WASH Needs Assessment

Transcription

1 WASH Needs Assessment SURVEY REPORT KHOST PROVINCE, AFGHANISTAN 6-21 April, 2016 Analyzed and reported by: Ammar Orakzai Emergency and WASH Advisor (PAK/AFG) NCA Pakistan & Afghanistan 1

2 Table of Contents Executive Summary Background.4 1.1Introduction WASH Project and Operation areas Funding Objective of survey Methodology Summary of Findings Water Supply Main Sources of drinking water Water Use Water collection and transportation Water storage Water Treatment Sanitation Defecation practices Hygiene Hand washing practices Materials for hand washing Knowledge on hand washing Solid wastes Management Knowledge and practices on hygiene/sanitation Bathing practices Oral Hygiene Diarrhea incidence Malaria Incidence Acronyms Survey Tools

3 Executive Summary Khost, a province of Afghanistan in the eastern part of the country, is bordering Pakistan's Federally Administered Tribal Areas (FATA) and with a population of 546,800 (mostly tribal society) has yet again, due to continued conflict in the area, experienced a high influx of refugees from Pakistan, many cared for by local host communities. Responding to this influx has put a strain on the communities and the infrastructure in the villages. NCA has recently completed a twelve month CHF funded relief programme to assist refugees in this province, targeting 9,800 beneficiaries. NCA and CoAR (implementing partner) conducted a primary needs assessment in April 2016 targeting 15 villages of Gurbez and Tani districts where the majority of refugees live in spontaneous camps (69% - established in isolated areas) and where refugees are residing with host communities (30%). 73% of refugee families interviewed in self-settled camps reported that they collect insufficient water quantities (less than 15 liters per person per day) from distant unprotected springs, open wells and surface water. Close to 80% of the refugees have inadequate size and type of water storage facility, 79% of respondents don't treat water before drinking while in 21% of cases, women practice a form of treatment to control water turbidity but by unhygienic cloth filtering. Water is mainly collected by women and children (young girls) who report that they feel insecure when they go to collect water due to the presence of men not known to them and threats of wild animals. To meet the water needs of large families, women go at least three times a day to collect water, and this considerably reduces the time women and girls have available for other activities. 92% of the refugees lack access to latrines and practice open defecation. Safe, lockable and well-lit latrines are not available for women and children. Night-time trips to fields for defecation and bathing puts them at risk of physical attacks and sexual violence. Hand washing facilities and soaps are non-existent. As a result, high prevalence of sickness among children is noted. Children below the age five are particularly exposed to water borne diseases such as diarrhea and measles To have a better understanding of the WASH needs of these communities, both quantitative and qualitative survey tools were designed. Through a consultative process with NPO/RRAA, a structured household-level questionnaire, composed of 51 WASH-themed questions, and WASH question-guides for focus group discussions (FGDs) and key informant interviews (KIIs) were finalized. All survey tools were originally developed in English and then translated in Pashtu, the dominant language of Khost province. The Sphere Project, Do No Harm, the ACT Alliance Code of Conduct, and the International Rescue Committee's Environmental Health Field Guide, were all used as reference documents in the elaboration of the survey tools. The refugees and host communities that participated in the rapid needs assessment are currently living in extremely poor and life-threatening conditions. In most cases, families are living in spontaneous settlements with more than five families living together is each demarcated compound. The survey has captured the WASH needs in more details which will be followed in separate sections in the report. 3

4 Water Supply: Up to 94% of population in Khost Province gets water from open springs, surface sources and hand pumps that are unprotected and 6% alternatively also use protected hand pumps for drinking and household purposes. 54% also depend on surface water and 28% on open springs (87% in total) Sanitation: 92% in Khost do not have a latrine and practice open defecation. Hygiene; Hand washing at the most critical times is very poor. About half 40% of the population do not wash hands during the key times and 55% of the respondents wash hands with water only. 86% do not have any dedicated hand washing facility at HH level. Solid wastes Management: 72% of the total population interviewed do not practice suitable solid waste management. 57% said that they throw the household wastes anywhere they can and 23% said they throw it in a pit near the compound. Diarrhea incidences: 43% had a household member who suffered from diarrhea in the last two weeks. Malaria Incidence: 30% informed they were suffering from Malaria. (Anecdotal) Recommendations: 1. There is need to increase awareness to people on the danger of drinking water from unsafe water sources which is the root cause of many diarrheal and water-borne diseases. Messages should discourage the use of rainy season surface water sources. 2. Appropriate times must be designed for women for hygiene sessions. It has been seen women are everyday being overburdened with domestic work and hence do not have time to attend hygiene sessions yet they are expected to be the role models on good hygiene/sanitation practices at the household level. 3. Targeted gender approaches need to be developed for both provinces and the women outreach is difficult in terms of information sharing and participation. 4. There is need for intensive campaign on hygiene/sanitation to strongly discourage open defecation which is a predominant practice among the population targeted. 5. The communities also need to be encouraged on other hygiene practices such as having rubbish pit, and taking care of oral hygiene. 6. Special campaigns should be arranged on diarrhea and its link to malnutrition 7. Field staff should as much as possible spend maximum time with the community to mobilize, aware and slowly transform the entire population from bad to good hygiene/sanitation practices. 8. In the targeted areas of Khost, proposed latrines (temporary VIP structures) are suited whereas 9. Most suitable solution for water supply is protection of springs and surface water is the most widely used. 1. Background 1.1 Introduction NCA Global: Norwegian Church Aid (NCA) is an independent humanitarian organization working for people s basic needs. NCA is founded on the belief that all human beings are created equal with the same human dignity. NCA was established in 1947, to work for the poor and vulnerable, and was mandated to be a professional and reliable channel for the resources available and to raise resources for humanitarian assistance to people in need. NCA provides emergency assistance in disasters and works for long-term development in local communities. In order to address the root causes of poverty, NCA advocates for just decisions by public authorities, businesses and religious leaders. For further details please see As a civil society organization NCA aims at developing relationships with local organizations that know the conditions and culture better than any international organization. A sustainable and conflict sensitive approach characterizes all of NCA s activities. NCA global program intervention is summarized as follow. Development aid (64.9%) 4

5 Emergency relief (24.3%) Advocacy (10.8%) NCA Afghanistan: Since the 1970s, Afghanistan has faced a set of insecurity, development and human rights challenges, and there is increasing uncertainty about the continued international engagement and support after The initial stability brought by the international intervention after 2001 have gradually been replaced by a worsened security situation in large parts of Afghanistan, uneven development opportunities and increased levels of corruption, continued human rights violations, and major concerns relating to democratization and governance. NCA has been working in Afghanistan for 30 years, under different political regimes. Current key programs for NCA s activities in Afghanistan are as follows: Women Peace and Security Value Based Communities and Peace Building Climate Change Mitigation Livelihood and Trade Water Sanitation and Hygiene NCA is a partner based organization which implements projects through national NGOs in Afghanistan. The national partner organizations of NCA implement programs with NCA funds in Uruzgan, Daikundi, Faryab, Khost and Kabul and they are present in nearly 30 provinces of Afghanistan. The low presence of NGO actors in these areas raised a need for development intervention due to remoteness and the potential to contribute towards peace and stability. Despite difficult access into the mentioned provinces for international organizations and authorities, NCA has been able to implement programs there through its network of local partner organizations. They better understand the local contexts, culture and traditions of the communities. 1.2 WASH Project and Operations Areas As a result of the primary needs assessment conducted by NCA and CoAR, the proposed project Will address the urgent and unmet WASH needs of refugees and host communities in 09 villages (out of 15 assessed) of districts Gurbez and Tani, Khost Province. The proposed project is an extension of the completed project in the same locations with focus on new refugee influx. The project will reach 18,760 refugees living in spontaneous settlements and host communities in Khost and 16,800 host ensure that beneficiaries have 1)Improved access to adequate sanitation facilities 2)Improved access to safe water supply 3)An increased understanding of key health risks related to WASH and adopt positive hygiene practices to prevent diseases transmission. Open defecation is practiced by 92 percent of the potential beneficiaries in Khost who do not have access to sanitation facilities. Construction of lockable latrines with hand washing facilities in communities and households will mitigate waterborne diseases, ensure privacy and security of women and children, and give easy access for the elderly and disabled. As bathing facilities are almost non-existent in all areas (97% do not have access), they will be built to improve personal hygiene practices and conditions. Facilities will be located in well-lit areas for safety preferably for each HH with large size. Water sources in the target areas are insufficient and unsafe. To meet need for adequate and safe water supply, wells will be chlorinated, open springs will be protected with piped access to communal collection points, and a system for regular water testing will be set up. To reduce burden on women and girls who spend many hours collecting water today, hand pumps will be located in the communities. Appropriate sizes of carrying cans will aid women and children in collection. Activities to promote good hygiene practices will be done to reduce health risks and to foster resilient bodies and minds. With participation at core, promotion activities will emphasize prevention of diarrhea, hand washing, menstrual hygiene, infant and young child feeding (IYCF), water treatment, food storage and waste disposal. Promotion activities will be accompanied by the distribution of hygiene NFIs. WASH committees will be composed of men, women and children. 5

6 1.3 Funding NCA has submitted a concept to Ministry of Foreign Affairs Norway with a budget of 5.4 million NOK with 18,760 refugees as planned direct beneficiaries of the project and 16,800 indirect host beneficiaries. 1.4 Objective of the survey NCA Emergency & WASH program conducted the baseline survey to ascertain the knowledge, attitude and practices of the target population on water supply, sanitation and hygiene before it implements its program activities. The Baseline will be used to plan, monitor and evaluate the project effectively and also to identify gaps areas where specific strategies could be developed and implemented. 2. Methodology KAP questionnaire and FGDs were used to collect the data. NCA Emergency WASH team and enumerators provide by partners were used for the data collection. The survey was conducted in the month of September but pre- project situation was captured. The survey took a period of 2 weeks. The KAP baseline used a mix of purposive (in order to cover scattered settlements of particular types) and random sampling method for the survey. The survey will took a sample size of 383 (calculated based on the formula mentioned below) for a population of 20,587 individuals. It was representative of geographical locations, income groups, gender, age, tribe, disability and type of settlement. 5% of the questionnaires were triangulated to verify the validity of information. Sample Size Z 2 * (p) * (1-p) sass = Where: c 2 Z = Z value (e.g for 95% confidence level) p = percentage picking a choice, expressed as decimal (.5 used for sample size needed) c = confidence interval, expressed as decimal (e.g.,.04 = ±4) Correction for Finite Population new ss = ss-1 1+ ss pop Where: pop = population 6

7 Province District Village Target population Weighted average Sample size Final Sample size Patholan 678 3% Nari Pashan % Bismiuladin Kaski % Gardi Kaski % Gurbez Kaski 815 3% Marmandi % Alamgi % Khost Shikh Amir % Sharshi % Etman % Soorkot % Tani Sanaki 586 2% Sangari % Nariza 642 2% Shirkhil 271 1% Total % Limitations 1. It is difficult to find skilled enumerators in the area; therefore available low skilled enumerators were used who are often too slow and time consuming. WASH Coordinator and Emergency Program Officer constantly supervised the survey teams in the field to maintain the quality of data collection. 2. Uncertain security situation can be a major problem hindering the plan and affecting access to the desired locations 3. Timing could also be a problem if not communicated to the communities beforehand. 4. Climate could also be a problem sometime but allowing the teams to be in field as planned 3. Summary of findings The assessment was conducted in 15 villages from in Districts Gurbez and Tani in. The communities identified were mapped during the assessment and visited by survey teams. Khost has received a new high influx of refugees from Pakistan due to military operation against militants in Waziristan. These areas are also highly challenging in terms of access to WASH facilities. The assessment conducted in the 15 villages will also serve as a baseline for the proposed project. The survey was conducted between 8-12 April, 2016 by the WASH Program Coordinator, Emergency and WASH Advisor (Expat) and Partner staff. During this survey pre-project situation was captured in order to monitoring project developments. 379 households were interviewed during the survey, which included host families and refugees in a period of 14 days followed by analysis and report writing. 7

8 4.0. Demographic profile: Nos. Particulars Khost 1 Type of respondents Refugees 98% Host 2% 2 Gender of the respondent Male 59% Female 41% 3 Marital Status Single 7% Married 90% Window/er 3% 4 Age bracket of respondent years 3% years 69% years 24% 60 years and above 4% 5 Role of respondent in HH Wife 32% Husband 55% Brother of the husband 1% Sister of the husband 1% Daughter 4% Son 3% Grand parents 4% 6 Gender/sex of head of HH Male 88% Female 12% 7 Average Age distribution in HH 0-5 years 25% 6-17 years 33% years 31% 60 years and above 11% 8 Type of residence Privately owned 1% Living with host communities 30% Rental accommodation 0% Spontaneous settlement 69% 8

9 1% 1% 6% 4% 3% 3% 8% 6% 9% 9% 19% 19% 28% 29% 59% 61% 69% 69% 3.1 Water Supply Main sources of drinking water 94% of the respondents get their drinking water from unsafe water sources (unprotected hand pumps or unprotected springs and surface water). 5% pay for water being delivered at their homes. This indicates that the use of water from open sources only diminishes when not available. Almost 6% still depend on protected water sources such as protected hand pumps and dug wells that are most likely to be contaminated due to its sanitary conditions and siting. Drinking Cooking Laundry Hygiene Water Use The graphs shows water consumption at HH level. 73% of respondents consume less than 15 litres of water per person per day. 3% consume less than 20 litres at HH level, 18% consume between litres at HH level and 35% consume litres for an average family size of 7 individuals which makes the average water consumption less than SPHERE minimum standards in an emergency. 44% still consumes more than 75 litres in a HH ranging from litres per person per day. less than 20 litres litres litres More than 75 litres 44 % 3 % 18 % 35 % 9

10 3.1.3 Water Collection and transportation Women (including girls) predominantly collect the water for the everyday use in the household with 54% of the total share. This is followed by boys (24%) and adult men (19%). 24% of the respondents said that the nearest water source is within 500m. 39% responded that the water source is between 500m 1km away, 33% mentioned the distance between 1-3 KMs and 4% mentioned the nearest water source to be more than 3kms away. 19% of the respondents who mentioned the distance to nearest water source to be within 500m, takes more than 30 minutes due to difficult terrain whereas remaining within 500m 500m - 1 KM 1-3 KM More than 3 KM 33 % 30 minutes. There is need to increase the number of water sources. 4 % 39 % 24 % Adult men Adult women Boys Girls Others 27 % 24 % 3 % 19 % 27 % 5% takes 15 minutes. 36% of the population takes 30 mins to 1 hour to collect water, 47% takes mins and 6% takes more than 1 hour. The mentioned time includes collection and travel time (back and forth). 11% takes less than 15 minutes. The aforementioned figures also implies that 54% women (including girls and adult women) are being overburdened with domestic work. 58% of the respondents travelled less or about half an hour to the nearest safe water source to fetch water. This indicates that about 42% do not fall in within the Sphere standard of less than Queuing time at the Water source 64% of the total respondents spend minutes to get water from the water point. 26% spend minutes and 10% more than one hour to fetch the water. 64% spend less than 15minutes. Spending more time on queuing (36%) is indicating that inadequate water points or inadequate yield of the water points serve the population. It can cause the lack of water intake per capita and contributes to the burden of work for women. Jerry cans are the predominant containers (49%) followed by buckets (45%) used for collection and transportation of drinking water. 10

11 3.1.4 Water Storage 7% of the respondent use jerry cans for storage of drinking water. Meanwhile 31% use plastic buckets and 25% use clay pots. Only 19% use drum/barrel for storage of water. 17% use other storage containers not fir for storage. It was observed during the survey that the water storage containers were not covered (58%) while in other instances some were covered and some were not (42%). At the same time more than 69% of the containers were not clean. The use of open buckets and pots without a lid is a poor practice simply because water can Jerry can Bucket Drum/Barrel Bottles Basin Clay pots Other easily get contaminated. Additionally, dipping method of fetching water from the storage container is a practice among only 31% the population, which can also lead to contamination. The general practice of the population is to wash the water containers by using water only. According the survey result 69% of the population do not WASH their containers on regular bases keeping in view the hygiene situation of the containers. 25 % 17 % 1 % 7 % 19 % 31 % Water treatment: According to the survey results, 73% of the respondents do not treat water. The remaining 27% largely depend upon cloth filtration method (47%) followed by chlorination (8%) and SODIS (8%) Only 1% treat water through sedimentation and boiling. Reasons for not treating water through the survey were being used to the water (24%), treatment being expensive (9%) and 9% thought the water they were drinking was safe. A big fraction (50%) did not know how to treat water. The figures collected through the survey shows that there is a high need for educating communities on suitable methods of treatment of water apart keeping in view the type of contamination. Water is safe Chlorination/ aqua tabs Cloth filtration Sedimentation Its expensive 38 % 11 % 23 % 25 % 3 % 11

12 3.2 Sanitation Defecation practices Khost: 92% of the respondents do not have latrines which shows open defecation is a predominant practice. Only 8% have latrines that were constructed through self-initiative. Women use isolated places in the HH to defecate while men go the open fields and bushes. The graph shows using bushes. Backyard/fields is a predominant practice (44%). 34% are contaminating the canals and rivers. 17% use communal defecation places, 7% use neighbor s latrine and 2% use plastic bag. Practice of open defecation contributes to the high occurrence Neighbours latrine Plastic bag A lot of space for defecation here Bush/backyard/field canal/river of diarrheal and other water-borne diseases (see later section on diarrhea incidence). The existing 8% latrines are mainly ditches with cover around and pit latrines without slabs. Main reason for not constructing latrines is being expensive (75%). 23% do not have any space for construction as the land does not belong to them. Regular users of latrines are shown in the graph below. 34 % 7 % 2 % 44 % 13 % Expensive No space for construction Defecation is not an issue Not a priority 1 % 1 % A lot of space for defecation here Children Women Elderly male members 14 % 15 % 0 % Elderly female member 14 % 23 % Women Only 14 % 43 % Men Only 75 % 12

13 3.3 Hygiene Hand washing practices About 42% of the respondents do not have a good hand washing practice during key times. 50% said they wash their hands during one of the three (3) critical times; 15% after defecation, 3% before preparing food and 32% before eating food. It is important to note that most of the respondents do not have a good hand washing practice after defecation (15% only), arguably the most important time to wash ones hands to prevent spread of diarrhea. The graph clearly explains responses from the respondents on hand washing times. As per the observation 98% did not have any hand washing facility available at HH level. Before eating After eating After Defecating After latrine use before feeding child After handling rubbish After handling babys feces Before food preperation After handling animals 11 % %3 % 3 %3 3 % 4 % 15 % 26 % 32 % Material for Hand washing Most of the respondents do not use soap or ash when washing their hands: 36% of the total respondents interviewed wash their hands with water only; washing hands only with water alone is not enough to stop the transmission of diarrhea. However, 6% indicated that they wash their hands with clean water and soap, 54% with ash and 4% with sand. 78% of the respondents who do not wash hands said it is expensive to buy a soap, 9% thought that water alone cleanses the hand, 8% said soap is not a practice, 2% thought it takes more time and 3% did not do it due to negligence and laziness. Water only water and soap water and sand water and ash 54 % 6 % 4 % 36 % Knowledge on hand washing About 40% of the respondents do not have knowledge on the importance of hand washing. Hand washing is done to get rid of dirt and to have clean looking hands only. 60% understands that washing hands with clean water and soap/ash is to remove/prevent diseases. 13

14 3.4 Solid wastes management Only 28% of the total respondents have a good practice on household solid management. They either collect the wastes into garbage pit/bury (23%), burn them (2%) and compost (3%). This indicates that about 72% of the total respondents do not have a good practice on solid wastes management at the household level. They throw the wastes anywhere, in land fill and rivers. The improper disposal of wastes encourages breeding grounds for disease vectors such as mosquito, flies, etc. Knowledge and practices on hygiene & sanitation is a key for improvement of situation Garbage pit/bury Composting Burn River Public disposal area Thrown anywhere landfill/ to fill lower ground 14 % 57 % 0 % 3 %2 % 1 % 23 % 3.5 Knowledge and practices on hygiene/sanitation Bathing practices About 97% of the total respondents do not show good bathing practices due to lack of facilities. Men can take a bath outside but due to privacy issue and lack of facilities women are not able to. This is mainly affecting the hygiene condition of women and leading to different diseases such as skin disease Oral Hygiene 46% of the total respondents do not clean their teeth. 54% that do mainly use Miswaq (62%), 33% use finger to clean their teeth and 5% use tooth brushes. This also shows that the community predominantly prefers using Miswaq than tooth brushes. 3.6 Diarrhea incidences Diarrhea incidences level in the Rain study area is high. About 43% of the respondents said at least Germs 2 % 3 %1 % 13 % someone in their household Flies (predominantly children under 5 19 % Dirty Hands years of age with 55% share of the total cases) had suffered from Dirty Foods 20 % diarrhea in the last two weeks Dirty Water (anecdotal evidence). This is most Part of childs growth likely as a result of lack of knowledge and predominant poor Poor Hygiene 4 % hygiene and sanitation practices. Open Defecation 27 % The pie chart below shows the 11 % understanding of the population on the causes of diarrhea. 27% of the respondents do not have any knowledge on diarrhea prevention. 11% understands that dirty hands and 19% understands that dirty water can cause diarrhea. In general, about 27% at least have some knowledge on the different causes of diarrhea. Many of the respondents say contaminated food is the major cause of diarrhea (27%). 14

15 3.7 Malaria incidences About 30% of the respondents said there were anecdotal evidence of Malaria at HH level. 43% of the cases are among the age group of 6-17 years, 26% among age group of years, 2% in age group of 60 and above and 29% in children below 5 years of age. 21% of the community do not know the cause of malaria. The graph shows different preventive measures community know about. Oil/lotion not taking dirty water/food use of smoke Proper hygiene Eliminate mosquito breeding sites Continue feeding Go to Clinic Use of bed nets 34 % 18 % 14 % 7 % 1 % 8 % 13 % 5 % 4. Acronyms NCA Norwegian Church Aid WASH Water Sanitation and Hygiene PHAST Participatory Hygiene and Sanitation Transformation CHAST Child Hygiene and Sanitation Training CHF Common Humanitarian Fund KAP Knowledge Attitude and Practices 5. Questionnaire. Assessment questionnaire 15