1. S. Kunikane, K. Toshiki, K. Suenaga, Md. R. K. Razu and K. Kawahara Dissemination of an Integrated Approach to Arsenic Mitigation in Bangladesh Water Safety Conference 2010

2. Scope of this study Objective To consider a better way of assistance in water supply development Method Review of an experience on an integrated approach to arsenic mitigation, and its follow-up and dissemination in Bangladesh through literature review, interviews and field surveys Water Safety Conference November 2-4 2010, Kuching, Malaysia

3. Profile of Bangladesh Water Safety Conference November 2-4 2010, Kuching, Malaysia ParameterDataYear Population156 million2006 Land area144,000km 2 Population density982 persons/km 2 Per capita annual incomeUS$4502006 Life expectancy642006 Infant mortality54/1,000 births2004 Population having access to improved water supply 74%2004 Population having access to improved sanitation 39%2004

4. Groundwater arsenic contamination in Bangladesh Nationwide contamination Arsenic from natural sources Estimated arsenicosis cases of approximately 38,000 Water Safety Conference November 2-4 2010, Kuching, Malaysia

5. Arsenicosis patients in Bangladesh Water Safety Conference November 2-4 2010, Kuching, Malaysia Symptoms such as melanosis, keratosis, skin lesion, Bowen’s disease and cancer Health impact accelerated with poverty and malnutrition

6. JICA/AAN Projects Water Safety Conference November 2-4 2010, Kuching, Malaysia ItemAM ProjectSAM-ILGS Project NameIntegrated Approach for Mitigation of Arsenic Contamination of Drinking Water in Bangladesh Sustainable Arsenic Mitigation under Integrated Local Government System in Jessore Duration Jan 2002 ～ Dec 2004Dec 2005 ～ Dec 2008 Target areasSharsha UpazilaSharsha and Chowgacha Upazilas BeneficiariesAbout 20,000About 35,250

7. Integrated approach in the JICA/AAN Projects Water Safety Conference November 2-4 2010, Kuching, Malaysia Activity AM Project SAM-ILGS Project Awareness raisingYes Community developmentYes Installation of safe drinking water supply facilities Yes Support of arsenicosis patientYes Involvement and training of DPHE staffs NoYes Involvement and training of Upazila Health Complex staffs NoYes Organization and Support of AMCsNoYes

8. Framework of maintenance and monitoring of community based water sources Water Safety Conference November 2-4 2010, Kuching, Malaysia DPHE Mechanics/ Health workers Union AMC Local mechanics User Committee Daily and routine maintenance Petty repair Water quality monitoring Monthly report to unions on safe water option status (i.e. monthly fee collection, accounts, meetings, water quality, water level, and sanitary inspection) Activate inactive User Committee Advice to solve social problems Request DPHE Mechanics and Health workers to provide User Committee with technical support Arsenic test with field kit Technical support ▪ Repair of water devices

9. The types of safe water supply facilities installed in the JICA/AAN Projects Deep Tube Well (DTW) Pond Sand Filter (PSF) Dug Well Sand Filter (DWSF) Arsenic Iron Removal Plant (AIRP) Piped Water Supply System (PWSS) Water Safety Conference November 2-4 2010, Kuching, Malaysia

10. The result of arsenicosis patient identification in Chowgacha and Sharsha Upazilas (unit: cases) Water Safety Conference November 2-4 2010, Kuching, Malaysia Upazila Suspected Patients (A) Confirmed Patients (B) Non- arsenicosis Patients (C) A – B – C Chowgacha1,300 68757142 Sharsha 843 478356 9 Total2,1431,16592751 Note) Figures as of 30 th September 2008

11. The condition of patient’s health at the end of the SAM-ILGS Project Water Safety Conference November 2-4 2010, Kuching, Malaysia UpazilaPatientImproved Not changed Deteriorated Chowgacha 687 (100%) 335 (49%) 332 (48%) 20 (3%) Sharsha 478 (100%) 185 (39%) 254 (53%) 39 (8%) Total 1,165 (100%) 520 (45%) 586 (50%) 59 (5%)

12. Follow-up and dissemination program* Water Safety Conference November 2-4 2010, Kuching, Malaysia Target areasActivities 2 Upazila Chowgacha Sharsha Follow-up of SAM-ILGS Project, and Dissemination of an integrated approach to arsenic mitigation 6 Upazila Abhaynagar Bagherpara Jhikargacha Keshabpur Manirampur Sadar Dissemination of an integrated approach to arsenic mitigation *From January 2009 to March 2011 under the funding of JICA

13. Progress of follow-up program 72 User Committees: Chowgacha Water Safety Conference November 2-4 2010, Kuching, Malaysia SAM-ILGS Project Follow-up Follow-up & Dissemination

14. Progress of follow-up program 9 Unions: Chowgacha Water Safety Conference November 2-4 2010, Kuching, Malaysia SAM-ILGS Project Follow-up Follow-up & Dissemination

15. General procedure of dissemination program 1) Communication with Upazila administration 2) Meeting with Union Chairmen 3) Organization of an Upazila orientation program 4) Organization of a Union orientation program 5) Purchase of one arsenic field test kit for each Union by Upazila’s own budget 6) Exchange-visit program (3 times) 7) Capacity building, awareness raising, doctors/health assistants training, technical training of DPHE staffs, and arsenic test training at Union level 8) Development of a safe water supply facility (if any budget is available) Water Safety Conference November 2-4 2010, Kuching, Malaysia

16. Unit cost of dissemination program (Per one Upazila) Water Safety Conference November 2-4 2010, Kuching, Malaysia ItemCost AMC organization and its orientationTK 100,000 Training medical doctors and health assistants TK 50,000 Training of DPHE staffs TK 15,000 Exchange visits TK 50,000 Awareness raising (rally, fair, etc.) TK 50,000 TotalTK 265,000

17. Safe water supply facility installation in dissemination program An example in Hayetpur Village, Patibila Union  Completed in October 2009  Initiative of community residents  Construction cost TK 75,000 funded by LGSP budget* Two more facilities are under planning at present Water Safety Conference November 2-4 2010, Kuching, Malaysia *) LGSP stands for Local Government Support Program which is financially supported by World Bank. Total LGSP budget allocated to Patibila Union in 2008-2009 was TK 500,000.

18. Key steps for new safe water supply facility installation in Patibila Union 1) Villagers’ request for installing a safe water supply facility 2) Decision of Union Parishad (council) to provide budget 3) The organization of Para (local community) 4) DPHE’s suitability test and certification on installing an AIRP 5) Cost estimation and facility design by DPHE 6) Construction budget allocation by Union Parishad 7) Purchase of construction materials with DPHE’s technical support 8) Facility construction 9) Water quality test by Union Parishad followed by UP’s permission to use the facility Water Safety Conference November 2-4 2010, Kuching, Malaysia

19. Conclusions Importance of continued support for ensuring drinking water safety Installation of a safe drinking water supply facility with local initiatives under the support of a dissemination program as a new possibility of assistance in Bangladesh Water Safety Conference November 2-4 2010, Kuching, Malaysia

20. Acknowledgement The authors express their gratitude to -DPHE, -LGD and the local government of Jossore District, -residents in the target areas of the AM and SAM-ILGS Projects, -JICA, -all the staffs of the JICA/AAN projects, -all the staffs of LGD-JICA Follow-up and Dissemination Program of SAM-ILGS Project, and -all other people concerned. Water Safety Conference November 2-4 2010, Kuching, Malaysia

21. Water Safety Conference November 2-4 2010, Kuching, Malaysia Thank you for your attention!