Larger Project "School Sanitation and Hygiene Education in Tajikistan" / ECOLOGIA Dushanbe, Tajikistan (Started on 08-14-01)


08-14-01 Giedre Donauskaite
Dear Review Committee members,
Please review this proposal by August 30.
Thank you.

School Sanitation and Hygiene Education in Tajikistan

/ID: liksanit01/
Author: Ikram Davnorov, ECOLOGIA Project Manager, Tajikistan
Consortium Member: ECOLOGIA-USA
Budget: $30,000

Background information
Drought in the year 2000 has clearly manifested how water distribution systems in Tajikistan are in a crumbling state. More and more systems are in disrepair, and the water supply for large portions of the country, especially in rural is becoming inadequate, causing many people to use alternative and unsafe water sources such as canals. The most affected communities live in pocket of “rainfed” agricultural lands and totally depend on precipitation not only for crop production but also for drinking and other domestic purposes. Many schools are spending time and energy expenditure for collecting water. Most of the rural population (70%) never had access to piped water supply and rely on open water sources. The community’s capacity to maintain and improve water and sanitation facilities remains poor due to the excessive reliance on centralized maintenance encouraged by the former system.
Where health and hygiene education has for a long time been a formal part of the official school curricula in Tajikistan, over the last ten years it was largely disregarded. Traditionally, it focuses on covering theory and memorization of facts rather than on strengthening hygiene practices. The Government provided formal, culturally non-specific education that failed to generate interest; particularly in remote rural areas.
Since 1994, UNICEF through the NGO ECOLOGIA has been developing activities in water, sanitation and hygiene education in more than 700 schools in Tajikistan. Despite efforts by UNICEF/ECOLOGIA and other International Organizations and NGOs, the safe water supply and basic sanitation in many schools remains poor. Large numbers of rural schools and health centres have no access to sanitary facilities like latrines and hand washing facilities. Even before the civil war, environmental sanitation in rural areas was not a priority. Less than 5% of the total rural population had access to proper sewerage systems. While pit latrines are the commonly used sanitation facility. Poor maintenance of these facilities, especially at public places as schools and health centres has resulted in unacceptable hygienic conditions.

Overall the PROBLEMS can be summarized as follows:
 non-existent or insufficient water supply, sanitation and hand-washing facilities;
 toilets or latrines that are not adapted to the needs of children, in particular girls;
 broken, dirty and unsafe water supply, sanitation and hand-washing facilities;
 children with poor hygiene and hand-washing practices.

Under these conditions, schools become unsafe places where diseases are transmitted. One of the major problems faced by school age children is infection by parasites and flukes. This and other diseases, often sanitation related, obviously contributes to absenteeism, but there is a more hidden aspect: Poor health of children affects their ability to learn and therefore influences their perspective in life. Good health at school is essential for now and an investment for the future.

Working with Children is very important:
 Most children are eager to learn. Schools can stimulate and support positive behavioral change in children.
 Children have important roles in household chores related to hygiene.
 Children may question existing practices in the household and become agents of change within their families and communities.
 Children are future parents. What they learn at school is likely to be passed on their own children.

Project time frame: sixteen months
Targer area: Sugd Oblast (around Khojand), 30 schools
Target groups: 20,000 Primary school children in the target area;
1500 school directors and teachers;
Parent and Teachers Associations with the aim of autreach to the communities;
Primary health care staff in targeted communities.

Programme strategies:
The development of life-skills in school children;
A healthy and safe school environment;
Outreach to families and communities.

Methods of implementation

Life-Skills Development:
Training of the school staff involved will be done using the, so-called, ‘cascade model’. Which implies that part of the staff will be trained, passing the knowledge on to other colleagues, school children and indirectly the parents.
Teachers and staff of the primary health care units in the target areas will be trained in life-skills education focussing on, at least, the following themes:
 Personal hygiene
 Drinking water
 Safe extra disposal
 Environmental conservation (including recycling and drought preparedness).
In addition several activities, such as ‘Clean-up days’, puppet plays and video training will be directly with the school children.

A Healthy School Environment
For each school, a joint assessment on the existing water and sanitation conditions will be made with the school director and teachers, as well as, with the school children, primary health care staff and representatives of the Parents and Teachers Associations.
On the basis of the budget available, a draft plan for renovation and a ‘maintenance and operation plan’ will be developed and agreed upon in writing by all parties involved.
The programme provides construction materials and supervision of construction. The school has to provide all manual labor preferably through volunteer labor of parents and/or community members. For the operation and maintenance of the facilities, mechanisms will be developed for the purchasing of materials need for minor repairs, soap, towels, etc.

Once the project has been implemented the school facilities will at least consists of:
 Adequate amount of easy to maintain latrines (special units for boys, girl and teachers);
 Latrines that are ‘nice, light and convenient places’ with enough privacy and security for its users;
 Adequate amount of hand wash facilities near the latrines and inside the schools;
 Facilities for drinking water, such as slow sand filters and water containers;  A system for safe garbage disposal.

Outreach to Families and Communities
In all stages of the implementation of the programme, parents and teachers associations will be involved. To strengthen the activities in the schools, simultaneously a public awareness campaign on sanitation and hygiene will be implemented at oblast level.

Monitoring and Evaluation
For the day-to-day implementation of the programme at school level, ‘implementation and monitoring committees’ will be established. These committees consist of the following members:
 School director
 Teachers
 Community Representatives
 Parents
 Primary Health Care Staff

In addition, to giving follow-up to the education and construction activities, the committee will keep a record on the health statistics/absentees in the school. This will allow them to monitor the health impact of the programme, as well as, will quickly show the need for corrective measures, if considered necessary. Frequency of meetings: every two months.

Management, implementation and sustainability
The implementation of the programme will be coordinated by local NGOs under the supervision of ECOLOGIA with the UNICEF Country Office in Tajikistan.
The design and construction of facilities in each school take a total of 8 months. The educational activities are an ongoing process simultaneously to the construction phase. The programme will support the educational part, for a period of 8 months, after which it should be self-sustained. Once the programme has been implemented, the "implementation and monitoring committees" in each school will be transformed into "monitoring committee". With technical support of the Ministry of Education and the Ministry of Health the programme will become self-sustainable after 15 months.

Rehabilitation and construction of facilities ($1,000/school) $15,000
Production of educational materials $7,500
Workshops and preparatory meetings for 30 schools $2,500.00
Programme support $5,000

Total $30,000


08-23-01 Alene N. Case Proposal Review
I shall get the proverbial ball rolling by enthusiastically approving this project. It gets to the heart of many ongoing problems in that region. Sanitation is always the first successful health and environmental approach in poor areas. Without that, nothing else really works.
One question: will the nice booklet produced in the earlier UNICEF project be used in this work? I hope so.

09-03-01 Karen Ingrid Hunt Proposal review
I support funding for the proposal "School Sanitation and Hygiene Education in Tajikistan."  There is nothing complicated going on here from a medical point of view, but good plumbing and hygiene education are often the simplest and most effective way to improve the health of a community.  Supplying these at the schools is obviously important, for all the reasons given in the proposal. 
Best of luck to this project.

-Ingrid Hunt, MD

09-17-01 randy Kritkausky Proposal Review
I whole-heatedly and without reservation support this project proposal.
I personally have twice met with and hosted Ikram, the project director. He is an extraordinary human being working tirelessly under extremely difficult circumstances.
The project proposal describes what needs to and can be done. It does not say what it could: hundreds of deaths from illness will be prevented, thousands of unnecessary illnesses will be avoided.
With this project proposal, we are serving the most needy of the world's poor. It is not throwing money at a hopeless situation; this is investing in the all too critical first giant step out of desperate poverty and illness.
Ikram was our first overseas colleague to write and express sorrow and dismay at what happneed in New York on September 11. Despite his own experience with a prolonged civil war he was not numbed to our suffering. Tadjikistan is a Muslim society bordering on Afghanistan.It would be especially timely if US donors could display comapssion and support to this part of the world.

10-03-01 Carolyn Schmidt, Executive Committee Proposal Adoption
I vote in favor of this project: it is created by someone with years of experience "on the ground" with these issues. Before it is posted on the website and officially available for donors to study, however, I would like to see:


10-04-01 Giedre Donauskaite Response to Carolyn's comments
I contacted Ikram concerning Carolyn's suggestions. I'll place his response as soon as I receive it.

10-04-01 Mike Case, EXCOM Proposal Adoption
Dear Colleagues:

I am going to vote to approve this project as a VF project and post it on our website with several IMPORTANT RESERVATIONS based on consultation with an expert hydrogeologist, Dr. Brian Redmond, who has supervised similar projects for the Peace Corps in Central America for the past 5 years.

The first requirement for this project to be successful is that the new or reconstructed latrine facilities must be downgradient from any new slow sand filters to improve the quality of the drinking water. More than likely, Dushanbe is at the base of an alluvial fan of porous sediments at the base of some range of mountains or hills. It is imperative that the latrines ALWAYS be lower topographically (at least 5 feet elevation) than the drinking water supply. Furthermore, the base depth of any drilled or handdug well cannot be below the latrine gradient. Otherwise, wastewater contaminated with bacteria will migrate underground back to the drinking water supply. The alluvial sands in this region are porous and will easily transmit live bacteria in the groundwater flow. Failure to adhere to proper hydrogeological practices to separate sewage and drinking water sources will result in project failure and continued morbidity and mortality.

Dr. Redmond says that the Peace Corps just pulled out of Tajikistan on October 2, 2001. Therefore, there will be a shortage of expertise to advise these people on this project. Both Dr. Redmond and I recommend that they attempt to obtain advice from some of the American military units that will be in the region. These units all have officers and non-commissioned officers who are engineers and experts in small scale sanitation facilities. These people cannot be fighting a war all the time. Here is a good deed they could do.

Finally, the water obtained from the rapid sand filters could be further sanitized by the addition of sodium hypochlorite solution. "Chlorox" solutions are 5% or 50,000 ppm free chlorine, roughly. I calculated that the drinking water will need a 2 ppm free chlorine residual after 1 hour to be safe to drink. This can be approximately achieved by adding 0.05mls (or 1 drop) to 1 liter of filtered water. Then you wait 1 hour and use a simple swimming pool test kit for free chlorine to see if you have 2 ppm free chlorine left. If not, you determine by trial and error (1 drop at a time) how much additional sodium hypochlorite solution (i.e. chlorox) is needed to achieve the free chlorine residual.

In summary, this project lacks two really cheap items that could be supplied. Sodium hypochlorite solution, several inexpensive chlorine test kits that are used for swimming pools, and some simple one liter calibration containers. Once they figure out roughly how much chlorox to add to a liter, they can scale it up by simply multiplying 0.05 mls/liter times the number of liters of sand filtered water in a storage cistern. Obviously, someone who has common sense and can do a little math should be in charge of checking chlorine levels in the cisterns. Too much disinfection with chlorine can cause severe diarrhea.

Dr. Case

10-06-01 Randy Kritkausky, Exec Com Proposal Adoption
I vote to adopt this project as an ECOLOGIA projecta nd to post it on our VF website.
In response to Mike Case's comments:
Ikram is a world class expert in bringing water sanitation to extremely poor arid countries and has written the book on this for practitioners. I will be interested in reading Ikram's responses to your suggestions. Concerning the addition of chlorine, I recall discussing this and as I recall, it is actually a burden to purchase and distribute this in the parts of the country where the per capita income is literally a few dollars per month. Every cent of income is treasured. Remember, this project supplies soap as it is often not available.

10-08-01 Ed Shoener, Exec. Comm Proposal Adoption
I vote to approve this project and post on the VF website. It is a basic public health project that seems to be well thought out and realistic for the conditions that exist in the area

10-17-01 Mike Case Proposal/VF Critique
In response to Randy's comment about my concerns regarding the water treatment technology, it is true that the UN and other research groups (Germany has been in the forefront) have developed slow sand filtration technology that is appropriate in rural settings of less developed countries. However, the VF review staff looking at this project is not correct in assuming that implementation of this technology on a small scale, even with supervision, is a simple matter. For slow sand filtration of raw surface waters without any chemical treatment to produce potable water that meets international drinking water standards for pathogens, it is imperative that the filter media be allowed to "age" properly (several weeks) to develop dense microbial zoogleal and gelatinous growths in the upper layers of the filter which do the work of trapping bacteria and parasites. Further, it is necessary to maintain and periodically scrape the filter bed properly (which can be a challenge) so that the filter does not overload resulting in a catastrophic breakthrough of disease causing organisms through the sand media. The truth is that sand beds have a nominal pore size of about 0.35-0.70 mm while bacteria have a typical size of 0.05-0.1mm. Without properly maintained surface ooze on the sand bed, slow sand filtration will not remove bacteria. The other water quality engineering truth is that no slow sand filter will remove viruses reliably because of the small size of viral particles.
I have spoken with a Ph.D. engineering expert on slow sand filtration (Dr. Marleen Troy) and the research literature supports my position, that it is essential that some kind of AT LEAST emergency backup disinfection procedure be available. If it is too expensive to routinely chlorinate, then the people using such systems will always be at some risk. But, these filtration systems are subject to operational failure with variations in runoff and temperature conditions. One really promising technology for arid areas is to use solar heating of the bed filtrate for at least partial disinfection.
Finally, my general observation is the VF review group is all too willing to just sign off on a $30,000 project without really asking some tough questions. A high budget proposal like this one deserves more carefully scrutiny of its objectives. When the proposers say they are going to produce cleaner drinking water, a very important goal to be sure, we should be asking how they are going to do this and who is going to do it. Failure to ask these questions and receive clear answers, could result in illness and death from improperly maintained systems worse than drinking the raw untreated water.
Mike Case

11-01-01 Project Posted; Concerns Communicated
The Board has voted to approve this project, taking into consideration the reservations addressed by Dr. Case. Giedre will communicate these concerns to Ikram and will provide us with his replies. Those replies will be incorporated into the proposal information.