface water. Instead, between 35 and 77 million people are now chronically exposed to dangerous levels of arsenic, which has been linked to neurological disorders, heart disease, cancers of the liver, kidney, bladders and skin.

Still now, it has been estimated that one in five die, or die earlier, from drinking arsenic-contaminated water in Bangladesh. According to a conservative estimate, around 20 million people (12.6% of households) are still drinking arsenic contaminated water. AMRF has a long experience in facilitating social mobilisation processes to ensure long-term access to safe water from community-based Deep Tube-Wells (DTWs). DTWs draw water from below the contaminated groundwater aquifers.

However, arsenic poisoning cannot effectively be addressed without also tackling other health problems: organs affected by arsenicosis will be less resistant to other diseases, and vice versa. Poor sanitation and hygiene are further compounding the arsenic problem. People commonly use pond water for bathing, washing clothes and kitchen utensils. These ponds also collect pollutants originating from agricultural, industrial, domestic and municipal sources, both locally and from upstream districts. The World Health Organization lists the following three major surface water quality hazards: toxins from cyanobacteria; pathogens from human and animal faeces; and chemical contaminants from agricultural/industrial pollution. Every year, this results in around half a million casualties from communicable diseases such as diarrhoea and cholera. Pond water pollution is also a reproductive health hazard. Based on a recent survey of 2500 women in the project, AMRF and AITAM found that 30% is suffering from Reproductive tract infection (RTI). Water use is an important factor in the transmission of this disease. We found that 73% of the women who are using ponds for bathing are suffering from RTI.

To combat these public health challenges, an integrated approach combining arsenic safe drinking water with sanitation and hygiene practices is needed. In this project, AMRF will facilitate community-based interventions in water, sanitation, hygiene and reproductive health care. AMRF in collaboration with its donors has gained much experience in the social mobilization processes required for the implementation of such community-based approaches.

Community based water supply facilities implemented by AMRF in the aforementioned PROWSHAR project provided a successful way to expand the reach of a single DTW to more households. Outputs of this project included well-organized direct beneficiary groups supported by maintenance committee and elected through community-based organisations.

The aforementioned AMCP project successfully installed a number of community washing facilities (CWFs) adjacent to the DTWs in Jessore district. This was prompted by the identification of (non-arsenic-related) skin and reproductive tract diseases caused by the day-to-day use of polluted surface water. According to the users expressed, the CWFs had significantly improved access to personal hygiene as well as reduced the incidence of water borne diseases. In this project, women will select appropriate (private) place for the CWFs. CWFs wil be connected to existing shallow tube-wells—as arsenic does not pose a risk through bathing water. This will maximise the use of existing facilities in a village and reduce pressure on deep water aquifers.

In our working district of Munshiganj, over 85% of shallow tubewells in the are affected by arsenic concentrations above the Bangladeshi standard (>50 μg/l); more would be contaminated above the stricter WHO standard (>10 μg/l). Deep tube-wells, on the other hand, were found to be safe—even according to WHO guidelines (GAP 2018). In this proposed project, we will target the following project locations: Patabhog and Tantar unions in Sreenagar Upazilla, Munshiganj district. These areas are part of a wider area in which AMRF has worked for many years. The most recent data is dated (from 2004), but indicates that 79.21% of tube-wells are arsenic contaminated according to Bangladeshi standards (National Resource Centre 2011).

Based on initial survey visits, it is clear that hygiene and sanitation situation is poor. There is no data available from the local government on arsenic contamination in these two unions. However, based on our knowledge of arsenic contamination in the surrounding unions, we can assume that the contamination will also be unacceptably high in the selected unions.

In short, communities will be assisted in addressing the interconnected problem of unsafe drinking water, lack of access to sanitation and hygiene practices. We will do so through an integrated and participatory process of implementation of deep tube-wells, community washing facilities and sanitation facilities. Alongside these installations, the project will include a range of supporting activities, such as training and awareness on sanitation and hygiene practices, health care for patients suffering from arsenicosis and RTI, and the development of local institutions that will ensure the sustainability of the installations.

Downloads

Please click here to view and download our posters, powerpoint slides, brochures, yearly reports, policy plans, etc.