Local Capacity Building for Arsenic...

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal

Environment and Public Health Organization NayaBaneshwor, Kathmandu, Nepal

Tel: 01-4493188, 4468641Fax: 01-4491376

Submitted to:Kyushu University, Japan

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal

Submitted by:

Prepared/Edited:Makhan Maharjan

Project Team, Japan and Experts:Masakazu TaNi, PhDaya SHiBuyaMayuko KiOMiSk akhtar ahmad, MBBSKiyoshi KuROSaWa, PhDKazuyuki SuENaGa, PhDMasako SaDaMaTSu, PhDTsutsui yaSuMi, PhDChhing Lamu Sherpa

Project Team, Nepal:Suman K. Shakya, PhDMakhan MaharjanBipin DangolLate Raju ShresthaNiranjan PradhanRajib BharatiGyan Prakash yadavTirth Raj Sharma DhunganaHari Bahadur Budhathokiumesh Man MaharjanNanda Kishor ChaudharyRajendra MahatoJamuna PuriJit Bahadur ChaudharyJyoti ShresthaKalpana KurmiManju Devi ChaudharyManmati HarijanMenuka ChaudharyMunki ChaudharyRamananda PandeyRamesh Kumar Pajiyar

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal iii

AMC arsenic Mitigation Committee

CBAM Capacity Building for arsenic Mitigation

CBO Community-based organization

CM Community Motivator

DDC District Development Committee

DPHO District Public Health Office

DTO District Technicians’ Office

DTW Deep tubewell

ENPHO Environment and Public Health Organization

FCHV Female Community Health Volunteer

GPS Global Positioning System

JICA Japan international Cooperation agency

KAF Kanchan arsenic Filter

LGCDP Local Governance Community Development Programme

NGO Non-Governmental Organization

NRCS Nepal Red Cross Society

O&M Operation and Maintenance

RMW Resource Mobilization Workshop

SWC Social Welfare Council

VDC Village Development Committee

WCF Ward Citizen Forum

WHO World Health Organization

WSSDO Water Supply and Sanitation Divisional Office

VDC Village Development Committee

Ave average

ppb Parts per billion

mg/L Milligram per liter

mg/kg Milligram per kilogram

m metre

Abbreviations & Acronyms

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepaliv

ENPHO would like to thank JiCa and Kyushu university for providing an opportunity for undertaking this CBaM project. We are especially grateful to Prof. Masakazu TaNi (Faculty of Design, Kyushu university, Japan) for collaborating with ENPHO as a local partner for implementation of the project.

We would like to thank Mr. akio ENDO (Representative, JiCa Nepal), Ms. Hirota NOBuKO (Coordinator, NGO-JiCa Japan Desk, Nepal), Ms. Sakiko KuROSaKa, Ms. Prerana Bishet (assistant Coordinator, NGO-JiCa Japan Desk, Nepal), Ms. Chieko MaRuyaMa (Senior Coordinator for international Cooperation Partnership Program Division from JiCa, Japan) for their cooperation.

Acknowledgements

We are thankful to Ms. aya SHiBuya and Ms. Tsutui yaSuMi (CBaM Project Coordinators, Kyushu university) and Ms. Mayuko KiOMi (Kyushu university) for their cooperation.

We are thankful to DDC, DTO, WSSDO, Ramgram Municipality, NRCS District Chapter, DPHO, District Hospital and Parasi Radio in Nawalparasi for their cooperation.

Last but not least, we heartily thank all people in the project VDCs and Ramgram Municipality and members of aMCs for their hospitality and cooperation.

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal v

Table of Contents

Abbreviations & Acronyms iiiAcknowledgements ivExecutive Summary vii1. Introduction 12. Objectives of the project 23. Project area 34. Coordination 4

4.1 Project information and sharing to relevant stakeholders 44.1.1 District level inception meeting 44.1.2 VDC level inception meetings 4

5. Project activities 55.1 Formation of Arsenic Mitigation Committee (AMC) 5

6. Capacity building 66.1 Capacity Buildings of AMCs 6

6.1.1 Training on ‘arsenicosis Case Detection’ 66.1.2 Training on ‘arsenic Testing’ 66.1.3 Training on Kanchan arsenic Filter (KaF) –

Construction and its Operation and Maintenance 66.1.4 Organizational development 7

6.1.4.1 action plan 76.1.4.2 Proposal writing 76.1.4.3 Registering aMC as a Legal Entity and collaborate with WCF 7

6.2 Capacity Buildings of local experts (project staff and local frontline workers) 76.2.1 Capacity building of CMs 8

6.2.1.1 Training on ‘arsenicosis Case Detection and Management’ 86.2.1.2 Training on arsenic testing 86.2.1.3 Training on GPS operation 86.2.1.4 Training on Kanchan arsenic Filter (KaF) – Construction and its O&M 86.2.1.5 Training on ‘Community Dealing, Reporting and Case Study Writing’ 86.2.1.6 Training on ‘Community Mobilization and Leadership’ 8

6.2.2 Capacity Building of other Frontline Workers 86.2.2.1 Training on ‘arsenicosis Case Detection and

Management’ to local health professionals 86.2.2.2 Training on ‘arsenicosiscase Detection and Management’ to FCHVs 96.2.2.3 Training on ‘arsenic and arsenicosis Cases’ to arsenicosis patients 96.2.2.4 Orientation training to ‘School Teachers’ 96.2.2.5 Orientation training to ‘Journalists’ 10

7. Surveys 117.1 Household surveys 117.2 Physical examination for skin manifestations 11

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepalvi

8. AMC activities 138.1 Preparation of social map 138.2 Arsenic testing 138.3 Filter observation, maintenance and construction 138.4 Patient screening and counseling 148.5 Arsenic classes 148.6 Monthly meeting 14

9. Model tubewells installation 1510. Hydro-geological testing 16

10.1.1 Wide areal hydro-geological survey 1610.1.2 Result of existing data analysis 1610.1.3 Result of field survey 1810.1.4 Classification of the sediments 1910.1.5 Arsenic concentration of each type of sediment 2010.1.6 Location of the groundwater aquifer 2010.1.7 The type of sediment that contain high arsenic and

its effect on the arsenic contamination of the aquifer 2410.1.8 Feasibility for deep tubewell (DTW) as alternative safe water option 24

11. Awareness raising 2611.1 IEC and training materials 2611.2 Radio messages 2611.3 Wall-paintings 2611.4 Hoarding boards 2611.5 Street Drama 2711.6 Stall in local fair 2711.7 ‘World Water Day 2012’ celebration 2711.8 School programme 27

11.8.1 Essay Competition 2811.8.2 Quiz Contest 2811.8.3 awareness rally 28

12. Workshops/Exposure Visit 2912.1 Resource Mobilization Workshop 2912.2 Experience sharing workshop 2912.3 Exposure visit 2913.1 Drinking water sources 3113.2 Arsenic removal filters 3113.3 Knowledge levels 31

13. Findings-Baseline & Post-Surveys 3114. Outputs-CMs & AMCs 3315. Monitoring & Supervision 36

15.1 ENPHO, Kathmandu Office 3615.2 Kyushu University, Japan & Experts 3615.3 Japan International Cooperation Agency (JICA) 3615.4 Social Welfare Council (SWC) 3715.5 Visit by Ambassador of Japan 37

16. Project Dissemination 3817. Impacts of the Project 3918. Lessons learned & sustainability concerns 4019. Conclusions & Recommendations 4120. References 4221. Annexes 43

Annex 1: Post survey - demographic summary data 43Annex 2: List of borings and model tubewells 45Annex 3: CBAM Project-Target versus Completed Activities 47Annex 4: Outputs-CMs 49Annex 5: Case Studies 52

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal vii

Executive Summary

Groundwater in lowland Nepal is arsenic contaminated and the surveys have revealed chronic arsenic toxicity related health effects. Both government and Non-Governmental Organizations have made continuous efforts for arsenic mitigation that are primarily focused on arsenic testing and provision of arsenic safe water options. inadequate awareness, chronic arsenic toxicity nature and lack of enough knowledge and skills to avoid such risks are the bottleneck for overcoming arsenic related problems.

Nawalparasi is the highest arsenic contaminated district of Nepal. Peoples’ awareness on arsenic and its health hazards is low and arsenic-safe water options are not regularly used. Thus, this project ‘Local Capacity Building for arsenic Mitigation in Nawalparasi district, Nepal’ (CBaM) funded by Japan international Cooperation agency (JiCa), coordinated by Faculty of Design, Kyushu university, Japan and locally implemented and managed by Environment and Public Health Organization (ENPHO) was undertaken.

Project duration: 27 months (January 2011-March 2013)

The overall objective of the project is to build local capacity for sustainable arsenic mitigation in the project area in Nawalparasi district, Nepal.

Specific objectives: To form a local organization for arsenic

mitigation in each target community; To foster local leaders for arsenic

mitigation activities; To transfer more technical information

and skills for arsenic mitigation to local experts;

To extensively disseminate arsenic related information to local population.

Project area: 59 arsenic affected communities from 15 VDCs and Ramgram Municipality

The major activities of the project in order to achieve the above mentioned objectives are as followings: Coordination with relevant stakeholders; Formation and initialization of Local

arsenic Mitigation Committee (aMC) at each project community;

Local capacity building (general public, local leaders and local experts) for arsenic mitigation;

awareness raising on arsenic related issues;

Surveys; Hydro-geological investigation; Provision of sustainable arsenic safe water

facility.

Formation of Arsenic Mitigation Committee (AMC)Local aMC, constituting six members in general, has been formed in all 59 communities. Prior to aMC formation,

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepalviii

project staff held consultation meeting with representatives of community people constituting social workers, mothers’ group and youth group so as to inform about the CBaM project and plan of aMC formation and its objectives. aMC members include male, female, youth, aged people with social inclusion. There are 357 aMC members (191 male and 166 female).

Local capacity buildingThe project emphasized capacity building on arsenic mitigation through the development of skilled human resources.

Target groups for capacity buildingHuman Resources Content of capacity building General public Knowledge about arsenic, its

related risks and arsenic safe water options

Local leaders (AMC members)

Basic skills and knowledge to assess arsenic risks

Local experts (staff members hired by the project and local frontline workers)

Technical skills and knowledge to implement arsenic mitigation measures

Different training activities were conducted aiming to build/ enhance local capacity on arsenic mitigation.

Capacity building of AMCs Training on ‘arsenicosis Case Detection’ Training on ‘arsenic Testing’ in water Training on Kanchan arsenic Filter (KaF)

– Construction and its O&M Organizational development - action plan

and proposal writing

Capacity building of local experts Training on ‘arsenicosis Case Detection

and Management’ (field staff) Training on ‘arsenic Testing’ in water (field

staff) Training on Kanchan arsenic Filter (KaF)

– Construction and its O&M (field staff) Training on GPS operation (field staff) Training on ‘Community Dealing,

Reporting and Case Study Writing’ (field staff)

Training on ‘Community Mobilization and Leadership’ (field staff)

Training on ‘arsenicosis Case Detection and Management’ to local health professionals

Training on ‘arsenicosis case Detection and Management’ to FCHVs

Training on ‘arsenic and arsenicosis Cases’ to arsenicosis patients

Orientation training to School Teachers Orientation training to Journalists

These trainings/orientations have built local capacity on arsenic issues and it has been expected that this will significantly help in highlighting arsenic problem and arsenic mitigation initiatives.

Household surveysin baseline survey, 6,190 households in 59 communities were visited and population of 35,026 (18,032 male and 16,994 female) was recorded with average household size of 5.66. in post survey, there were 6,275 households with total population of 36,154 (18,326 male and 17,828 female); the average household size was 5.76. Population in the survey communities was comprised of Tharu, Dalit, Brahmin, Janjati, Muslim, Chhetri and other ethnicities.

Physical examination for skin manifestationsHealth examination for identifying arsenicosis cases was conducted in some project communities. Dr. Sk akhtar ahmad, Bangladesh identified a total of 171 persons (117 male and 54 female) to suffer from chronic arsenic toxicity. Melanosis was found as the dominant skin manifestation in the identified patients.

AMC activities Preparation of social map arsenic testing Filter observation, maintenance and

construction Patient screening and counseling arsenic classes Monthly meeting

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal ix

Model tubewells installationa total of 60 borings to depth around 50m were made for installation of tubewells as ‘Model tubewells’ for arsenic safe water source. Dry layer with no water was found in 14 borings. So, 44 tubewells have been installed in different project communities and platform with improved sanitation has been made in all installed tubewells.

Hydro-geological testingFor hydro-geological testing related to arsenic contamination in the project area, 20 tubewells of depth around 50m were installed in different places and soil samples collected from different depths analyzed.

DTW is effective alternative safe water option in arsenic contaminated area of Nawalparasi district. However, situation varies because characteristics of deep aquifer depend on hydrogeological condition such as permeability and water quality.

Awareness raisingFor educating and raising awareness of the local people on arsenic, its health effects and mitigation measures, various activities were carried out. Development and distribution of iEC and

training materials airing of radio messages (6 times in a day

– in Bhojpuri 3 times and in Nepali 3 times) Wall-paintings (28 locations with priority to

eye-catchy places) Hoarding boards (9 locations with priority

to eye-catchy places) Street Drama (74 shows; about 25,000

people observed) Stall in local fair ‘Khichadi Mela’ in Manari ‘World Water Day 2012’ celebration School programme (essay competition,

quiz contest and awareness rally)

Knowledge levels (arsenic, its health effects and arsenic safe water options) of people in project communities was found considerably raised in post survey compared to baseline survey. in baseline survey, 56.7% people knew about arsenic problem while it increased

to 91.6% in post survey. People who knew about arsenic-induced health effects prior to project interventions were only 46.9% which rose to 85.4% during post survey. Likewise, knowledge on arsenic safe water options climbed up from 63.5% to 90.6%.

Monitoring and SupervisionMonitoring of the project was been done at two levels – internal and external. Regular communications and periodic visits to Parasi Field Office and project area were done from ENPHO, Kathmandu office. Visits were also made from Kyushu university, JiCa and Social Welfare Council (SWC). Mr. Kunio TaKaHaSHi, ambassador of Japan for Nepal visited the project field office and one of the project communities and appreciated the project and the efforts made.

Impacts of the projectThe CBaM project has made a positive impact for sustainable arsenic mitigation in the project communities. The project has built local capacity on arsenic mitigation of three target groups such as local people, community leaders (aMC members) and frontline workers along with staff members. as learned from discussion during the field visit, the empowered aMC members are capable of independently conducting arsenic testing in water using field kit, construction of KaF and its O&M and screening of arsenicosis cases (skin manifestations). They are making advocacy for mobilizing local funds and resources.

Furthermore, the project has sensitized local people on arsenic by wider awareness raising activities. People have shown concerns for arsenic-free water.

Lessons learned awareness is the most important factor

that determines the success or failure of the efforts made in peoples’ behavior change.

Local capacity development and peoples’ active involvement are necessary for sustainable arsenic mitigation.

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepalx

Sustainability concerns arsenic-related health implications being

of chronic nature, people are not serious in regular use of arsenic safe alternatives.

Peoples’ dependent nature (usually not willing to share the cost) is a problem.

Overall, the CBaM project has been successfully completed accomplishing all targeted activities and achieving desired outputs. Coordination was maintained at both district and central levels and there was good cooperation from all relevant stakeholders. The project has sensitized community people on arsenic issue and built local capacity on arsenic mitigation through different training programmes. aMC members have been basically developed as skilled human resources. it is assumed that aMCs and other experts shall locally contribute in arsenic mitigation efforts.

aMCs were formed as a grass root level entity of CBaM project. Skills of aMCs and other experts on arsenic mitigation should be utilized by concerned agencies.

active participation of aMCs should be made in arsenic mitigation activities and activation of aMCs should be considered for sustainable arsenic mitigation.

Monitoring of tubewells and provided safe options (usage, performance, O&M) should be done occasionally.

arsenicosis case management should be done.

Follow up support and refresher trainings will help keep aMCs active and local capacity alive.

Probability to obtain safe water could be high by drilling deeper than top depth of third aquifer.

Good coordination among concerned authorities is needed.

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal 1

Groundwater in lowland Nepal is arsenic contaminated and the surveys have revealed chronic arsenic toxicity related health effects (Maharjan et al., 2005, 2006, 2007). Both government and Non-Governmental Organizations (NGOs) have made continuous efforts for arsenic mitigation that are primarily focused on arsenic testing and provision of arsenic safe water options. The programmes gave less emphasis on awareness raising and local capacity building on arsenic problem, and majority of local people lacked information on arsenic and its consequences and provided arsenic safe water options are not regularly used. inadequate awareness, chronic arsenic toxicity nature and lack of enough knowledge and skills to avoid such risks are the bottleneck for overcoming arsenic related problems.

Nawalparasi is the highest arsenic contaminated district of Nepal but peoples’ awareness on arsenic and its health hazards is low and arsenic-safe water options are not regularly used. Thus, this project ‘Local Capacity Building for Arsenic Mitigation in Nawalparasi district, Nepal’ (CBaM) funded by Japan international Cooperation agency (JiCa), coordinated by Faculty of Design, Kyushu university, Japan and locally implemented and managed by Environment and Public Health Organization (ENPHO) was undertaken.

The project duration was 27 months (January 2011-March 2013).

Figure 1: Project Implementation Model

Financial Support(JICA)

Monitoring and evaluation

Coordination

Capacity Building(General Public, Staff, AMC

Members, Frontline workers)

Social Welfare Council

End Users

Awareness/Surveys/Safe Water

Kyushu University

Project Implementation(ENPHO)

Introduction

1

Local Capacity Building for Arsenic Mitigation in Nawalparasi District, Nepal2

The overall objective of the project is to build local capacity for sustainable arsenic mitigation in the project area in Nawalparasi district, Nepal.

Specific objectives: To form a local organization for arsenic

mitigation in each target community; To foster local leaders for arsenic

mitigation activities; To transfer more technical information

and skills for arsenic mitigation to local experts;

To extensively disseminate arsenic related information to local population.

Objectives of the project

2


expected, based on aiMS data. Most of these “communities” denote geographically separated settlements, but in Ramgram Municipality, communities sometime refer to wards in city.

The criteria for community selection are a two-fold: (1) there are at least 10 tested tubewells in the community, and (2) there is at least one tubewell whose arsenic concentration is more than 300 ppb. among communities excluded by these criteria, there are those which include a high percentage (highest 93%) of contaminated tubewells above the national standard of 50 ppb; but arsenic concentration of these contaminated tubewells is not very high. The reason for this exclusion is that relatively low levels of arsenic contamination may not lead to immediate health threats. Therefore, communities satisfying the above criteria were given priority in this project.

Nawalparasi district is located in the middle of the Terai belt in the southern Nepal (Figure 2). its area measuring 2,162 km2 lies at the end of hills extending ultimately from the Himalayas and is partially part of the Terai plain. The district is divided into 73 Village Development Committees (VDCs) and one municipality where district headquarters is situated. among these VDCs, 36 VDCs belong to the hill area, and the remaining 37 VDCs and one municipality to the plain. The district has 6,35,793 people.

according to aiMS (ver. 2.0), while little arsenic is detected in the hills, extensive and serious arsenic contamination exists in the plains that causes health problems by chronic arsenic poisoning. This CBaM project selected 59 communities from 15 VDCs and Ramgram Municipality, where arsenic contamination is serious and further health damage is

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Figure 2: Map of Nepal showing Nawalparasi district and CBaM project areas


4.1 Project information and sharing to relevant stakeholdersFollowing agreement between Kyushu university and ENPHO on the project, an application for the approval of the project for its execution was processed at the Social Welfare Council (SWC), Kathmandu. The SWC granted approval for the execution of the project with the need of monitoring of the project from its side sometime during the project period. Similarly, Water Quality improvement and Monitoring Section (WQiMS) at Department of Water Supply and Sewerage (DWSS), Kathmandu was informed about the project.

Meetings were held with key district level stakeholders such as District Development Committee (DDC), District Technicians’ Office (DTO), Water Supply and Sanitation Divisional Office (WSSDO) for informing about the project and their cooperation.

4.1.1 District level inception meetinginception meeting on the project was organized among district level key

stakeholders at the Meeting Hall of DDC, Parasi, Nawalparasi on 10th February 2011. The meeting was chaired by Mr. Basant adhikari, former Local Development Officer (LDO), DDC, Nawalparasi and there were a total of 22 persons representing from DDC, DTO, WSSDO, District Public Health Office (DPHO), District Education Office (DEO), Nepal Red Cross Society (NRCS), District - Water, Sanitation and Hygiene Coordination Committee (D-WaSH-CC), Kyushu university etc.

4.1.2 VDC level inception meetingsinception meetings were organized in all 15 VDCs and for municipal communities so as to inform community leaders and locals about the CBaM project. During the meetings, status of arsenic contamination in the respective VDCs and planned project activities were presented to the participants.

Coordination and sharing of the project progress was regularly done with relevant stakeholders.

Coordination

4


The major activities of the CBaM project in order to achieve the desired objectives are as followings: Formation and initialization of Local

arsenic Mitigation Committee (aMC) at each project community;

Local capacity building (general public, local leaders and local experts) for arsenic mitigation;

awareness raising on arsenic related issues;

Survey; Hydro-geological investigation; Provision of sustainable arsenic safe water

facility.

5.1 Formation of Arsenic Mitigation Committee (AMC)Local aMC, constituting six members in general, has been formed in all 59 communities. Prior to aMC formation, project staff held consultation meeting with representatives of community people constituting social workers, mothers’ group and youth group to inform about the CBaM project and plan of aMC formation and its’ objectives. Participants welcomed the proposal enthusiastically and aMC was formed later at their convenience representing male, female, youth, aged people as well as social inclusion by discussion. Community people themselves chose the members for aMC and accepted the responsibility to help in mitigating arsenic. There are 357 aMC members (191 male and 166 female).

Project activities

5


The major aim of the project was local capacity building of three target groups for sustainable arsenic mitigation (Table 1). Such capacity building was to be materialized through the development of human resources.

Table 1: Target groups for capacity building Human Resources Content of capacity building General public Knowledge about arsenic, its

related risks and arsenic safe water options

Local leaders (AMC members)

Basic skills and knowledge to assess arsenic risks

Local experts (staff members hired by the project and local frontline workers)

Technical skills and knowledge to implement arsenic mitigation measures

Different training activities were conducted aiming to build/ enhance local capacity on arsenic mitigation.

6.1 Capacity Buildings of AMCsWithin the project period, CBaM project organized four types of trainings for aMCs and the training certificates were provided to all participants.

6.1.1 Training on ‘Arsenicosis Case Detection’Two persons from each aMC were invited to participate in ‘arsenicosis cases Detection’ training organized in august 2011 and January 2012. Trainings were facilitated by Dr. Sk akhtar ahmad from Bangladesh, who possesses ample experience on diagnosing arsenicosis cases. The topics discussed in the training were field method

for identification of chronic arsenic poisoning (skin manifestations), patient counseling, importance of nutritious food for patient and arsenic safe water options. a total of 109 persons (64 female and 45 male) participated in the trainings. This training helped to screen arsenicosis patients in communities.

6.1.2 Training on ‘Arsenic Testing’For building arsenic testing skill to all aMC members, hands-on trainings on ‘arsenic Testing’ in water using field kits were organized in June, July and December in 2011 and February, March, april and May in 2012. ENPHO arsenic Field Kit and MERCK arsenic Kit were used in the trainings. There were 333 aMC members (173 female and 160 male) from 59 aMCs. This has capacitated aMCs for arsenic testing in water in the field.

6.1.3 Training on Kanchan Arsenic Filter (KAF) – Construction and its Operation and MaintenanceThere are several thousand KaFs distributed by government and non-government organizations in arsenic affected communities.

Capacity building

6


But lack of operation and maintenance (O&M) skills on the filter among majority of the users have left most of filters unused. in this consideration, CBaM project conducted trainings on construction of KaF and its O&M to aMCs in May and June 2012. a total of 249 aMC members (132 female and 117 male) participated in the training. The training provided knowledge and skill on KaF construction and its O&M to aMC members.

it is learned that after this training some aMCs have started maintaining of unused filters (that need no replacement of filter components) in their respective communities. To add, some aMCs have also constructed KaF themselves and distributed in response to community request (in Kirtipur). This has also helped those aMCs in income generation. it is noteworthy that aMC members are motivating people in their respective communities for regularly using the filter for preventing from possible health hazards. it is expected that this will considerably help in arsenic mitigation in project communities in long-run.

6.1.4 Organizational development6.1.4.1 Action planaMCs were formed as a grass root level entity of CBaM project. Thus, all aMCs were trained on preparation of work plan related to arsenic mitigation such as preparation of social map, arsenic testing in community, KaF–construction and its O&M, screening of arsenicosis cases, awareness activities (arsenic class, home visits, distribution of iEC materials), proposal writing etc. With this, all aMCs prepared their own action plan themselves.

6.1.4.2 Proposal writingTo develop aMCs skill for approaching government budget, the CBaM project oriented aMC members in resource mobilization and development of small grant support proposals. after this, aMCs approached government and non-government agencies for financial support for deep tubewells construction, overhead tank construction, filter supply, dugwells improvement, arsenic classes etc. But to get access to funds, making just application is not enough; they should go through Ward Citizens Forum (WCF) where government budget is finalized/ channelized for grass-root level activities. By this period, eight aMCs have submitted proposals for small grant. among them, aMCs in Kirtipur and Manjhariya have been supported for KaF production and Parsa for dugwell improvement. Furthermore, with request of aMC and community people in Mahuawa, WSSDO has already planned for overhead tank construction with deep boring.

6.1.4.3 Registering AMC as a Legal Entity and collaborate with WCFaMC is not registered in any government agencies. it is important to register it in government agencies for accessing to funds/ grants. Nevertheless, some aMCs got merged and some are collaborating with local NGOs and Community-Based Organizations (CBOs). Some aMCs have collaborated with WCFs because members of some aMC are also WCF members. Collaborating with WCF is best way to work with government agencies because WCFs are formed by local government agencies. Thus, the CBaM project also organized an experience sharing workshop so as to help collaborating and merging of aMCs with NGOs, CBOs and WCF.

6.2 Capacity Buildings of local experts (project staff and local frontline workers)With objectives to develop skills on survey, arsenic testing, arsenicosis case detection and management, KaF construction and its O&M, community dealing, reporting and case study writing, different trainings were organized to locals that include project staff members and other frontline workers.


6.2.1 Capacity building of CMs6.2.1.1 Training on ‘Arsenicosis Case Detection and Management’Two days training on ‘arsenicosis Case Detection and Management’ was organized on 28 February to 01 March 2011 for Community Motivators (CMs). Dr. Sk akhtar ahmad, Bangladesh was the resource person. Refresher training on the same was also carried out on 18 January 2012 which considerably raised confidence of CMs on screening of arsenicosis cases (skin manifestations).

6.2.1.2 Training on arsenic testingOn June 23, 2011, project staff particularly CMs were given hands-on training on water sampling and arsenic testing in water using field test kit. in the training, precautionary measures to be taken while handling field kit and data recording were also discussed.

6.2.1.3 Training on GPS operationTraining on handling of GPS device to staff members was conducted on March 12, 2011 so as to make them capable to properly handle and record GPS data. CBaM staff are now able to operate GPS device independently.

6.2.1.4 Training on Kanchan Arsenic Filter (KAF) – Construction and its O&MOn November 04, 2011, training on construction of KaF and its O&M to CMs was conducted. The training provided knowledge and built skill on KaF construction and its O&M to CMs.

6.2.1.5 Training on ‘Community Dealing, Reporting and Case Study Writing’Skills of CMs on community dealing, reporting and case study writing were developed with series of trainings facilitated by an awareness expert from Japan and social mobilization expert from Kathmandu. Experts made visits to Nawalparasi in august, 2011; February, april, May, September and December 2012. Knowledge and confidence of CMs on community dealing, reporting and case study writing have considerably raised through these trainings.

6.2.1.6 Training on ‘Community Mobilization and Leadership’Training on ‘Community Mobilization and Leadership’ to CMs was provided through facilitators from indreni Development Forum from 22-27 September 2011. This training enhanced community mobilization skill of CMs.

6.2.2 Capacity Building of other Frontline WorkersWith the objective of sustainably addressing arsenic problem, the project also aimed to educate and mobilize frontline workers in arsenic mitigation initiatives. in this effort, various trainings/ orientations were organized on arsenic, its health risks and mitigation measures to some frontline workers.

6.2.2.1 Training on ‘Arsenicosis Case Detection and Management’ to local health professionalsOn March 02, 2011, one day training cum workshop on ‘arsenicosis Case Detection and Management’ was organized for local health professionals (medical doctors and health post staff) of Nawalparasi district. in total, there were 45 participants representing from District Hospital, DPHO and different health posts. They gained knowledge on arsenicosis case


detection and its management from Dr. Sk akhtar ahmad, Bangladesh.

6.2.2.2 Training on ‘Arsenicosiscase Detection and Management’ to FCHVsin Terai society, women usually stay at home and do not disclose health problems to others. Female Community Health Volunteers (FCHVs) are grass root level health volunteers in the communities who are close to women villagers for most of health-related problems. Orientation trainings on ‘arsenicosis Case Detection and Management’ to FCHVs were organized from 05-06 September 2012. Participants said that it was the first training they attended on arsenic-induced health problems and that the training was very useful to them as they did not possess knowledge about arsenic and arsenicosis cases before. it is expected that trained FCHVs will contribute in screening of arsenicosis cases and flow arsenic related information in the communities.

6.2.2.3 Training on ‘Arsenic and Arsenicosis Cases’ to arsenicosis patientsWith objectives to make aware and help regularly use arsenic free water options, all identified arsenicosis patients in the CBaM project area were invited for orientation

training on ‘arsenic and arsenicosis Cases’ scheduled for 3rd, 4th and 7th of September 2012. There were 134 patients (84 male and 50 female) who joined the training in 5 different groups. The trainings were facilitated by Dr. Sk akhtar ahmed, Dr. atulesh Chaurasiya and Dr. Gajananda Bhandari. information on arsenic, its health effects, importance of consuming arsenic free water and nutritious foods, and arsenic safe water options were highlighted and discussed. The participants said they will regularly consume arsenic free water and change their food habits.

This training was found to be effective because most of the participants (patients) soon showed behavioral change on drinking water and food habits.

6.2.2.4 Orientation training to ‘School Teachers’School teachers who are considered respectable in the communities have influential role in educating and behavior change of people. With this, orientation training on ‘arsenic, its health effects and mitigation measures’ was carried out on 14 and 18 June 2012. There were 32 health/science teachers (22 male and 10 female). Teachers were requested to flow arsenic related information


to students in their respective schools so that students as change agents take the knowledge to home and play significant role in sustainable arsenic mitigation in long run.

it is learned that trained teachers occasionally provide arsenic related information in their classes and discuss important roles of schools /students in arsenic mitigation.

6.2.2.5 Orientation training to ‘Journalists’in consideration of important role of media in disseminating the information and messages, one day orientation training on arsenic, its health effects and mitigation measures was

ARSENIC AWARENESS PROGRAMME

Vishnu Roka, 12/04/2069 awareness programmes and water testing has been done in Swathi VDC-6, Bankatti.awareness programme and water testing is being done by the arsenic Mitigation Committee in Swathi VDC-6, Bankatti and Hardiya under the CBaM project of ENPHO, supported by JiCa and KyuSHu uNiVERSiTy as informed by Manmaya Gurung, the member of aMC. The main subjects for awareness programme were introduction of arsenic, its sources of contamination, health effects and arsenic-free water sources. and the training was for 28 people and in total 174 hand pipes was tested. among them, 67 hand pipe’s water is drinkable and 104 hand pipes contain high arsenic levels, as said by Ms. Jamuna Puri, CM of CBaM project, ENPHO. aMC member Krishna Bahadur Poudel said “The effect of arsenic is seen slowly due to arsenic present in water used; therefore we are running awareness programme.

organized to local journalists on June 06, 2012. a total of 19 persons (17 male and 2 female) joined the training. Participant journalists learned about arsenic problem, health risks and arsenic safe water options in general.

after this training, local radio stations aired information about arsenic problem in Nawalparasi. Parasi Radio enquired CBaM field office for arsenic-related important activities and broadcasted in news. This has significantly helped in highlighting arsenic problem and mitigation initiatives.


7.1 Household surveysBaseline survey was conducted in March-May 2011. a total of 6,190 households in 59 communities were visited and population of 35,026 (18,032 male and 16,994 female) was recorded with average household size of 5.66. Population in the survey communities was comprised of Tharu, Dalit, Brahmin, Janjati, Muslim, Chhetri and other ethnicities.

Post survey, in 59 project communities, was conducted from November-December 2012. in post survey, there were 6,275 households with total population of 36,154 (18,326 male and 17,828 female). The average household size was 5.76. Summarized data for sex-wise population from the survey is given in annex 1.

Surveys

7

7.2 Physical examination for skin manifestationsHealth examination for identifying arsenicosis cases was conducted in some project communities. Residents who were present during the visits (august 2011, January 2012 and September 2012) were physically examined for arsenicosis cases by Dr. Sk akhtar ahmad, Bangladesh. in the surveys, only those who were continuously living in the study areas at least for six months were included whilst others such as not living in the study areas for more than six months continuously, visitors or guests were excluded.

a total of 171 persons (117 male and 54 female) were found to suffer from chronic arsenic toxicity. The proportion of arsenicosis cases for male was 38.9% and for female 16.3%, with overall prevalence of 24.2%. By age group, the subjects in 50-64 age group and 15-49 age group were found to be suffered more from chronic arsenic toxicity (Table 2). Melanosis was found as the dominant skin manifestation in the identified patients (data not shown). Present finding is consistent with several preceding studies in india and Bangladesh and some recent studies

Table 2: Distribution of arsenicosis patients by age group and sexAge group (years) Male Female Total

5-14 0/13 (0.0) 2/11 (18.2) 2/24 (8.3)15-49 78/208 (37.5) 40/243 (16.5) 118/451 (26.2)50-64 31/56 (55.4) 9/55 (16.4) 40/111 (36.0)65+ 8/24 (33.3) 3/23 (13.0) 11/47 (23.4)Total 117/301 (38.9) 54/332 (16.3) 171/633 (24.2)


in Terai, Nepal. (ahmad et al., 1999; Guha Mazumder et al., 1998; Watanabe et al., 2001; Maharjan et al., 2005, 2006, 2007).

The prevalence of arsenicosis for male was higher as compared to female, suggesting male suffering more than female from arsenicosis. Though there are unexplained factors like nutritional status of the subjects, genetic factors that cause sex difference for

arsenicosis, or resistance to arsenic toxicity, which might be influencing the occurrence of arsenicosis more in male, it is reported that ingestion of more arsenic through increased amount of drinking water by male is higher compared to that of female and that might have contributed for the higher prevalence of arsenicosis in male.


aMCs carried out different activities in their respective communities.

8.1 Preparation of social mapaMCs have prepared social map of their respective communities. in the map, high arsenic contaminated tubewells, houses with arsenicosis patients, alternative water sources, houses with filters etc were marked along with other features. The map has been considerably useful to aMCs while planning for arsenic classes, home visits, filters observation, awareness activities etc.

8.2 Arsenic testingaMCs have conducted arsenic testing of tubewells using field test kit in their respective communities. a total of 5,071 water samples were tested for arsenic. More than half of the tested samples (54.0%) exceeded the National standard of 50 ppb, 17.5% samples were found with 11-50 ppb of arsenic and 28.5% samples within the 10 ppb of arsenic (Figure 3). arsenic concentration in approximately 4.0% samples (201 samples) was measured above 300 ppb at the time of testing.

8.3 Filter observation, maintenance and constructionaMC members made home visits in their respective communities for filter (KaF) observation and also performed maintenance of some filters which lacked cleaning. Notably 6 aMCs have also constructed and distributed KaFs at low price in response to community demand.

AMC activities

8

1,447(28.5%)

886(17.5%)

2,738(54.0%)

upto 10 ppb 11-50 ppb Above 50 ppb

Figure 3: Classification of water samples by arsenic levels


8.4 Patient screening and counselingaMC members made door-to-door house visits for screening of suspected arsenicosis cases. They also counseled all arsenicosis patients for regularly using arsenic free water, consumption of nutritious foods and cessation of alcoholism and smoking habits.

8.5 Arsenic classes

aMCs organized arsenic classes to different target groups in the communities such as child clubs, women groups, general community people and some schools in the project area (Table 3). Classes were organized with the objectives of educating people and providing

them information on arsenic and its health effects, arsenic safe water options and the importance of arsenic-free water in preventing arsenic toxicity. CMs, in their respective communities, were present to monitor/ support aMC classes.

Table 3 Summary of arsenic classes

Target TimesParticipants

Male Female Total

Community 60 502 1,234 1,736

Women Group 17 63 413 476

School 43 913 1,041 1,954

Child Club 34 495 500 995

Total 154 1,973 3,188 5,161

8.6 Monthly meetingaMCs regularly hold meeting once in every month at their convenience for discussions on arsenic related works such as work plan preparation, filter observation and maintenance, arsenic class, arsenicosis patient counseling, saving, resource mobilization, collaboration etc.


a total of 60 borings to depth around 50m were made for installation of tubewells as ‘Model tubewells’ for arsenic safe water source. Dry layer with no water was found in 14 borings. So, 44 tubewells have been installed in different project communities and platform with improved sanitation has been made in all installed tubewells.

Contrary to expectation, arsenic concentrations in 5 installed tubewells were measured high exceeding the national standard of 50 ppb. These tubewells with high arsenic levels should be routinely monitored. List of borings and model tubewells is given in annex 2.

Model tubewells installation

9


For hydro-geological testing related to arsenic contamination in the project area, 20 tubewells of depth around 50m were installed in different places and soil samples collected from different depths analyzed. Experts on hydro-geology from Kyushu university, Japan visited the project area for supervising hydro-geological testing work.

10.1 Geological investigation10.1.1 Wide areal hydro-geological surveyContents and methodin order to confirm feasible water source and disseminate knowledge of safe water option, a wide areal hydro-geological survey was carried out. The survey consists of existing

Hydro-geological testing

10

data analysis for confirmation of arsenic contaminated situation in Nawarpalasi district, test boring for analysis of aquifer structure and well boring for installation of model water options. Fifteen test borings were conducted in Terai plain of Nawarpalasi district and well borings were conducted in each target communities (Figure 4). Borings were performed by using a manpower percussion method (also known as “Slugger method”) which is a local drilling technology. During the boring work, disturbed geological samples are collected for geological description in each 1m interval up to 50m in depth.

as the result of data analysis, aquifer characteristics were clarified in a project area of Nawalparasi district. Field works such as site management, geological description, well installation and progress management were done by project staff through technical supervision from Japanese experts.

10.1.2 Result of existing data analysisNational level arsenic screening results by field kit were compiled in the arsenic information Management System (aiMS, NaSC/uNiCEF 2007). High level arsenic affected VDCs were located in the north-western area of Terai plain in Nawalparasi district (Figure 5). Most affected VDC is Manari (50.38%), after that Ramgram Municipality (48.73%), Ramnagar (37.55%), Pratappur (37.71%), Hakui (36.36%), Tilakpur (34.12%) were also highly affected VDCs. From a viewpoint of the vertical distribution, arsenic contaminated groundwater exceed 50 ppb are found from 5-40m in depth, especially


Figure 4: Location map of boring site (•: Test boring, ○: Model well)

Figure 5: arsenic affected situation (data source: aiMS; inside a dotted line: Terai plain)


high contaminated groundwater exceed 100 ppb are concentrated from 10 to 30 m in depth (Figure 6).

10.1.3 Result of field surveyGeology is composed mainly of clay layer (clay and silt) and contains intercalated sandy layer (sand and gravel) in the survey area. These sandy layers become aquifer which is divided into first, second and third aquifers in descending order (Figure 7 and 8). Geological structure is accordant to topography and gently inclines toward indian border.

according to the relationship between well depth and arsenic concentration as shown in Figure 6, it is clearly found that second aquifer is most affected zone. First and third aquifers

could be safe water source in the area where second aquifer is contaminated. But first aquifer has limitation because the layers are thin or absent. On the other hand, third aquifer becomes effective aquifer as alternative safe water source due to wide distribution of thick layer.

Probability to obtain safe water could be high by drilling deeper than top depth of third aquifer as shown in Figure 9. However, thickness of third aquifer varies from place to place (Figure 10). additional investigation in deeper zone would be required because enough water volume as alternative source cannot be expected in the area where aquifer has finer grain size and thin.

Figure 6: Vertical distribution of arsenic concentration in groundwater

Figure 7: Geological profile and aquifer structure (West – East)


Figure 9: Contour map of the top depth of third aquifer (GL-m)

Figure 10: Facies and thickness of third aquifer (m)

Figure 8: Geological profile and aquifer structure (North – South)

10.1.4 Classification of the sedimentsFigure 11 shows the results of the distribution of each type of sediment according to the depth at each community. Sediment profile was different from community to community from Figure 11 and 12. at Kasiya, clay and silty clay were found at depths from the ground surface to 7.5m, sand (fine, medium and coarse) was found at depths from 7.5-11m, clay was found at depths from 11-12.5m, and peaty clay, sand, and peaty clay were found at depths from 12.5-16m, 16-18m and 19.5-20.5m, respectively. Clay was mainly found at depths from 20.5-41.5m, and sand (fine, medium) was mainly found at depths from

41.5-50m, respectively. at Goini, fine sand was found at depths from 1-3m, clay and silty clay were found at depths from 3-12m, and peat and peaty clay were mainly found at depths from 12-14.5m. Sand, peaty clay and fine sand were found at depths from 14.5-19.5m, 20-21m, 21-22m, respectively. Clay, sand, mainly peaty clay and mainly clay were found at depths from 22-42m, 42-44m, 44-47m and 47-50m, respectively.

at Sano Kunuwar, clay and silty clay weremainly found at depths from the ground surface to 16.5m, but sand was found at several positions in between them. Peat was


found at depth of 16.5-17m, and fine sand was found at depths from 18.5-19.5m and 20.5-21.5m, respectively. Peaty clay was found also at depth of 21.5-22m. Though clay and silty clay were mostly found at depths from 22-50m, fine sand and peaty clay were also found at depths from 38-39.5m and 44.5-45m, respectively. at Thulo Kunuwar, fine sand was found at two locations in between 0.5-4m. Clay and peaty clay were found at depths from 4-14m and 14-15m, respectively. Clay and silty clay were mainly found at depths from 15-19m, but fine sand can be found in between them. Peaty clay was found at depths from 19-20m but not found at depths deeper than 20m. Clay, fine sand and clay were mainly found at depths from 20-30.5m, 30.5-31m, 31-33m, respectively. Sand was found at depths from 33-34m, clay was mainly found at depths from 34-44m, and sand was mainly found at depths from 44-50m, respectively.

at Mahuawa, clay and silty clay were mainly found at depths from the ground surface to 12.5m, but fine sand was found at depths from 2.5-3m. Peaty clay was found at depths from 12.5-13m, and fine sand was found at depths from 13-14m and 15.5-19.5m. Peaty clay was found at depths from 19.5-21m, followed by fine sand at depth of 21-21.5m. Clay, silty clay and silt were found at depths from 21.5-41.5m. Sand (fine, coarse) were mainly found at depths from 41.5-45m. Clay was found at depths from 45-50m, however, peaty clay was also found at depth of 47-47.5m.

10.1.5 Arsenic concentration of each type of sedimentTable 4 shows the arsenic concentration of the sediments according to the type and depth at each community. These sediments were the representative samples at each site. The maximum arsenic concentration of the sediment at a site was 19.6 mg/kg at depth of 19.5-20m in Kasiya, 27.1 mg/kg at depth of 20.0-20.5m in Goini, 15.0 mg/kg at depth of 18-18.5m in Thulo Kunuwar, and 21.8 mg/kg at depth of 19.5-20.0m in Mahuawa, respectively. The type of sediment for these cases was peaty clay. The maximum concentration was 10.2 mg/kg at depth of

17.0-17.5m in Sano Kunuwar, where the type of sediment was clay.

On the other hand, the range and average arsenic concentration for each sediment across all communities is as follows, where n means the number of observations and ave means the average; peaty clay (n=15): from 2.7-27.1, ave=11.6 mg/kg; silty clay (n=8) from 2.1-15.0, ave=7.6 mg/kg; clay (n=16)：from 3.0-11.4, ave= 6.0 mg/kg; silt (n=3): from 1.5-5.3, ave=3.2 mg/kg; sand (fine, medium and coarse) (n=7)：from 1.2-5.4, ave=2.7 mg/kg; respectively. There was only one sample of peat sediment and its arsenic concentration was 7.3 mg/kg. Based on the averages of each sediment, arsenic concentration for each sediment was in order of peaty clay>silty clay>peat>clay>silt>sand. Here, only one raw value was applied for peat.

10.1.6 Location of the groundwater aquiferSand layer, which generally has a good permeability, is considered to be the groundwater aquifer. The sand (fine, medium, coarse) layer, distributed thickly with larger than 2m even though it has a slight discontinuity, is found at depths of 7.5-11m, 16-18m, 41.5-50m, respectively in Kasiya; 1.5-3m, 14.5-19.5m, and 42-44m in Goini; 18.5-21.5m in Sano Kunuwar; 44-49.5m in Thulo Kunuwar; and 15.5-19.5 m and 41.5-45m in Mahuawa, respectively.

From these depths, the groundwater aquifer is recognized to locate at the depth between 14-22m in 4 communities of Kasiya, Goini, Sano Kunuwar, and Mahuawa, commonly. in Thulo Kunuwar, no aquifer (sand layer) can be found at this depth range, but a thin sand layer was observed at depth of 16-16.5 m.

The groundwater aquifer at depth between 14-22 m can be called as the first aquifer. The range of aquifer was decided to have enough thickness to cover the aquifers of those communities, considering its variation with site. On the other hand, in 4 communities of Kasiya, Goini, Thulo Kunuwar, and Mahuawa, another aquifer was found to locate at depth between 41 and 50 m, which can be called as the second aquifer.


Figure 11: Distribution of each type of sediment with depth at the 5 communities (Depth from 0-25m).


Figure 12: Distribution of each type of sediment with depth at the 5 communities (Depth from 25-50m).


Table 4 Arsenic concentration of the sediment according to the type and depth in Kasiya, Goini and Sano Kunuwar

Community Depth (m) Sediment type As concentration (mg/kg)

Kasiya

6-6.5 silty clay 12.77.5-8 medium sand 1.2

9.5-10 fine sand 1.414-14.5 peaty clay 5.015.5-16 peaty clay 11.519.5-20 peaty clay 19.623-23.5 clay 6.030.5-31 clay 4.331.5-32 peaty clay 7.237-37.5 clay 8.148.5-49 medium sand 1.3

Goini

6.5-7 silty clay 6.69.5-10 clay 6.012-12.5 peat 7.312.5-13 peaty clay 12.014-14.5 peaty clay 6.615.5-16 fine sand 2.820-20.5 peaty clay 27.125.5-26 clay 7.429.5-30 silty clay 10.446-46.5 peaty clay 14.0

Sano Kunuwar

7.5-8 silty clay 5.412-12.5 clay 4.814-14.5 clay 6.216.5-17 peaty clay 9.617-17.5 clay 10.219-19.5 fine sand 2.620-20.5 silt 5.333-33.5 clay 3.035.5-36 silty clay 2.144.5-45 peaty clay 3.4

Thulo Kunuwar

9.5-10 clay 3.611.5-12 silty clay 2.913-13.5 clay 5.014-14.5 peaty clay 9.018-18.5 silty clay 15.019-19.5 peaty clay 14.023.5-24 clay 6.324.5-25 clay 11.427-27.5 silt 1.546.5-47 fine sand 4.2

Mahuawa

2-2.5 silt 2.79-9.5 clay 7.2

11.5-12 clay 3.412.5-13 peaty clay 2.716.5-17 fine sand 5.419.5-20 peaty clay 21.827.5-28 clay 3.031-31.5 silty clay 5.947-47.5 peaty clay 10.1


10.1.7 The type of sediment that contain high arsenic and its effect on the arsenic contamination of the aquiferThe maximum arsenic concentration of the sediments at a boring site was observed at depths between 17-21m at each community. Here, the type of sediment is peaty clay at 3 communities (Kasiya, Goini, Mahuawa) with the arsenic concentration of 19.6-27.1 mg/kg, silty clay at a Thulo Kunuwar with the concentration of 15 mg/kg (which was, however, close to the second maximum of peaty clay with 14 mg/kg), and clay at Sano Kunuwar with the concentration of 10 mg/kg, respectively.

The sediment having the maximum arsenic concentration was located in between or close to the first aquifer, which depended on the site. Therefore, the high arsenic containing sediment, mainly peaty clay, is thought to affect arsenic contamination of the first aquifer. arsenic concentration of the sediment was measured for a small number of the

samples at depths from 41-50m (Table 4), in which the second aquifer is located. However, the arsenic concentration of 1.3-14.0 mg/kg observed at this depth, which included 3 peaty clay values, was far lower than that of the sediment at the first aquifer (19.6-27.1 mg/kg). Therefore, the effect of arsenic concentration of the sediments at depths from 41-50m on the arsenic contamination of the second aquifer was thought to be small.

10.1.8 Feasibility for deep tubewell (DTW) as alternative safe water optionDTW is effective alternative safe water option in arsenic contaminated area of Nawalparasi district. However, situation varies because characteristics of deep aquifer depend on hydrogeological condition such as permeability and water quality. Feasibility for DTW in the target communities was evaluated using a standard as shown in Table 5. Results of evaluation in each community are shown in Table 6.

Table 5: Standard of feasibility for deep tubewell

DescriptionAs (ppb)

<= 30 30<, <=50 50<

Gran size of Aquifergravel, coarse, medium feasible possible not suitable

fine possible possible not suitablevery fine not suitable not suitable not suitable

Table 6: Feasibility for DTW as alternative safe water option in each community

VDCWard No. Community

Boring No.

Target Aquifer

Arsenic (ppb)

Grain size of third Aquifer

DTW feasibility

Remarks

Badaharadubauliya 7 Badahara 27 2 0 - -As free in

second aquifer

Badaharadubauliya 7 Jitpur 28 1 0 - -As free in first

aquifer

Makar 2 Chisapani 15 2 20 fine -As free in

second aquiferMakar 8 Lagunaha 17 3 10 fine possible 　Manari 1 Manari 33 3 10 coarse feasible 　Manari 2 Tadipipara 1 3 10 medium feasible 　Manari 4 Patani 5 3 20 medium feasible 　Manari 5 Tilauli 31 3 10 fine possible 　Manari 6 Ahirauli 40 3 0 fine possible 　Manari 7 Jawa 30 3 10 medium feasible 　Manari 9 Mahuawa 3 3 150 fine not suitable 　

Panchanagar 9 Gaidahawa 14 3 10 fine possible 　


VDCWard No. Community

Boring No.

Target Aquifer

Arsenic (ppb)

Grain size of third Aquifer

DTW feasibility

Remarks

Panchanagar 8 Bhagajogani 10 3 10 medium feasible 　Ramgram 4 Suryapura 38 3 10 fine possible 　Ramgram 6 Phokharapali 36 3 0 fine possible 　Ramgram 8 Ghanshyampur 41 3 - very fine not suitable no waterRamgram 11 Ranipakad 29 3 150 medium not suitable 　Ramgram 11 Ranipakad 44 3 80 fine not suitable 　Ramnagar 1 Bhumahi 45 3 - very fine not suitable no aquifer

Ramgram 1 Sahuwatikar 2 2 0 fine -As free in

second aquiferRamgram 3 GodamTole 12 3 40 fine not suitable turbid waterRamgram 3 Ghodapali 16 3 30 fine possible 　Ramgram 5 Driver Tole 11 3 10 fine possible 　Ramgram 6 Deurwa 22 3 0 fine possible 　Ramgram 8 Baikunthapur 13 3 10 fine possible 　Ramgram 8 Garden tole 19 3 20 fine possible 　Ramgram 8 Lohasada 20 3 20 fine possible 　Ramgram 8 Unwatch 21 3 70 fine not suitable 　Ramgram 8 Chamkipur 24 3 0 medium feasible 　Ramgram 8 Unwatch 43 3 50 fine possible 　Ramgram 10 Manjhariya 6 3 10 fine possible 　Ramgram 12 Kasiya 4 3 20 medium feasible 　Ramgram 12 ThuloKunuwar 7 3 - fine not suitable no waterRamgram 12 Panchagaun 18 3 - fine not suitable no water

Ramgram 13 Kanchanaha 25 2 10 fine -As free in

second aquiferRamgram 13 Padatikar 39 3 0 very fine not suitable 　Sarawal 6 Sarawal 26 3 40 fine possible 　Sawathi 5 Hardiya 32 3 10 coarse feasible 　Sukrauli 3 Sukrauli 9 3 30 medium feasible 　Sukrauli 7 Nadawa 8 3 20 medium feasible 　

Sunawal 3 Kirtipur 35 2 10 fine -As free in

second aquiferSunawal 1 Somnath 37 3 40 medium possible 　

Swathi 5 Bankatti 34 2 10 - -As free in

second aquiferTilakpur 7 Patakhauli 42 3 0 fine possible 　Tilakpur 9 Khokarpura 23 3 - very fine not suitable no water


For educating and raising awareness of the local people on arsenic, its health effects and mitigation measures, various activities were carried out.

11.1 IEC and training materialsPrint iEC materials such as flyers, poster, sticker (student name tag), bookmark, calendar, brochure, booklet and arsenic testing record card were developed and produced. These materials were distributed during meetings, orientations, arsenic class, household visits, street drama show, local fair, school coordination etc. ‘arsenic Testing Record Card’ was provided to aMCs which was then distributed to each household following water testing for arsenic. Similarly, two different types of flexes (one each showing health effects and arsenic mitigation options), for using in arsenic classes, were produced and provided to all aMCs.

11.2 Radio messagesFor a wider coverage of the awareness, airing of radio messages related to arsenic (6 times in a day – in Bhojpuri 3 times and in Nepali 3 times) was done through Radio Parasi throughout the project period.

11.3 Wall-paintingsWith the objectives of raising public awareness and providing information on arsenic-induced skin manifestations and arsenic safe water options, wall painting was done in 28 different locations with priority to eye-catchy places in the project area.

11.4 Hoarding boardsNine hoarding boards with information on arsenic-induced skin manifestations and arsenic safe water options were also placed in different eye-catchy locations.

Awareness raising

11


11.5 Street Dramaa street drama titled ‘Now i understood’ providing information on arsenic contamination and its source, health effects and mitigation measures was performed in all 59 project communities. The languages used in street drama were Bhojpuri (where majority of people speak Bhojpuri) and Nepali (where majority of people speak Nepali). it was estimated that number of people who observed the street drama was about 20,000. The street drama was found to be very effective for raising awareness among community people of all age groups regardless of the literacy.

Furthermore, revised version of the same drama was performed in 15 communities where awareness on arsenic was found low. about 5,000 people observed the street drama in the second phase.

11.6 Stall in local faira stall, in a local fair called ‘Khichadi Mela’ in Manari – a project area, was kept from 14-15 of January 2012 and from 13-14 of January 2013. in addition, the street drama ‘Now i understood’ was also presented. The fair was organized on the occasion of Maghi, celebrated by local Tharu communities. The purpose of the stall was to disseminate arsenic

related information and raise awareness of local people on arsenic issues. There were estimate of 5000+ people in the fair in both years. Dr. Sk. akhtar ahmad, Bangladesh had examined the people visiting the CBaM stall who were interested for voluntarily participation for health examination related to chronic arsenic toxicity.

11.7 ‘World Water Day 2012’ celebration‘World Water Day 2012’ was celebrated on March 22, 2012. The CBaM Project and DDC, Nawalparasi, jointly organized an awareness campaign in Buddha Chowk of Parasi. CBaM staff provided information about arsenic and safe drinking water to stall visitors and relevant iEC materials such as flyers, brochures, posters, bookmark and sticker were distributed. Similarly, DDC provided Open Defecation Free (ODF) and sanitation related information. There were about 1,000 visitors.

11.8 School programmeCBaM project has recognized students as one of the key change agents in awareness generation on arsenic and sustainable arsenic mitigation. So, different activities were carried out under ‘school programme’.


11.8.1 Essay CompetitionSome schools were requested to organize an essay competition on the topic ‘arsenic’ and three schools did organize the event at their own management. a total of 57 students (30 female and 27 male) participated in the event.

11.8.2 Quiz ContestQuiz contest on arsenic was organized. a total of 110 students from five schools took part.

11.8.3 Awareness rallyWith the objective of raising awareness on arsenic in the school catchment areas, 7 child groups organized rally in September and October 2012 in seven different places. Children walked around communities and chanted the slogans “Drink Safe water, Be Safe from arsenic”, “arsenic is Slow Poison”, “use arsenic Removal Filter Regularly for arsenic Safe Water”. There were above 500 children who took part in the rallies.


12.1 Resource Mobilization WorkshopResource mobilization workshop (RMW) was held on 29 april 2012 at meeting hall of DDC Office, Nawalparasi. Ms. Lamu Chhing Sherpa, an expert on social mobilization, had facilitated the workshop. There were 17 participants (12 male and 5 female) representing from DDC, DDC-WaSH unit, Ramgram Municipality, WSSDO, NRCS etc.

The RMW with key stakeholders was successful in the chairmanship of acting Local Development Officer (LDO) at DDC. all invited stakeholders had actively participated and shared about their ongoing and future programmes. Presentation of CBaM project provided information of the project and its achievements, learning and suggestion to stakeholders and drew their attention for future ownership at the local for the sustainability.

12.2 Experience sharing workshopan experience sharing workshop on “Grant receiving procedure from different government offices” was organized in one of the project

12Workshops/ Exposure Visit

communities, Goini on 27 December 2012. in the workshop, there were 10 participants representing from 5 aMCs (2 persons from each aMC). Mr. Santosh Murau, Mr. Jaganath Chaudhary and Mr. Jeevan Singh Tharu shared their experiences about irrigation programme, overhead water tank and Janjati (indigenous) fund, respectively. Mr. Tharu also shared on the importance of Ward Citizen Forum (WCF), its objectives and grant receiving procedure.

Objectives: inform about process and appropriate time

of grant proposes; Share the experience from grant receiver

organization representative; Share the importance of WCF on grant

receive.

instant outputs: aMC members and CMs knew all the

process and time of grant receive, they committed to share the knowledge with other aMC members;

CMs are planning to organize the same kind of workshop in their areas.

12.3 Exposure visitOn October 3, 2012, 57 aMC members (one from each aMC) were taken to Kirtipur, one of the project communities. Kirtipur aMC members shared their experiences about KaF construction and distribution with cost, water testing for arsenic with cost in neighbour communities, coordination with VDC, documentation (record keeping) etc to visitors.


Objectives: To introduce each other; To share good experience; To show good operating system of the

committee; To help build aMC network.

Outputs of the visit: Most of aMC members shared their

experience openly; Discussed on expert skill exchange

and use between each other (filter construction, arsenic testing, trainings conduct);

aMC members introduced with each other.


Some findings from baseline and post-surveys are presented below:

13.1 Drinking water sourcesin baseline survey, a total of 6,138 water sources were recorded which increased to 6,280 in post-survey. Of these, tubewell was found to be major water source (baseline-81.8%, post-survey-82.8%). Other water sources were tap (baseline-16.2%, post-survey–14.5%) and dugwell (baseline–2.0%, post survey–2.7%) (Figure 13).

13.2 Arsenic removal filtersin baseline survey, households with arsenic removal filters (KaF or SONO) were 1,720 (27.7%). Of these, only 1051 filters (61.1%) were in use and rest 669 filters (38.9%) were not in use during the survey. The number of filters in post survey dropped to 1,316; filters in use were 854 (64.9%) with 462 filters (35.1%) not in operation. With less number of filters in use during post survey than in baseline survey, number of households with no filter was high for post survey than baseline survey (Figure 14). as it was learnt from field observation, the main reasons behind filters left unused were breakage/ leakage of filter and access to other water supply such as piped supply, improved dugwell.

Figure 14: Status of arsenic removal filters in communities

13.3 Knowledge levelsKnowledge levels (arsenic, its health effects and arsenic safe water options) of people in project communities was found considerably raised in post survey compared to baseline survey. in baseline survey, 56.7% people

1213Findings-Baseline & Post-Surveys

Baseline survey

Tubewell (81.8%)

Tap (16.2%)

Dugwell (2.0%)

Tubewell

Tap

Dugwell

Tap

Post survey

Tubewell (82.8%)

Dugwell (2.7%)

Tap (14.5%)

Figure 13: Water sources in communities

1,051 854669

462

4,4834,959

-

1,000

2,000

3,000

4,000

5,000

Num

ber

of

filte

rs

In use Not in use No filter

Baseline survey Post survey


knew about arsenic problem while it increased to 91.6% in post survey. People who knew about arsenic-induced health effects prior to project interventions were only 46.9% which rose to 85.4% during post survey. Likewise, knowledge on arsenic safe water options climbed up from 63.5% to 90.6% (Figure 15).

Figure 15: Knowledge level of people

Table 7 summaries the source of arsenic related information. among events and media offered by the project, the most cited source of information was street drama (65%). Following street drama, booklets, posters, flyers, arsenic classes, and radio are referred by more than 30% of respondents. These popular items seem to be the ones either that people actively participated in, or that people usually see them. On the other hand, less popular items include things that people may not see very often, such as hoarding boards and wall paintings. TVs compared to

radios exist few in number. The lowest ranked arsenic fair was held only twice, though it drew thousands of people, and the arsenic issue might not have stood out there because it was held as a regular fair with entertainment purposes.

as the person from whom people obtain arsenic information, aMC members were the most cited (74%), the highest percentage including events and media. Second to aMC, neighbours were most frequent sources for such information. Other than these two, the remaining sources are relatively minor in proportion. This result shows that aMCs played a central role in awareness activities of local residents, and it fits this project design very well (Table 7).

The recognition rate of the arsenic problem by the general public has increased almost a two-fold, and reached more than 90%. This is not just simple recognition of arsenic, but people seem to acquire more specific knowledge on arsenic as well. The sources of information from which people obtain arsenic information were events, trainings, and various media presented and distributed by this project. To sum up, these results showed that the recognition of arsenic and its related risks as the first step of promoting autonomous arsenic mitigation by local communities has been achieved through the project activities.

56.7

91.6

46.9

85.4

63.5

90.6

0.0

20.0

40.0

60.0

80.0

100.0

Per

cent

age

(%)

Know arsenic problem Know health effects Know arsenic safe watersources

Baseline survey Post survey

Table 7: Sources of obtained arsenic information (post survey)Event/Media Response (%) Person Response (%)Street drama 65% AMC Member 74%Booklet 50% Neighbour 61%Poster 47% Child Club 22%Flyer 45% Relative 13%Arsenic Class 35% Female Group 12%Radio 31% NGO 8%Sticker 20% Family 6%Wall paintings 17% Children 4%Hoarding board 11% Government staff 3%TV 11% Medical personnel 1%Arsenic fair 6% Others 1%


Locally employed nine CMs and members of village-based 59 aMCs are assets and pillars of CBaM project which aimed to develop local human resources. They were expected to develop their capacity and network to mobilize resources for arsenic mitigation at the grassroots level.

Outcome of the CMs’ works can be measured by the progress of aMCs’ works in their respective working areas. However, the aMCs vary in size – number of households, in composition of members and their experiences, and whether there are alternative water sources. it is not easy to assess performance of CMs as per the aMCs’ works. Hereinafter, the achievements of CMs are examined according to the following data including the written test and interviews held on 25 December 2012.

For this section please refer to annex 4. Self-assessment done on 10 august 2012

(Table a) Compiled monthly CM monitoring forms

by FO/aFO as of December 2012 (Table B) Results of written test held on 25

December 2012 (Table C) Case studies written by CMs Reports by coaching consultant and EaR

Lack of baseline data of each CM made it difficult to measure development of CMs since the beginning of the project period. a draft form of CM monitoring indicators were developed by Project Manager, Country Coordinator and Expert on awareness Raising in February 2012 (Table B). Supervisory level staff, FO and

aFO, started applying the indicators since May 2012 as a part of their monthly monitoring. in august 2012, CMs reviewed their confidence in each task (Table a). Both results were used for capacity building of CMs by their supervisors.

1) Skills for arsenic mitigation: Monitoring, maintenance and making of filters (Table B)according to Table B-1, the CMs repaired 88 filters, newly made 31 filters and monitored 483 filters in total. They have contributed a lot to making filters (re-) function well. Some CMs did more while the others did less because the needs of their working areas were different. Therefore, two CMs said that they do not have confidence in filter maintenance and making due to lack of practices.

2) Conducting training and awareness raising sessions (Table B)The CMs have enough experiences in conducting awareness raising sessions 106 times at community levels (Table B-2-3) and 33 times to school teachers in total (Table B-2-5) though the numbers of sessions each CM conducted vary. They have not yet done them at VDC levels (Table B-2-4) and to health volunteers (Table B-2-6). Most of them were invited as resource persons for public programmes (Table B-2-8 & 9). Some CMs have developed good relations with local organizations as well as line agencies of local government, e.g. Women Development Office. awareness raising works at community levels will be done by the aMCs in future. The CMs need to conduct trainings at higher levels and promote themselves as resource persons.

14

Outputs-CMs & AMCs


3) Knowledge and networking to support AMCs (Table B)The above mentioned points are expected roles of the aMCs not only the CMs. it is more important for CMs to be good at resource mobilization and networking with other agencies, VDCs, municipality or other programmes, e.g. Local Governance and Community Development Programme (LGCDP). it is a nationwide programme for good governance and capacity building of civil society representatives at grassroots levels. The programme encourages forming WCF as a foundation for needs assessment at ward level and a channel for budget application. Some CMs were familiar with LGCDP and advantages to link aMCs with it while the others and supervisory staff of CBaM paid little concerns with it.

The most important task for the CMs is supporting proposal and application writing. Only one CM had experience in these works while others were sometimes less confident than the senior members of their partner aMCs. Though they have participated in a resource mobilization workshop and proposal writing training, it was still difficult for them to facilitate the process when members of aMCs were not well motivated to do. This may cause delay in proposals approval by line agencies and local government.

4) Expected roles of the CMs after the phase-out of CBAM projectDuring the project period, major responsibilities of the CMs were facilitation and supervision of the aMCs. Their relationships with the aMCs will be changed when the aMCs became mature enough to do their works, e.g. monitoring, maintenance and making of filters, awareness raising, and resource mobilizations by themselves. it is not necessary for the CMs to continue exactly same tasks as they have done during the project period.

Now the CMs are expected to contribute arsenic mitigation through different ways after the project period. all CMs have got almost same trainings but have different strengths Some CMs developed their skills in repairing

any types of household filters while the others extended their networks with various organizations. They need to utilize their own expertise but to keep themselves as a team.

a CM originally had a plan to be a self-employed filter supplier. However, he found that filter business is not profitable to get enough income for his family when he estimated cost and benefit of the business and future scenario of the project area. at first, he mentioned that some aMC members have similar plans and already provide service to villages. He does not want to be a competitor of them. in addition, he believes that people in the area will stop using filters within a few years when they have access to alternative safe drinking water sources. He still does not know how he can utilize this skills and knowledge that he gained through CBaM. But, at least, he observes capacity of aMC members well and knows future scenario of his working areas.

all CMs want to continue supporting their own communities, but do not have concrete plans what they can do and how to start. Probably it is meaningful to provide data and information to the CMs as well as aMCs. The CMs will be able to utilise them for resource mobilization and for consultation with aMCs.

AMCThe CBaM project provided training to aMC members and tried capacity building of aMCs. all 59 aMCs have got almost same input though size and location of their working areas vary. The largest area has 283 households while the smallest area has only 24 households. Some locates in market area of Ramgram Municipality while others are in rural setting. Performance of 59 aMCs cannot be compared easily.

1) Diversity of AMC membersin the composition of aMC members by jaat and gender, ratios of Dalit members and chairpersons were significantly less than that of other groups. On the contrary, ratio of Bahun is much higher than any other groups. Women share almost half sheets of aMC membership. But there is no Muslim woman even where Muslims are dominant. it was


necessary to diverse membership as per ratio of dwellers in each community and to motivate members from Dalit and Muslim women to join at the formation stage of aMCs.

2) Affiliation with local organizationsas learnt, 53.7 % of aMC members are affiliated with local organizations. Many of them are also members of multi-purpose self-help organization for community development, e.g. Tole Development Committee, youth Club, Child Club and Mothers’ Group. These members are potentially active in local development and may continue works for arsenic mitigation voluntarily even after the project period.

WCF, a ward level platform established by LGCDP, is the most important channel for needs assessment and budget request at grassroots level. There are 26 aMCs that have WCF members. These members are familiar with budget planning procedure. They are expected to prioritize issues on arsenic problems at WCF meeting and to mobilize resource for alternative water sources and other works by aMCs.

3) Performance of AMCsFor evaluation of performance of aMCs, monitoring indicators were divided into three areas, skill, knowledge and attitude. Each area was expected to be assessed as per measurement indicators and their means of verification. However, the indicators have not been used until mid-2012. But performance and mutuality of aMCs can be assessed with some indicators, e.g. number of events organized by aMC using iEC material, Number of proposals submitted to relevant organizations and arsenic testing with charge.

in august 2012, 59 aMCs were categorized into three groups in order to provide supports efficiently to the aMCs with high potential for growth. Seven aMCs were categorized as the aMCs at ‘graduated level’ that can continue their works without assistance by the CBaM. Twenty-one aMCs were classified as the ‘focus’ aMCs that can function well if the project provides intensive supports. Thirty-one aMCs were categorized as ‘less focus’ aMCs in which aMC members do not show interest in the CBaM

including some areas where alternative water sources has been already installed. Meaning of the categorization was also not well understood by CMs and project staff. Therefore, it is difficult to assess whether such categorization made any differences in effectiveness and efficiency in project management.

Future direction of AMCsThe role of the aMCs can be summarized as follows:a) Through cooperation with drinking water user committee where there are alternative water sources: mobilize resource and apply subsidy

schemes to ensure equitable access to safe drinking for all community members including poor families;

need collecting maintenance fee for regular cleaning and maintenance in order to avoid contamination of the sources;

need regular monitoring of drinking water sources.

B) Through collaboration with other local organizations and WCF where there is no alternative water source: prioritize arsenic mitigation as local

issue and mobilize local resource for construction of alternative water sources and other works;

collaborate with neighbouring aMCs to negotiate with local authorities;

regular monitoring and maintenance of filters;

regularly conduct water quality testing; take care of patients with symptoms of

arsenicosis; identify new arsenicosis patients in

collaboration with health professionals.

in order to carry out these activities, it is necessary to strengthen further relationship between aMCs and the local organizations and administration, such as VDC and line agencies. it is also important to start budget advocacy at grassroots level. Some activities by aMCs, e.g. awareness campaign, arsenic class at schools, need to get regular assistance by local government.


Monitoring of the project was been done at two levels – internal and external. Regular communications and periodic visits to Parasi Field Office and project area were done from ENPHO, Kathmandu office. Visits were also made from Kyushu university and JiCa.

15.1 ENPHO, Kathmandu OfficeDr. Suman Shakya (Executive Director, ENPHO and CBaM Project advisor) and Mr. Makhan Maharjan (Country Coordinator, CBaM project) made several visits to CBaM Parasi Office and project communities for observation of ongoing project activities and discussion with local project staff. During visits, they gathered information related to project activities and supervised for regular updating and proper documentation of project related data and information.

15.2 Kyushu University, Japan & ExpertsProf. Masakazu TaNi (CBaM Project Manager) visited the project areas several times during the project period. He visited different aMCs, gathered information related to the project,

provided feedback and supervised concerned project staff for better output. Dr. Masako SaDaMaTSu, awareness Expert for the CBaM project, had also supervised and evaluated the field staff, aMC related activities with repeated visits.

They had observed household surveys in the field, participated in meetings and discussions with project staff as wells as some local stakeholders.

Ms. Lamu Chhing Sherpa, an expert on social mobilization, had facilitated RMW, staff coaching and monitored the progress.

15.3 Japan International Cooperation Agency (JICA)Representatives from JiCa Nepal visited and monitored the project four times and JiCa Japan monitored the project once. Mr. akio ENDO (Representative, JiCa Nepal), Ms. Sakiko KuROSaKa and Krishna Prasad Lamsal from JiCa Nepal visited Nawalparasi in March 2011. Similarly, Ms. Chieko MaRuyaMa (Senior Coordinator for international Cooperation Partnership

15

Monitoring & Supervision


Programme Division) from JiCa, Japan and Ms. Hirota NOBuKO (Coordinator, NGO-JiCa Japan Desk, Nepal) and Ms. Prerana Bishet (assistant Coordinator, NGO-JiCa Japan Desk, Nepal) monitored CBaM project related activities in December, 2011. Likewise, Mr. akio ENDO, Ms. Prerana Bishet and Ms. Bidhya Pokharel (Programme Officer, JiCa Nepal) were in Nawalparasi from 18-19 august 2012. During the visits, they had visited several project communities and interacted with community people and aMC members, observed project related activities such as arsenic classes in communities and schools, patient counseling, arsenic removal filters and its installation, child club orientation.

Ms. Hirota NOBuKO visited Nawalparasi from 04-05 March 2013 for monitoring of the CBaM project and also joined in the District Level Project Dissemination Workshop organized on 04 March 2013.

15.4 Social Welfare Council (SWC)a monitoring team comprising three persons (Mr. Kesharmani aryal, Team leader; Mr. Gopi Chaudhary, Member and Mr. Balkrishna Maharjan, Member) from SWC monitored the CBaM project in field from 27-29 December 2012. During the period, they visited CBaM

office, discussed with key staff members, discussed and gathered project related information from Executive Officer and other personnel of Ramgram Municipality, Nawalparasi. The team also visited some project communities and interacted with aMC members there and observed documentation by them, and observed arsenicosis patients, arsenic removal filters and model tubewells. information on the project was also gathered by meeting staffs of DDC and WSSDO. The team also checked finance related documents at CBaM Parasi Office.

15.5 Visit by Ambassador of JapanOn 17 March 2012, Mr. Kunio TaKaHaSHi, ambassador of Japan for Nepal and Mr. Seiji TaKaHaSHi, Second Secretary (Embassy of Japan in Nepal) visited the project field office and one of the project communities. During the visit, ambassador TaKaHaSHi gathered the project related information, observed arsenicosis cases and a KaF at a house in one of the project communities (Paratikar) where aMC class was ongoing. He appreciated the project and the efforts made.


16

Project Dissemination

CBaM project was disseminated both at national and international forums. 3rd international Symposium on Health

Hazards of arsenic Contamination of Groundwater and its Countermeasures, 23-25 Nov 2012, Miyazaki, Japan.

international Workshop on Fair access of Safe Water Option for all in the Ganges Basin, 18-20 Feb 2013, arsenic Centre, Jessore, Bangladesh.

On March 04, 2013, the project was disseminated to local key stakeholders. in the workshop, representatives from DDC, DTO, WSSDO, DPHO, NRCS, aMDa Nepal, health posts, NGOs, CBOs etc were present. Representatives from JiCa Nepal, Kyushu university, Japan and ENPHO, Kathmandu were among other participants.


in summary, the CBaM project has made a positive impact for sustainable arsenic mitigation in the project communities. The project has built local capacity on arsenic mitigation of three target groups such as local people, community leaders (aMC members) and frontline workers along with staff members. as learned from discussion during the field visit, the empowered aMC members are capable of independently conducting arsenic testing in water using field kit, construction of KaF and its O&M and screening of arsenicosis cases (skin manifestations). They are making advocacy for mobilizing local funds and resources.

Furthermore, the project has sensitized local people on arsenic by wider awareness raising activities. People have shown concerns for arsenic-free water.

17

Impacts of the Project


Lessons learned awareness is the most important factor

that determines the success or failure of the efforts made in peoples’ behavior change.

Local capacity development and peoples’ active involvement are necessary for sustainable arsenic mitigation.

Sustainability concerns arsenic-related health implications being

of chronic nature, people are not serious in regular use of arsenic safe water options.

Peoples’ dependent nature (usually not willing to share the cost) is a problem.

18Lessons learned & sustainability concerns


Overall, the CBaM project has been successfully completed accomplishing all targeted activities and achieving desired outputs. Coordination was maintained at both district and central levels and there was good cooperation from all relevant stakeholders throughout the project period. The project has sensitized community people on arsenic issue and built local capacity on arsenic mitigation through different training programmes. aMC members have been basically developed as skilled human resources. it is assumed that aMCs and other experts shall locally contribute in arsenic mitigation efforts.

DTW is effective alternative safe water option in arsenic contaminated area of Nawalparasi district. However, situation varies because characteristics of deep aquifer depend on hydrogeological condition such as permeability and water quality.

Recommendations: aMCs were formed as a grass root level

entity of CBaM project. Skills of aMCs and other experts on arsenic mitigation should be utilized by concerned agencies.

active participation of aMCs should be made in arsenic mitigation activities and activation of aMCs should be considered for sustainable arsenic mitigation.

arsenicosis case management should be done.

Follow up support and refresher trainings will help keep aMCs active and local capacity alive.

Probability to obtain safe water could be high by drilling deeper than top depth of third aquifer.

Good coordination among concerned authorities is needed.

19Conclusions & Recommendations


ahmad Sa, Sayed MHSu, Hadi Sa, Faruquee MH, Khan MH, Jalil Ma, et al. (1999) arsenicosis in a village in Bangladesh. Int J Environ Health Res 9:187-195.

District Development Profile of Nepal, a Socio-Economic Development Database of Nepal (2012). Mega Publication & Research Centre, Kathmandu, Nepal.

Guha Mazumder DN, Haque R, Ghosh N, De BK, Santra a, Chakraborty D, et al. (1998) arsenic levels in drinking water and the prevalence of skin lesions in West Bengal, india. Int J Epidemiol 27:871-877.

Maharjan M, Watanabe C, ahmed Sk, and Ohtsuka R. (2005) arsenic contamination in drinking water and skin manifestations in Lowland Nepal: The First Community-based Survey. Am. J. Trop. Med. Hyg., 73(2): 477-479.

Maharjan M, Shrestha RR, ahmed Sk, Watanabe C, and Ohtsuka R. (2006) Prevalence of arsenicosis in Terai, Nepal. J Health, Popul Nutr, 24 (2, Pt 1):251-257.

Maharjan M, Watanabe C, ahmed Sk, umezaki M and Ohtsuka R. (2007) Mutual interaction between nutritional status and chronic arsenic toxicity due to groundwater contamination in an area of Terai, Lowland Nepal. J. Epidemiol.Community Health 2007;61;389-394.

NaSC/uNiCEF (2007) The State of arsenic in Nepal-2007. National arsenic Steering Committee.

Watanabe C, inaoka T, Kadono T, Nagano M, Nakamura S, ushijima K, et al. (2001) Males in rural Bangladeshi communities are more susceptible to chronic arsenic poisoning than females: analyses based on urinary arsenic. Environ Health Perspect 109(12):1265-1270.

20

References


Annex 1: Post survey - demographic summary data

SN Community HouseholdsPopulation

Total Male Female1 Ahirauli 116 636 333 3032 Badahara 113 723 394 3293 Badera 96 513 250 2634 Baikunthapur 59 355 179 1765 Bankatti 292 1543 753 7906 Bhagjogani 174 952 464 4887 Bhumahi 125 637 315 3228 Chamkipur 35 220 107 1139 Chisapani 246 1278 629 64910 Deurawa 98 631 336 29511 Driver Tole 78 424 221 20312 Gaidahawa 134 702 339 36313 Gallamandi 74 392 211 18114 Garden Tole 32 158 81 7715 Ghanshyampur 58 325 155 17016 Ghodaha 117 682 338 34417 Ghodpali 67 432 211 22118 GodamTole 68 370 185 18519 Goini 1 62 379 191 18820 Goini 2 52 327 165 16221 Hardiya 164 900 458 44222 Jamunawari 107 597 309 28823 Jawa 150 916 463 45324 Jitpur 24 166 87 7925 Kanchanaha 70 420 220 20026 Kasiya 136 745 390 35527 Khairahani 245 1469 772 69728 Khokharpura 77 415 211 20429 Kirtipur 125 668 304 36430 Lagunaha 142 702 357 34531 Lohasada 57 332 161 17132 Madhavpur 26 187 98 8933 Mahuwa 111 647 346 30134 Manari 113 692 363 32935 Manjhariya 118 777 384 39336 Nadawa 70 421 219 202

21

Annexes


SN Community HouseholdsPopulation

Total Male Female37 Pachgawa 90 555 271 28438 Padatikar 54 333 173 16039 Parsa 87 603 309 29440 Patani 135 755 379 37641 Patkhauli 122 667 338 32942 Patkhauli (Tilakpur) 108 609 304 30543 Pokharapali 179 1073 565 50844 Purano Bank Tole 78 481 245 23645 Ranipakad 151 922 465 45746 Sahuwatikar 146 808 411 39747 Sano Kunuwar 62 402 199 20348 Sarawal 162 943 473 47049 Semari 191 1149 571 57850 Shanti Tole 32 146 69 7751 SomnathTole 122 662 336 32652 Sonbarsa 171 1033 537 49653 Sukrouli 51 308 166 14254 Suryapura 34 204 115 8955 Tadi 128 729 377 35256 ThuloKunuwar 92 536 276 26057 Tilauli 133 863 426 43758 Unwauch 116 640 322 318Total 6,275 36,154 18,326 17,828Data of Khairahani a and B are merged. So, there are only 58 communities in the list.


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Jan

2012

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7.32

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387.

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Jan

9-Ja

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27-F

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.5

N27.

31.7

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083.

39.5

38`

200

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Jan

12-J

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11-J

an14

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1026

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37.0

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11-J

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2026

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17-J

an20

29-J

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3.41

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wat

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19-J

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22-J

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40.5

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13-F

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37.7

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3.39

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53`

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26-F

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31.8

95È

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29`

5037

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Som

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Mar

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-Mar

44.5

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7.36

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3.39

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5138

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Mar

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083.

41.1

2052

3852

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Ram

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11-M

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3°40

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53

3953

Ram

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19-M

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ay32

.0

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32.6

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42.0

2554

4054

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7°32

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3°42

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ater

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7°31

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44.2

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AMC member well functions the filter

Majority of people in the communities did not know where they can buy arsenic removal filter and how to install it if there is defect in the filter. After participating in the training on ‘Kanchan Arsenic Filter (KAF) - Construction and its Operation and Maintenance’ organized by CBAM project in Manari-6, Ahirauli, members of Ganga Devi AMC gained knowledge and skill on the filter.

Mr. Dinesh Gupta a new member of Shree Ganga Devi AMC was using concrete (round) filter but filter had problem in flow rate and water quality. So, Mr. Gupta utilized the knowledge he had gained on the filter and reinstalled the filter himself. Mr. Gupta is now happy that filter yields enough quantity of water for drinking and cooking for his family and that arsenic level of effluent water is below 50 ppb.

Dugwell reuse

Manari VDC-5, Tilauli is a residential area of Tharu and Dalit. There is an old dugwell in this community which was constructed many years ago. In the past this community had no tubewells and people used to collect water from this dugwell extensively for drinking, cooking and washing purposes. But people slowly discontinued using the dugwell water after they installed tubewell.

Since Shree Trimurti Arsenic Mitigation Committee was formed with initiation of CBAM project, AMC members eagerly sit together for discussing about arsenic related problems in their respective community. From arsenic testing results of tubewells conducted by the AMC in May 2012, people came to know that majority of tubewells in the community are arsenic contaminated. So as to prevent possible heath damage of the community people, AMC members conducted awareness classes and home visits for disseminating information on arsenic, its health risks and arsenic safe water options to community people. IEC materials provided by CBAM project and street drama show also greatly helped in this effort. This sensitized local people on arsenic issue and people have shown concerns for arsenic-free water. They learnt that dugwell water contain less or no arsenic. Through one of monthly meetings, they came up with decision that it would be wise to revive the abandoned dugwell for arsenic-free water and they will rehabilitate it.

With this they planned and cleaned up the dugwell and did some maintenance as well. Now this dugwell is cleaned and people are back to old days collecting dugwell for drinking and cooking usages.

Annex 5: Case Studies

KAF got reused

Anita Devi is a 55 years old woman who was born in India. She came to Nawalparasi 39 years ago after her marriage. She is uneducated woman.

People conducting arsenic testing of her tubewell had informed that the tubewell water she was using has 150ppb of arsenic and it is not good for health. Anita and her family did not know about so called 'arsenic and its effects. However, she got arsenic removal filter called ‘Kanchan Arsenic Filter’ and used it for some months. Later the filter did not work properly and they again started using arsenic contaminated tubewell.

During home visit by Shree Narayani AMC members for screening of arsenicosis cases and filter observation, the filter in Anita’s house was found left unused. They observed the filter and found that the filter basin got jammed with iron rusts and that was the very reason for filter did not work. They cleaned the filter basin and top fine sand layer of the filter and oriented Anita about filter cleaning and maintenance – when and how to do it?. Later Anita also participated in arsenic class conducted by the AMC in the community and gained knowledge about arsenic, its health risks and alternative arsenic-free water sources.

Anita was very glad that her filter started working and that she also learned about arsenic and the filter. She has been sharing her knowledge since then to neighbours saying ‘Arsenic is slow poison. We should always use arsenic-free water for drinking and cooking’.


Filter demand after arsenicosis patients training

Mr. Kedar Tharu is 65 years old. He has studied up to grade three and agriculture is his livelihood. He has developed with black and white spots in his trunk and hard nodules on palms and soles. And this is not hereditary because these kinds of spots were not seen among other family members. He worries about this a lot.

Mr. Tharu has constructed tubewell several years back and his family has been regularly using it for water needs. Water testing showed arsenic concentration of 400 ppb in his tubewell. A Community Motivator working for the CBAM project and AMC members during door-to-door visit in this community informed him that skin lesions on his body are due to arsenic. In the health survey, Dr. Sk Akhtar Ahmad, Bangladesh confirmed Mr Gupta as arsenicosis patient. He got knowledge about arsenic from IEC materials distributed by AMC members and other activities such as arsenic class and street drama. Community Motivator and AMC members advised Mr Gupta and his family members not to use their tubewell water directly for drinking and cooking purposes. They also suggested his family to use neighbour’s tubewell or improved dugwell that contain less or no arsenic. In addition, they also informed that if his family wants to use his tubewell water for drinking and cooking then water must be filtered using special arsenic removal filters such as ‘Kanchan Arsenic Filter’, ‘SONO Filter’.

The training he had participated on ‘Arsenicosis Cases’ to arsenicosis patients organized by CBAM project on 3rd of September 2012 worried a lot when he saw some persons among participants had more deteriorated health effects of arsenic. This made him very serious thinking his health would further damage if he continued drinking tubewell water. And he decided to purchase ‘Kanchan Arsenic Filter’ for arsenic safe water and prevent his family members to suffer from arsenic related health effects. He managed to getthe filter, KAF. His family is now using the filter regularly. It is difficult to change peoples’ behavior but the training finally made Mr Kedar to listen to suggestion provided by the Community Motivator and AMC members for switching to arsenic safe water option.

AMC makes change

CBAM project initiated formation of ‘Shree Nandan Arsenic Mitigation Committee’ in Ramgram-10, Manjhariya. The capacity of AMC has been built on arsenic mitigation through different trainings such as arsenic testing in water using field kit, construction of KAF and its O&M and screening of arsenicosis cases (skin manifestations). AMC members are now capable of independently conducting arsenic testing in water using field kit, construction of KAF and its O&M and screening of arsenicosis cases for skin lesions. The AMC does awareness campaigns, arsenic class, home visits, arsenic testing, O&M of filters, screening of arsenicosis cases etc in the respective community. They have also done advocacy for mobilizing local funds and resources.

It is noteworthy that some people in this community including AMC members had heard the word ‘Arsenic’ but they did not know about it, its health risks and arsenic-free water alternatives. But the activities of AMC have considerably raised peoples’ awareness level on arsenic issue. Peoples’ perception on arsenic has been changed and they have shown changes in their behavior using arsenic safe tubewell, filter, and dietary habit. People have shown concerns for arsenic-free water.

Behavior change comes in arsenicosis patient

Ganesh Kewat is 35 years. He lives in Ramgram-8, Unwachha with his wife and two children. He has got adult education. His daily routine work is agricultural work but he also make earnings from labour work. He is identified as arsenicosis patient from health check-up of CBAM project.

Mr. Kewat said, ‘I continuously used water from my untested tubewell which was installed 10 years ago’. Actually he forgot the name of the organization that provided him arsenic removal filter few years back. He got the filter but the filter was not used regularly for different reasons.

During the AMC formation in Unawauch, Mr. Kewat became a member of it. He gained a lot of arsenic related knowledge through various trainings provided by CBAM project. This helped him to have healthy behaviors using arsenic-free water option and food habits - consuming nutritious foods, avoiding smoking and alcohol drinking. His skin lesions related to arsenic toxicity have gradually improved.


Environment and Public Health Organization (ENPHO)110/25 Aadarsha Marg, New BaneshworG.P.O. Box 4102, Kathmandu, NepalTel: +977-1-4468641/4493188 • Fax: +977-1-4491376Email: [email protected] • Website: www.enpho.org

desig

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wps

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