This action research programme is concerned with safe drinking water in rural Bangladesh – a matter of grave urgency since the discovery of arsenic in the groundwater more than a decade ago. Between 35 and 77 million users are exposed to dangerous levels of contamination, and the implementation of solutions has been slow and inadequate. Few projects have been undertaken, and even fewer have managed to develop suitable operation and maintenance arrangements, to bypass existing power relations, and to extend services to the very poor.

The aim is to understand these failures and to suggest a more successful approach. The findings come out of a safe drinking water supply programme, implemented by the Arsenic Mitigation and Research Foundation (AMRF) in several arsenic affected villages.

Description of field-level activitiesProblem and aim

Phys

ical

pro

cess Tube-well testing Site selection

Site selectionAn installation site for the water supply is selected during a village meeting. Informal talks reveal whether the choice is appropriate or not. Landownership is legally vested in the community. This step is crucial to avoid monopolisation of the water supply by the landowner.

Installation of the water supplyWith the assistance of the staff, a contractor is selected. The community provides some material and logistical support. The installation process is monitored to ensure proper installation.

Setting up an information centreA simple shed is set up and furnished with posters and information material. This will help facilitate the dialogue between staff, committee members and the community (see social process).

Setting up homestead gardeningAs arsenicosis is worsened by malnutrition, affected households are helped to establish fruit and vegetable gardens.

Data collection in the working areaGeneral geographic information is collected about a working area (usually a union or sub-district).

Tube-well screeningIn several survey villages, tube-wells are tested for arsenic (and marked) in order to identify those most seriously affected.

Technology assessmentsPrevious and present drinking water projects are assessed. Villages are selected where no other programmes are running, or where they have previously failed.

Money collection and savingsThe committee opens a bank account and collects financial contributions from water users. The contributions are not large, allowing everyone to participate. Some of the money can be used to share in the investment; some for maintenance. The committee is encouraged to meet once a month in the information centre to discuss operation and maintenance issues, the use of the bank accounts, and so on.

Maintenance of the water supplyFinancial contributions serve to buy and stock spare parts. The committee repairs the water supply whenever required. Since women are usually first to signal problems with the operation of a water supply, they have an important role in the committee. When expensive repairs are needed the committee is encouraged to collect more money from water users.

Water usersInformation centre

Tube-well marking Water supply installation Handpump maintenanceInformation centre

Studying existing water supplies Water supply installation Platform in disrepairHomestead garden

Soci

al p

roce

ss

Household survey School programme

Consultation and agreementThe implementation process is discussed and agreed upon with the community. The technologies assessed during the surveys are discussed. This leads to the selection of a water supply option.

Establishment of a committeeIn a village meeting, the staff facilitates the election of twelve committee members - both men and women. With an understanding of the local socio-economic conditions, the staff can better assist the poor and improve their representation in the committee.

Raising awarenessInformation about arsenic is initially disseminated during surveys. Later, meetings are organised to reach different social groups (courtyard gatherings, school programmes, tea stall meetings and information centre meetings). As people may be alarmed or feel powerless, simple nutritional tips are suggested.

Treatment of patientsRegular treatment is provided to arsenicosis patients identified during surveys. They are also given seeds and support for starting homestead gardening (see physical process).

Paramedic training

Orientation meetings(Non-) Governmental Organisations in the working area are visited to form an idea about who is doing what on arsenic.

Socio-economic surveyIn order to select the poorest survey village, data are gathered about the social, economic, educational and familial status of households.

Arsenicosis patients identificationTrained staff screens possible arsenicosis patients. This initial investigation may reveal more serious poisoning in some villages.

Maintenance of the committeeWith increased awareness of the dangers of arsenic, and interest in a functioning water supply, water users are more likely to keep an eye on committee members. The staff helps to motivate or replace inactive members. This is the beginning of peopleʼs control over the committee. To encourage self-monitoring in the long-term, village volunteers are selected to monitor committee members and their duties.

Follow-up treatmentArsenicosis patients still require treatment long after having shifted to arsenic-free water. Better diets through homestead gardens may gradually replace medical support. Paramedic training will help increasing people's understanding.

People's organisationsThe committee is encouraged to become a 'peopleʼs organisation' that will independently establish access to other public services (such as sanitation, education, or road construction).

Courtyard meeting

Data analysis Committee election Village volunteersPatient treatment

Patient screening Committee New road in the villagePatient treatment

OrganisingSurveying Facilitating

Select and analyse a

village

Establish drinking water and public health systems

Improve well-being through sustainable

water and health systems

Overview of field-level activities

Phys

ical

pro

cess Tube-well testing Site selection

Site selectionAn installation site for the water supply is selected during a village meeting. Informal talks reveal whether the choice is appropriate or not. Landownership is legally vested in the community. This step is crucial to avoid monopolisation of the water supply by the landowner.

Installation of the water supplyWith the assistance of the staff, a contractor is selected. The community provides some material and logistical support. The installation process is monitored to ensure proper installation.

Setting up an information centreA simple shed is set up and furnished with posters and information material. This will help facilitate the dialogue between staff, committee members and the community (see social process).

Setting up homestead gardeningAs arsenicosis is worsened by malnutrition, affected households are helped to establish fruit and vegetable gardens.

Data collection in the working areaGeneral geographic information is collected about a working area (usually a union or sub-district).

Tube-well screeningIn several survey villages, tube-wells are tested for arsenic (and marked) in order to identify those most seriously affected.

Technology assessmentsPrevious and present drinking water projects are assessed. Villages are selected where no other programmes are running, or where they have previously failed.

Money collection and savingsThe committee opens a bank account and collects financial contributions from water users. The contributions are not large, allowing everyone to participate. Some of the money can be used to share in the investment; some for maintenance. The committee is encouraged to meet once a month in the information centre to discuss operation and maintenance issues, the use of the bank accounts, and so on.

Maintenance of the water supplyFinancial contributions serve to buy and stock spare parts. The committee repairs the water supply whenever required. Since women are usually first to signal problems with the operation of a water supply, they have an important role in the committee. When expensive repairs are needed the committee is encouraged to collect more money from water users.

Water usersInformation centre

Tube-well marking Water supply installation Handpump maintenanceInformation centre

Studying existing water supplies Water supply installation Platform in disrepairHomestead garden

Soci

al p

roce

ss

Household survey School programme

Consultation and agreementThe implementation process is discussed and agreed upon with the community. The technologies assessed during the surveys are discussed. This leads to the selection of a water supply option.

Establishment of a committeeIn a village meeting, the staff facilitates the election of twelve committee members - both men and women. With an understanding of the local socio-economic conditions, the staff can better assist the poor and improve their representation in the committee.

Raising awarenessInformation about arsenic is initially disseminated during surveys. Later, meetings are organised to reach different social groups (courtyard gatherings, school programmes, tea stall meetings and information centre meetings). As people may be alarmed or feel powerless, simple nutritional tips are suggested.

Treatment of patientsRegular treatment is provided to arsenicosis patients identified during surveys. They are also given seeds and support for starting homestead gardening (see physical process).

Paramedic training

Orientation meetings(Non-) Governmental Organisations in the working area are visited to form an idea about who is doing what on arsenic.

Socio-economic surveyIn order to select the poorest survey village, data are gathered about the social, economic, educational and familial status of households.

Arsenicosis patients identificationTrained staff screens possible arsenicosis patients. This initial investigation may reveal more serious poisoning in some villages.

Maintenance of the committeeWith increased awareness of the dangers of arsenic, and interest in a functioning water supply, water users are more likely to keep an eye on committee members. The staff helps to motivate or replace inactive members. This is the beginning of peopleʼs control over the committee. To encourage self-monitoring in the long-term, village volunteers are selected to monitor committee members and their duties.

Follow-up treatmentArsenicosis patients still require treatment long after having shifted to arsenic-free water. Better diets through homestead gardens may gradually replace medical support. Paramedic training will help increasing people's understanding.

People's organisationsThe committee is encouraged to become a 'peopleʼs organisation' that will independently establish access to other public services (such as sanitation, education, or road construction).

Courtyard meeting

Data analysis Committee election Village volunteersPatient treatment

Patient screening Committee New road in the villagePatient treatment

OrganisingSurveying Facilitating

Select and analyse a

village

Establish drinking water and public health systems

Improve well-being through sustainable

water and health systems

Overview of field-level activities

The diagram shows two basic processes: a physical and a social one. The physical process relates to technological and ecological assets; the social process to human and organisational assets. The processes run in parallel, and both roughly follow the three phases of surveying, organising and facilitating. The first phase leads to the selection of a village. In the second phase, AMRF assists the community with investments in new assets, such as a water option, a maintenance committee, knowledge, skills, and so on. In the third phase, AMRF's direct involvement is reduced, as it begins to support activities leading to the sustainability of the water and health systems. The diagram represents work-in-progress, and will be elaborated as new findings emerge from practice.

Approach, processes and phases

Tube-well testing

Tube-well marking

Studying existing water supplies

Data collection in the working areaGeneral geographic information is collected about a working area (usually a union or sub-district).

Tube-well screeningIn several survey villages, tube-wells are tested for arsenic (and marked) in order to identify those most seriously affected.

Technology assessmentsPrevious and present drinking water projects are assessed. Villages are selected where no other programmes are running, or where they have previously failed.

SurveyingPhysical Process

Household survey

Data analysis

Patient screening

Orientation meetings(Non-) Governmental Organisations in the working area are visited to form an idea about who is doing what on arsenic.

Socio-economic surveyIn order to select the poorest survey village, data are gathered about the social, economic, educational and familial status of households.

Arsenicosis patients identificationTrained staff screens possible arsenicosis patients. This initial investigation may reveal more serious poisoning in some villages.

SurveyingSocial Process

Select and analyse a

village

Outcome of the surveying phase

Site selectionAn installation site for the water supply is selected during a village meeting. Informal talks reveal whether the choice is appropriate or not. Landownership is legally vested in the community. This step is crucial to avoid monopolisation of the water supply by the landowner.

Installation of the water supplyWith the assistance of the staff, a contractor is selected. The community provides some material and logistical support. The installation process is monitored to ensure proper installation.

Site selection

Water supply installation

Water supply installation

OrganisingPhysical Process

Setting up an information centreA simple shed is set up and furnished with posters and information material. This will help facilitate the dialogue between staff, committee members and the community (see social process).

Setting up homestead gardeningAs arsenicosis is worsened by malnutrition, affected households are helped to establish fruit and vegetable gardens.

Information centre

Information centre

Homestead garden

OrganisingPhysical Process

Consultation and agreementThe implementation process is discussed and agreed upon with the community. The technologies assessed during the surveys are discussed. This leads to the selection of a water supply option.

Establishment of a committeeIn a village meeting, the staff facilitates the election of twelve committee members - both men and women. With an understanding of the local socio-economic conditions, the staff can better assist the poor and improve their representation in the committee.

Courtyard meeting

Committee election

Committee

OrganisingSocial Process

Raising awarenessInformation about arsenic is initially disseminated during surveys. Later, meetings are organised to reach different social groups (courtyard gatherings, school programmes, tea stall meetings and information centre meetings). As people may be alarmed or feel powerless, simple nutritional tips are suggested.

Treatment of patientsRegular treatment is provided to arsenicosis patients identified during surveys. They are also given seeds and support for starting homestead gardening (see physical process).

School programme

Patient treatment

Patient treatment

OrganisingSocial Process

Establish drinking water and public health systems

Outcome of the organising phase

Water users

Handpump maintenance

Platform in disrepair

Money collection and savingsThe committee opens a bank account and collects financial contributions from water users. Low contributions allow everyone to participate. Some of the money is used for the investment; some for maintenance. The committee meets regularly in the information centre to discuss operation and maintenance.

Maintenance of the water supplyContributions serve to buy spare parts. The committee repairs the water supply whenever required. Women are usually first to signal problems with operation of a water supply, and have an important role in the committee. For expensive repairs the committee collects more money.

FacilitatingPhysical Process

Paramedic training

Village volunteers

New road in the village

Maintenance of the committeeWith increased awareness and interest, water users keep an eye on committee members. The staff helps to motivate or replace inactive members. Village volunteers monitor committee members and their duties. This is the beginning of peopleʼs control over the committee.

Follow-up treatmentArsenicosis patients still require treatment long after having shifted to arsenic-free water. Better diets through homestead gardens may gradually replace medical support. Paramedic training increases understanding.

People's organisationsThe committee is encouraged to become a 'peopleʼs organisation' that will independently establish access to other public services (such as sanitation, education, or road construction).

FacilitatingSocial Process

Sustainable development of water and health

systems

Outcome of the facilitating phase