WASH Baseline Survey 1 Step: - Results

WASH Baseline Survey 1st Step
- Results -
August 2009
Action Against Hunger (AAH) Project

Improving Living Conditions in a Changing Environment
Thatta Coastal Farmers
AAH Project OBJECTIVE

To provide locally sustainable & environmentally sustainable
access to boreholes turned saline
Pakistan, Sindh province, Thatta district,

Keti Bunder (KB) & Kharo Chan (KC) sub-districts
Thomas VIGER – AAH WASH Officer

MISSION: PAKISTAN
TABLE OF CONTENTS
INTRODUCTION 3
I- CONTEXT OF THE SURVEY 4
II- OBJECTIVES OF THE WASH SURVEY 6

st
2.1. Objectives of the WASH Survey 1 Step 6
st nd
2.2. Objectives of the WASH Survey - 1 + 2 Steps 6
III- METHODOLOGY OF THE WASH SURVEY 8
3.1. WASH Survey: Human Resources 8
3.2. Detail on the WASH Questionnaire 8

3.2.1. Section 1 – General Questions 9
3.2.2. Section 2 – WASH Questions 10
3.3. Organisation of Focus Group Discussions 13
IV- RESULTS OF THE WASH SURVEY 1ST STEP 14
4.1. Results of the GENERAL questions 14
4.2. Results of the WASH questions 15

a) Drinking & Cooking Water Resources Used by the Household 15
Water Sources Used during the Dry & Rainy Seasons 15
Water Quality Perception 16
Drinking & Cooking Waters Collection 17
Water Containers Used + Practices 19
Water Sources Quality Changes 21
b) Sanitation & Solid Waste Management Practices 22
Defecation Facility & Hand Washing Practices after Defecation 22
Solid Wastes – Management Practices & Impacts on Household members 23
c) Food Safety Knowledge 24
Food Safety Measures Known 24
d) Health & Hygiene Knowledge & Practices 25
Unsafe Waters – Perception & Prevention Knowledge 25
Diarrhoea – Number of Cases + Actions Taken for Treatment 26
Most usual Diseases among Children, Causes & Preventions 27
Hygiene Practices at the Household Level 29
e) Open & Informal Questions 31
AAH Staff Observations – Evidence of Faecal Contamination 31
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Open Discussions Results 33

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Thomas VIGER, WASH Officer WASH Thatta Baseline Survey 1st Step - Results
November 2009
MISSION: PAKISTAN
V- WASH SURVEY ANALYSIS & RECOMMENDATIONS 34
5.1. Drinking & cooking water 35
5.2. Sanitation & Solid Waste Management Practices 38
5.3. Food Safety Knowledge 40
5.4. Health & Hygiene Knowledge & Practices 41
VI- WASH SURVEY CONCLUSION 44
6.1. Conclusion on the work relations between the AAH WASH & Food Sec departments 44
6.2. External Coordinations 46
6.3. Conclusions on the WASH project strategy 47

6.3.1. Solar water desalination technology 47
6.3.2. Improvement of hygiene conditions 49
6.3.3. Final conclusion 49
List of Annexes:
Annex 1 - AAH Thatta Env Management Plan – May 2009

Annex 2 - HH WASH Questionnaire - August 2009
Annex 3 - WASH Survey August 09 Data Results
Annex 4 - HP Knowledge Sheets
Annex 5 - 5 Keys to Safer Food (English & Urdu)
Annex 6 - Village Borehole Identification Form - Nov 09
Annex 7 - NGO Coordination Form - Oct 09
Annex 8 - Reports on NGOs activities in KB & KC - Nov 09
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INTRODUCTION
AAH Pakistan has conducted a Food Security & Livelihood (FSL) survey in the
beginning of its project “Improving living conditions in a changing
environment – Thatta coastal farmers” during the months of July, August,
and September 2009. A second and final FSL survey should be carried out at
the end of the three (3) years project in 2012.
The objectives of this first FSL survey were to establish:

- A strong baseline of the people assisted and their environment;
- Concrete projects outputs and impacts;
- Livelihoods profile identification;
- Guidelines for the local authorities and cooperatives created;
- Documents or reference for the actors;
In order to get some information on the two (2) Talukas (sub-district) of Keti
Bunder & Kharo Chan where we are going to work on WASH problematic too,
the WASH department decided to accompany the FSL survey team during its
survey.
The WASH baseline survey realised in August 2009 (1st Step) did not aim to
draw final conclusions on what, where, or with whom AAH WASH activities
should be carried out. Further actions such as close coordinations between the
two departments of AAH Thatta - Food Sec & WASH - have to be done.
It is important to recall here that the WASH department was fully dependant on
the FSL department of AAH regarding the methodology and strategy during the
survey reported here – villages to visit, time frame… 3
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I- CONTEXT of the SURVEY

AAH received funds to develop a Research & Development project over
Talukas (sub districts) Keti Bunder (KB) & Kharo Chan (KC) of Thatta district.
The topic of the research is SALINITY.

The main aim is to find easily replicable and sustainable measures against the
impact of the increased salinity of soils (Food Security and Livelihoods
Department) and water sources (Water, Sanitation, and Hygiene Department).
Taluka Keti Bunder has an area of more than 150,000 acres (at about 60,900
hectares) and Taluka Kharo Chan an area of approximately 235,000 acres
(95,000 hectares).
Saline agricultural field in Keti Bunder

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The main constraints in achieving the WASH survey were:
a) No map available of KB & KC;

It is impossible to find accurate maps of the two Talukas even through the local
government offices. Due to security reason it was also not allowed to take GPS
points in the Talukas – situation not clear on this issue.
b) No reliable data on villages and population numbers in KB & KC;

It is also impossible to get clear figures on the number of villages in KB & KC.
Different sources give different figures – with important discrepancies.
For the Thatta Department of Revenue there are 82 villages in KB and 23

villages in KC. According to an AAH local staff who was born in Kharo Chan and
now lives in Keti Bunder (Mr. Mir Jan Pathan), there would be 186 villages in KB
& 240 in KC. It is a huge discrepancy between these two sources. None
organisation uses the same figures.
One reason explaining the discrepancies is linked to the definition itself of ‘what
is a village?’ that appears to be different between local actors.
c) Access to women;
Only female staffs can get access to women.
We had to introduce AAH visit aims before getting the formal permission to
interview the women for the WASH project - by our female staffs - inside the
village.
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II- OBJECTIVES of the WASH Survey
2.1. Objectives of the WASH Survey 1st Step

3 Main Objectives:
1) Follow & integrate a WASH questionnaire into the FSL survey activities –
discovering Talukas KB & KC;
2) Get information & knowledge on the ground water salinity impacts on

the lives of the population in KB & KC – zone affected by saline waters,
salt concentration in drinking water consumed, etc;
3) Get information & knowledge on hygiene conditions over the villages –

identification of gaps and definition of possible actions for AAH;
In order to complete our current baseline survey we need (a) to coordinate

internally with the AAH Food Sec department, (b) to coordinate with the NGOs
working locally, local authorities & basic health units, (c) further field trips to
assess other villages’ ground reality & needs – if required.
This represents the 2 nd step of the WASH Survey.
2.2. Objectives of the WASH Survey - 1st + 2nd Steps
The objectives of the WASH baseline survey (1st & 2nd Steps) are:
1) to identify at least five (5) saline boreholes to be rehabilitated;

2) to identify the needs of villages regarding ‘hygiene practices
improvement’;
When the 2nd step of the AAH WASH baseline survey will be completed we will
be able to select 400 interested households living near the saline boreholes
identified.
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Once more it should be highlighted that the AAH WASH & Food Sec
departments work closely to coordinate their strategies in selecting their 400
households.
Indeed we strongly believe that our actions should be harmonised in term of

village selection. It is also pertinent to get harmonised in term of household
selection when possible as our main activities will be to monitor our research
performances in link with salinity issues.
However some households may be different between the two departments

according to the field reality and criteria required by each department in the
selection of their households
General hygiene promotion activities in the selected villages (where saline

boreholes will be identified) may start before the formal identification of the
400 households interested to receive a solar still unit at home for field tests.
This can be explained by the fact that we need to first design an appropriate
solar still before fabricating & distributing it to 400 households.
The selection of the potential villages for the WASH activities should be
completed before the end of the year 2009. The WASH main criteria in village
selection are 1) presence or not of saline boreholes, 2) saline boreholes water
qualities - bacteriological, chemical, and physical parameters, 3) respect of our
Environmental Management Plan – EMP (Annex 1 - AAH Thatta Env
Management Plan – May 2009).
Introduction of AAH aim before getting access to women inside the villages
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III- METHODOLOGY of the WASH Survey

It is important once again to highlight that the WASH department of AAH
Thatta integrated the FSL survey but did not have authority to develop the
action strategy of the survey. This was the responsibility of the FSL expert.
Both departments created their own questionnaires.
Questions were asked but possible answers never given to

the respondents.
3.1. WASH Survey: Human Resources

All the survey staffs have received training on the WASH (and FSL)
questionnaire before the field activities. All the questions were studied,
analysed, and criticised to ensure the best comprehension of all of them by the
AAH staffs for the best outputs possible.
The original plan was to have 1 man and 1 woman to perform the WASH
survey; after the questionnaire field testing activity we observed that women
did not have much knowledge on agriculture (main topic in the FSL survey) and
men did not have much knowledge on water uses at home (main topic in the
WASH survey).
That is why we decided to adapt our teams; the WASH man staff joined the FSL
team and the FSL woman staff joined the WASH team. So 2 women were
performing the WASH survey; they interviewed women only.
3.2. Detail on the WASH Questionnaire

The WASH department developed a Household (HH) questionnaire – see Annex
2 - HH WASH Questionnaire - August 2009
The Household (HH) WASH Questionnaire was divided into two main
sections:
Section 1 – General Questions
Section 2 – Questions on WASH Activities
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Before starting the interview the enumerator had to write:

- her name;
- the date & time of the interview;
- GPS coordinates of the village where the interview took place – activity
cancelled later on due to unclear information / clearance;
3.2.1. Section 1 – General Questions

This section was initiated and prepared by the FSL survey expert. Its aims
were:
a) To get global information on the village where the interview

took place;
- Name of the village, number of houses, distance from the village to Garho
town – where the AAH sub-office is;
b) To know which organisations – governmental or not –

were/are working in the village;
- NGOs which currently work or who worked the last two years in the village,
which sector of activity (infrastructure, WASH, education…), and how many
training given by the other organisations;
c) To assess the general household profile;

- Number of people living in the household, activities & incomes (Household
Profile sheet), children school attendance, type of households, etc.
Not all the information gathered in this section was interesting for the WASH
department but all the questions were asked to women who answered the
WASH questionnaire to support the collection of information for the FSL team.
AAH random selection of men & women to be interviewed in villages

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3.2.2. Section 2 – WASH Questions

This section has been fully initiated and prepared by the WASH department of
AAH Thatta. The aims were to get knowledge and information on:
a) Drinking & Cooking water resources used by the

household;
- Available water sources along the year & their qualities;
- Who is responsible of water collection & how many times a day?
- Water containers used for the collection, the transport & the storage of the
drinking/cooking water; Lids used? When & how the water containers are
washed/cleaned?
- Are there currently salty / brackish drinking water sources in the village OR
previous drinking water sources they STOPPED using because the water is now
bad testing?
Borehole water salinity checking by ACF staffs in every village visited
b) Sanitation & Solid Waste Management practices;

- Defecation practices;
- Hand washing practices after defecation? How?
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- Solid waste management practices;

- Knowledge on impacts of solid wastes on family;
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c) Food Safety knowledge;

- What measures are known as being safe to protect the food consumption?
Women preparing the lunch
d) Health & Hygiene knowledge & practices

- Kind of water that carry diseases + Prevention/protection knowledge?
- Number of children who got diarrhoea the previous month? What actions are
taken by the family? How much does it cost?
- Last year health expenditures evaluation;
- Most common diseases children get in the village? Causes of the diseases?
Preventive actions?
- Hygiene measures taken by the family? Who taught them? Why applying
these hygiene measures?
During this section we shared

the recipe of the Oral Rehydration Solution
to women who claimed using it but who gave us a wrong recipe.
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e) Open & informal questions

To end the interview the female staffs of ACF asked to the women if they
wanted to share something else regarding water, sanitation, and/or hygiene in
their village or family. What is missing to improve their lives?
Then they terminated the interview with an open discussion on menstruation

practices. The aim was to know which practices are used by women in the
villages and how the hygiene conditions could potentially be improved.
The final part of this section 2: WASH questions was for the ACF staffs to make
recommendations on possible trainings to be organised in the villages according
to the field reality and by also commenting on the women willingness.
Moreover ‘Observations’ also took place during the interviews to cross-check

some information when possible - use of lids on water containers, presence of
faeces in or nearby the houses.
While leaving the villages the AAH staffs coordinated to check the information
on village name, the number of houses…
AAH internal coordination

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3.3. Organisation of Focus Group Discussions

The WASH team of AAH Thatta organised three Focus Group Discussions (FGD)
in three different villages. Results were not exploitable in the survey.
The reasons of the non-success of these activities are:

a) Lack of training of the AAH WASH staffs;
We did not have time and did not take it neither as we had to follow the
rhythm of the FSL survey activities. I did not consider it as a capital point
as I also wanted the team to learn by doing. New FGD could be
organised in new villages after village selection.
b) Non-cooperative attitude of women;

Women in villages were told by men to over exaggerate the problems
and to demand on everything. This – common – practice was really
negative here as women were simply lying to us. Accurate information
was difficult to get.
c) Men supervision of the women FGD;

Some men from the village were supervising the women FGD; women
were not really free to talk. Men also sometimes participated in
answering the questions from the AAH women staffs.
WASH Focus Group Discussion in Keti Bunder

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IV- RESULTS of the WASH Survey 1 st Step

All the WASH questionnaires were entered & compiled in an Excel document to
analyse the results of this WASH survey 1st step. This document is attached in
the Annex 3 - WASH Survey August 09 Data Results.
As said previously in the report (paragraph 3.2.1.) not all the information in the
general section of the WASH questionnaire was interesting for the WASH
department; most of the questions have not been treated indeed.
4.1. Results of the GENERAL questions
— Number of women/respondents interviewed

60 women – representing 60 different households - over 34 villages (21 in KB &
13 in KC) were interviewed. The total number of households is estimated at
1935 over the 34 villages; so we covered only 3% of the total number of
households.
This little coverage of the household population will have impacts on defining
accurate possible actions to be taken related to hygiene promotion educational
sessions. Nevertheless it does not have a huge impact on saline borehole
identification activity as this information is communal and not individual.
— School attendance
47% of the women interviewed said there are no school in their villages (or
nearby) and/or no teacher. When the school and teacher are available in the
village more than 40 % of the women say that all the children can attend
school.
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4.2. Results of the WASH questions
a) Drinking & Cooking Water Resources Used by the Household
— Water Sources Used during the Dry & Rainy Seasons

The most common water sources used by the communities visited are shallow
boreholes – between 15 and 50 feet deep.
98% of the women interviewed use these boreholes during both dry and rainy
seasons; these boreholes are sometimes just connected from a nearby
irrigation canal but are called boreholes by the communities.
Surface waters are often used by the people - especially for personal hygiene &
animal drinking purposes but also for drinking & cooking purposes - during the
dry season.
43% of the women interviewed said they harvest the rain water during the rainy
season as it is considered as better quality than the surface waters for all the
purposes.
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— Water Quality Perception

Women assessed the quality of 94 water sources in or near their villages. 72%
of these 94 water sources are described as “good water quality”.
18% of the same 94 water sources are perceived as being saline and 10 %
brackish.
The WASH team discovered that women often get confused on the differences
between saline & brackish water.
Difference between SALINE & BRACKISH waters
The terms saline and brackish water refer to the total dissolved solids (TDS) the
water contents.
Fresh water has TDS less than 1,000 ppm (parts per million);
Brackish water refers to TDS content within 1,000-5,000 ppm.
Saline water has TDS content within 5,000 - 30,000 ppm, and sea water has
salt content within 30,000-40,000 ppm.
Source: http://www.scienceclarified.com/Vi-Z/Water.html
Moreover women do not always recognise water that contains salt even when
they taste it. Indeed some questionnaires showed that women described the
water as being good or brackish and the measurement of the water salinity with
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the EC metre showed a high level of salt in the water.

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— Drinking & Cooking Waters Collection

As usual women are the responsible persons in charge of water collection. Most
of the time children accompany their mothers in fetching the water from the
water sources but can also be the persons in charge if the mothers are busy
working in the field. Men are mainly not involved in this activity.
57% of the women interviewed said they collect drinking & cooking waters more
than twice a day, 38% twice a day and 5% said they collect waters only once a
day.
Water is not kept for a long time to avoid disease outbreaks.
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Almost 50% of women and children who collect drinking and cooking waters
fetch more than 50 litres per collection trip. The average number of people in
each household in Keti Bunder & Kharo Chan is 9 (ACF FSL report survey from
Ms PRADHAN Nirvana).
A child collecting water - Sindh

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— Water Containers Used + Practices

Water can get contaminated from the collection points until the time we
consume it. We wanted to know the practices regarding which water containers
are used for the different water activities stated below:
P Water collection
P Water transport
P Home water storage
Women collect and transport the waters in the same containers – metal and
plastic buckets, respectively 51% & 34% of containers used.
The cultural practice to store water at home is to use ‘canaries’ for 78% of the
women interviewed.
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Canaries for drinking water storage at home

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100% of the women say they use a lid with their home water storage containers;
observations from the AAH staffs of the visible home water storage show a real
trend of protecting the drinking water at home with lids – at about 95%.
Women say they clean their water storage containers every time before filling it
(47%) and/or once a day (38%) at least.
Women use different methods to clean their water containers but mainly use
water only (77%). Detergent is used with water in 28% of cases to clean the
water containers and rice husk in 12% of cases.
Moreover 46 women over the 60 said they protect their drinking waters from
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animals and 44 of these women protect from the children.

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— Water Sources Quality Changes

We asked women if some of the water sources they use(d) had changed in their
qualities tastes. 57 villages have reported changes in the quality of some of
their water sources.
Boreholes were cited 26 times (46%) as well as the surface water. People
explained that boreholes mainly turned saline and surface water becomes
brackish (strong smell, wastes from animals…) regularly during the year.
In total 44% of the water sources became saline and 56% became brackish –
according to our results. As said earlier the perception does not reflect the
reality with 100% accuracy.
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b) Sanitation & Solid Waste Management Practices
— Defecation Facility & Hand Washing Practices after Defecation

Few latrines are available in the villages visited. Sometimes we can find some
but they are in the middle of the village (see the front page picture) so nobody
uses them regularly – and especially women who get shy as men can see them
going in.
That is why 83% of the women prefer defecating in the bush; most of them also
shared with us difficulties and problems of this practice (especially snake bites
during the rainy season).
82% of the women said they wash their hands with water & soap after
defecation. This does not mean they do it but it means they got the knowledge.
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— Solid Wastes – Management Practices & Impacts on Household

members
There is no communal system for collecting and managing solid wastes in
villages of KB & KC. 83% of women interviewed say they dump their wastes far
from their homes; they sometimes burn or bury them after a while.
When we ask the women what are the bad impacts of solid wastes on the
members of their households they are 93% to say solid wastes attract flies.
They know flies contaminate the food and water and can spread diseases.
58% of women believe that solid wastes create bad smell. They are 47% saying
that solid wastes develop mosquito areas and 33% it attracts rats and other
harmful animals.
Even if 22% of women said that solid wastes in the bush are not beautiful, only
2% talked about the pollution it can breed for lands and waters.
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c) Food Safety Knowledge
— Food Safety Measures Known

Women are aware - 97% - that food should be protected from flies. They also
know that hands should be washed before preparing the food or before eating
(55%). They say food should be protected from animals (40%), sun (33%), and
children (22%).
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d) Health & Hygiene Knowledge & Practices
— Unsafe Waters – Perception & Prevention Knowledge

Surface waters are viewed as carrying diseases for 78% of the women
interviewed. 25% of them believe that a water container without lid can carry
diseases too.
The perception of waters coming from boreholes is good – do not carry

diseases. 10% of women do not have idea which water could carry diseases.
To use a lid on the water containers is a simple method to protect the drinking
water for 83% of the respondents. To protect from children and animals is a
measure taken by 27% of the women. Only 3% talk about boiling the water as a
method for having safe drinking water. 3% do not know what to do and 3%
believe that nothing can be done to prevent unsafe drinking water.
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— Diarrhoea – Number of Cases + Actions Taken for Treatment

We asked the women how many children suffered from diarrhoea last months in
their household. 15 women out of 60 said they got 4 cases of diarrhoea last
month and 13 said 3 cases – this represents almost 50% of the women
interviewed who reported 3 to 4 diarrhoea cases the previous month.
When diarrhoea cases appear 2 main actions are taken:

a) Go to medical centre / see doctor for an injection – 55%
b) Give ORS (Oral Rehydration Solution) – 45%
Traditional medicines are not a common practice in KB & KC to treat diarrhoea.
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— Most usual Diseases among Children, Causes & Preventions

90 % of the women said they spend more than 1,000 PKR (12 USD) per year in
health care costs for them and their families (with an average of 5,000 PKR –
60 USD per year and per family in health care costs).
This represents an important part of expenses for most of the families in KB &
KC.
The most usual diseases among children in villages visited are diarrhoea for
97% of the women interviewed followed by malaria for 93% of them. Skin
diseases are also usual diseases for 37% of the respondents.
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Women analysed the causes of diarrhoea diseases as being in link with food
(28%), water (14%), and flies (7%).
35% of women said that mosquitoes are the cause of malaria. Weather (14%)
and lack of hygiene (10%) are the main causes of skin diseases according to
the respondents.
In term of prevention women do not know well what to do for 29% of the
diseases cited previously. They know (17%) that the use of mosquito nets will
prevent the children to get malaria. It is believed by 16% of the women that the
use of medicine will prevent to get diseases.
Boiling water is known to prevent children to get diarrhoea by 10% of the

respondents but is not widely used in the reality.
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— Hygiene Practices at the Household Level

We asked the women which hygiene practices they were daily applying in their
houses - possible answers were not suggested to them.
Results show that 93% of women answered they wash their hands (and 73%
with soap), 87% said they wash their bodies and hair too. Flies control is done
by 52% of respondents; water is protected by 43% of them.
Sharing glasses is a cultural practice; no women avoid it. The control of animal
– far from houses and people – is not applied in KB & KC. Women reported that
animals can get stolen so they prefer to keep them close to the houses.
18% of the respondents only said they use a mosquito net.
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When we ask the women from where they got the knowledge on good hygiene
practices they are 36% to say knowledge come from NGOs. It also comes from
friends and neighbour according to 21% of answers.
Doctors and nurses represent 18% of the source of hygiene knowledge. Radio
represents only 11% - mainly because people do not possess radios.
When we ask the respondents what are the reasons for applying the hygiene
practices they are 20% to say it prevents diseases and it keeps a healthy
environment for the household.
The prevention against flies is cited by 12% of women. Only 1% of respondents

do not have specific reasons for applying the hygiene practice.
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e) Open & Informal Questions
— AAH Staff Observations – Evidence of Faecal Contamination

The WASH AAH staffs had to observe the villages and houses in order to report
faecal contaminations and their origins. 100% of villages visited have evidence
of faecal contamination - 52% along the roads and paths.
80% of faecal contaminations were observed outside but near the houses and
38% inside the houses.
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There are evidences of faecal contaminations close to the water points as

shown in this picture below in one village in Kharo Chan. On the right top corner
of the water point slab there are goat excreta; they are mixed with stagnant
water. Children are playing nearby the water point…
A faecal contamination observation close to a communal water point – KC
Animals’ excreta are the main origin of the faecal contaminations observed in
villages. Indeed 95% of villages visited are contaminated by animal excreta
along their paths, houses… 58% of the excreta observed come from children
excreta and only 3% from adults.
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— Open Discussions Results

To conclude our questionnaires we asked 1 open question to the women - Is
there anything else you would like to share with us about the water, sanitation,
health & hygiene in your family or village? We also asked details on hygiene
practices during menstruations.
Is there anything else you would like to share with us about the water,
sanitation, health & hygiene in your family or village?
— Water boiling practices only when children get diarrhoea;

— Open defecation in the bush is a real problem for a lot of women as some
incidents happen with bad animals such as snake & rats. Women sometimes
urinate in thatched latrines but rarely defecate in;
— ORS (Oral Rehydration Solution) recipe given is not correct for more than
90% of respondents;
— The health expenses are high but include also transportation costs;
— Soap is not often used even if available in the house. Some women said
people laugh when they see them using soap.
Soap is also hided from animals which sometimes eat it;
— River waters are sweet during the dry season and saline during the rainy
season according to the women;
— The saline waters are mainly given to animals for drinking purposes;
— Problem of teachers who rarely come at work as they are rarely paid by the
government;
— Villagers complain that NGOs come for survey purposes but never give
anything – that is not true;
— Males do not share information on household incomes. One woman told us
she does not mind of health expenses as it is not her money;
— No good hospital coverage;
Informal talk on women menstruation hygiene practices.
— Some women do not use anything during their menstruation but change
clothes 2 or 3 time a day. Some women believe they can become sterile if they
use clothes or something during their periods;
— Mainly women use clothes, wash and dry them before using them again or
throwing them in the bush. Some just throw them away without prior washing;
— Some women get scared to take bath during their menstruations because it is
believed water from the river can enter their vagina and make them sick and/or
33
stop their cycle – validated by some doctors;

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V- WASH Survey Analysis & Recommendations

This report section attends to analyse the first results of the WASH survey held
last August (2009).
Each analysis will be followed by recommendations on what are the possible

actions to be done by AAH and their constraints. All actions suggested will be
argued and may require further field trip / coordination / brainstorming activities
in order to better analyse & answer the needs of the communities in term of:
a) Lon-term access to domestic potable water through desalination

technology;
b) Improvement of water, hygiene and environmental related
knowledge & practices;
A non-maintained water tank in Kharo Chan

34
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5.1. Drinking & cooking water

A Water sources used
— Rain water harvesting

It is common practice for communities to harvest rain water during the rainy
season even if the mean annual rainfall is inferior at 200 mm in Sindh and
Baluchistan provinces (http://www.pakmet.com.pk/rnd/pdf/seismic.pdf).
If we can diversify the uses / purposes of the AAH solar desalination unit
distributed in the villages we would facilitate its acceptance from households.
Recommendations
Integrate a rain water catchment on the desalination unit if technically possible –
depends on the final design – as we did on the 2nd experimental unit at AAH
office – Brick Masonry Solar Water Desalination unit (see picture below).
Rain Water Catchment on the Brick Masonry desalination unit

AAH office Thatta
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— The main drinking water resource used is ‘Borehole’

There are a lot of boreholes in each village. These boreholes are 15 to 50 feet
deep and sometimes connected directly to canals or to the Indus River.
Ground water boreholes often turn saline few months (less than a year) after
drilling. 73% of villages visited have saline boreholes - so we will most likely not
get difficulties to identify 5 saline boreholes to rehabilitate.
The biggest difficulty will be to find 400 households living near these 5 saline
boreholes. The villages’ sizes vary from 10 to 300 houses but with an average
of 40 houses per village.
Recommendation
At least 10 saline boreholes should be budgeted for rehabilitation in the WASH
budget realignment if we want to reach 400 households use a desalination unit.
A Water quality perception
— Surface water quality is bad

The surface water is perceived as “unsafe” and “unclean” by the women
interviewed for drinking and washing purposes as it is an open & non-protected
water body. Indeed animals bath and defecate in it and household washing
activities take place in too.
It is anyway the primary and/or secondary source of drinking water for 37% of
women during the dry season & for 28% in the rainy season.
Recommendations
Communicate on:
P Water boiling practices if surface water used for drinking purposes;
P Operate & maintain correctly the desalination unit (when distributed) –
then no need to go to the river/canal to get non-saline & unsafe drinking water;
P Use soap when taking bath;
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A Drinking & cooking waters collection
— Water collection is time consuming for women & children

Women explain they cannot handle all the tasks assigned to them (cooking,
washing houses, working in the field, fetching water, etc.) and take care of
themselves and children’s health.
This lack of care impacts the health of women, children, and men – i.e. skin
diseases, diarrhoea - and creates health expenses as well as a diminution of
incomes – when somebody is sick he/she cannot work (men & women).
Recommendations
Communicate on:
P Time saving for women & children if operating & maintaining well the
desalination unit distributed;
P Excellent quality of the desalination water harvested and in sufficient
quantity for the daily needs;
P Fewer diseases and less health care expenses;
A Water containers used + practices
— Water containers cleaning

Good practices in the villages visited as more than 75% of the women said they
regularly clean their home water containers everyday at last.
Recommendations
Communicate on:
P Regular cleaning of all the water containers used for collection,
transport, and storage of the drinking & cooking water;
P Use lids for all water containers – not only at home – if the water
source is far from the houses;
P Protect the drinking & cooking water from animals & children;
The AAH team should continue the development of HP Knowledge Sheets

(Hygiene Promotion) and especially on “Cleaning with Rice Husk, Clay, Ashes –
advantages & drawbacks”. These sheets were imagined & developed following
needs the AAH team had during the survey regarding the ORS (Oral
37
Rehydration Solution) recipe knowledge - see Annex 4 - HP Knowledge Sheets.

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5.2. Sanitation & Solid Waste Management Practices

A Defecation facility & hand-washing practices after defecation
— Open defecation practices

Few pit latrines are available over the 34 villages visited. Moreover they are
rarely used by the communities as not adapted to the cultural customs – it is
communal latrines.
Women complain because using bushes for open defecation is dangerous.

During the rainy season they are attacked by snakes. They sometimes use
latrines to urinate.
Some villages have thatched latrines where women get privacy. They burn the
excreta after a week when using for this purpose. Most of the women keep
going to the bush for defecation instead of using the communal latrines.
Women have been told that washing hands after defecation is important, and so
they told us they do it every time after using toilet. We know this is not the truth
– observations and cross checking of information given all along the survey.
The majority of women met during the survey said they need latrines. Some of
them said they would support us for this purpose but mainly requested AAH to
simply provide latrines – this is not an option for AAH currently.
Recommendations
Communicate on:
P Wash your hands with soap after using ‘toilet’;
It could be an option to develop CLTS (Community-Led Total Sanitation)

projects in villages but not at the beginning of our project. We need first to
focus on saline boreholes rehabilitation, design & select a desalination unit that
works well, and basic hygiene promotion activities.
But the CLTS activity could be good to implement if communities keep asking
AAH support on building latrines - not before the last quarter 2010. All costs
should be supported by the communities themselves and AAH team should be
really clear on this issue of cost bearing.
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— Solid Wastes – Management practices & impacts on household

members
There are impacts on household members and on their environment because of
the non-management of solid wastes. Plastic is one of the main wastes we can
find everywhere in the bush of Keti Bunder & Kharo Chan. No hardware solution
can be brought by AAH within our current research project.
Recommendations
Communicate on:
P Dump your wastes far from houses and then bury and/or burn them to
avoid:
Flies;
Bad smell;
Creation of mosquito areas;
Rats & other bad animals;
…
The introduction of ‘composting’ - in collaboration with the Food Security

department of AAH Thatta - should/could be done. Most of the wastes produced
at the village level are organic so it could be a good way to treat the wastes at
the same time than producing a good & natural fertiliser.
This compost could also develop the wish & capacities of households in making
their own vegetable garden, and so to decrease their dependence on food
products.
Another option for these wastes is to feed the animals with – if not already
done.
Medical wastes such as syringes are also non-managed all over the 2 Talukas
of KB & KC. This can have bigger impacts on environment and communities’
health.
If incinerators are suggested they would not be financed by the current project’s
funds.
39
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MISSION: PAKISTAN
5.3. Food Safety Knowledge

The basic food safety measures are known by the women – protect food from
sun, flies, animal, and children & wash hands before handling food.
Recommendations
Communicate on:
P 5 Keys to Safer Food – WHO;
This document explains the basic measures to be taken to ensure a
safe food for the family. The 5 keys to safer food are:
Keep clean;
Separate raw and cooked;
Cook thoroughly;
Keep food at safe temperature;
Use safe water and raw material;
Annex 5: 5 Keys to Safer Food (English & Urdu)
This document should be used for communicating on Food Safety but AAH
would need to adapt it – more drawings than texts as few people are educated
in the villages.
WHO agrees anyone to use its document for free but it should be kept identical
to the original. However if adaptation to our context of the 5 keys to safer food
document is done, be sure to keep the same sentences for the 5 keys. It keeps
a coherence between all actors.
I think we should also print this document in Urdu for the most educated people
in the villages; give some exemplars to health care centres with some
information to nurses and doctors can be an option too.
This activity could support our objective to reduce by 10% the health care costs
by decreasing the number of diarrhoea cases.
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5.4. Health & Hygiene Knowledge & Practices

A Unsafe waters – perceptions & prevention knowledge
Surface water is once again perceived as giving irritations and skin diseases. In
the mean time women do not regularly take bath (on average once a week) &
do not use soap while bathing. Women also sometimes use detergent powder
for their personal hygiene.
Women get itchy skin and think this may come from their husbands when they
go for 2-3 weeks fishing and don’t take bath at all during the period.
All these factors encourage skin diseases.
Recommendations
Communicate on:
P Use soap & shampoo during regular bath;
P Avoid sharing glass with others – especially when diarrhoea;
P Boil water when you use for drinking purposes;
Some researches should be carried out on:

Impacts of saline water on skin;
Impacts of detergent on skin;
Bactericide efficiency of soap compared to detergent;
SALT TOLERANT SOAP available locally? Quality? Price?
A Diarrhoea – Number of cases + Actions taken for treatment

It is a classic issue to have a high rate of diarrhoea diseases among children.
Our aim to reduce by 10% the health care costs could be done by following the
next recommendations:
Recommendations
Communicate on:
P Water boiling practices;
P Food safety – 5 Keys to Safer Food;
P ORS recipe – Oral Rehydration Solution;
Check the Pakistani regulation & strategy on

41
“Oral Faecal Transmission Route” knowledge sharing!

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A Most usual diseases among children, causes & preventions

As stated earlier in this report 97% & 93% of women interviewed cited
respectively diarrhoea & malaria as the most usual diseases among their
children.
It is important to highlight that people in Pakistan are really worried to get

malaria and as soon as they have fever and do not feel well they expect to have
malaria. It happened for 3 or 4 cases in our AAH office with our own staffs. After
the malaria tests ran at the hospital none had got malaria.
It is anyway a reality that malaria infects many people every year, and
especially in rural areas.
Recommendations
Coordinate with the local government and organisations to get mosquito nets to
distribute to the people. One organisation – name to be confirmed by Mir Jan
Pathan – distribute(d) for free some bed nets to families.
In case there is no one currently providing mosquitoes nets AAH could

potentially include it in its Hygiene kits (price & quality to be checked) after
being sure that people will use them. Socialisation should be done on:
P Malaria disease – cause, symptom, treatment, prevention, etc;

P Benefits of using a mosquito net;
42
Children of Keti Bunder & Kharo Chan

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November 2009
MISSION: PAKISTAN
A Hygiene practices at the household level

Women mentioned different hygiene practices they have knowledge on but do
not apply them in reality for most of them.
“How to make the women practising

the good hygiene practices they know?”
is our greater challenge.
Recommendations
We would need to:
P Analyse why women & villagers do not really apply some hygiene
practices known & develop our approach accordingly;
P Involve children & men in any WASH strategy & activities;
Women said that knowledge mainly came from NGOs. This means that if we
are well prepared and we know what we are talking about (this is one of the
objectives of HP Knowledge Sheets) women will remember AAH messages
delivered and will potentially spread it to friends and neighbours.
Theatre plays could be a simple approach (close to people) to touch the

majority of people in the villages about the desalination technology, its
importance today but also for the future, etc. as well as for basic hygiene
practices.
Radio messages can be used to finalise our hygiene promotion strategy (if
prices reasonable) involving real people from villages and nobody else.
Animal control activities should be organised too. It is a serious problem in the

villages.
43
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MISSION: PAKISTAN
VI- WASH Survey Conclusion

The integration of the FSL (Food security & Livelihood) survey activities
throughout a WASH questionnaire allowed the AAH WASH department to get
information and knowledge on:
P Ground-water salinity impacts on the lives of the Keti

Bunder (KB) and Kharo Chan (KC) populations;
P Hygiene conditions over the villages visited;
6.1. Conclusion on the work relations between the AAH

WASH & Food Sec departments
The ground-water salinity is a global problem for the populations of KB & KC.
More than 70% of the 34 villages visited during the FSL survey have boreholes
that turned saline. Data on the salt concentration in borehole waters were taken
by the WASH team with 2 EC (Electro Conductivity) metres.
The highest level measured of salinity borehole waters was in Peer Allah Bux
Shah village in KB. The EC metre displayed 15,250 µS/cm – the limit given by
WHO for drinking water purposes is 1,400 µS/cm.
As the AAH project is a Research & Development project we do not need to

find the poorest villagers - most likely situated in the creeks. Working in the
creeks would increase the AAH constraints and especially in term of logistic
issues - to provide the material and/or to organise the regular monitoring visits.
That is why the WASH & Food Sec departments decided to get harmonised
regarding the selection of villages – the same than the survey.
The WASH team will follow the Food Sec team in the targeted villages and will
focus on getting detailed information on villages’ boreholes through village
mapping activities. Which boreholes are sweet? Which ones are saline? Which
ones are in use? Etc. See Annex 6 - Village Borehole Identification Form - Nov
09.
44
Information on villages’ hygiene conditions will be gotten through village

observations.
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MISSION: PAKISTAN
The final selection of saline boreholes that AAH will rehabilitate should:
P Respect the AAH Environmental Management Plan;
P Ensure prior chemical water quality tests for all

borehole waters by an independent laboratory in Karachi;
These 2 criteria are the base of the WASH department activities. If none of the
villages finally selected by the Food Sec department can match with our
requirements, so we will not be able to work in the villages.
Another aspect to take into account in the final selection of the saline boreholes
to be rehabilitated is the number of households living nearby. We have to
identify 400 households living near the rehabilitated saline boreholes to provide
them a desalination unit.
Observations and data from the survey infer that the average size of villages is
around 40 houses per village. We cannot match our objectives of 5 saline
boreholes rehabilitated and 400 households living nearby.
We should budget the rehabilitation of 10 saline boreholes instead of

5 if we want to identify 400 households living near the saline
boreholes rehabilitated.
This budget realignment has been done in coordination with the Admin
Coordinator in Islamabad.
45
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MISSION: PAKISTAN
6.2. External Coordinations

It is a truth that we did not assess the entire 2 Talukas during the FSL survey.
That is not an important issue as our project is a Research and Development
project.
If we get success in finding easily replicable and sustainable measures against

the impact of the increased salinity of soils and water sources we would
possibly be able to extend the project benefices to new beneficiaries (with new
funds).
Moreover the KB & KC areas are vast. We cannot assess all the areas by
ourselves.
AAH should better coordinate

with the whole stakeholders in KB & KC.
We would need to draw our own maps of Talukas KB & KC based on AAH local
staffs knowledge of the areas (activity on going) to better understand where our
actions take place.
Moreover it is almost 6 months we have started our work in the 2 Talukas and
we have not taken the time to coordinate with the local authorities yet. This non-
coordination can have serious negative impacts on our project outputs if we are
not supported by the local leaders.
Finally we would also need to coordinate with the NGOs working locally (Annex
7 - NGO Coordination Form - Oct 09) with the following objectives:
P Introduce AAH Thatta to stakeholders working in KB & KC;

P Discover stakeholders’ activities in KB & KC;
P Coordinate & integrate AAH actions with the current
stakeholders’ activities in KB & KC;
The reports on NGOs coordination are available on Annex 8 – Reports on NGOs

activities in KB & KC - Nov 09.
46
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MISSION: PAKISTAN
6.3. Conclusions on the WASH project strategy

The 2 main objectives of the WASH activities regarding the introduction of the
solar desalination technology and the improvement of the hygiene conditions
should be driven as followed:
6.3.1. Solar water desalination technology

In order to increase the acceptance and the use of the solar technology by the
communities we should design the desalination unit for several purposes. This
proposition depends on the design of the final desalination unit.
P Classic solar water desalination design – most likely not the AAH final choice
We should include a rain water catchment to the design to multiply its use by
the communities.
Classic solar water desalination unit (www.thefarm.org/charities/i4at/surv/sstill.htm)
The first experiments done at AAH office Thatta are negative in term of quantity
of distilled water harvested per m2 with this technology.
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MISSION: PAKISTAN
P Parabolic reflector desalination design

If our research brings us to design a desalination unit using the parabolic
reflector system we could increase its acceptance and uses by the communities
through the multiplication of its purposes as followed:
— Water desalination – good performances expected;

— Solar Cooker – no need to go and collect wood for cooking purposes;
— Water heater – hygiene purposes;
This option would require the development of accessories specifically dedicated

to each purpose.
Parabolic Reflector Desalination Design
The conclusion is that we need to multiply / diversify the uses of the unit we will
distribute - if technically realisable.
Whatever the desalination design technology chosen by the WASH team, it

should be understood that the 400 units should not be distributed at once.
One reason is the time needed for logistic issues.
The monitoring of the first units (50 or 100 units) could allow AAH to improve
the design of the unit as well as supporting the development of local businesses
in fabricating the units (mould development, etc.). 48
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MISSION: PAKISTAN
6.3.2. Improvement of hygiene conditions

We should focus our activities of improvement of hygiene conditions in villages
where we will rehabilitate saline boreholes only. We will not implement
hardware activities.
The next steps we should follow are:

P Keep developing the HP Knowledge Sheets on:
— Saline water impacts on skin;
— Bactericide efficiency of soap in saline water;
— Bactericide efficiency of detergent powder + skin impacts;
— Salt resistant soap availability – TEEPOL brand;
— Washing hands with ashes, clay, rice husk, etc. What is the efficiency
of these practices?
P Pakistani rules & regulations on Hygiene Promotion

activities
We need to get clear information to know if AAH can talk on the “Oral Faecal
Contamination Routes” to the communities or if we need to be a doctor or a
nurse for this purpose.
When we would have identified the villages where we will work we could
develop some theatre plays to talk about the desalination process – operational
& maintenance activities at the household level – and the hygiene practices.
We would need to involve the children in these activities and to get clear
information on how to involve the women in this activity – even just as an
audience.
6.3.3. Final conclusion
The WASH & Food Sec departments should work closely and in the same
villages if technically possible – according to each department criteria.
Households chosen can be different but would be better to be the same too.
This coherence in the AAH strategy would facilitate the research and its
monitoring phase and especially in term of logistic.
49
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November 2009

WASH Baseline Survey 1 Step: - Results

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WASH Baseline Survey 1st Step

Action Against Hunger (AAH) Project

AAH Project OBJECTIVE

Pakistan, Sindh province, Thatta district,

Thomas VIGER – AAH WASH Officer

I- CONTEXT OF THE SURVEY 4

II- OBJECTIVES OF THE WASH SURVEY 6

III- METHODOLOGY OF THE WASH SURVEY 8

3.1. WASH Survey: Human Resources 8

3.2. Detail on the WASH Questionnaire 8

3.3. Organisation of Focus Group Discussions 13

IV- RESULTS OF THE WASH SURVEY 1ST STEP 14

4.1. Results of the GENERAL questions 14

4.2. Results of the WASH questions 15

Open Discussions Results 33

V- WASH SURVEY ANALYSIS & RECOMMENDATIONS 34

5.1. Drinking & cooking water 35

5.2. Sanitation & Solid Waste Management Practices 38

5.3. Food Safety Knowledge 40

5.4. Health & Hygiene Knowledge & Practices 41

VI- WASH SURVEY CONCLUSION 44

6.2. External Coordinations 46

6.3. Conclusions on the WASH project strategy 47

Annex 1 - AAH Thatta Env Management Plan – May 2009

The objectives of this first FSL survey were to establish:

I- CONTEXT of the SURVEY

The topic of the research is SALINITY.

Saline agricultural field in Keti Bunder

The main constraints in achieving the WASH survey were:

a) No map available of KB & KC;

b) No reliable data on villages and population numbers in KB & KC;

For the Thatta Department of Revenue there are 82 villages in KB and 23

II- OBJECTIVES of the WASH Survey

2.1. Objectives of the WASH Survey 1st Step

2) Get information & knowledge on the ground water salinity impacts on

3) Get information & knowledge on hygiene conditions over the villages –

In order to complete our current baseline survey we need (a) to coordinate

This represents the 2 nd step of the WASH Survey.

2.2. Objectives of the WASH Survey - 1st + 2nd Steps

1) to identify at least five (5) saline boreholes to be rehabilitated;

Indeed we strongly believe that our actions should be harmonised in term of

However some households may be different between the two departments

General hygiene promotion activities in the selected villages (where saline

III- METHODOLOGY of the WASH Survey

Questions were asked but possible answers never given to

3.1. WASH Survey: Human Resources

3.2. Detail on the WASH Questionnaire

Before starting the interview the enumerator had to write:

3.2.1. Section 1 – General Questions

a) To get global information on the village where the interview

b) To know which organisations – governmental or not –

c) To assess the general household profile;

AAH random selection of men & women to be interviewed in villages

3.2.2. Section 2 – WASH Questions

a) Drinking & Cooking water resources used by the

Borehole water salinity checking by ACF staffs in every village visited

b) Sanitation & Solid Waste Management practices;

- Solid waste management practices;

c) Food Safety knowledge;