DEVELOPMENT, by definition, is an on-going effort recognized by both local and national governments and multinational agencies. This dynamic concept assumes various shapes and forms based on overall need of its surrounding. In Bangladesh, the need seemed greatest in the sanitation sector. The Government of Bangladesh, UNICEF and NGO Forum for Drinking Water Supply and Sanitation (hereinafter referred to as NGO Forum) recognized that, in order to curb the high incidence of infections and parasitic diseases and reduce infant and child mortality, a comprehensive plan needed to be developed in the area of sanitation. Such realization prompted the Bangladesh Government to launch, in 1992, a national programme named "Social Mobilization for Sanitation (SOCMOB)", to help increase the awareness of rural communities about the critical nature of sanitation and hygiene health practices. NGOs were identified as the crucial partners in this effort. Consequently, the NGO Forum - as a network and service delivery agency of 560 NGO and CBO partners (Community Based Organizations), engaged in various development activities, including Water and Sanitation (WatSan) at the rural grassroots level of Bangladesh - was selected as the key organization for implementing this national programme. The highlights of this project are outlined below:
- A national programme referred to as "Social Mobilization for Sanitation (SOCMOB)" was launched in 1992 with the intent of utilizing the dynamism of social mobilization by involving people from various social strata in the efforts of promoting sanitation coverage.
- NGO Forum implemented a 3-years project (April 1993 - March 1996) in three phases through its NGO partners in twenty diarrhea prone thanas (sub-districts) of five administrative divisions of Bangladesh.
- At the beginning of each phase, a baseline survey was conducted in each and every thana (sub-district) which provided an overall scenario of existing conditions. The survey became the basis for the project's action plan and strategy.
- Based on the findings of the survey, extensive promotional and motivational activities were carried out in the project areas, following various innovative and pragmatic methods in order to achieve the desired output.
- The primary messages in this project were: a) Methods of excreta disposal, and b) Hygiene practice and safe water use in order to reduce the diarrheal diseases.
- The project's coverage targeted the entire population and not a subset of it. The concept of universal coverage was the first of its kind at NGO Forum.
- At the end of this project, the motivated and educated people constructed their own latrines. In twenty thanas, up to 93 percent of the people who took part in the activities constructed their own latrines.
- In the twenty thanas, roughly 92 percent people washed hand after defecation using soap, ash or soil.
- Regarding cleaning and maintenance of the latrines : it was observed that 52 percent of the households who constructed their own latrines cleaned and maintained them properly.
- In the twenty thanas, it was noticed that latrines of 90 percent of the households were used by all members of the family.
- Regarding usage of tubes for draining wellwater (handpump) for drinking and other domestic purposes, it was found that in the twenty thanas, a vast majority of the households (i.e. 97%) used tubewell water for drinking purpose, while 46 percent of the households were using tubewell water for domestic purposes.
- It was found that about 73 percent of these inhabitants were aware of the causes of diarrhea and dysentery.
- The local community members were hired and joint alliances with various social groups were established to carry out various mobilization tasks according to the plan of action. This approach proved very effective and helped to achieve the desired results.
- Remarkable behavioral changes were recorded as a result of the project. In the project areas, achievement of over 90 percent of the sanitation coverage was confirmed by external evaluators.
Bangladesh is the ninth most populated country in the world, with about 120 million inhabitants and a population increasing at an annual growth rate of about 2.2 percent. Except some island-states, Bangladesh has the highest population density in the world, which has increased by 3.7 times during the last nine decades. Agriculture, the primary industry of the country, provides employment to about three-quarters of the population. Rice is the main crop grown, followed by wheat, jute, sugarcane, etc. The country is often facing natural disasters causing acute disruption in the food supply resulting in severe malnutrition of the most vulnerable groups. Nutritional levels have declined significantly during the 1965-85 twenty years period and this situation continues to deteriorate. A large majority of the population, both urban and rural, is affected by this phenomenon. An estimated 50% of the total population suffer from malnutrition. This particularly affects women and young children, and some 13.5 million children under the age of 5 are malnourished.
The over population of Bangladesh suffers from extreme poverty, malnutrition, ignorance, illiteracy, unhygienic living conditions, diseases and consequent deaths. The deplorable condition of public health is one of the drawbacks hindering the development of the country. The rural population represents about 85% of the total population. The vast majority of the rural population face poverty and lack hygiene. The housing conditions are deplorable and most people lack proper knowledge for health care and hygienic practices. Despite the fact that 85% of the rural population have access to handpump water (tubewell) within 150 meters of their households, only 97% use it for drinking purpose and 26% use it for all domestic purposes, and only 46% wash hand properly before taking meal and after defecation.
On the other hand, 36% of the rural households have hygienic latrines which implies that the other 64% have unhygienic latrines or defecate in the open space. Thus 28,000 metric tons of human excreta are deposited in the open everyday, which constantly pollutes the surface water. The attacks of unhygienic and environmental sanitation practices combined with a limited use of safe water, constantly threat the public health of the country. About 80% of diseases are related to unclean water, to which children are found to be most vulnerable. Every year, an average of about 300,000 children under 5 years of age -accounting for one-third of all child deaths- die of diarrhea in Bangladesh. This alarming figure counts for one third of the total child mortality.
The Social Mobilization for Sanitation Project
Social mobilization is a concept which involves the creation of a social movement for initiatives in development projects. This movement aims to create a major thrust to solve problems of national magnitude by promoting participation of all possible sectors and levels of society, mobilizing local resources and using indigenous knowledge. It aims to enhance people's creativity and productivity through mass campaign. This concept is of extreme relevance for a real change can be initiated by orchestrating a joint attack against the alarming sanitation situation with minimum social conflict. The participation of people in any development programme is the pre-requisite for sustaining any achievement. Social mobilization involves not only people in the community, but all sectors and levels of society as well as service delivery agencies, i.e. where local resources are tapped to its fullest which ensures the sustainability of the programme.
The strategies adopted for the above objectives are spelled out as follows:
* to increase the awareness of all communities of the benefits of sanitation improvements with the help of appropriate communication media;
* to promote affordable and appropriate technology with an emphasis on defecating in a fixed place and on construction of home-made latrines;
* to mobilize resources and build alliances with all potential partners -such as political leaders, local governments, professional groups, NGOs, CBOs, women groups, educational and religious institutes, mass media, cultural groups, etc.- for sanitation improvement through dialogues and advocacy campaigns.
However, it was decided that the programme would have national coverage with a special focus given on intensive sanitation activities in the selected diarrhea prone areas. Accordingly, NGO Forum implemented the SOCMOB project in collaboration with the DPHE (Department of Public Health Engineering), a government department, and with the financial assistance from UNICEF. NGO Forum made agreements with its NGO partners for implementation of the programme, jointly determining the operational strategies. In complement of the NGO Forum and its NGO partners staffs, additional personnel was hired for supervising, monitoring and coordinating the projects activities : for each thana, one Thana Coordinator, three Field Supervisors and twenty Field Extension Workers were hired. It was then decided that a Baseline Survey would be undertaken in each and every thana before starting the project activities for assessing the existing situation and potential needs.
The SOCMOB project was carried out in twenty thanas of the five administrative divisions of Bangladesh. The project areas were selected considering the diarrhea and dysentery status as well as the water and sanitation conditions. The project was implemented in three phases. In the first phase (i.e. April 1993 to March 1994), NGO Forum put this programme into practice in seven thanas located in six counties. These thanas were: Chirirbandar, Gongachara, Digholia, Lohagora, Gournadi, Mehendiganj and Patharghata. In the second phase (i.e. April 1994 to March 1995), NGO Forum picked on seven more diarrhea prone thanas located in five districts under Barisal Division. For the second year of practice, the thanas selected for the programme were: Bhandaria, Bauphal, Bamna, Dashmina, Babuganj, Bekerganj and Rajapur. In the third phase (i.e. April 1995 to March 1996), NGO Forum conducted its SOCMOB programme in the remaining six thanas, of which three were from Comilla district named Debidwar, Burichang and Brahmanpara and three from Sunamganj district named Sulla, Derai and Chhatak.
The project was implemented through NGO Forum's partners. A Thana Coordinator is responsible for each thana. Three Field Supervisors are directly placed under the Thana Coordinator. For each thana, there are twenty Field Extension Workers who work under the direct supervision of three Field Supervisors. It is to be noted here, that in some cases NGO Forum was not precise in formulating approaches. Based on field experiences, changes were made on the projects approaches and new ideas were incorporated. However, the structures core was under the direct supervision of the person in charge on a regional level at NGO Forum. This enabled NGO Forum to rely on a minimized capital and a relevant administrative expenditure. This also enabled workers to have access to the various structures and formations created by NGO Forum for diverse interventions.
For this programmes purpose, 100 percent of the population was considered as the target population. Practically each household (6/7 people) was contacted by the Field Extension Workers (FEWs) at the community level. The method of action chosen for this project was a communication on a personal level with each household, for the desired result was the social mobilization of the rural population at large. The female members of each household (mothers and housewives) were the primary target group for this hygiene educational programme, but male members were also contacted as well as other family members. In the selected thanas the sanitation coverage was much lower than the national average coverage. Incidence of diarrhea and periodical outbreak were also found more frequent. The general environment was highly polluted and hygiene practices were unacceptable. The economic indicators for the households were as follow : 67% illiterate, 55.4% farmers, 60.5% lived in kacha (raw) housing, 48% were landless, yearly income was 29,300 per annum with no family savings and 95% of the households did not have proper latrines.
To operate the participatory aspect of the programme, the operational set-up was established at the grassroots level. The Thana Coordinators and Field Supervisors performed their duties from their offices based in NGO Forum partners offices. Field Extension Workers kept close contact with those offices though they did not have any specific office accommodation. For the purpose of fortnightly and weekly meetings with Field Extension Workers, Thana Coordinators and Field Supervisors used NGOs offices, Health and Family Welfare Centres, Union Parishad Offices, etc., all located in their working areas in a central and convenient manner.
NGO Forum recruited its entire SOCMOB project staff before initiating the programme. Twenty Thana Coordinators, 60 Field Supervisors and 400 Field Extension Workers (FEWs) were recruited. All of them had some previous experience of working with other NGOs in related fields and some of them were also engaged in previous such project activities of NGO Forum. The qualification and job responsibilities of the SOCMOB personnel are described below:
The Thana Coordinators were recruited at the Head Office of NGO Forum, and was posted in each thana for close supervision of the field activities, thus each thana programme was supervised and managed by a Thana Coordinator entirely responsible for the programme activities within the thana assigned to him. The Thana Coordinators supervised the Field Supervisors and Field Extension Workers responsible for union/village level implementation of the programme. Monitoring the quality of the programme and coordination with the Government's Thana Administration, DPHE and financial management at the thana level were the part of his duties. He regularly visited the field areas and reported to the Regional-in-Charge of NGO Forum's regional office. Each Thana Coordinator had about 2 to 4 years experience of working with different development organizations in relevant work having minimum graduation degree.
The Field Supervisors were responsible for supervising the activities of 6/7 Field Extension Workers. He/She was directly supporting the sanitation promotion programme at union/village level and was continuously monitoring its quality and progress. He/She attended the training programme, organized by NGO Forum, of the Field Extension Workers along with them and physically ascertained in the interpersonal communication abilities of the Field Extension Workers. Regularly he/she cross-checked the performance of the Field Extension Workers in the field and took corrective measures to ensure desired quality. Each Field Supervisor directly contacted local elite, Union Parishad Chairman, Imams (religious leaders) of the mosques, teachers of school/madrashas and conducted meetings at schools/madrashas, mosques, village market committees. His/Her role as a field implementation monitor was felt to be very important from the point of successful implementation of the project. Village committee were formed by Field Supervisors and with male/female groups within his/her working areas. He/She also conducted fortnightly/weekly co-ordination meetings along with co-ordination meetings as and where needed with Field Extension Workers and directly reported to the Thana Coordinator and the Regional-in- Charge of the respective Regional Offices of NGO Forum. All Field Supervisors worked in this programme had previous experience in working with NGOs having minimum qualification of Higher Secondary Education.
Field Extension Worker
The Field Extension Workers were directly responsible for the motivation and promotion of sanitation and hygiene practice among the rural population. They were the real propagators who influenced the behaviors of the target population through house to house visits and interpersonal communication. Each Field Extension Worker was directly responsible to the Field Supervisor for his/her assigned activities. There was no experience required for the Field Extension Workers, but the educational qualification needed for them was Secondary School Education.
The management structure of the Social Mobilization for Sanitation Programme is shown in Annex-B.
Training and Staff Development
Following the recruitment, all Thana Coordinators, Field Supervisors, and Field Extension Workers attended training courses facilitated by NGO Forum training personnel. Promotion and use of safe water, better sanitation and hygiene practices, effective interpersonal communication with rural households, community mobilization, programme planning, supervision, monitoring, and baseline survey techniques were covered in the training. These training sessions became the foundation of all the works the project individuals performed.
As previously claimed, the "Social Mobilization for Sanitation" project aimed to increase awareness towards sanitation and water hygiene within its entire population instead of within a demographic subset of the area mass. To do that appropriately, an analysis of the existing inclination or mindset of the people was needed to be evaluated. The result of the exercise permitted proper distribution of efforts towards the overall goal. An assessment of the existing situation was very much critical in deciding how forcefully the message about sanitation was needed to be established. To attain this end, a baseline survey was conducted within ten percent of the household of each thana. This exercise gave a bird's eye view of the conditions of the sampled households. A structured questionnaire (Annex-C) on sanitation, personal hygiene, and some socio-economic and demographic indicators was distributed among these ten percent households randomly selected for this survey. A brief summary of the findings of the baseline survey is outlined below:
The baseline survey was carried out in 2176 villages of 135 unions of 20 thanas of 5 administrative divisions of Bangladesh. From each thana, roughly 1780 households were sampled, thus having a total of roughly 35592 households were covered by the survey in 20 thanas. The total number of persons enumerated in the survey were 219401, of them 77509 were male, 69404 were female, and 72488 were children under the age of 14 years. The mean size of family in the sampled households was calculated about 6 which is slight higher than the present national coverage. About 40.1 per cent population in the studied areas were found literate which is higher than the present national literacy rate. This was particularly reflected in the male literacy. Roughly 56.3 per cent of the total males were found literate. It should be mentioned here that educational characteristics of the studied households were analyzed according to knowledge on writing their name in any language was considered literate in the study.
The level of education of the head of households involved in different types of occupation differed in several respects. However, roughly 65.5 per cent of the head of households of the total were found literate although 23.4 per cent were in the category primary and 23 per cent of the head of households were found who could sign only. It was also found that among the total head of households only about 1.8 per cent were female and most of them were involved in the household works. The occupational composition of the head of household was more or less same in the thanas i.e. the majority of the head of households, roughly 51 per cent, were engaged in farming as the main occupation, while 12 per cent were service holders, 10 per cent were businessmen, 9 per cent were day laborer, 4 per cent were agri-labor, 3 per cent were skilled laborer, 2 per cent were share-cropper and 2 per cent were rickshaw-puller. The remaining occupational groups were too small to merit discussion.
Regarding the monthly income status of the sampled households it was found that approximately 17 per cent of the households had monthly income within the range of Tk. 001-500, which was the top percentage followed by the households who had monthly income within the range of Tk. 1001-1500, Tk. 501-1000, Tk. 1501-2000, Tk. 2501-3000, Tk. 2001-2500 and Tk. 3001-3500, while roughly 15 per cent of the households were found having the highest income group i.e. Tk. 3501 and above. The mean monthly income of the households was found only Tk. 1,760 and annual per capita income was calculated about Tk. 3,093.
Regarding the landholding pattern of the sampled households it was found that roughly 56 per cent of the households were functionally landless having a maximum landholding of one acre or less, nearly 19 per cent of the households were functionally landless having a maximum landholding of one acre or less, nearly 19 per cent of those households were totally landless. In case of family size by arable landholding pattern, it was observed that the household size of landless class tends to be smaller than those who had cultivable land. Regarding usage of tubewell water for drinking purpose, the data indicated that although a vast majority of the households (79.3%) were using tubewell water for drinking purpose but on the other hand most of them were found using river/canal/ pond water or ringwell water for their cooking, washing, bathing and home-stead gardening purposes.
It was also found that only 28.8 per cent of the sampled households used tubewell water for all purposes. Regarding defecation practice of the sampled households it was seen that the great majority of the households (86%) were defecating in unhygienic places like two types of unhygienic latrines and open space, while 14 per cent of the households were found defecating in some kind of hygienic latrines. Regarding washing hands by the heads of the households after defecation using soap, ash or soil, it was found that 46 per cent were practicing the same while in case of hand washing practice before eating it was found that only 5 per cent of the head of the households were washing hands in a hygienic manner. Regarding usage of latrine by all members of the family, the data showed that roughly 53 per cent of the households used latrine by all members of the family, while nearly 44 per cent of the households reported that their children below the age of 5 years do not use latrine. In the area of purchase of latrine by sources it was found that about 20 per cent of the households purchased their latrines form NGOs, while 34 per cent and 35 per cent of the households answered that they had purchased their latrines from government owned center and open market respectively. And roughly 11 per cent of the households mentioned that they had made their latrines by themselves using materials, available around them.
Regarding washing soiled napkins for babies, it was found that about 19 per cent of the households wash soiled napkins using soap, while 66 per cent of the households reported that they wash soiled napkins for babies using only water. On the other hand 14 per cent of the households were found not washing soiled napkins for babies. Regarding knowledge on some water-borne diseases, it was seen that roughly 52 per cent of the head of households were aware of the causes of the following water-borne diseases: diarrhea and dysentery. An attempt had also been made to know the morbidity pattern of the sampled households. In the sampled households the occurrence of morbidity by water-borne diseases it was found that roughly 70 persons per thousand population suffered from diarrhea, dysentery, typhoid and jaundice during the last one year counting from the survey period. It was also found that nearly 47 per cent of the sufferers were diarrhea patient and this was the top percentage followed by the sufferers who were attacked by dysentery.
After analyzing the findings of the baseline survey, NGO Forum became aware about the overall situation of its targeted areas. And accordingly, NGO Forum designed its programme activities. However, the crust of the programme began at this point. Until then, the mobilizing taskforce was merely being equipped to handle the field activity, the task of negotiating, motivating, and increasing awareness about the water and sanitation reality.
The selected thanas were representative of the country's overall village culture. People were generally conservative, and both the sexes maintained defined roles in society. It was observed immediately that to reach each and every household, measurable amount of forbearance coupled with tactful marketing techniques would be required. The Field Extension Workers were the major force in this regard since they were the front end troops. They had the arduous task of motivating the masses towards hygienic sanitation. With the kelp of flip-charts, diagrams, home-made latrine procedures, and the baseline survey questions, they gained the comfort and trust of the village dwellers at an early stage. Subsequent to that, the following activities were carried out:
This activity played a vital role in the SOCMOB project. Under this, the Field Extension Workers visited each house and intimately spoke to the house members, mainly female members about sanitation. They differentiated safe and unsafe water, explained the importance of hygiene latrines, advantages of home-made latrines, hand washing practices, etc. These household visits, personal in nature, proved to be the most effective in the social mobilization effort. A total of 1267139 households were visited under this project.
Hygienic Latrine Construction
It is widely recognized that hygienic disposal of human excreta and safe water are the prime elements for improvement of public health and conservation of environment which have a twisting relation with the total development of the society. Nevertheless, construction and use of the hygienic latrines for defecation by all the members of family was a crucial part in the overall design of the programme. During each household visits, this idea was instilled
in them. Any pit latrines with cover, water-seal ring slab latrines, and septic tank latrines were used as examples of usable hygienic latrines. Pit latrines were easy to make using available and inexpensive material, the Field Extension Workers insisted. After the initial household visits, the construction of latrines was promoted and supported by the programme. The Field extension Workers maintained a contact liaison with the government department (DPHE) and NGO Forum to assist motivated house members to build ring slab water seal latrines. By the end of the programme, the average number of latrines constructed stood at 93 per cent.
Usage of Latrine by All Family Members
Although the usage of latrine in rural areas of Bangladesh is poor, but the relation between personal hygiene and health is very close and maintenance of personal hygiene is highly dependent upon sanitation facilities. Thus set of latrine is not enough, rather proper use of latrine by all members of the family should also be ensured. Keeping this objective in mind, the Field Extension Workers in addition to motivating people for construction of latrines employed all their efforts to increase the number of users. During the baseline survey about 59 per cent of the households were found using latrines by all members of the family. But after one year intervention the number of users got up to 90 per cent which could be assumed within acceptable range.
Hand Washing after Defecation
Unclean hands are one of the leading causes for the transmission of diarrheal diseases. Therefore, it is incumbent on all that hands are cleaned after defecation to avoid any risk of transmitting diseases. The baseline survey indicated little awareness in this area. Through rigorous motivational efforts, a behavioral change was observed. The number of people washing hands with soap, ash or soil went up from 61.9 per cent to 92 per cent within the entire targeted population.
Cleaning and Maintenance of Latrines
It has been found from empirical experience that the ultimate goal of the water and sanitation programme i.e. the reduction of some water and excreta borne diseases, could not be achieved if the infrastructure components are not maintained and cleaned in a hygienic way. Personal hygiene and health is hugely dependent upon proper sanitation practice and regular cleaning and maintenance of latrines. Keeping this objective ahead, the Field Extension Workers motivated people for regular cleaning and maintenance of their latrines in a hygienic way. During the baseline survey 10.7 per cent of the households were found cleaning and maintaining their latrines regularly. But after strong motivation by the Field extension Workers during one year of project duration, the percentage increased up to 52 per cent.
Sources of Water for Different Purposes
Although the primary concern of the project was sanitation, the relation between water and health were kept in mind. Safe drinking water is specially important for the Guinea worm disease and various types of diarrhea. Guinea worm has only transmission route and can be successfully interrupted to zero prevalence, just by drinking only uncontaminated water. Thus drinking water was one of the most important indicator in regard to general hygiene status of the households. Although the proportion of the population using safe drinking water has increased significantly over time, the cultural practices of using surface water for cooking, washing and bathing has virtually remained unchanged in the rural areas of Bangladesh. So tubewell water for drinking purpose is not enough, rather proper use of tubewell water for all other domestic purposes should also be ensured. Keeping this objective in mind, the people were motivated and educated to use tubewell water for drinking and all other domestic purposes. It has been observed that there was significant change in usage of tubewell water for drinking purpose as well as all other domestic purposes. During the baseline survey it was found that roughly 82.3 per cent of the households in 20 thanas are using tubewell water for drinking purpose and about 19.2 per cent of the households are using tubewell water for domestic purpose. The percentages increased to 97 and 46 respectively after the subsequent follow-up visits at the households by the Field Extension Workers.
Increased Awareness in the cases of Diarrhea and Dysentery
The all encompassing goal of the water and sanitation programme was the reduction of water and excreta borne diseases. Research shows that while approx. 50 diseases originate from unhygienic latrines, 80 diseases are originated from pollution water. One third of child mortality is caused by diarreal diseases. These basic facts were conveyed to the dwellers on those areas. Through creative and joint motivational efforts, this message was propagated throughout the entire target population. The subsequent survey found the number of people aware of water and excreta borne diseases rose from 51.4 % to 73%.
Social Mobilization for Sanitation Programme through Inter-Agency Collaboration
To successfully carry out a massive social mobilization of this nature requires creative marketing techniques. In a rural setting, such marketing maneuvers would include community participation, unimposing approaches, institutional participation, joint alliances with cultural and religious elite, cautious dealings with religious issues, mutual respect, and occasionally reasonable force. The following is a list of activities and other party involvement in the SOCMOB project:
NGO Orientation and Agreement
A participatory orientation workshop with members of the partner NGOs were held. The purpose of the workshop was to discuss in details the modus operandi of the SOCMOB project and role of partner NGOs in it. Subsequent to the workshop, the implementation plan was prepared and the formal agreement on the roles and responsibility was signed.
Small and Large Group Meeting
The Field Extension Workers regularly visited 40 to 50 households in a day and during those visits usually they met female members of the households, since the male members of the households were mostly engaged in their work outside home. The male members of the households, visited by the Field Extension Workers once a week, were invited for a group meeting. There were two types of meeting -small group and large group. In most cases 5 to 10 grassroots people participated in those small group meetings while the large group meetings were organized with the participation of 10 to 20 participants. Most of the meetings were conducted with the participation of female members of the households and sometimes male members of the community also attended in these meetings and such types of group meetings were generally conducted on the first day of the following week or as and when needed. The sanitation and hygiene related messages were conveyed to the participants (household members) by the Field Extension Workers in those meetings. This was the primary method by which the Field Extension Workers educated and motivated the people for improved sanitation and hygiene practices. During the project period a total of 43719 small group meetings and 17989 large group meetings were conducted in 20 thanas.
Village Level Discussion Forum
The Village Level Discussion Forum was initiated before embarking of the core programme. This included the people from the grassroots where they were addressed by the local influential and the NGO representatives. Such forum helped to get people's commitment and their general acceptance regarding the essence of messages provided intensively by the Field Extension Workers and Field Supervisors. This process continued as a platform for constant feed-back for taking corrective measures at the later phase of programme implementation. During one year intervention on an average 1928 discussion forums were arranged in each of 20 thanas.
Formation of Village Sanitation Development Committee
During the project period a total of 2614 Village Sanitation Development Committees were formed in the project areas. Those committees included the grassroots people where they were addressed by the local influential persons and the NGO representatives. One opinion leader from the community was selected as the Chairman of this committee. This committee regularly followed-up the total SOCMOB activities of the respective villages and undertook necessary measures, if any discrepancy had arrived. This committee also helped to get people's commitment and their general acceptance regarding the essence of messages provided intensively by the Field Extension Workers and Field Supervisors. During the one year intervention on an average roughly 294 meetings in each of the 20 thanas were organized by such committees.
Formation of Union/Ward Sanitation Committee
In 20 thanas a total of 179 Union Sanitation Committees were formed. The objective of formation of such committee was to gain cooperation of all concerned sectors for identifying the problems and also for taking remedial measures. Those committees were formed comprising from all concerned departments (government, non-government, autonomous and opinion leader), and the Union Council Chairman were made the Chairperson of this committee. During the project period a total of 531 union sanitation committee meetings were arranged in 20 SOCMOB thanas. A total of 822 Ward Committees were formed and those used to arrange meetings regularly for discussing about their related issues.
Union Level Discussion Forum
In the project area, a total of 357 Union Level Discussion Forums were organized for getting people's commitment and their general acceptance of the SOCMOB project's activities as well as objectives, which provided intensively by the SOCMOB staff. This forums included the Union Council Members, Chairman, teachers, local elite and the people from the grassroots. This process also continued as a platform for constant feed-back for taking corrective measures at the later phase of programme implementation.
Thana Level Workshop
At the beginning of each phase one-day Workshop was arranged in each and every thana with a view to involving people from all walks of life in the project activities and to formulate effective plan and methodology for implementing the project at the field level. The workshops were attended by the representatives of the local electorate, teachers, representatives from the govt. and other bodies, religious leaders, local elite.
Formation of Thana Advisory Committee
A total of 20 Thana Advisory Committees were formed to gain cooperation from all concerned sectors of each thana, to identify the problems and to take necessary measures to resolve those problems. Those committees were formed comprising representatives from all concerned departments and the Thana Nirbahi (Executive) Officer of each thana was made the Chairperson for each thana advisory committee. During the project period a total of 78 meetings were conducted by such committees in 20 thanas.
Coordination Meeting with Government Departments and NGOs
To ensure support and cooperation from the concerned sectors, the Regional Officer of NGO Forum, Thana Coordinators and Field Supervisors maintained close liaison and contacted with district and thana level government officials and NGOs working in the thana. Union Council Chairman and local elite were also contacted and a good working relation was established with the Union Council Chairman, DPHE and government thana administration. During the project period, 40 such meetings were arranged.
Meeting with Teachers
One-day meetings with School Teachers were conducted at the union level to reinforce school based discussions and to motivate teachers for getting involved directly with the programme. The other important objective of such meeting was to create a mass awareness and to enforce the sanitation concept in the project area. During the project period, a total of 244 meetings with teachers were organized by the Thana Coordinators and Field Supervisors in 20 SOCMOB thanas.
School Based Discussion Forum
To ensure support from primary and secondary School Teachers and Students, the Field Supervisors and the Thana Coordinators conducted school programme with support of the concerned Teachers and partner NGOs. This activity was implemented with a view to involving the students and teachers of the schools for transmitting project related messages among their respective families. There was a provision to organize a consequent follow-up system of the School based Discussion Forum which helped them in sharing their knowledge to their own community regarding sanitation and hygiene practices. During one year intervention on an average roughly 191 School based Discussion Forums in each of 20 thanas and a total of 1146 school programmes were followed-up in 20 thanas.
Discussion Forum with Imams and Imam Training Workshop
One-day Discussion Forum with Imams - the religious leaders - were conducted at the union level to reinforce mosque based discussions and to motivate them directly for getting involved with the programme. Another important objective of such discussion forum was to eradicate dogmatic notions and disbelief of the community so that those issues do not become a hurdle on the way of the progress of the project. During the project period a total of 170 meetings with Imams and 1564 mosque based discussion forums were arranged by the Thana Coordinators and Field Supervisors in 20 thanas. With the same objective 3 Imam Training Workshops were also organized where Imams of 20 thanas participated.
To sustain and uphold the achievement of any project, follow-up is an essential tool for continuous tabbing to the beneficiaries. Keeping this view in mind subsequent follow-up to the constructed latrines were done and during the total project period roughly forty five thousand and six hundred constructed latrines were followed-up by the Field Extension Workers and Field Supervisors in 20 thanas.
Meeting with Ansar-VDP and with the Union Council
This exercise was also a part of the motivational and sharing activities of the SOCMOB project. As the goal of this project was to disseminate the related important messages to each and every group and members of the society, so Ansar-VDP (the law and enforcement authority of the government) also were the target group of the SOCMOB activities. To gain maximum support from them the Thana Coordinators and the Field Supervisors of the respective thanas regularly participated in the monthly meetings of the Ansar-VDP. A total of 22 such meetings of the Ansar-VDP were attended by the Thana Coordinators and Field Supervisors. Apart from those, a total of 40 meetings with Ansar-VDP were conducted in 20 SOCMOB thanas during the project period.
Meeting with the Groups of Partner NGOs
To promote improved sanitation and hygiene practices through the group members of the partner NGOs, roughly 658 meetings were conducted by the Field Supervisors and Field Extension Workers. This meeting included the group members where they were addressed by the respective concerned partner NGOs. Such meeting helped to get group members' commitment and their general acceptance to the SOCMOB activities and objectives. This process was also continued throughout the project period as a bench for constant feed-back for taking corrective measures.
To propagate messages regarding hanging latrines, open latrines and hygienic latrines among the entire population of the project areas, Miking activities were carried out intensively. This Miking exercise was found very much effective. The people responded in this connection to a great extent when they were called upon to demolish open/hanging latrines and replace those by hygienic latrines. A tremendous success was achieved in constructing hygienic latrines among the community using such type of activity. During the project period 515 times of miking activity was carried out in 20 thanas.
To create a mass awareness and to enforce the sanitation concept in the project areas Rallies were arranged at the village/ward level. The rallies were participated by the school children, teachers, government health workers, union council members, Ansar-VDP members and others. On an average nearly 27 rallies were arranged in each of 20 thanas during the project period.
Documentary Film Show
Audio-visual media are generally very much liked by the community people, and it has already proved as an effective media for motivating the target people. Accordingly, video shows were shown at the community and schools of the project areas as and when needed. A total of 170 film shows were shown in 20 thanas during the mentioned period.
Postering (posturing N?)
During the reference period various communication materials viz. posters, flip-charts and leaflets designed and developed by NGO Forum in conjunction with UNICEF and DPHE, which were duly used for motivating people on safe water use, sanitation and hygiene practices. On an average roughly 23633 posters were displayed at different important communicable angles in each of 20 thanas.
To strengthen the hygiene education with special emphasis on sanitation, street meetings were organized where every group and member of the society had actively participated. 123 meetings in 20 thanas were arranged during the project period.
Monthly Meeting of the Family Planning Workers, Health Workers and Women's Rally
Since the goal of the project was to disseminate the related messages to each and every group of the society, the health & family planning workers and women were also considered as the target groups of the SOCMOB activity. To get maximum support, create mass awareness and to enforce the sanitation concept in the project areas, a total of 24 monthly meetings with the family planning workers, 33 monthly meetings with women health workers, and 24 women's rallies were arranged in the project areas during the period.
There were some families in every thana which were not being motivated by only one Field Extension Worker. In those cases, a team was being made comprising of Field Extension Workers, Ansar, VDP, school children and local elite of different villages engaged in motivating those families about the positive sides of latrine construction. The members of those families became motivated as they saw that the people from different strata had been guiding them for developing something positive that ultimately was beneficial to them. And following this way the target was achieved through the Team Work of the social bodies. All the 20 thanas were covered with the positive result through a total of 1713 team-work.
Monthly Co-ordination Meeting
Monthly co-ordination meeting was conducted to help all staff who were involved with this project. The objectives of the meetings were to review the progress of the project, identify the problems, formulate possible ways and means to resolve those problems and to exchange views and experiences. In those meetings progress reports were collected through structured formats distributed earlier to the Thana Coordinator and Field Supervisors. Those progress reports were submitted to the NGO Forum Regional Office and after processing, the NGO Forum Regional Office used to send those reports to the NGO Forum Head Office for the necessary measures.
Though the home-made pit latrine was promoted first, but an increased demand for ring-slab water seal latrine had been generated in the project areas. There were some areas in the projected thanas where no NGOs had any programme activities. And as a result, there was no production center of ring-slab water seal latrine. In this situation, to ensure the supply of ring-slab latrine NGO Forum advised the local people to set-up ring-slab production centers by themselves. For this purpose, NGO Forum imparted necessary training to the local people. In this way some local private ring-slab production centers were established. And thus, the demand of the community people was met.
The flow process of this SOCMOB project is shown in the Annex-D.
Supervision of Activities
Supervisory supports of the staff were carried out at all levels. Each Field Supervisor directly supervised about 6 to 7 Field Extension Workers working under him/her. The Field Extension Worker submitted his/her monthly work plan to the concerned Field Supervisor in advance for the forth coming month specifying his/her day to day activities, number of households and the location of the households, that the Field Extension Workers showed in their monthly work plan. The Field Supervisors reviewed the activities of the Field Extension Workers in monthly meetings. The Field Supervisors used note and pointed out the success and failure of the Field Extension Workers, and suggested accordingly to overcome those problems, if any, during next visit. The Field Supervisors were also holding a coordination meeting with the Field Extension Workers as and when needed under his/her operation area.
Each Field Supervisor regularly prepared and submitted his/her action plan/tour programme to Thana Coordinator for the forth coming month based on the action plans of the Field Extension Workers. The Thana Coordinator supervised the activities of Field Supervisors and the concerned Field Extension Workers. He paid regular visits to the working areas of the Field Supervisors and Field Extension Workers. The Thana Coordinators were responsible for overall management and supervision of all field activities in their respective thanas. The Regional-in-Charges of NGO Forum's Regional Offices used to visit the programme areas frequently and observed the work of Thana Coordinators, Field Supervisors and some times also of the Field Extension Workers. He supported and assisted Thana Coordinators in their supervision of Field Supervisors and Field Extension Workers. He reported back to the Director and the Monitoring Officer of NGO Forum' Head Office.
At all level regular information flow was established and the coordination and monitoring system appeared to perform better.
Activities of the Field Extension Workers were monitored for assessing the impact of their motivational works at the household and community level. They recorded current status of the households in monitoring formats. This monitoring format indicated the changes occurring due to motivating and reinforcement by the Field Extension Workers visit to the households. Based on this visit record a regular reporting system was developed. In this connection a performance reporting format was prepared and supplied to the Field Extension Workers. Those formats were updated after paying visits to the households.
The monitoring and performance reporting formats indicated the changes occurred as a result of training and reinforcement activities by the Field Extension Workers also. In the concerned regional offices, all progress reports were processed and checked. The changes of each of households were regularly monitored from the progress reports of the Field Extension Workers. The Thana Coordinators, the Field Supervisors and the Regional Officers of NGO Forum used to visit the field areas regularly to monitor the performance of the Field Extension Workers. Along with monitoring formats programme monitoring activities were included, such as the meetings of the Field Extension Workers with the Field Supervisors; the Field Supervisors meeting with the Thana Coordinator and the Regional Officers.
The level of performance on the output of the SOCMOB project is given in the Annex-E.
An external evaluation was carried out through UNICEF appointed evaluator at the end of each phase to verify the field reports and to assess the impact of the intensive Sanitation and Hygiene Promotion programme in the projected areas.
Specific Objectives of the Evaluation
* To evaluate the effectiveness of the programme in terms of mobilization of partner NGOs and their role in sustaining the progress after the withdrawal of NGO Forum.
* To evaluate the effectiveness and sustainability of the programme approach and the methodology adopted to motivate the people to bring about the desired behavioral changes in hygiene and sanitation practices.
* To measure the degree of knowledge on sanitation, hygiene and transmission of diseases.
* To find out the level of personal hygiene practices.
* To find out the level of use of safe water for all domestic purposes.
* To find out the level of hand washing practices with soap/ash or soil before handling food and after defecation.
* To find out the physical achievements and quality of construction in terms of Home Made/Water Seal/Any other hygienic type of latrine constructed by people.
* To find out the level of use of sanitary latrine for defecation by all members of the household including disposal of children faeces.
The Major Findings of Evaluation
* The five messages of the programme as increased use of safe water, use of hygienic latrines, washing hand after defecation by using soap, ash or soil, keeping the latrines clean and usage of latrine by all members of the family have been disseminated effectively to the target population of the programme area.
* A general trend of gradual conversion from home-made latrines to water-seal latrine is evident in the project area.
* Women contribute much more in household sanitation than others. Cleaning and maintenance of latrines are generally carried out by them.
* During evaluation survey 93 per cent of the households were found having hygienic latrines.
* About 98 per cent of the respondents were found washing hand hygienically after defecation using soap or ash or soil.
* About 62 per cent of the latrines were found having ash or soap pot.
* About 73 per cent of the family members were found using latrines. This figure does not include children under five. About 39 per cent of babies' faeces are disposed off in the latrine while 61 per cent in open places, in bush or in ditches.
* About 60 per cent of the latrines are regularly cleaned while 24 per cent are irregularly and the remaining 16 per cent are never cleaned.
* Over 97.9 per cent of households were found using tubewell water for drinking and 27.26 per cent for washing purposes.
* Almost cent per cent of the respondents wash hands before eating and handling foods but mostly with water. A very insignificant percentage (<5 per cent) use soap.
* About 96 per cent of the respondents were found aware of the causes of diarrheal diseases.
* As regard physical quality of latrines over 96 per cent of the water-seal latrines were found with stable pit and firm floor condition, while 49 per cent of the home-made latrines were found with collapsing pit and 56 per cent with unstable floor condition.
* Involving all concerned agencies and local institutions and bringing all of them in a forum to draw supports and address various sanitation issues are a pre-requisite to achieve envisaged sanitation goals.
* Selection of appropriate communication channels proved important for effective propagation of message to a particular community.
* Intervention from within the community proved more effective than external intervention. Selection of Field Extension Workers from the concerned locality was instrumental in ensuring successful community work.
* Interpersonal communication through household visits was more effective compared to other approaches.
> Baseline survey provided an overall scenario of existing conditions. The survey became the basis for the project's action plan and strategy.
> Recruitment of female Field Extension Workers proved to be effective in building consensus among female household members.
> Detailed action plan and a linear reporting structure ensured a balanced functioning of the project.
> Household visits were the most effective mean of propagating the sanitation message.
> Internal intervention is more effective than external intervention. Selection of Field Extension Workers from the locality was instrumental in ensuring successful completion of the work.
> Involving local social and cultural elite such as teachers, Imams, opinion leaders, ANSAR-VDP to generate enthusiasm and help spread the message was another crucial effort in this project.
> Involving local community based NGOs who have string working bases proved to be helpful.
> Demonstration of latrine construction was a successful activity. Part of the population constructed its own latrines after learning from the public demonstration.