World Water Week

Stockholm, Sweden

29 August 2012

Sanitation, Hygiene Education and

Water Supply – Bangladesh

(SHEWA B)

The WASH Situation in Bangladesh

• 1 Source: Bangladesh 2011 Census (Bangladesh Bureau of Statistics) • 2 Source: JMP 2010 data • 3 Source: National Drinking Water Quality Survey 2009 (part of MICS 2009)

Estimated Population (2011) 1 149,772,364

Estimated population density 1015/km2

Urban/Rural %1 23.3% % / 76.7% %

Access to improved water sources2 81% (Urban 85%, Rural 80%)

Access to improved sanitation sources2 56%

(Urban 57%, Rural 55%)

Coverage of sanitation facilities in Primary schools 65%

Extent of Arsenic contamination – Household (sources > 0.05 mg/l) 3 13.4%

Estimated number of people drinking water in excess of 0.05 mg/l 22 million

Estimated number of people living in urban slums 7 million

ESHWSRA SHEWA-B

2001-2006 (Development Phase)

Environmental Sanitation,

Hygiene and Water Supply in

Rural Areas (ESHWSRA)

2007-2012 (Implementation Phase)

Sanitation, Hygiene Education

and Water Supply - Bangladesh

(SHEWA-B)

WORKING AT SCALE

ESHWSRA SHEWA-B % CHANGE

2001 – 2006 2007-2012 -

Development Phase Implementation Phase -

8 Million Beneficiaries 30 Million Beneficiaries 275%

10 Districts 31 Districts 210%

37 Sub-districts 114 Sub-districts 208%

37 Agencies 81 Agencies 119%

273 Local Government Institutions

708 (690 rural + 18 urban) Local Government

Institutions

159%

2,909 Community Hygiene Promoters

10,000 Community Hygiene Promoters

243%

4,844 Primary Schools

13, 000 Primary Schools

168%

750,000 New Latrines Promoted

1.14 Million New Latrines Promoted

52%

6,939 New Water Points 23,100 New Water Points 233%

SANITATION ACTIVITIES

Promotion and construction of low cost latrines at household level;

Construction of demonstration latrines in urban and rural areas;

Piloted latrines for the disabled;

Piloted (EcoSan) Ecological Sanitation latrines;

Targeted rural ultra-poor for government subsidies;

Development of low cost sanitation guidelines;

HYGIENE PROMOTION ACTIVITIES

Developed hygiene promotion training manuals and materials;

Community hygiene promoters (CHP) trained and supported to assist communities;

Facilitated development of Community Action Plans (CAP) and Community Maps;

Mass-media campaign with radio, TV and multi-media messaging;

Community level activities in tea stalls, mothers’ meetings, courtyard sessions, house-to-house visits and interactive popular theater;

Construction of new wells;

Rehabilitation of existing wells;

Use of evidence-based appropriate technology;

Water quality testing of all new wells;

Training for Operation & Maintenance;

Water Point Coding System established and implemented;

ARSENIC SITUATION

Policy changes:

Cease shallow well construction in arsenic areas;

Construct only deep boreholes in arsenic areas;

Advocate to change GoB admissible levels to WHO global standards;

Focus new construction of deep wells in heavily contaminated areas;

CHPs Trained on using Arsenic Field Testing Kits;

Provide other water supply options if wells contaminated;

Pilot testing of household arsenic filters;

Painting of spigots:

Red – contaminated

Green - safe

WASH IN SCHOOLS ACTIVITIES

School Brigades

Student involvement in school hygiene;

Monitoring of catchment areas;

Taking home hygiene messaging to family;

Ensuring running water with all latrines;

Construction of new water points, latrines & hand washing stations;

Rehabilitation of existing water points and latrines;

Separate stalls for boys and girls, and urinals for boys;

Lessons & Demonstrations;

SHEWA B ACHIEVEMENTS

Hygiene Promotion Sanitation (Latrines promoted)

Water Supply WASH in Schools

1.5 Million mothers of children under 5 participated in BCC activities

1.14 Million new latrines constructed by communities

14,500 water points constructed & tested and 8,600 under construction

2,617 primary school facilities constructed/repaired

133,000 Community Maps & Community Action Plans Created

2,789 New latrines constructed in urban slums by project

29,000 caretakers trained on O&M

70,000 teachers/ school management committee members trained

11,000 urban adolescent girls active as peer change agents

300 EcoSan latrines constructed

1,600 CHPs trained to monitor using arsenic field-testing kits

1.08 Million Students in Brigades trained and functioning

Trained 10,000 CHPs

6 Compost Plants Constructed

MIS & geo-coding system developed and implemented

National Standard facilitated and approved

SHEWA-B INTERIM RESULTS

1. The extent of the health impact is under evaluation –final evaluation June 2013;

2. Due to the scale of the project, any slight % reduction in diarrhoeal cases would be significant in terms of population affected;

3. Significant knowledge increases were noted throughout the process and impact monitoring;

4. Open defecation reduced from 25% to 5%;

5. Reduction in the number of people drinking arsenic contaminated water;

Urban Sanitation and Hygiene: Baseline-Midline Findings

Indicator Baseline 2009 Midline 2010

Intervention HHs have clean latrines (spot check) 12% 24%

Intervention HHs have soap/ash and water at convenient place for hand washing after defecation (spot check) 24% 49%

Mothers washing both hands with soap after cleaning baby’s bottom (observation)

12% 33%

Mothers washing both hands with soap before feeding baby (observation) 2% 7%

Interim School Findings 2011

Indicators Combined hardware

and software intervention schools

Software only intervention

schools Control Schools

Schools maintaining a functional water point and environmental sanitation around it.

56% 42% 35%

School latrines that are operational, accessible, clean and useable.

66% 65% 56%

Schools having soap/ash and water at a convenient hand washing place after defecation event.

81% 79% 68%

Schools having an appropriate solid waste disposal system

61% 65% 54%

0%

5%

10%

15%

20%

10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9

Mean d

iarr

hea p

revale

nce

Intervention Control

Month

2007 2008 2009

Prevalence of diarrhoea among children < 5 years

First 8 quarters 2007-2009, Rural Bangladesh

10.1% 9.9%

Prevalence of diarrhoea among children < 5 years

2011-2012, Rural and Urban Bangladesh

Rural: 13% vs. 9% (p=0.02)

Urban: 7% vs. 7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

1 2 3 4 5 6 7 8 9 10 11 12 1 2

2011 2012

Mea

n d

iarr

hea

pre

va

len

ce

Control(Rural) Intervention(Rural)

Control(Urban) Intervention(Urban)

Month

Enormous scale of the project affected quality and sustainability • Data should be consistently integrated/used for project

management and corrective actions;

• Aspects of sustainability with all stakeholders should be integrated from the start of the project:

– payment versus volunteer status of field workers (CHPs);

– exit strategy should be agreed and initiated from the start;

– real ownership at the community level must be a priority;

• Enabling environment is critical to ensure sustainability;

• Development partnerships and working at a Ministerial level, across sectors;

• Opportunities to ensure pockets of innovation should be expanded throughout the project;

SHEWA-B – LESSONS LEARNED

• Evaluate behavior change strategies to identify which activities are leading to changes in behaviour versus increased knowledge;

• Increase the focus on strengthening the enabling environment at all levels;

• Expand to a programme approach to encompass national and global trends;

• Projects of such a scale should be incorporated into long term (+ 25 years) sector planning;

• Support policy development and implementation at Ministerial levels, across sectors;

• Partnerships need to be nurtured in order to share risks, responsibilities, resources and benefits;

• Ensure expansion of innovations by documenting and disseminating all WASH innovations, both successes & failures;

SHEWA-B - RECOMMENDATIONS