Comprehensive WASH Needs Assessment Lal Wa Sar Jangal District Ghor Province, Afghanistan

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Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Comprehensive WASH Needs Assessment Lal wa Sar Jangal District Ghor Province, Afghanistan

September/October 2016

Prepared by: Rosanna Keam, WASH Specialist, WV Afghanistan Supported by: Shoaib Wasiqi (M&E Officer), Anley Mihret Melesse (M&E and Program Quality Coordinator), Faraidoon Osmani (Associate Program Officer), Mojtaba Esmatzada (M&E Advisor), Fairadoon Barekzay (Badghis Zonal Manager) Dated: 5th December 2016

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Acknowledgments First and foremost, WV Afghanistan would like to acknowledge the community members, community and religious leaders, and partners who took part in the assessment. In particular, WV Afghanistan wishes to acknowledge the generous support of several organizations including Catholic Relief Services in Lal for providing office space and services during the field data collection phase of the assessment, Help International for providing Ms. Sima Soja and Mr. Zia Jafari to support the initial scoping and data collection for the assessment, and DACAAR for conducting water quality testing at survey sites.

WV Afghanistan would like to recognize the technical Monitoring and Evaluation expertise of Shoaib Wasiqi (M&E Officer), Anley Mihret Melesse (M&E and Program Quality Coordinator), Mojtaba Esmatzada (M&E Advisor), and Abdullaq Zia (external M&E contractor) for their support for phases 2 and 3 of the assessment. WV Afghanistan also wishes to recognize Faraidoon Osmani, Faraidoon Barekzay, Rosanna Keam and Dwain Hindriksen for providing continuous oversight of the assessment process, as well as Ahmad Seyar Haqmal for providing technical input during the initial scoping phase of the assessment, and the Mojtaba Niknam for providing security and logistical support during the assessment design and implementation.

Finally, WV Afghanistan would also like to thank WVUS for the financial support for this assessment, as well as Brian Hilton, Food Security Advisor from WV Australia for providing technical insight during the initial scoping phase of the assessment.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Contents 1. Introduction ...... 6 2. Background ...... 7 2.1 General ...... 7 2.2 Population ...... 8 2.3 Environment and hydrological context ...... 9 2.3.1. River Basins ...... 9 2.3.2. Climate and Precipitation...... 12 2.3.3. Environmental Concerns ...... 13 2.4 Water, Sanitation and Hygiene (WASH) ...... 13 2.5 Education ...... 16 2.6 Economy ...... 16 2.7 Health ...... 16 2.8 Protection ...... 19 2.9 Agriculture, Livelihoods and Energy ...... 19 2.10 Security and Accessibility ...... 19 2.11 Infrastructure ...... 20 2.12 Partners and Governance Structures ...... 21 3. Methodology ...... 23 3.1 Qualitative Study ...... 23 3.2 Quantitative Study ...... 24 3.3 Sampling Strategy ...... 24 4. Limitations ...... 26 5. Results & Analysis ...... 27 5.1 General ...... 27 5.2 Water ...... 29 5.3 Sanitation ...... 41 5.4 Hygiene ...... 45 5.5 Health ...... 48 5.6 Environment, Food Security & Livelihoods ...... 53 5.7 Education ...... 62

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

5.8 Cross-cutting themes ...... 64 5.8.1 Gender ...... 64 5.8.2 Peacebuilding & Governance ...... 65 5.8.3 Child Protection ...... 65 5.8.4 Disasters ...... 65 6. Conclusions & Recommendations ...... 67 7. Sources ...... 71 8. Appendices ...... 72 8. Annex A ...... 73

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Acronyms

ACF Action Contre La Faim ACTD Afghanistan Centre for Training and Development ANSF Afghan National Security Forces AOG Armed Opposition Group ARCS Afghan Red Crescent Society CLTS Community Led Total Sanitation CRS Catholic Relief Services CSO Central Statistics Office DACAAR Danish Committee for Aid to Afghan Refugees DAIL Department of Agriculture, Irrigation and Livestock DRRD Department of Rural Rehabilitation and Development ETP Evapotranspiration Potential FGD Focus Group Discussion IAM International Assistance Mission JMP Joint Monitoring Programme KIG Key Informant Group KII Key Informant Interview LEPCO Leprosy Control MRRD Ministry of Rural Rehabilitation and Development MUNCH Maternal and Under five Nutrition and Child Health NGO Non-Governmental Organization NSP National Solidarity Program ODF Open Defecation Free ORS Oral Rehydration Salts ORT Oral Rehydration Therapy PHAST Participatory Hygiene and Sanitation Transformation PRA Participatory Rural Appraisal SDG Sustainable Development Goal TDS Total Dissolved Solids UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund VIP Ventilated Improved Pit WASH Water, Sanitation and Hygiene WHO World Health Organization WV World Vision WVA World Vision Afghanistan

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

1. Introduction In September and October 2016, WV Afghanistan undertook a WASH assessment in Lal wa Sar Jangal District in Ghor Province. This assessment was intended to provide information regarding the WASH needs and existing resources in the communities in order to enable WV Afghanistan to prioritize and make choices about the focus of future project implementation in Lal District. It was also envisioned that the data collected during this assessment would support future resource acquisition, particularly in the WASH sector, as well as related sectors such as Health and Livelihoods, by building an evidence base for key interventions. The purpose of the assessment was also to support future strategic planning for programming locations. The assessment was implemented in one District (Lal) in Ghor Province over several weeks and included both quantitative and qualitative elements, such as household surveys, key informant interviews, focus group discussions, site assessments (village profiles, sanitary survey of water points, health centre and school site assessments), as well as a water quality survey. It assessed the WASH situation in the planned implementation areas, as well as basic indicators for associated sectors.

The specific objectives of the assessment were:  To create links with local partners and communities in Lal District in order to support future programming.  To collect and analyze quantitative and qualitative assessment data to: o Determine the existing levels of access to clean water and sanitation in target communities. o Determine the level of knowledge, attitudes and practices regarding hygiene in the communities. o Determine the adequacy of water and sanitation facilities in key community institutions (i.e. schools and health centres). o Understand the physical context and existing water and land use practices in the area. o Understand the hydrological dynamics in the district. o Understand the socio-cultural and political environment in which WV may be potentially operating in in the future. o Anticipate risks that will need to be mitigated in future project implementation. o To determine the level of conditions in the communities including agriculture, education, health etc.  To provide specific, actionable and practical recommendations for future programming in the district.  To create a report that can be used as supporting evidence for future WASH-related grant proposals/designs.

The product of the assessment process is this assessment report which contains relevant analysed data from secondary sources, survey questionnaires, focus group discussions, key informant interviews, site observations, and water quality data. This evaluation report will be shared with all relevant staff and stakeholders and will be also be used for grant applications.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

2. Background

2.1 General Lal wa Sar Jangal is a district in the north-east of Ghor Province in the Eastern Region of Afghanistan. Ghor Province is bordered by eight other provinces: Bamyan in the North-East, Daikundi in the East, Helmand in the South, Farah in the South-West, Herat in the West, Badghis in the North-West, and Faryab and Sar-i-Pul in the North. It covers a land area of 36,657.4 square kilometres, representing 5.6 percent of the total Afghan territory. Ghor is home to 2.7 percent of the total population of Afghanistan. The province is divided into 10 districts – the provincial centre, Chaghcharan, Dawlatyar, Char Sada, Shahrak, Duleena, Pasaband, Lal wa Sar Jangal, Tulak, Saghar, and Taywara. Lal wa Sar Jangal district was joined as a grade two district in the Ghor Provincial structure in 1964. It is located in the north-east of Ghor Province, with Sar-i-Pul Province to the north, Bamyan Province to the east, and Daykundi Province to the south. Chaghcharan District is located to the west of Lal wa Sar Jangal.

Figure 1: Map of administrative divisions of Afghanistan. Source: University of Texas at Austin, 2009.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Lal wa Sar Jangal is located within the Hazarajat region in the central highlands of Afghanistan, among the Koh-i-Baba mountains and the western extremities of the Hindu Kush. ‘Hazarajat’ is a regional name for the territory inhabited by the ethnic Hazara people. It denotes an ethnic and religious zone, rather than a geographical one – that of Afghanistan’s Turko-Mongol Shi’ites. Hazarajat is primarily made up of Bamyan, Maidan, Ghazni and Daykundi provinces, but it also includes parts of Ghor, Uruzgan, Parwan, Samagan,

Baghlan, Balkh, Badghis and Sar- Figure 2: Map of ethnic groupings in Afghanistan. Source: lahistoriaconmapas.com, 2016. i-Pul provinces. Although Hazarajat is inhabited by ethnic Hazara, Tajik, Pashtun and Uzbek, the majority of the population is Hazara.

2.2 Population With its 701,653 inhabitants, Ghor Province is the 13th (out of 34) most populous province in the country.1 The population of Ghor is distributed among the 10 districts. The most populous districts are the Chaghcharan Provincial Centre and Lal wa Sar Jangal. With a population of 116,238 (57,692 female, 58,546 male), Lal wa Sar Jangal contains 16.6 percent of Ghor Province’s 2 population. There are 676 Figure 3: Map of ethnic groupings in Ghor Province of Afghanistan. Source: Naval Postgraduate School, 2016.

1 http://www.cso.gov.af/en/page/demography-and-socile-statistics/demograph-statistics/3897111 2 Ibid.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

villages and 28,750 families in Lal wa Sar Jangal District according to the 2014 National Solidarity Programme (NSP). According to the Central Statistics Organization (CSO) of the Republic of Afghanistan, the population is predominantly rural. By population density, which is the ratio of the population to land area, Lal wa Sar Jangal has the most number of people who occupy the same size of land (40 persons per square km of land area) in Ghor Province.3 The average household size in Lal is 5.8 persons. The median age of people in Lal is 16 years old (both male and female). Lal has a relatively young population with 47.1% of the population between the ages of 0 and 14.

2.3 Environment and hydrological context Lal wa Sar Jangal comprises two main valleys and a number of sub-valleys. The area is very mountainous. Its highest peak (Bande Kashan) reaches up to 4200m above sea level. The total area of the district is approximately 5115 square kilometres. The height of the district centre is approximately 2880m above sea level.

2.3.1. River Basins The main water sources in Lal wa Sar Jangal are the Lal and Sar Jangal rivers which are tributaries of the large Harirud River. The Harirud River is part of the Harirud-Murghab river basin which consists of four watersheds. The Harirud River, as with most river systems in Afghanistan, is endorheic, meaning that it flows only into a basin of interior drainage rather than to an external body of water. The Harirud River flows 1100km from the mountains of Central Afghanistan in a nearly straight westerly direction down a fault-guided valley towards the Iranian border, before looping north to Turkmenistan, where it disappears in the Kara-Kum desert forming the Tejend oasis. The average annual discharge of the Harirud River is about 55m3/s. It is a seasonal river. Maximal flows in spring and summer melt-water river-discharges are followed by fall and winter minima, when the river can completely dry up. Most runoff is delivered from melting of seasonal winter snow or older glacial ice and high sediment loads are characteristic.

Lal wa Sar Jangal is located in the Upper Harirud watershed. The Lal River, the main river feeding Lal, is connected to the Harirud River and passes through Lal wa Sar Jangal, traversing approximately 85km of the district’s territory. This river is seasonal and can dry up during the summer months. The Sarjangal River, also connected to the Harirud River, passes through Lal wa Sar Jangal District until it reaches Chaghcharan city. Like the Lal River, the level of the Sarjangal river drops during summer, however it does not completely dry up. The main users of these rivers are farmers, however it should be noted that agricultural usage is limited due to the low amount of productive agricultural land in the district. The only other uses for the rivers are drinking water and other domestic uses.

3 http://collaborativemonitoring.com/wp-content/uploads/2016/01/Ghor-Socio-Demographic-and-Economic- Survey-2015.pdf

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Figure 4: Sarjangal River, October 2016

Figure 5: Sarjangal River, October 2016

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Figure 6: Map of some of the main rivers of Afghanistan showing the regional transboundary hydrological context. Source: The Center for Afghanistan Studies, University Nebraska Omaha, 2016.

Figure 7: Map of the main rivers in Afghanistan, highlighting the Harirud Drainage System. Source: The Center for Afghanistan Studies, University of Nebraska Omaha, 2016.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

2.3.2. Climate and Precipitation The Afghan climate is continental, with temperatures for the country ranging from 30°C in summer to - 20°C in winter. Lal wa Sar Jangal is located in an area of ‘cold desert climate’, based on the Köppen climate classification scale.

Figure 8: Köppen climate classification, Afghanistan.

The mean temperature in Lal wa Sar Jangal, however, is 2.9°C, one of the coolest mean temperatures recorded in the country. Like much of Afghanistan, Lal wa Sar Jangal has an arid to semi-arid climate. In common with other mountainous districts in the province, Lal Wa Sarjangal suffers from low rainfall and severe and long winters, both of which affect agriculture, the most important source of income. The wet season is concentrated in winter and spring. Precipitation often falls in the form of snow which is critical for river flow and irrigation in summer. From June – October there is hardly any precipitation. The mean annual precipitation in Lal wa Sar Jangal is 227.4mm. These rainfall patterns result in higher dependency on snow-melt for irrigation. Under these climatic conditions, one of the major limiting factors for agricultural production is water availability at critical growing periods. Lal wa Sar Jangal is also drought-prone. ‘Severe drought’ is considered to be low winter rainfall in two consecutive years. This occurs once every 10-15 years, although it has been increasing in frequency.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Figure 9: Annual precipitation in Afghanistan. Source: GEOCART, ‘National Atlas of the Democratic Republic of Afghanistan’, Warsaw, 1984.

In Lal wa Sar Jangal, total evapotranspiration (ETP) is 695mm, with the month of highest ETP being July and the lowest being January. The ETP rate in the maximum month (July) is 4.33mm per day, which is considered relatively high. The ETP rate in the minimum month (January) is 0.20mm per day, one of the lowest recorded rates in Afghanistan. ETP rates are low in this area due to long and severe winters.

2.3.3. Environmental Concerns Deforestation has dramatically increased in Afghanistan in the past three decades, along with desertification. Much of the original forest coverage has been decimated, little land is available for farming, and natural resources have been poorly managed. Despite an abundance of renewable energy possibilities – including wind, water and solar – inadequate technology and a lack of policy and management capacity means these are not properly exploited. Climate change is a particular threat, with the impacts likely to undo development gains, particularly for rural poor.4 Flooding is another concern in the area due to a lack of tree cover to support infiltration, and steep terrain.

2.4 Water, Sanitation and Hygiene (WASH) Unprotected springs, surface water and dug wells are the main sources of water for most households in Lal district. According to the 2012 Socio-Demographic and Economic Survey, only 21.4% of the population in Lal has access to an improved drinking water source, compared to a provincial average of

4 http://www.af.undp.org/content/afghanistan/en/home/ourwork/environmentandenergy/in_depth/

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

20.6% and a national average of 55%.5 An improved water source is considered by the JMP to be piped water into a dwelling, piped water to a yard/plot, public tap or standpipe, tube well/borehole, protected dug well, protected spring or rainwater.

Figure 10: Percentage Distribution of Households by Source of Drinking water and District, Ghor, September 2012. Source: Ghor Socio-Demographic and Economic Survey, UNFPA, CSO, 2012

Water quality is also a concern, with many sources containing physical (e.g. sediments, organic materials), chemical (e.g. fluoride and nitrate) and biological contaminants (e.g. bacteria, viruses, protozoan and parasites). Groundwater salinity is of particular concern in many parts of Afghanistan, including Lal District; as is the presence of fecal coliforms in shallow and surface water. Fecal coliforms have also been detected in water storage containers in households in Ghor Province during the 2014 WV Maternal and Under five Nutrition and Child Health (MUNCH) Project baseline, which suggests that water may be being contaminated during transportation or storage in the household. These contaminants present health risks for populations consuming the water. There is little secondary information available on water treatment practices in Lal District, however the 2014 MUNCH Project

5 http://collaborativemonitoring.com/wp-content/uploads/2016/01/Ghor-Socio-Demographic-and-Economic- Survey-2015.pdf

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

baseline for Ghor Province suggests that only 8.7% of people in Ghor Province treat their water before drinking.

Latrine access is low in Ghor Province, according to the 2012 Socio-Demographic and Economic Survey, with an average of 2.1% of households having an improved latrine.6 As defined by UNICEF, an improved latrine can be any of these types: flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved pit latrine (VIP), pit latrine with slab, and composting toilet. In Lal District, the majority of households (65.5%) are using the elevated type of toilet facility in which waste is deposited in a chamber above ground and emptied when it is full. 27.7% of the population is practicing open defecation, compared to a provincial average of 32.3% and national average of 13%.7

Figure 11: Percentage Distribution of Households by Type of Toilet Facility and District, Ghor, September 2012. Source: Ghor Socio-Demographic and Economic Survey, UNFPA, CSO, 2012

People with disabilities face multiple barriers to accessing facilities, especially sanitation. It is estimated that 3.9% of the population 5 years and older in Lal District have some kind of functional disability (difficulty self-caring, communicating, remembering, hearing, seeing and/or walking). WASH facilities, particularly latrines, must be designed with such disabilities in mind.

There is little secondary information available on hand washing practices in Lal District, however the 2014 MUNCH Project baseline for Ghor Province suggests that only 14.9% of mothers of children under 5 years old in Ghor Province report washing their hands with soap after using the toilet. This is within the critical range according to WV’s triggers for action. There seems to be a low level of knowledge and practice of good hand washing behaviors in the Province and this is likely to also be the case in Lal District.

6 Ibid. 7 Ibid.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

It should be noted that the government budget has almost no financial allocation for the WASH sector to ensure that every Afghans has access to improved water and sanitation. In 2013, the government allocated 2% of the budget to WASH, with the aim of increasing this to 5% by 2016.

2.5 Education There are 28 high schools, 27 secondary schools, and 17 primary schools in Lal District, with a total of 31,700 pupils. According to the 2012 UNFPA/CSO Ghor Socio-Demographic and Economic Survey, Lal wa Sar Jangal has the highest literacy rates for people 10 years and above in the province at 41.1% (54.5% of men, 28% of women). 87.3% of people (78.9% of men, 96.4% of women) aged 25 years and above in Lal wa Sar Jangal have not completed any schooling, which is the lowest percentage of people who have not completed any schooling in the province, however this rate is still considered to be concerning.8 Schools in the area are under-resourced, lacking basic requirements such as school buildings, furniture and books. Despite the challenges and remote location, however, people in Lal value education with boys and girls walking many hours to attend school and even further to continue on to higher education.

2.6 Economy 40.2% of the population of Lal wa Sar Jangal District is considered economically active (worked 6 or more months in the last 12 months), which is the third lowest level in Ghor Province. The unemployment rate is 12.6% (3.2% of men, 21.9% of women), which is the 4th highest rate out of the 10 districts in Ghor. 7.8% of children aged 5-17 have been engaged in employment in the previous 12 months.9 The majority of the population in Lal wa Sar Janagal work in agriculture, hunting, forestry and fishing, followed by community, social and personal services.

Lal has the lowest level of household ownership in the province, with 79.5% of households having ownership of the houses they occupy, compared to a provincial average of 94.1%.10

2.7 Health There is limited health information available for Lal wa Sar Jangal District. The following basic health indicators relate mostly to Ghor Province. The infant and child mortality rates are high in Ghor Province. It is estimated that the infant mortality in Ghor is 70 deaths per 1,000 live births and that the under-five mortality estimate is 97 deaths per 1,000 live births. These figures for males are 69 and 98, respectively, and 71 and 98 for females, respectively. This means that 1 in every 14 children in Ghor die before reaching age 1, while 1 in every 10 do not survive until his/her fifth birthday.11 There is, however, a declining trend in both infant and under-five mortality over time: for infant mortality, from around 87 per 1,000 live births in late 1990s to around 70 in 2008, and for under-five mortality, from around 124

8 Ibid. 9 Ibid. 10 Ibid. 11 Ibid.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

per 1,000 live births in late 1990s.12 The maternal mortality rate in Ghor is 2,300 deaths per 100,000 live births and only 9.3% of births are attended by skilled birth attendants. 97% of births are delivered at home. Only 0.8% of expectant mothers are receiving antenatal care.13

According to a 2014 assessment conducted in Ghor Province by ACF, only 18% of measles vaccinations could be confirmed with a vaccination card. Global acute malnutrition rates in Ghor were found to be 9.2% in the 2014 ACF survey and 7% in a baseline survey conducted in 2014 for WV Afghanistan’s MUNCH Project; both within the ‘attention required’ range according to WV’s triggers for action. Severe acute malnutrition rates were 0.7% according to ACF and 2.4% according to the MUNCH Project assessment. Total stunting was 55.2% according to ACF and 64.1% according to WV; both within the critical range according to WV’s triggers for action. Severe stunting was 29.3% according to ACF and 46% according to WV. Total underweight was 35.7% according to ACF and 17.7% according to WV; both within the ‘critical’ or ‘requires attention’ categories according to WV’s triggers for action. The rate of children who were severely underweight was found to be 12.7% according to ACF and 6.9% according to WV.14 For additional health-related indicators for Ghor Province, see table below.

Figure 12: Health Indicators for Ghor Province (2014 MUNCH Project Baseline) % of women who have had four of more antenatal visits 5.6%

WV triggers: >60%=acceptable 40-60%=attention required <40%=critical Global Acute Malnutrition (GAM) (wasting, weight for height) 7%

WV triggers: <5%=acceptable 5-9%=attention required ≥10%=critical Moderate Acute Malnutrition (MAM) (wasting, weight for height) 4.6% Severe Acute Malnutrition (SAM) (wasting, weight for height) 2.4% Global Chronic Malnutrition (stunting, height for age) 64.1%

WV triggers: <20%=acceptable 20-29%=attention required ≥30%=critical Moderate Chronic Malnutrition (stunting, height for age) 18.1% Severe Chronic Malnutrition (stunting, height for age) 46% Underweight (weight for age) 17.7%

WV triggers: <10%=acceptable

12 Ibid. 13 https://www.unicef.org/infobycountry/files/Best_Estimates_Fact_Sheet_-_Ghor.PDF 14 https://www.humanitarianresponse.info/system/files/documents/files/SMART- Final%20Report_GHOR_ACF%20October%202014_FV.pdf

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

10-19%=attention required ≥20%=critical Moderately Underweight (weight for age) 10.8% Severely Underweight (weight for age) 6.9% % of children 6-59 months with anaemia 72.7%

WV triggers: <5%=acceptable 5-39%=attention required ≥40%=critical % of women who report that they breast fed their youngest child 99.1% % of mothers of children aged below 2 years who reported having exclusively 30.2% breastfed her youngest child for at least 6 months

WV triggers: >80%=acceptable 75-80%=attention required <75%=critical % of children 6-23 months with minimum diet diversity 14.4% % of families that consume all the food they grow 91.6% % of children reported to have had diarrhoea in the past 2 weeks 39.8%

WV triggers: <15%=acceptable 15-40%=attention required >40%=critical % of children under 5 with diarrhoea who received ORT + zinc 54%

WV triggers: >70%=acceptable 60-70%=attention required <60%=critical % of people satisfied or very satisfied with the services they received at their nearest 65% health facility Penta III immunisation coverage among children 1-5 years (card + mother’s recall) 47.1%

WV triggers: >80%=acceptable 75-80%=attention required <75%=critical Measles immunisation coverage among children 1-5 years (card + mother’s recall) 4.5%

WV triggers: >80%=acceptable 75-80%=attention required <75%=critical Average time taken to access nearest health facility 180 minutes

Lal has the highest total fertility rate in Ghor province at 7.6 children per woman aged 15-49 compared with a provincial average of 6.1. There is a lack of proper maternal health in Lal. Accessibility is a significant issue, with poor roads limiting access to health facilities and low levels of service. Acute respiratory infections are common in the winter time and acute gastroenteritis is common in the summer time due to lack of access to the clean, safe drinking water which forces people to consume

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

water from unclean sources. Other illnesses such as urinary tract infections, malnutrition in children and women, and joint pain are also common in this district during all seasons.

2.8 Protection There are some protection-related concerns in Lal District. 14.7% of the population under the age of 5, for example, have birth registration, compared with the national level estimate of 35%. 3.9% of the population 5 years and older has some kind of functional difficulty in one of the following: seeing, hearing, walking, remembering, communicating, and self-catering, which is similar to the provincial average of 4.8%. 1.2% of children under 5 have lost at least one parent.15

2.9 Agriculture, Livelihoods and Energy Despite the reliance of the local economy on agriculture, Lal wa Sar Jangal is located in one of the least agriculturally productive provinces in the country. Most of the land is barren and inaccessible with serious water shortages, small landholdings, extensive food insecurity, and poor soil quality. The main crops grown are wheat, barley, potato and beans.16 69.4% of households in Lal own agricultural land, with the remaining 30.6% owning non-agricultural land.17 Animal dung is the main source of energy for cooking for 92.4% of households in Lal. 4.8% use straw, grass or shrubs, and 1.3% use wood. This is most likely reflective of the physical environment which is sparsely vegetated due to the high altitude and deforestation. 82.2% of households in Lal use solar energy for lighting and the remaining use kerosene (8.6%), electricity from generator, gridline or hydropower (8.1%), or another source (1.2%). Households in Lal have the heaviest reliance on solar energy for lighting out of all of the districts in Ghor Province. 89.5% of households in Lal have electricity in their homes, the second highest level in the province.

2.10 Security and Accessibility Lal wa Sar Jangal is a relatively stable district that does not experience any specific armed conflict. This is mainly attributed to the unity among the population that comes from the relatively homogenous ethnic composition (Hazara). People are very united in the district and cooperative with local government in Ghor Province and always have up to two seats in the elected provincial council as well as in the parliament representing Ghor Province. Political demonstrations are not common practice. Armed opposition groups (AOGs) do not find it easy to infiltrate the area due to a low level of acceptance. Local warlords exist in the area but armed clashes and tribal tensions have not been recorded in the district. There have been no incidents of road robberies within Lal wa Sar Jangal in the recent past. There may be terrorist groups present, however they have limited operational capabilities and acts of terrorism are extremely rare. ANSF and law enforcement agencies are reachable. The local

15 http://collaborativemonitoring.com/wp-content/uploads/2016/01/Ghor-Socio-Demographic-and-Economic- Survey-2015.pdf 16 Ibid. 17 Ibid.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

population is also cooperative and provides support and information to the ANSF if there are any suspicions of criminal groups trying to infiltrate the area.

The NGOs working in Lal wa Sar Jangal have good community acceptance and cooperation from the local communities. NGOs operating in Lal wa Sar Jangal have freedom of movement traveling to project sites. Very few incidents have been recorded in terms of access denial and when there have been cases, they have been resolved swiftly.

The road between Lal wa Sar Jangal and Ghor’s capital (Chaghcharan) is currently considered insecure as AOGs operating alongside the road often establish illegal checkpoints and abduct civilians. There have been some abductions of Hazara along the road between Chaghcharan and Lal wa Sar Jangal this year for ransom and/or revenge attacks. The safest route to access Lal wa Sar Jangal is to either fly in directly from Kabul/Bamyan via UNHAS flight once per week or to fly into one of the neighboring provinces (Panjab, Nili, or Bamyan) via UNHAS flight and drive to Lal. The roads between these provinces and Lal wa Sar Jangal are considered safe, however the road conditions are poor. These routes can take between 3-8 hours to drive. The roads between Lal wa Sar Jangal district administration and the villages are poorly maintained and blocked for 6-7 months per year in winter due to snow. There are high passes which can make driving difficult, especially during the winter season when many of these roads are blocked by snow and floods. 4x4 vehicles should always be used and these vehicles should be maintained to a high standard in order to avoid road traffic accidents. Driving conditions should be considered when attempting to transport personnel and equipment.

2.11 Infrastructure There are 11 health centers in Lal wa Sar e Jangal district, consisting of Lal district health center, Safid- Ab, Daimirdad, Khame-e-Shur, Qala-e-Pechi, Kerman, Talkhak and Garmab basic health centers, Ghighanace health sub-center, Afghan Red Crescent Society (ARCS) health center in Talkhak valley and the Leprosy Control (LEPCO) special health clinic for the treatment of tubercles and leprosy patients. All of the health centers are funded by the Ministry of Public Health, except ARCS and LEPCO clinics that are funded by national and international organizations. The lack of qualified medical doctors, specialists, obstetricians and medical technicians is a big challenge for the provision of health services to the communities. Poor quality roads, the isolation of the district from capital city and the center of the province, under-qualified medical staff, lack of proper training and the lack of interest of medical staff to come to Lal for work add to challenges and health problems.

There are 72 schools in Lal District, however the number of classrooms remains limited, with some children attending classes in tents or outside.

There is no central power grid in the district. All power is provided by private generators. There is a small local market where the district population purchases their supplies. Prices are high, however. This may present challenges for local procurement.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Transport infrastructure is not well developed, with the majority of roads unable to handle car traffic in all seasons. Some parts of the district have no roads at all. Not only does this affect people’s ability to access markets from rural areas as well as transporting goods, it also limits the ability of people to access healthcare and education facilities.

2.12 Partners and Governance Structures Ghor Province has its own provincial administration and a Provincial Governor. The Provincial Governor is appointed by the President of Afghanistan, is representative of the central government, and is responsible for all administrative and formal issues within Ghor Province. The current governor of Ghor is Ghulam Nasir Khaze, who was appointed in December 2015, following Sima Joinda, the first women appointed as a governor in Ghor and the third woman in the country holding a position of governor. Ghor Province also has a Provincial Council that is elected through direct and general elections for a period of four years. The function of the Provincial Council is to take part in provincial development planning and to participate in the monitoring and appraisal of other provincial governance institutions. Each central government ministry is also represented by departments at the provincial capital level.

Figure 13: Local Institutions at Provincial Level. Source: Local Government in Afghanistan: How it works and main challenges, Shabnam Habib, Public Policy and Administration Faculty, Balkh University, Afghanistan, 2013.

Each city has a Mayor whom, although intended to be elected through free and direct elections every four years, in reality is appointed by central government. The current Mayor of Chaghcharan is Mohammed Arif Qazizada. Each district in Ghor is also represented by a District Governor, appointed by the Provincial Governor.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Figure 14: Local Institutions at the District Level. Source: Local Government in Afghanistan: How it works and main challenges, Shabnam Habib, Public Policy and Administration Faculty, Balkh University, Afghanistan, 2013.

There are currently 7 NGOs working in Lal in the following sectors:

NGO Sectors

International Assistance Mission (IAM) WASH (hygiene promotion) and food security

Action Contre Le Faim (ACF) Nutrition and WASH

Afghanistan Center for Training and Development Health (ACTD)

Power Unknown

Catholic Relief Services (CRS) Education and food security

Afghan Aid Disaster Risk Reduction

LEPCO Health, WASH (CLTS)

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

3. Methodology The WASH assessment used both quantitative and qualitative methods to collect the required information. The data collection process was conducted using study guides and checklists developed by the assessment team. The assessment applied the following data collection tools to different individuals and groups:  Secondary data review  Key Informant Interviews (KIIs) around pre-determined topics  Focus Group Discussions (FGDs) with community men, women and children  Participatory Rural Appraisal (PRA) and observation  Sanitary Survey  Household structured surveys  Water quality testing

3.1 Qualitative Study The following qualitative methods were used by the assessment team:  Document review: In order to make the study more comprehensive and informative, and to triangulate with primary data, secondary documents were reviewed and included where relevant. Documents included, but were not limited it, national and provincial statistical data from the Central Statistics Office (CSO), hydrological data from the Afghanistan Information Management Service (AIMS), maps of Afghanistan from the University of Nebraska, World Vision MUNCH Project baseline data, and local reports.  Village sanitary survey: In order to assess the communities’ sanitation statuses, sanitary surveys were conducted in 10 villages. The sanitary survey assesses community perceptions of water quality, the quality of community water systems, and the environmental sanitation situation in communities. The sanitary survey complements the water quality data by helping to provide explanations for water quality results.  Focus Group Discussions: FGDs were used to both triangulate with other data sources and also to gain greater insight into some of the quantitative data that was collected through the household survey. The FGD guides (questions) prepared by the M&E and PQ coordinator were also used to identify specific development and emergency problems and potential interventions for different sectors. There were different FGDs for different target groups. Below are the list of different FGD groups that participated in the assessment process: o Male household members of selected villages o Female household members of selected villages o Children over 12 years old (boy and girls)  Key Informant Interviews: KIIs allow individuals to express their personal opinions, feelings and experiences which they may find difficult to share in group settings. Information from the KIIs was used to supplement and triangulate qualitative and quantitative data. The assessment conducted KIIs with each target group separately, as listed below. o Acting District Governor

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

o Head of District Development Assembly o Provincial Council members o District Hospital staff o High school staff  Participatory Rural appraisal (PRA) and observation: Participatory Rural Appraisal (PRA) is a set of tools and techniques used with households to gather and analyze information on community resources, problems, potential and needs. PRA exercises were conducted with key informant groups (KIG) in the villages. The KIGs were comprised of village community leaders, religious leaders, community development council members, Shura leaders, teachers, and health workers. A total of 7 PRA exercises were conducted in 10 communities. These exercises included: o Historical timelines o Village resource mapping o Village social mapping o Transect walks o Wealth ranking o Seasonal calendars o Pair-wise ranking/matrix scoring and ranking

3.2 Quantitative Study The following quantitative methods were used by the assessment team:  Water quality testing: The Danish Committee for Aid to Afghan Refugees (DACAAR) was contracted to conduct water quality testing in 10 communities to identify water quality issues in communities. All parameters required by the WHO and Afghanistan National Drinking Water Standards were tested.  Household survey: A household survey was conducted to complement qualitative findings, and to determine the status of key wellbeing indicators, with a particularly strong focus on WASH indicators. Household survey questions, although heavily focused on WASH, also included other related sectoral questions. In sampled villages of the district, household heads (both male and female) in each village were surveyed to gather the required quantitative information. Key community members interviewed included: o Male household head o Female household head or spouse

Data was collected using the mobile data collection platform, ‘SMAP’, and analyzed using Excel.

3.3 Sampling Strategy The sample size was as follows:

 Qualitative Study: o One PRA was conducted in each of the 10 villages selected to get one overview per village sampled.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

o One sanitary survey was conducted in each of the 10 villages selected. o Three focus group discussions were conducted in each of the 10 villages selected. The groups comprised of randomly selected men, women and children from each of the sampled villages. Each group had 10-12 members. The total number of FGDs conducted in this assessment was 30 (3 from each village). o Five key informant interviews were conducted, based on availability of informants.

 Quantitative Study: With regard to the household survey, 10 villages were randomly selected from a list of 282 villages in the district. Since all households in each sampled village are considered in this survey, the study used one cluster systematic random sampling technique to select households to be interviewed. Participants of the survey were both men women of each household.

The assessment deployed systematic random sampling with a margin of error of 5% and confidence level of 95% with a 10% correction factor. With design effect (D=1) the sample size for the assessment comprises of 400 households. The survey considered all households in 10 sampled villages and in this survey 400 households were interviewed. The sample size was calculated using the following formula with 10% correction factor.

2 2 n = D * (Zα + Zβ) * [ p1 (1-p1) + p2 (1-p2)] / [(p2 – p1) * (1-r)]

n = minimum sample size required D = design effect; D = 1 if you use two-stage cluster sampling design

p1 = estimated value of the key indicator at baseline (or control group)

p2 = expected value of the key indicator at the end-line (or intervention)

Zα = Z-score for the desired degree of confidence (α = .95, Zα =1.645)

Zβ = Z-score for the desired level of power (β = 0.80. thus Zβ =0.84) r = non-response error (normally = 0.1, 10%)

It should be noted, however, that on arrival of the assessment team in the communities, actual population numbers were lower than reported. Consequently, the household survey coverage had to be expanded to 23 villages to satisfy sample size requirements.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

4. Limitations Time, accessibility and security were considered to be the major limitations with regard to assessment processes as the fragile and dynamic context in Afghanistan makes it challenging to follow a set agenda. To address this issue, the assessment team planned to allow extra overflow days for field data collection. The WVA team worked closely with the security department to ensure that the site visits, interviews, focus group discussions, and surveys were conducted at the most appropriate time and in secure conditions.

The capacity of the external data collectors also represented a potential limitation for the assessment and to mitigate this, 3 days of training was allocated. There were enough qualified people in Lal to assist with data collection and this did not present a problem. There were some political issues with participant selection, however this was managed by assessment team staff and did not affect the results of the assessment.

A lack of secondary data presented an issue for the assessment. Very little secondary data is available in Afghanistan due to the political and security situation, and what is available can be of questionable quality. This affected the quality of the sampling for the household survey as actual population levels were lower than reported population levels. As such, the number of villages sampled for the survey had to be expanded from 10 to 23 villages in order to satisfy sample size requirements. The lack of secondary data has also limited the scope of the background research in this report.

The assessment was conducted over Eid, which limited the scope of the Key Informant Interviews as many people were away for the holiday. As such, WV was unable to interview some relevant government departments, health centre staff, education providers, and NGO staff.

World Vision Afghanistan has limited experience using mobile data collection. The ‘SMAP’ mobile data collection platform presented some initial difficulties such as the creation of the mobile data form, however these difficulties were overcome with support from the developers. During data collection, the assessment team experienced very few technical issues and the data collection process was carried out very smoothly. SMAP proved to be a very useful data collection tool and should be used for future data collection in Afghanistan.

Despite the ability of WV Afghanistan to collect water quality data, the lack of hydrogeological surveyors in-country and lack of finances meant that data on groundwater location and quantity could not be scientifically assessed. There also seems to be a lack of secondary hydrogeological data available so the assessment is limited in this respect.

Finally, some of the standard WV WASH indicators have recently been realigned with Sustainable Development Goal (SDG) indicators so some of the necessary information (particularly with regard to institutional WASH) has not been collected. The majority of the data, however, is still in alignment with the new SDG indicators.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

5. Results & Analysis

5.1 General Of the 10 villages surveyed, the average age of respondents was 37 years old. 30% of respondents were male and 70% of respondents were female. The majority of respondents stated that there was only one (43%) or two men (28%) in the household; one (34%) or two (35%) women; one (24%) or two (27%) boys; and one (29%) or two (24%) girls.

According to the results of the PRA, the majority of people in the communities are Hazara, with a small minority of Sayed. They are Persian speaking.

In the household survey, 24/400 (6%) respondents stated that there was one boy with a disability in the household. 23/400 (5.8%) respondents stated that there was one girl with a disability in the household. 2/400 (0.5%) respondents stated that there were 2 boys with disabilities in the household. In total, there were 49 children with disabilities in the sampled households (out of 400 households surveyed).

Age of Respondents Gender of Respondents 10% 9%

14-18 14% 16% 30% 19-25 26-35 Male 36-45 Female 46-55 22% 56-80 70% 30%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Number of men, women, boys and girls in each household 180

160

140

120

100 Number of men 80 Number of women

60 Number of boys Numberofrespondents 40 Number of girls

0 One Two Three Four Five Six None More then 6 Number of men/women/boys/girls per household

Number of children with disabilities per household 400 374 377 350 300 250 200 Number of boys 150 Number of girls

100 Numberofrespondents 50 24 23 2 0 0 One Two None Number of boys and girls with disabilities

According to the Focus Group Discussions (FGDs), there is a lot of sympathy and respect for families that have a person with a disability but there is also stigmatization in some cases. There is some government support for these families, however it is limited. Several groups mentioned that some people with disabilities are registered with ‘Martyrs’ and received 6000 Afs per year. There has been very little assistance from other organizations.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

5.2 Water The main household drinking water sources are unprotected springs (20.2%) and open public wells (21.9%), both of which are considered by the JMP to be unimproved water sources. No one reported piped water to dwelling, rainwater, dam, canal, kariz, bottled water or water from a truck as their main household water source. An improved water source is considered by the JMP to be piped water into a dwelling, piped water to a yard/plot, public tap or standpipe, tube well/borehole, protected dug well, protected spring or rainwater. Unimproved sources include unprotected springs, unprotected dug wells, cart with small tank/drum, surface water and bottled water. Based on these definitions, 38.5% of people are using improved water sources and 61.5% of people are using unimproved water sources.

Main household drinking water source

0.3% 0.3% 1.8% Piped into yard / 2.3% plot 1.0% Public tap 3.3% 3.8% Protected dug well in dwelling Protected dug well in yard / plot 15.2% Protected public 20.2% dug well Tubewell / borehole

Protected spring

8.7% Open well in dwelling Open well in yard / plot Open public well 7.8% 21.9% Unprotected spring 5.8% River / stream / 7.8% creek Pond / lake

Other

According to the PRA and FGDs, DACAAR, Oxfam and the Department of Rural Rehabilitation and Development (DRRD) were responsible for constructing a lot of water systems in 2004. ACF has also been involved in water system construction recently. Based on feedback from communities, almost half of the water systems constructed in 2003-2004 are no longer functional.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Water is not available from these sources all year round, however. 40% of people Water available from the main household reported that the water from the main drinking water source in all seasons household water source is not available 0.3% all year round. This was reflected in the FGDs, with some people saying that water is available from wells in spring Yes (March – June) but that the wells dry up 40.0% during and after summer (July – No December). For those who do not have 59.8% Don’t know year-round access to water, only 13% are using an improved water source as their secondary source of drinking water. 87% are using water from unimproved water sources as their secondary source of drinking water.

Secondary household drinking water source

2% 3% 1% 5% 4% 5%

3% Protected dug well in dwelling 1% 15% Protected public dug well Tubewell / borehole Protected spring Open well in yard / plot Open public well Unprotected spring River / stream / creek 31% Pond / lake Kariz Other 31%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

The average time taken to collect water and return home is 25 minutes. 22.5% of respondents stated that it took them more than 30 minutes to collect water and return home. These respondents fall outside the WV and JMP requirement of access within a 30 minute round-trip of the household. The average amount of drinking water each household has access to per person per day is 8.9 litres. This is below the WV and JMP standard of 20 litres per person per day. 97% of respondents stated that they have access to less than 20 litres of drinking water per person per day. 47.3% of respondents stated that they have access to less than 7.5 litres of drinking water per person per day, falling below the sphere standard for total basic water needs (7.5 – 15 litres per person per day). Based on the WV standard of ‘year-round access to 20L of water per person per day from an improved source within a 30 minute round trip of the household,’ only 1/400 (0.25%) people meet this standard. If the standard is reduced to the minimum sphere standard of 7.5L, only 37/400 (9.25%) people meet this standard. 6% of respondents stated that there is a limit on the amount of water they are able to collect each day and that they do not get enough water for the family for drinking and cooking.

The average amount of money paid for water is 34 Afghanis (US$0.51) per month.

Limit on how much water can be accessed each day

31% None

Yes, and I do NOT get enough for the family for drinking and cooking Yes, but I get enough for the family for drinking and cooking 64% 6%

The burden of collecting water lies mainly with women in Lal District. Based on the survey results, the main people responsible for collecting water in the household in Lal District are adult women (56%) and

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

female children (27%). This was also reflected in the FGDs, with one community reporting that women collect water up to 8 times per day.

Main person responsible for fetching water

11%

Adult woman

Adult man 27% Female child (under 15) 56%

Male child (under 15)

Regarding institutional water access (schools and health centres), there were two functional hand pumps attached to boreholes present at the District Hospital when the enumerators visited. There was no shortage of water in the hospital and, according to hospital staff, the two wells have sufficient water all year round. Water is not being treated, however. At the high school that was visited, there were 3 wells, 2 of which had a hand pump (improved) and 1 was an open well (unimproved). Water is available all year round. Two out of three of the wells at the school and both wells at the District Hospital appear to meet the SDG standard for ‘basic’ drinking water sources (improved and on premises), however the quality of the water is unknown.

Water quality is somewhat of a concern in Lal District. The quality of water from the water systems in the 10 communities selected was tested. Out of all of the parameters tested, the results of concern are listed below. 8/10 water sources are contaminated with fecal coliforms. Turbidity is only an issue in the one dug well that was tested; turbidity is generally common in dug wells. Hardness is a concern in 8/10 water sources; a common issue with groundwater in Afghanistan.

The levels of nitrate in 3 of the water sources exceed both WHO and Afghanistan National Water Quality Standards. This may indicate the presence of nitrogen fertilizers, human waste (particularly from pit latrines) and/or animal waste. The WHO and Afghanistan National Water Quality standard for nitrate is 50 mg/l. Nitrate levels at or above this level have been known to cause a potentially fatal blood disorder in infants under six months of age called methemoglobinemia or "blue-baby" syndrome, in which there is a reduction in the oxygen-carrying capacity of blood. An infant with mild to moderate blue-baby

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

syndrome may have diarrhea, vomiting, and/or be lethargic. In more serious cases, infants will start to show obvious symptoms of cyanosis: the skin, lips or nailbeds may develop a slate-gray or bluish color and the infant could have trouble breathing.

The other contaminant of concern is fluoride. The WHO and Afghanistan National Water Quality Standard for fluoride is 1.5 mg/l. One community water system has a fluoride level of 2.6 mg/l. This is concerning due to the negative health impacts of prolonged fluoride consumption. Consumption of water with fluoride levels in excess of 2mg/L can lead to tooth discoloration and/or pitting of children’s teeth during the formative period of tooth growth. Consumption of drinking water with fluoride levels in excess of 4mg/L can lead to crippling fluorosis, a condition characterized by pain and tenderness of the major joints.

WP Total Fecal Village Type EC TDS Turbidity Chloride Sulphate Fluoride Nitrate Hardness Coliforms Ghar Tube 246 Sangak Well 3580 3 3.42 270 416 2.16 168.4 600 251 Tube 123 Safidar Well 1801 9 3.56 185 152 0.69 117.6 530 2 Shahr - Tube e- naw Well 778 535 0.73 53 26 0.48 40.94 400 0 Dahan Nawe Tube 131 Qiaq Well 1908 3 0.13 81 205 1.04 150.2 570 233 Sar Nawe Dug Qiaq Well 621 427 10.66 16 29 0.5 3.98 350 172 Kushk Sofla Spring 882 607 0.97 29 175 1.28 4.44 500 151 Qalacha Tube Ghar Well 582 400 0.32 20 65 1.03 4.02 280 9 Malmur ak Spring 516 355 3.93 16 2 0.46 20.46 220 11 Manjue Kuhna Spring 719 498 0.97 14 32 0.46 5.58 470 6 Now Abdulla h Spring 1405 967 0.66 41 248 1.33 23.66 570 0

The EC (Electrical Conductivity) of the highlighted water points is higher than WHO recommendation (should be ≤1500 µS/cm), but according to Afghanistan National Water Quality Standard the EC (≤3000µS/cm) is acceptable. The EC (Electrical Conductivity) of the highlighted water points is higher than Afghanistan National Water Quality Standard (EC should ≤3000µS/cm) . The Turbidity of the highlighted water points is higher than WHO recommendation and Afghanistan National Water Quality Standard (Turbidity should be < 5 NTU). The TDS (Total Dissolved Solid) of the highlighted water points is higher than WHO recommendation (should be ≤1000 mg/l), but according to Afghanistan National Water Quality Standard the TDS (≤2000mg/l) is acceptable. The TDS (Total Dissolved Solid) of the highlighted water points is higher than Afghanistan National Water Quality

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Standard (TDS should ≤2000mg/l) . Bacteriological analysis result of the highlighted water points are not pure. Disinfection treatment is recommended. The Chemical determination result, of the highlighted water points is higher than WHO recommendation. The Chemical determination result, of the highlighted water points is higher than WHO recommendation and Afghanistan National Water Quality Standard.

A sanitary survey was also conducted in the communities where water was tested to identify risks and assess the quality of the water systems that might be leading to some of the water quality results listed above. The results of the sanitary survey are listed below. Based on the sanitary survey results, all communities commented that they believed their water was sweet and potable, despite some of the poor water quality results, however the FGDs revealed that there are some concerns about the quality of drinking water in communities. In alignment with the lower water quality results for Ghar Sangak, the sanitary survey in Ghar Sangak shows there are issues with the quality of water systems in the community. Likewise, Sar Nawe Qiaq’s water quality results show a high level of turbidity which is to be expected in an open dug well. Surprisingly, the best water quality results are from the tube well in Shahr-e-naw, however this had very poor sanitary survey and transect walk results, with latrines being located in close proximity to water sources and human waste seeping into alleys. Community members were also concerned about the proximity of latrines to wells, based on the FGDs. One would expect to see higher levels of fecal coliforms in this community, however this is not the case. These conflicting results may be due to different sources being tested and surveyed. People in Safidar, Ghar Sangak, Qalacha Ghar, Manjooha, and Now Abdullah seem to be using latrines and fecal coliform levels in these communities are relatively low or zero except for Ghar Sangak. Nitrate levels, which detect the presence of human waste, animal waste and/or fertilizer, are also low in Shar-e-naw, Qalacha Ghar, Manjooha, and Now Abdullah which may be linked to the higher level of sanitation in these communities.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Concrete Fence/wall Community Concrete Type of Concrete headwall Permanent to protect perception Drainage base free Functioning system base (flood cover from of source of cracks protection) animals Ghar Pumped well, Sangak Sweet and well and No No No No No No No (Naw potable spring Toori) Sweet and Safidar Pumped well Yes Yes No No Yes Yes No potable Shahr-e- Pumped and Sweet and naw No No No No No No No open wells potable (Shahrak) Dahan Pumped well Sweet and Yes Yes Yes Yes Yes Yes Yes Nawe Qiaq and spring potable Sar Nawe Pumped well Sweet and No No No No No No No Qiaq and spring potable Pumped well Sweet and Kushk Sofla No No Yes Yes No No No and spring potable Qalacha Pumped well Sweet and Yes Yes Yes Yes Yes Yes No Ghar and spring potable Pumped well, Sweet and Malmurak No No No No Yes Yes No open wells potable Manjooha (Includes Pumped well Sweet and Yes Yes Yes Yes Yes Yes Yes Manjue and spring potable Kuhna) Now Pumped well Sweet and Yes Yes Yes Yes No No No Abdullah and spring potable

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Village Activities upstream that upstream that may be may be Observations depositing their contaminating wastes into the water source water source The families are using the open well and unprotected spring. There is a high risk of water Ghar contamination as it is open and direct can enter the water source. All pumped wells have Sangak No No been dismantled and are not functioning. Almost all families in the village use non-standard (Naw latrines. The community was not familiar with composting and children and other animals Toori) such as chickens were exposed to dirt near the wells where children were playing. Approximately 20 families are using this water for drinking and cooking. Waste was being disposed of about 10 metres away from the well. Almost all families in the village use non- Safidar No No standard latrines. The community was not familiar with composting and children and other animals such as chickens were exposed to dirt near the wells where children were playing. There are wells in the village but they are unprotected and have limited water. There is also Shahr-e- a high risk that the wells are contaminated because the latrines were built about 5 metres naw Yes Yes away from the wells. Almost all families in the village use non-standard latrines. The (Shahrak) community was not familiar with composting and children and other animals such as chickens were exposed to dirt near the wells where children were playing. Four wells in the village that were functioning. The wells were in good condition and they Dahan Yes No were constructed by DACAAR in 2004. A few households have, however the majority of Nawe Qiaq people use the area for open defecation. There was only one unprotected well which the entire village use for drinking water and the Sar Nawe No No spring is located very far away from the village. About 50% of the houses had non-standard Qiaq latrines and the rest used the area for open defecation. Wells are not functioning and there was a spring in the village which the community preferred to use for drinking. The time for collecting water took 20 minutes. The water was Kushk Sofla No No coming from a pipe. Animals were drinking from below the spring water drainage. The majority of the community is openly defecating. There were around four wells of which two of them were pumped wells, however all wells Qalacha were protected. Almost all families in the village use non-standard latrines. The community Yes No Ghar was not familiar with composting and children and other animals such as chickens were exposed to dirt near the wells where children were playing.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

The village has 2 pumped wells, and 7 open wells. Most of the wells don’t have enough water. There are very few latrines in the village. Most of the houses have no latrines. Malmurak No No Houses are muddy and rubbish and dirt are seen everywhere in the village. Children and chickens are playing in the rubbish. The well was functioning and the people preferred to use the well and also the spring Manjooha water. It is worth mentioning that ACF started to channel the water from the spring to the (Includes village. CRS also provided some training on hygiene for the villagers. Almost all families in Yes Yes Manjue the village use non-standard latrines. The community was not familiar with composting and Kuhna) children and other animals such as chickens were exposed to dirt near the wells where children were playing. The well and spring were functional and the spring was inside the village. People preferred Now to use the spring water since it is clean and sweet. Almost all families in the village use non- No No Abdullah standard latrines. The community was not familiar with composting and children and other animals such as chickens were exposed to dirt near the wells where children were playing.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Despite the presence of fecal coliforms in all but two water sources, 34.8% (139/400) of respondents reported not treating their water. The most common method of water treatment was boiling, with 220/400 (55%) people using this method. One community noted during the FGDs that CRS has provided them with water filters and chlorine. Two of the respondents from the household survey who reported using ‘other’ treatment methods, use salt to treat their water; an inadequate treatment methodology and one which causes further contamination of the water. Some reported employing multiple treatment methods, for example six respondents reported both straining water through a cloth and boiling. For those who reported not treating their drinking water, 36/139 (25.9%) people said it was because they didn’t have a container or vessel to use for treating the drinking water, 32/139 (23%) people said it was because they had no knowledge on how or why to treat the water, and 31/139 (22.3%) people said they didn’t need to as they believe the water is safe to drink. This was reflected in the FGDs, with many people stating that they were unable to treat drinking water due to a lack of household filter. For those who do treat their drinking water, on the other hand, the majority of people (222/255 = 87.1%) stated it was to avoid getting sick, which shows some level of understanding about the connection between drinking unsafe water and illness.

Water treatment methods

250 220 200 139 150

100 40 50 36 Numberofpeople 7 13 5 4 6 0

Treatment methods

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Reasons for not treating drinking water

40 36 35 32 31 30 25 20 20 15 13

10 7 Numberofpeople 5 0 No container / No access to No money to No knowledge No reason to do Other vessel to use for treatment purchase on why / how to so as water is treating water treatment treat the water believed to be safe to drink Reasons

Reasons for treating drinking water

250 222

200

150 121

100 43 Numberofpeople 50 13 11 0 To avoid getting We were told by Water is dirty, not Water has a Other sick some agency or safe different smell someone to treat our drinking water Reasons

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

62% of respondents reported storing drinking water in a container that is used only for drinking water, with the remaining 38% storing water in containers that are used for other purposes. Of the 156 containers that were able to be directly observed, only 72 (46%) had a narrow mouth (>10cm), 6 (3.9%) had a spigot/tap, and 110 (70.5%) had a lid or fitted cover. 3 (1.9%) containers observed had none of these characteristics. None of the containers satisfied all 3 requirements.

Storage of drinking water in a Water storage container characteristics container used only for drinking 120 water 100 80 60 38% 40 Yes

20 Numberofcontainers No 0 62% Narrow Spigot / Tap Lid or fitted None of the mouth (<10 cover above cm) Container characteristics

The largest proportion of respondents reported that these containers were cleaned every week (32.3%). Only 14.3% of respondents reported that they rarely clean the water containers and 0% of respondents reported that they never clean their water containers.

How often water containers are cleaned

14.3% 27.3% Every day 9.3% Every second day

Every week Every month Rarely 16.8% 32.3%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

5.3 Sanitation According to the survey results, the rate of open defecation in Lal District is 42.8%. This is echoed in the FGDs, where many respondents stated that there is a high level of open defecation in their communities. 33% of respondents reported using an unimproved pit latrine (pit latrine with no slab/open pit). 13% reported using an improved pit latrine (pit latrine with a slab). 9.8% of respondents reporting using a latrine that flushes to a pit. Based on the JMP definition of an improved latrine (flush to piped sewer system, flush to septic tank, flush to pit latrine, ventilated improved pit latrine (VIP), pit latrine with slab, and composting toilet), only 23.9% of respondents are using an improved latrine, 33.3% of respondents are using an unimproved latrine, with the remaining 42.8% practicing open defecation.

Types of latrines Flush to septic tank

0.3% 0.3% 9.8% Flush to pit latrines 0.8%

Ventilated improved pit latrine 13.0% Pit latrine with slab 42.8%

Pit latrine with no slab/open pit

Hanging toilet/latrine (latrine built over a river, pond, lake, sea, etc.) No Facility / bush / field

33.0% 0.3% Don't know

It was noted by a group of girls during the FGDs that some schools have no latrines (e.g. school in Manjue Kuhan), which may affect the ability of children to attend school.

In the FGDs, people reported using water to clean themselves after defecation, which should be taken into consideration when designing sanitation facilities.

For those who do not use a latrine, the main reason for the majority of respondents (72%) was cited as the cost of constructing a latrine. This was followed by ‘other’ (15%), with the majority of these respondents stating that they either did not own the land or there was no space to construct latrines. In the FGDs, people mentioned that they would need materials such as cement, doors and piping to be able to construct latrines. For those who did use a latrine, the main reason for using a latrine was cited as “to have a clean community” by 54% of respondents. 28% of respondents reported using latrines to

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

avoid getting sick. 15% provided other reasons, with the majority of these reasons relating to security and religion.

Main reason for not using a latrine 1% Cost of constructing a latrine 1% Lack of knowledge 1% 15% 1% No need felt 3% 1% Don't want to have one

5% Too dirty / unclean / smells bad / too many flies Too far away 72% Local belief / tradition doesn’t allow it Other

Main reason for using a latrine

15% 28% To avoid getting sick

We were told by some agency or someone to use it

To have a clean community 3%

Other

54%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Of the people who reported having a latrine, 25% reported sharing the facility with people Household latrine facility shared who were not members of their household. The average number of people per latrine is 11. 91% 25% of people reported that their latrines are located less than 50 metres from the household, which meets sphere standards. Based on the WV and Yes sphere standard of ‘an improved latrine within 50m of the household’, only 22.5% of people No (90/400) meet this criteria. This includes latrines that are both shared and not shared. Regarding Sustainable Development Goal (SDG) indicators, 75% there are two standards: a basic sanitation facility and a limited sanitation facility. A basic sanitation facility is an improved latrine that is Location of the latrine relative to used by only one household, whereas a limited home sanitation facility is an improved latrine that is shared by two or more households. Based on 9% the new SDG requirements, 17.25% of people (69/400) stated that they have access to a basic Less than 50 (improved) sanitation facility within 50 metres of metres the home and 5.25% of people (21/400) have More than 50 access to a limited (improved) sanitation facility metres within 50 metres of the home. Excluding the distance requirement, 18% of people (72/400) have access to a basic (improved) sanitation 91% facility and 5.75% of people (23/400) have access to a limited (improved) sanitation facility.

Regarding institutional (schools, hospitals) latrine access, the Lal District Hospital has 9 latrines situated at the back of the hospital, approximately 150 metres away. There are limited menstrual hygiene facilities in the building. These latrines, therefore, do not meet the sphere standard of 50 metres or less and are unlikely to meet the SDG requirements for basic latrines in health centres which require that latrines in health centres must be: improved, on premises, usable, sex-separated, have one improved latrine for menstrual hygiene needs, have one improved latrine for staff, and have one latrine for people with limited mobility. At the high school the enumerators visited, there were 11 pit latrines to the right side of the school building, some of which had been constructed by UNICEF. There were no menstrual hygiene facilities present, thus failing to meet the SDG requirement of having at least one latrine with menstrual hygiene facilities available.

The quality of latrines in communities was noted as a concern during the PRA and in FGDs. One woman noted that latrines are located in close proximity to surface water and that human waste is entering the

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

river system. During the transect walk it was noted that animals and children in some communities were seen playing in close proximity to latrines. Poor environmental sanitation could present health issues such as diarrhea and environmental enteropathy.

Of the people who reported having children aged 0-23 months, 64% reported throwing their children’s stools in an open field. Only 18% of people reported disposing of their infant’s stools in an appropriate manner (in a latrine).

Disposal of children's (0-23 months) stools 7% 2% 18% Put / rinsed into toilet or latrine Put / rinsed into drain or ditch 5% Thrown into garbage 1% 3% Buried Threw into open field Other Don't know 64%

Regarding household waste disposal, 91% of people reported disposing of household waste in an open field, 7% reported dumping waste in a landfill area identified by the community or government, and 2% of people reported burning or burying their household waste. During the transect walk, enumerators noted that many of the communities were littered with rubbish, that children were playing around the rubbish, and that chickens were scratching around the rubbish.

Household waste disposal 2% Burn or bury 7%

Informal dumping in landfill area identified by community or government

91% Throw it in an open field

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Regarding medical waste, hospital staff stated that medical waste is incinerated in a corner of the hospital or outside the hospital in an open area. Regarding solid waste management at schools, the enumerators who visited the high school noted that adequate solid waste management was not observed in the school and waste was seen everywhere. The school staff member, however, noted that solid waste is incinerated in a place near the school.

5.4 Hygiene Hand washing seems to be practiced by almost all people (as shown in both the household survey and FGDs), however inconsistently across the ‘critical times’ (after defecation, after cleaning a child, before preparing food, before feeding a child, and before eating). Two out of 400 people reported not washing their hands at all, however these people later reported that they always wash their hands. The majority of people (346/400 = 86.5%) reported washing their hands when they are dirty. Very few reported washing their hands before eating (30/400 = 7.5%). Just over half of respondents reported washing their hands after using the latrine (246/400 = 61.5%) and before preparing food (255/400 = 63.8%). Out of the 5 critical times for hand washing, 7% (28/400) couldn’t report any critical times; 24.75% (99/400) only reported one critical time; 37% (148/400) reported two critical times; 19.5% (78/400) reported three critical times; 11.75% (47/400) reported four critical times; and 0% (0/400) reported all five critical times for hand washing.

Reported times of hand washing 400 346 350 300 246 255 250

200 163 161 150 125

Number of people of Number 100 71 50 30 2 3 0 After using After Before Before Before After When they When I don’t Other the latrine cleaning a feeding a preparing eating attending are dirty praying wash my child child food to animals hands Hand washing times

When asked why they wash their hands, the majority of people who reported washing their hands said they wash them to remove dirt / make them clean (351/398 = 88.2%). 42.2% (164/398) reported washing their hands to prevent disease, 32.7% (130/398) cited religious reasons, and 25.9% (103/398) reported washing their hands to remove bacteria.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Reasons for hand washing 400 351 350

300

250

200 164 150 130 103 Numberofpeople 100

50 27 17 0 To remove dirt Personal To make them To prevent To remove Religious / make them appearances smell good disease microbes / reasons clean bacteria Reasons

28% of people who wash their hands reported washing their hands with soap and water. 70% of people who wash their hands use water only, likely suggesting either a lack of knowledge or resources to be able to wash their hands with soap. This was reflected in the FGDs, where people said that the lack of use of soap can be attributed to lack of affordability and lack of awareness.

What people wash their hands with 1%

28% Soap and water Ash and water Water only 1% Other 70%

Of the 328 hand washing stations that were able to be directly observed, however, only 33% of households had water available, despite 99% of people reporting hand washing with either soap and water, ash and water, or just water. This shows a gap between reported behaviors and actual behaviors. Of the 328 hand washing stations that were directly observed, 20.7% (68/328) had soap available, 6.4% (21/328) had detergent available, and 3.7% (12/328) had liquid soap available. 74.7%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

(245/328) of households had no hand washing materials available. 112 Observed water availability at hand people reported washing their hands washing location with soap and water, yet soap (bar, detergent, or liquid soap) and water was only available in 58 instances 33% (58/382 = 17.7%), showing a gap Water is available between reported behavior and actual behavior. Water is not available At the District Hospital, there was a 67% designated place for hand washing in the hall of the main building, where both a tank of water and soap are present. It does not appear to meet the SDG standard for a ‘basic’ hand washing facilities in health facilities: a basin, water and soap (or alcohol-based rub) present, and Observed presence of hand washing located at critical points of care and materials within 5 metres of sanitation 300 facilities. At the high school, there 245 250 was no designated place for hand washing and no soap or water was 200 observed anywhere in the school. 150 This, therefore, does not meet the 100 68 SDG standard for a ‘basic’ hand 50 21 washing facility in education facilities: 12 5 6 soap and water present, available to 0

Number of hand stations hand of washing Number Bar of Detergent Liquid Ash Mud / None girls, boys and staff, on premises, and soap soap sand in or near a sanitation facility. Hand washing materials

Regarding menstrual hygiene management, most women use reusable cloth to manage their menses, according to the FGDs. Women noted that they are unable to afford disposable products. According to a group of girls, “Our mothers say to use a clean cloth for the period. We do not have enough money to buy hygienic tampons. We heard that hygiene materials are very expensive.” During the visit to the local high school it was also noted that there were no menstrual hygiene materials available for girls.

For the purposes of disseminating hygiene messaging, this study also looked at the communication channels people have access to in Lal District. Over half of the people surveyed have access to televisions (234/400 = 58.5%). This was supported with feedback during the FGDs and PRA. The other main communication channels seem to be word of mouth (203/400 = 50.8%) and mobile phones (128/400 = 32%), however there are some communities that do not have mobile phone coverage. Some also stated ‘community gatherings’ (76/400 = 19%) and ‘attending mosque’ (63/400 = 15.8%). If hygiene

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

messaging is to be implemented in the future, therefore, it would be worth considering the use of television, mobile phones and word of mouth.

Communication channels people have access to 250 234 203 200

150 128

100 76 63

Numberofpeople 50 28 2 1 9 6 0 Radio Newspaper Posters / Community Attending Television Internet Mobile Word of Other print gatherings mosque phone mouth materials Communication channels

5.5 Health The main health issues that were identified by communities during the FGDs were diarrhea, vomiting, measles, headaches, post-delivery care, brucellosis, respiratory illnesses such as pneumonia and the common cold, miscarriage, and hepatitis. This was echoed by Lal district hospital staff in the key informant interviews who stated that the most common issues in the last 12 months are respiratory diseases, pneumonia and diarrhea. In the FGDs, people associated pneumonia with cold winter weather (November – January), brucellosis with consuming milk and meat from infected animals, and diarrhea with drinking unclean water and poor hygiene practices. It was noted during the PRA that diarrhea is most prevalent between May – July. One man stated that “For some time in the past year, bloody diarrhea was very common in our village.” Health centre staff stated that Prevalence of diarrhoea in children the main causes of diarrhea in Lal are <5 giardia and amoeba. The district hospital 1% receives an average of 70-80 cases per 25% month and 70% of these cases are children aged 0-7 years old. Based on Yes household survey results, diarrhea No prevalence in children under 5 in Lal was Don’t know reported to be 25%. This lies within the ‘attention required’ range (15-40%) 74% according to WV’s health triggers for action.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

For the 99 people who reported that their child had diarrhea in the last 2 Amount the child was given to drink weeks, 54% of people reported that they during the diarrhoea, including gave their child more to drink. This was breast milk reflected in the FGDs from one 2% 1% 9% community where one woman said, “For children affected by diarrhea we give Nothing to drink them lots of liquid.” 20% reported that 14% Much less they gave the child about the same, 14% reported that they gave the child Somewhat less somewhat less, 9% reported that they About the same 54% gave much less, and 1% reported that More they gave the child nothing to drink. 2% 20% Don’t know of people did not know.

For the 99 people who reported that their child had diarrhea in the last 2 weeks, 10% of people reported that they Amount the child was given to eat gave their child more to eat, 18% during the diarrhoea reported that they gave the child about the same, 38% reported that they gave 3%2%2% the child somewhat less, 27% reported 10% Never gave food that they gave much less, 2% reported that they stopped food, 2% of people 27% Stopped food never gave their child food, and 3% of Much less 18% people didn’t know. Somewhat less 44% of people whose children had About the same experienced diarrhea in the past 2 weeks More reported giving their child Oral Don’t know Rehydration Salts (ORS). 54% did not and 2% did not know. A total of 27% of 38% people with children 0-59 months treated diarrhea correctly, based on the WV standard of oral rehydration therapy (ORT), increased breastfeeding and/or fluids and/or continued foods.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Percentage of people who gave their child ORS during diarrhoea episode 2%

Yes 44% No Don’t know 54%

Of the 53 people who reported giving their child additional remedies, 43.4% (23/53) stated that they gave their child an unknown pill or syrup and 43.4% (23/53) stated that they gave their child a home remedy or herbal medicine. Of the 10 people who reported that they gave their child something ‘other’ than the options listed, people stated that they gave their child dried yoghurt and water, fried flour and oil, mountain grass, khakshir (plant), and eggs. During the FGDs, many people mentioned that they treat diarrhea with doogh (boiled yoghurt) or grass mixed with doogh.

Other remedies given to the child to treat the diarrhoea 25 23 23

15 10 10

Numberofpeople 5 2 1 1 0 Pill or Syrup: Pill or Syrup: Unknown Pill or Unknown Home remedy / Other Antibiotic Antimotility Syrup Injection Herbal medicine Remedies

77% of people (308/400) believe that people get diarrhea from consuming dirty water. This was reflected in the FGDs, with several people stating that they get diarrhea from consuming dirty water. 69.3% of people (277/400) believe that people get diarrhea from bad food. Only 17% of people (68/400) believe that people can get diarrhea from flies. 15.3% (61/400) people stated ‘other’ reasons for getting diarrhea, with the majority of these reasons relating to the weather (hot weather, cold weather, bad weather, change of weather).

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

How do you think people get diarrhoea? 350 308 300 277 250 200 150

100 68 Numberofpeople 61 49 46 50 7 8 5 2 5 0

Reasons for getting diarhoea

In order to prevent people from getting diarrhea, 48.8% (195/400) people stated that they cook food properly and 35% (140/400) of people said they boil their drinking water. 19.5% of people (78/400) said they do nothing to prevent people in their households from getting diarrhea. For the 51 respondents who stated that they do ‘other’ things to prevent people from diarrhea, the majority of these actions included taking people to the doctor and feeding people doogh (boiled yoghurt). This was also reflected in the FGDs, with people stating that they traditionally treat diarrhea with doogh. During the FGDs, people also said that they observe hygiene and sanitation practices to avoid getting sick.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

What do you do in your household to prevent people from getting diarrhoea? 250 195 200

150 140

100 85 69 78 59 51 Numberofpeople 50 36 33 36 22 22 17 23 19 21 4 2 2 0

Methods of prevention

Regarding treatment capabilities, 41% of people reported that over the last 12 months, there was at least one time when a family member was sick and there was not enough money to cover the cost of treatment. This was reflected in the FGDs, with people stating that they experience issues with health- related expenses.

Access to healthcare services in Lal Over the last 12 months, was there a seems to be an important issue, based on time when one of your family members results from the FGDs and PRA. Some was sick and you did not have enough communities reported that it took up 4 money to get treatment? hours to walk to the nearest health 8% 1% centre, which presents issues in emergency situations. It can also cost up No to 5000 Afs to hire a car to take someone to the hospital. Access issues are Yes 51% particularly acute during winter when the No one was sick 41% roads are closed. According to District Don’t know Hospital staff, “During the winter the roads are blocked, especially the villages located far from the centre of the district

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

and people can’t get access to the hospital or the health posts for almost 6 months.” During the FGDs, one man said that, “During the winter time mostly the roads are closed and because of that reason the people who are very sick mostly die during winter.” Another man stated that in the last few years, 10 people have died on the way to hospital. One woman said that, “With the delivery of newborns, the mothers have a lot of problems accessing health facilities. In emergencies our only hope is Allah.” There are community health workers in some communities, however not all. Community members have asked the government to build clinics, however there has been no change in this regard so they have expressed a desire for NGOs to construct clinics.

The quality of services was also a concern raised by most people in the FGDs, with one man stating that, “The health services in our community are very low and there are not good doctors in Lal clinic.” During the key informant interviews at the district hospital, interviewees stated that there are approximately 2 health staff per 1000 people in Lal district. Several people expressed a desire for an improvement in the quality of health services. People also highlighted a lack of resources and medicine at the clinics. IAM has provided health services to the communities previously, however now, there are not enough drugs and equipment and the hospitals according to some respondents. Also, despite the services at health centres being free of charge, the cost of medicine is high. According to one woman, “There are no professional doctors and that’s why we need to go to private drugstores which are very expensive and most poor people cannot buy medicine so they are bound to traditional way of treatment.” These concerns about quality of health services were echoed by staff at the Lal District Hospital. The main challenges they stated were: lack of sufficient health staff; quality of medicines; lack of medical equipment particularly in the surgical unit – cardiograph and adequate oxygen capsules; and issues with the standard of the hospital building. The quality of medicines was a particular concern for the hospital staff who were interviewed.

Antenatal and postnatal care is not being delivered in the villages, however one group of women noted that IAM has been providing workshops on pregnancy over the last few years. Most births are happening in the village. Family planning is being observed by some people, however the level of awareness is low.

Vaccination is being implemented by EPI.

5.6 Environment, Food Security & Livelihoods When asked what people use to cover the soil in their fields/gardens with all year round in order to improve soil quality, the majority of people (238/400 = 59.5%) stated that they do not use anything to cover their soil. 35% (140/400) did not know. Only 1.5% of people (6/400) reported using mulch and 0.5% (2/400) people stated that they use crop residue, other plant or tree matter. Of the 16 people who selected ‘other’, the majority of respondents stated that they used ash to cover their soil. This was supported by feedback from the FGDs, with one woman stating that, “Due to poverty we cannot afford fertilizer for our land, instead we pour ash on our land.” During the FGDs, some people also stated that they use animal waste as fertilizer.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

What do you use to cover the soil in your fields or gardens with all year round in order to improve soil quality? 238 250

200 140 150

100

Numberofpeople 16 2 6 0 Crop residue, other Mulch Other Nothing (not kept Don't know plant or tree covered) matter Soil cover

In terms of tree coverage, 34.75% of people stated that the number of Is the number of trees in this area more, less trees in the area is the same as one or the same this year as one year ago? year ago. 17.75% of people stated that there were fewer trees. 18.75% According to one respondent in the 28.75% FGDs, “The number of trees has More lowered by 70% as previously there Same were 10,000 trees but now there Less are 3000 and this is all because of drought and the low level of Don’t know water.” 18.75% of household 34.75% survey respondents stated that 17.75% there were more trees, however. According to one woman in the FGDs, “A few years ago there were few trees in the village and now the number of trees has increased and people are planting new trees every year.” 28.75% of household survey respondents didn’t know if the number of trees had increased or decreased. It should be noted that CRS has been providing trees to some communities.

When trees are cut, 34% of people stated that part of the tree is left and protected so that it can regrow. 5% of people stated that the tree is cut to the ground and/or burned. 10% stated that a new tree is planted. 51% of respondents didn’t know.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

When the trees are cut, is part of the tree left to regrow, is a new one planted to take the place of the tree that was cut, or is the tree not replaced? 5% Tree is cut to ground and / or burned Part of trees are left and protected 34% so they regrow 51% New tree planted

Don’t know

10%

The major source of fuel in households in Lal District is animal Major source of household fuel waste (96.3%). This may be 1.8% 0.8% 0.8% 0.3% largely due to the lack of tree cover in the area and therefore a Natural forest lack of firewood. This was supported by the PRA and FGDs, Animal Dung with many stating that they use Corps residue either animal waste or bushes for Fuel (gas) heating in winter. Other Many of the communities’ environmental concerns relate to 96.3% water availability and quality. According to the survey results, the main environmental concerns in the community seem to be the diminishing levels of water / shrinking water sources (283/400 = 70.8%), followed by contamination of water (137/400 = 34.3%), and flooding (129/400 = 32.3%). For those who selected ‘other’, many of these relate to poor weather (cold), avalanches, and garbage.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Main environmental concerns in the community 300 283 250 200 137 150 129

100 71 62 45 31 Numberofpeople 50 27 25 0

Environmental concerns

31% of respondents reported that in the In the past 12 months, were there times last 12 months there were times when when you did not have enough food to they did not have enough food to meet meet your family's needs? their family’s needs. During the PRA, people noted that the hungry months are November – April (winter). During the 31% FGDs, many people noted that harvests have been decreasing, that there is not Yes enough food for the family’s consumption, No and that sometimes they must supplement their food with purchases 69% from the bazaar.

In 54% of households, there is one or more adults (over 18 years old) earning a regular income to meet household needs. 43% of people stated that there are no adults in the household earning a regular income. Based on the results of the PRA and FGDs, between 20-70% of families have at least one family member who is working in Iran or neighboring Afghan provinces.

For those people that have an adult earning an income in the household, 40.5% (88/217) are self- employed, 35.5% (77/217) reported that they earn income from the sale or exchange or produce, 35.5% (77/217) of people reported that they are in wage employment, 23% (50/217) reported that they earn an income from the sale of livestock and livestock products, and 0.92% (2/217) reported that they earn an income from the sale of handicrafts. According to the FGDs, carpet making used to be a significant

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

income earner for people in Lal, however it has slowed down recently as people are unable to obtain the raw materials.

Is there one or more adults (over 18 years) in the household that is earning a regular income to meet household needs? 3%

Yes 43% No 54% Don’t Know

Main sources of household income 100 88 90 77 77 80 70 60 50 50 40

30 Numberofpeople 20 11 10 2 0 Sale / exchange of Labour (self- Wage employment Sale of livestock Sale of handicrafts Other own produce employed) (working for and their products such as carpet (agricultural someone else) farming) Income sources

According to the results of the household survey, the average monthly income is 7235 Afs (approximately US$108), compared to a national average monthly salary of 11,214 Afs (approximately US$168).18 The results of the PRA and FGDs, however, seem to show a lower average monthly income of between 2898 and 4200 Afs.

18 https://asiafoundation.org/resources/pdfs/Afghanistanin2015.pdf

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

The results of the wealth ranking exercise show that a relatively even distribution of people across the ‘medium’, ‘poor’ and ‘poorest’ categories. Very few people were considered to be ‘rich’, although it should be noted that the definitions are relative to community perceptions.

When asked if people have access to land for farming, 59% of people said they did have access to land for farming and 40% did not. Of those who do have access to land for farming, the average number of jeribs was 11.77 jeribs (2.35 hectares). Of the people who have access to land for farming, 86% of people own this land or have rights to it.

Do you have access to land for Do you own this land or have rights farming? to it? 1% 13% 1%

40% Yes Yes No No 59% Don’t Know Don’t Know

86%

The main type of irrigation used is rain (63.45%), followed by surface irrigation (31.93%). 42% of people reported that the current levels of water for agriculture are low, 38% said they are very low, and 17% said they are moderate. Only 1% of respondents reported that the levels of water are high and no respondents stated that the levels of water are very high.

Main type of irrigation The current levels of water for agriculture are... 4.20% 1% 2% 31.93% 17% Surface Irrigation Very low Watering by 38% Low hand Rain-Fed Moderate High 63.45% 0.42% Don’t Know

42%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

The types of crops grown are mostly wheat (225/238 = 94.5%) and Type of crops grown potatoes (165/238 = 69.3%), 250 225 reflective of the cool, high altitude 200 climate. 38 people stated that they 165 grow ‘other’ crops. Most of these 150 respondents stated that they grow 100 either oats or alfalfa. Other crops 38 50 18 Numberofpeople 17 mentioned include rye, carrots, and 1 7 5 turnips. During the FGDs, people 0 mentioned that they would like to cultivate carrots and other vegetables, however they questioned Crops whether there was enough water to do this. “The main problem of our farming is water and because of that we are not able to cultivate other crops. If a deep well was dug in our village we could use it to water our land and farming in our village would improve.”

Land is cultivated in March – April (spring) after the snow has melted, and with the use of donkeys and cattle, however some communities noted that they use tractors. The cost of tractors is very expensive, however, and many noted that they could not afford the use of tractors which cost approximately 600- 700 Afs per hour. Production occurs in August and September. Both men and women are engaged in agricultural activities. The people of Lal were considered by the enumerators to be very hard working people.

The main difficulties producers face include lack of improved seed varieties (150/238 = 63%), lack of rainfall (111/238 = 46.6%), and pests and disease (94/238 = 39.5%). This was also reflected in the FGDs. Disease was raised as an issue, as was the presence of pests such as birds and rats. It should be noted that several communities received improved seed varieties from an organization, however the seeds did not produce a good harvest for the communities. People noted that harvest levels have been markedly decreasing. According to one man, “The harvest level of the agricultural lands has decreased by 50%.” Of those who selected ‘other’ difficulties in the household survey, most related to lack of land, poor soil quality, cold weather, and a lack of men. During the FGDs, people also mentioned a lack of support from government and other agencies with agricultural services.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

The main difficulties for producers 160 150

140

120 111

100 94 84 81 80

Numberofpeople 40 19 21 23 20 12 5 0

Difficulties

As a coping mechanism, several people in the FGDs reported that they pray first, and then seek technical support (e.g. chemicals for crops) after, if that fails. If crop harvests are poor, people also resort to selling 3-4 livestock per year or sending family members to Iran to work. If they are unable to sell livestock, some people take out loans to purchase food.

In terms of livestock ownership, only 11.5% of people do not own any livestock (46/400=11.5%). The majority of households own livestock (88.5%), including chickens, turkeys or other small birds (282/400 = 70.5%); goats or sheep (294/400 = 73.5%); cows (222/400 = 55.5%); and/or horses or donkeys (265/400 = 66.3%).

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Livestock owned by members of the household 350 282 294 300 265 250 222 200 150 100

Numberofpeople 46 50 0 Chickens / turkeys Goats / sheep Cows Horses / donkeys None / other small birds Livestock

In terms of water requirements, according to sphere standards, cattle, horses and mules require approximately 20-30 litres per head per day; goats and sheep require approximately 10-20 litres per head per day; and chickens and small birds require approximately 10-20 litres per 100 birds per day. Due to the high level of large and medium livestock ownership, therefore, water requirements may be high.

In the focus group discussions, people noted that donkeys are used for transportation and farming. There was one community identified during the PRA exercises, however, that did not have any livestock as there are no places to feed the animals (Shahr-e-naw, Shahrak). Lack of stock feed/silage/grass was identified by several communities as a barrier to raising livestock in the district, with one community purchasing grass to feed animals during winter. It was noted that the lack of animal feed is a result of consecutive droughts and the long winter. In order to address this, people would like to cultivate more silage on rain-fed lands.

According to feedback during the FGDs, there have been some issues with livestock (particularly sheep and chickens) loss due to illness. The loss of chickens seems to be very common across almost all communities. One community noted that 50% of their animals died this year due to disease. Some communities are able to afford medicines and vaccinations and have noted a decrease in livestock loss since vaccination, however others are not able to afford it. According to one respondent, “We had about 40 turkeys which were kept at the house. After six months the turkeys grew up enough but unfortunately, due to an unknown disease, seven of them died at once and also the other turkeys got sick one by one and died too.” Death of turkeys and chickens seemed to be a common issue across several communities and many noted that they don’t have access to veterinarian services. Due to the high cost of caring for livestock, most families don’t own more than 15 sheep or goats, 2-3 cows and a donkey. There was one community, however, where most people have 80-90 sheep. Children are involved in caring for the livestock.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Livestock are important for consumption and sale of livestock products. According to one respondent in a focus group discussion, “animal husbandry is very important to us because we can benefit from milk wool, and waste for heating.” Some communities sell Ghoroot (dried yoghurt), with one group noting that each family receives an average of 2,500 Afs per year from the sale of Ghoroot. Families sell up to 20kgs of dried yoghurt each year. In a one year period, 5-30% of the needs of the family come from selling animal products. The sale of 4-5 sheep can provide a total of 20,000 Afs and the sale of livestock products can provide 5000-10,000 Afs per year. People seemed to be interested in beehives for honey consumption and sale and noted that it may be possible due to the existence of flowers in the communities, however several communities noted that they couldn’t afford to purchase beehives unless they were supported by an organization. It should also be noted that beehives were distributed to one community 6 years ago, however 3 years ago all of the bees died due to the cold. Some communities located in close proximity to rivers were interested in fishing, however they do not have the equipment to raise fish.

5.7 Education Quantitative data was not collected for education, however the PRA and FGDs revealed some insights into the status and challenges related to education in the communities. Children attend school from spring until winter. School attendance seems to be relatively high, with many people reporting that almost all of the children in their communities attend school. Both girls and boys attend school and there seems to be a strong commitment to girls’ education. One female community member noted, “We like our daughters to go to school and there is no discrimination between boys and girls.” Another female community member said, “We want out girls and boys to equally go to school. Our children, especially our girls, by going to school have become smarter and we want them to continue their education.” A young girl said, “We know that education is good and if we complete our schooling we can help the women and girls of our community, for example if we become doctors or teachers.” It is interesting to note that almost all of the respondents who discussed the importance of girls’ education were female (except one group of men).

Due to poverty, some children have to work, resulting in absences. Child labor was mentioned several times, with some children having part-time jobs to pay for family needs, earning 300-400 Afs per month. One community even noted that “Most of the families are economically weak and have to send their children to Iran for work; therefore they cannot continue education.”

Children walk long distances to attend school. Some children walk up to four hours to get to school. For this reason, some NGOs like Catholic Relief Services (CRS), have been building community-based schools, for example in Kushk Solfa and Manjue Kuhna. Children do not seem to experience threats on their way to school, however one community did note that the children from their community are at risk of falling into the river or traffic accidents.

The quality of infrastructure and resources is generally low. One community is using tents for classrooms, for example. According to one respondent, “We have one governmental school, with the building half constructed, and it is not equipped with facilities. Students in the school have no school

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

books, blackboard and the teaching is low quality.” One young girl said, “Our school does not have chairs and tables and some of the school books are also not available.” Another respondent said, “Our children have access to school but the condition of the school building is bad. For example, there is no chair and our children are sitting on the wet floor. School books are hardly found, and the capacity of the teachers is low. Also, other problems like bribe-taking are common.” One of the school staff noted that there is no furniture in the schools and also a lack of books. If supplies are required, teachers sometimes contribute from their salaries. NGOs working in the area have been supporting the improvement of school infrastructure, for example CRS has been involved in school construction (see above) and IAM has provided doors and windows to schools.

The quality of teaching seems to be low, with one respondent stating that “Quality of teaching in schools is low because most of the teachers were not assigned by their skill level but by their connections to influential people. For instance, there are college graduates who are jobless but the teachers who are in the schools, some of them have not even graduated from high school.” This was echoed by a group of people in another community. One group of men stated that the lack of capacity of teachers and principals has caused students to become discouraged.

There also seem to be political issues affecting the quality of education in Lal, with one person noting that there is some prejudice and discrimination when it comes to securing support from the Ghor Provincial Department of Education and at the national level due to the Hazara ethnicity. It was also noted that every 6 months the head of the Education Department in Lal changes due to the actions of political parties in the district.

Several people noted that to improve education in Lal, both the quality of teaching and the quality of infrastructure/resources should be improved. Schools should also be located in closer proximity to communities. One group of women noted that they would like latrines to be built.

Despite the issues, there is a strong sense of commitment to education, with several communities noting that they have contributed carpet, mud for roofing, and wood to the school to assist with construction and heating. One community member said, “We love to contribute to school so that our children are educated.” Another community member said, “We are supporting our children to go to school because we are illiterate and we are like blind people. We don’t have a good perception of our life therefore we don’t want the future of our children to be like ours. We live in the centre of Lal and the school is very close to our village so we send our children to school, and also our children take courses during winter. If we are good economically, we will continue sending our children to school.” One young girl echoed this statement, saying, “Our parents say to both girls and boys to go to school so that you will not become blind like us and your future will become better than ours so you won’t have to work hard for a loaf of bread.” Children also enjoy attending school, with one young girl saying, “When we finish our chores we come running to school because we love education.”

Pass rates seem to be reasonably high, based on community feedback in the PRA and FGDs. Several communities noted that pass rates are over 90%.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

There is a teacher training centre in the district and some local organizations hold education courses for community members. For example, English and Mathematics courses are held to support university entrance, at a cost of 10,000 Afs per year. Illiteracy amongst adults seems to be high, and most communities stated that only 2-9% of adults have graduated high school. One group noted that the lack of jobs amongst university graduates acts as a deterrent for parents providing their children with an education.

5.8 Cross-cutting themes

5.8.1 Gender Based on the results of the FGDs, both women and men are involved in agricultural work, which is relatively unusual for Afghanistan. This may be due to the heavy labor requirements associated with preparations for long winters. Women do, however, have the double burden of working in the home, as well as helping their husbands in the fields. In terms of access to resources, men still seem to have greater access to resources than women. One woman said, “Men have more access to resources than me.” One young girl said, “We girls do not have access to any resources.”

Men have greater decision-making power as the head of the household. According to one woman, “In our community, the man’s role is more important because they are the heads of the household.” A young girl said, “Our fathers are the decision makers because they are the heads of families. In the families, males have more opportunities and men have a better position.” Another woman said, “Due to the existing culture and traditions, the women cannot complain about their problems anywhere in the village because no one listens to the complaints of women and it’s perceived badly to do so.” This was echoed in a statement by another woman: “Men in this society have more important roles than women. They have strong communication and they are more knowledgeable. They are the priority all the time so they have more opportunity. In our community, men have more freedom and they can easily walk in the community and have communication with others, but women, due to some traditions and customs, are not able to live the way they want and if they do so they will be punished by men and everyone will say bad things about them.” Some communities did, however, note that despite the male being the ultimate decision-maker in the family, women are often consulted when decisions are being made. According to one man, “I consult with my wife in every important decision. For example, when I wanted to buy a pair of cows I talked with my wife and she said that we need to buy sheep instead of cows because, considering the condition of the village, the sheep has a better income. I accepted her logic and bought sheep.” In the case of divorce, however, women are forced to give up 50% of their dowry.

There seems to be a strong desire for female education, with many parents (both male and female) expressing their desire for their female children to be educated. One woman noted, however, that “the people allow their daughters to study lower grades in school, but when they reach grade 9 and 10 the people want their girls to withdraw from school and not continue.”

Regarding marriage of children, the process seems to be relatively consultative, with the father consulting the mother, as well as the children (both boys and girls). According to one woman, “In the

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

issue of marriage, the consent of the girl is a must, however the parents of the girl must also agree.” One man echoed this statement, saying that “No marriage takes place without the willingness of the children, be it boy or girl.”

One woman did have some concerns about the safety of women after dark. According to her, “As women when we go to the mountain together with our children to collect weeds, on the way back at the time of sunset and when it is dark we have security concerns. Irresponsible people are along the way who may have the tendency to harass women.”

5.8.2 Peacebuilding & Governance According to the FGDs, there has been some conflict in the past prior to the elections, however this has recently subsided and the communities consider the situation to be very peaceful. According to one woman, “In the past years the political parties were in conflict with each other, and were trying to influence others…but now there is no conflict anymore and things have improved.” Likewise, one man said, “There haven’t been any conflicts between people since the elected government.” It was noted, however, that there have been some individual land disputes in communities. The security situation, however, is considered by the communities to be relatively stable. According to one woman, “Our village is fully peaceful and secure and we have no security concerns. We love peace and we are for peace. 10 years ago there was a conflict but now there is peace and security so we don’t have any problem in this regard.” People also reported that there is no violence against women and children and no cases of early marriage.

In terms of governance structures, all communities have a Community Development Council (CDC) and village Shura. Some communities also have mosques and school defense committees. Several community members noted that the presence of government departments is relatively weak.

5.8.3 Child Protection The main child protection issues identified by community members during the FGDs were: a lack of nutritious food for children; lack of money for other resources such as clothing and sanitation; environmental hazards such as avalanches, floods, wild animals, and falling into wells and pits; road accidents; and the involvement of children in agricultural activities at the expense of education. According to one young girl, “Our parents love us but because our families are poor, we have to work so that they can have enough for eating.”

Multiple people in the FGDs mentioned that people do not beat their children and there is no forced or early marriage in the communities. According to one man, “People of our village believe that children should receive good food and nutrition, they should be encouraged and receive good education and nurturing, and should not be beaten or violated. In our community, children are not beaten or abused.”

5.8.4 Disasters According to the FGDs, some of the disaster risks for the communities in Lal are: disease outbreaks such as pneumonia and diarrhea, exacerbated by the lack of adequate health facilities; avalanches which destroy houses and present a personal safety risk; road traffic accidents; and attacks from wild animals.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

According tone woman, “Sometimes when our children go to the mountain we are afraid of wild animals to attack children.”

People also seem to be concerned about conflict. According to one young girl, “We girls are afraid of conflicts because we couldn’t come to school if a war breaks out.” Another woman stated, “Sometimes looking at the overall security situation in Ghor Province, we are afraid that the insecurity is escalating in Ghor and that affects our villages as well.”

Flooding is a particular concern in most communities. These mostly occur during spring. Floods have reportedly destroyed farmland and drinking water sources. According to one man, “Our village usually is exposed to flooding during the spring, which destroys our farm lands. We had flooding in the previous years, which destroyed our lands. We went to government for help but did not receive any assistance, even invited the ANDMA and fed them for lunch but did not receive any assistance.” According to multiple respondents, there has been very little disaster assistance for communities in Lal, however Afghan Aid has constructed retaining walls in the past.

Drought is also a concern for communities, with one community reporting that there has been constant drought from 2008 – 2016. Droughts usually occur in July – October, over the summer period, and have a negative impact on crop production and drinking water access. People have also noted that the climate has been warming year by year. The level of snow seems to be decreasing. According to one respondent, “Comparing to 20 years ago, the level of snow and rain has decreased remarkably and the weather became hot…Previously there used to be about a metre high level of snow but now the highest the snow gets is about 30 centimetres.”

Disaster Risk Reduction (DRR) committees are present in some communities to address some of the concerns above.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

6. Conclusions & Recommendations

The results of the assessment show that Lal District is falling short in most of the key indicators for WASH. The following section provides a summary and recommendations for each of the key findings.

Diarrhea prevalence and treatment  Diarrhea prevalence in children under 5: 25% (this lies within the ‘attention required’ range of 15- 40% according to WV’s health triggers for action).  Percent of parents or caregivers of children aged 0-59 months with diarrhea in the past two weeks who report that the child received oral rehydration therapy (ORT) and increased breastfeeding and/or fluids and/or continued foods, as appropriate: 27%  In the last 12 months, percentage of people who report that there was at least one time when a family member was sick and there was not enough money to cover the cost of treatment: 41%

Recommendations: The high level of diarrhea prevalence in children aged 0-59 months indicates that there is a need for additional WASH programming in Lal. Training and materials should be provided for the prevention (see recommendations below) and treatment of diarrhea. Furthermore, WASH programming should be supplemented with income generating activities so that households are able to afford medical treatment when required.

Water access  Access to an improved water source: 38.5%  Year-round access to at least 20L of clean water per person per day from an improved source within a 30 minute round trip of the household: 0.25%. If the standard is reduced to the minimum sphere standard of 7.5L, only 9.25% of people meet this standard.

Recommendations: The percentage of people that meet the WV standard for access to clean water is extremely low. An investment should be made in the construction and rehabilitation of improved water systems in close proximity to households with flood protection measures in place. It is vital that investments are also made in Water Management Groups (WMGs) to ensure the ongoing management, operation and maintenance of the systems as almost half of the water systems constructed in communities are no longer functioning. Water infrastructure at schools and health centres should also be improved in order to meet SDG requirements. It is not recommended that infrastructural work should be conducted by WV immediately, however. WV currently does not yet have a presence in Lal District and, given the logistical challenges of large infrastructural work in such a remote location, it is advisable that WV begin with soft programming in order to allow time to understand the context and develop a plan to overcome logistical challenges.

Water treatment  Percentage of households reporting water treatment: 65.2%

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Recommendations: Water quality results revealed concerning levels for nitrates, fecal coliforms, hardness, sulphates, chlorides, turbidity, and total dissolved solids (TDS). With only 65.2% of households reporting water treatment, at least 34.8% of households will be consuming contaminated water (this percentage is likely to be higher based on the appropriateness of the treatment technology to the particular contaminants present). Appropriate household water treatment options, therefore must be investigated based on the water quality results for each community. Both training on appropriate treatment methods and materials should be provided to communities. Water treatment methods should also be investigated for health centres to ensure that patients are consuming clean, safe water.

Latrine access  Access to an improved sanitation facility: 23.9%  Access to a basic (not shared) improved sanitation facility: 18%  Access to a limited (shared) improved sanitation facility: 5.75%  Access to an improved sanitation facility within 50m of the household: 22.5%  Access to a basic (not shared) improved sanitation facility within 50m of the home: 17.25%  Access to a limited (shared) improved sanitation facility within 50m of the home: 5.25%  Open defecation: 42.8%

Recommendations: Investments must be made in eliminating open defecation and ensuring household access to basic (improved) latrine facilities within 50m of the household. Based on MRRD recommendations, Community Led Total Sanitation (CLTS) should be implemented in order to achieve Open Defecation Free (ODF) status. Investments could also be made in upgrading existing latrine facilities so that they meet the SDG standards for basic (improved) latrine facilities. Although community members expressed a desire for material support for latrines, CLTS is a zero-subsidy approach, therefore investigations must be made into ways to make latrine construction a priority and affordable for households. Institutional (schools, health centres) must also be addressed to ensure that students and patients have access to improved latrines on premises that meet SDG standards. Particular attention must be paid to the creation of menstrual hygiene facilities in institutions.

Hand washing practices  Reported hand washing with soap and water: 28%  Household hand washing stations observed where both soap and water are present: 17.7%  Knowledge of at least 3 of the 5 critical times for hand washing: 31.3%

Recommendations: Despite almost 100% of people reporting hand washing practices, the level of hand washing with water alone and lack of availability of soap and water at household hand washing stations shows that more work needs to be done in this area. Both hygiene behavior change programming should be implemented in order to impress upon people the importance of hand washing at critical times. Soap making activities could also be implemented with communities in order to support the affordability of soap, as well as providing income generating activities for community members.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Solid waste management  Appropriate disposal of household solid waste: 9%.

Recommendations: Adequate solid waste management is lacking in Lal and can present a health risk to communities. Community members should be supported to dispose of waste safely and appropriately in order to avoid human contact with waste. Participatory Hygiene and Sanitation Transformation (PHAST) could be investigated as a potential methodology to address this issue. Appropriate solid waste disposal facilities should also be ensured at health centres and schools.

Despite the main focus of this assessment on WASH and the identification of water access as the number one priority for communities, other sectors were also investigated and could be addressed. These sectors include environment, livelihoods and food security; education; and health. Key findings and recommendations are listed below for each sector. a) Environment, livelihoods and food security: The main concerns identified by communities were: lack of irrigation infrastructure; a lack of improved seed varieties; poor soil quality; lack of agricultural knowledge; lack of resources (particularly associated with pest management); lack of veterinary services for livestock; the high cost of livestock vaccination and disease treatment; and the lack of employment opportunities. Recommendations therefore include: construction of water- efficient irrigation infrastructure (however, see concerns about large infrastructural projects noted above); provision of improved seeds; establishment of fruit gardens; capacity building on agricultural knowledge and skills, particularly with regard to soil quality improvement and natural regeneration techniques; consideration of biogas digestion to generate gas for heating and nutrient- rich slurry for fertilizer (see Help International’s biogas work in Bamyan); capacity building on crop and livestock disease prevention; establishment of a veterinary clinic; creation of additional income generating activities in order to allow households to be able to purchase the resources required to address crop and livestock disease (as well as other household requirements such as health care and education); and the provision of vocational training such as mobile phone repair, tailoring, carpet weaving, embroidery, and WASH infrastructure (consider Sanitation Marketing methodology). It should be noted, however, that other NGOs are active in these sectors. Coordination is therefore vital in order to avoid duplication. b) Education: The main issues identified by communities were access and quality of education, as well as a lack of household income and resources at schools. NGOs that are currently active in the area have been setting up community-based schools to overcome the issue of access and community members have requested WV to set up more community-based schools. Mobile education, however, has not been implemented in Lal and could be considered, however it could only be implemented in areas with mobile phone coverage. Recommendations to address education issues include: establishment of community-based schools; implementation of mobile education in areas with mobile coverage; income-generating activities to support the resourcing of students and schools; and advocacy with government to support the improved quality of teaching and resourcing of schools.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

c) Health: The main issues identified by communities were access and quality of health care, as well as a lack of household income and resources at health centres. Recommendations therefore include: training and equipping of mobile health teams to reach communities; training of midwives; income- generating activities in order to allow families to pay for health care; advocacy with government to support the adequate resourcing of health centres including equipment and personnel; and investments in preventive health care activities such as hygiene and sanitation behavior change training.

Based on the cumulative findings of this assessment, it is advisable that WV begins with soft programming in Lal District, such as mobile education and mobile health, before considering infrastructural programming such as WASH. Once WV has an established presence in Lal and has a clear understanding of the logistical challenges and how to overcome these, infrastructure WASH programming could be considered, given it was the number one priority identified by communities. Coordination with NGOs that have an existing presence in Lal district is also vital in order to ensure complementarity of programming and to avoid duplication.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

7. Sources

Action Contre la Faim, “Nutrition Anthropometric and Mortality Survey: Province of Ghor,” 2014, https://www.humanitarianresponse.info/system/files/documents/files/SMART- Final%20Report_GHOR_ACF%20October%202014_FV.pdf

Center for Afghanistan Studies, “Distance Learning Module 3 - Rivers of the Hindu Kush, Pamir, and Hindu Raj,” University of Nebraska Omaha, 2016, http://www.unomaha.edu/international-studies-and- programs/center-for-afghanistan-studies/academics/transboundary-water-research/DLM3/DLM3.php

Central Statistics Organization, “Population,” 2016, http://www.cso.gov.af/en/page/demography-and- socile-statistics/demograph-statistics/3897111

GEOCART, "National Atlas of the Democratic Republic of Afghanistan”, Warsaw, 1984.

Habib, Shabnam, “Local Government in Afghanistan: How it works and main challenges,” Public Policy and Administration Faculty, Balkh University, Afghanistan, 2013, http://www.nispa.org/files/conferences/2013/papers/201304161044150.Paper_Habib.pdf?fs_papersPa ge=8

La Historia con Mapa, “Ethnic Groups in Afghanistan Map,” 2016, http://www.lahistoriaconmapas.com/atlas/country-map01/ethnic-groups-in-afghanistan-map.htm

Naval Postgraduate School, “Ghor Provincial Overview,” 2016, https://my.nps.edu/web/ccs/ghor

UNDP, “Environment,” 2016, http://www.af.undp.org/content/afghanistan/en/home/ourwork/environmentandenergy/in_depth/

UNFPA & CSO, “Ghor Socio-Demographic and Economic Survey,” 2012, http://collaborativemonitoring.com/wp-content/uploads/2016/01/Ghor-Socio-Demographic-and- Economic-Survey-2015.pdf

UNICEF, “Best Estimates Provincial Fact Sheet 9: Ghor,” https://www.unicef.org/infobycountry/files/Best_Estimates_Fact_Sheet_-_Ghor.PDF

University of Texas at Austin, “Afghanistan: Administrative Divisions,” 2009, http://www.lib.utexas.edu/maps/middle_east_and_asia/afghanistan_admin-2009.jpg

World Vision, “MUNCH Project Baseline Report,” 2014.

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8. Appendices

Lal WASH Villages surveyed.xlsx Assessment TOR v3.doc

FGDs.docx FGD- Translation.docx

WASH Assessment WASH Assessment Household Survey v3.doc Household Survey Translation.doc

Key Informant Key Informant Interviews Translation1.docx Interviews.docx

PRA.docx PRA-Translation.docx

Sanitary Survey Template.docx

WQ Analysis result report of Lal district Ghor province for WVI-A.xls

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

8. Annex A Hydrological Maps

Map of the rivers of Afghanistan showing the master drainage systems, as well as the glacier meltwater sources (green dots, where each dot equals about 10 glacier ice masses), which are concentrated in the north and east of the country. Source: The Center for Afghanistan Studies, University of Nebraska Omaha, 2016.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

Environmental features and agriculture in the upper Hari Rod watershed. Source: Watershed Atlas of Afghanistan, Raphy Favre and Golam Monowar Kamal, 2004.

Lal wa Sar Jangal Comprehensive WASH Needs Assessment

River systems and settlements in the upper Hari Rod watershed. Source: Watershed Atlas of Afghanistan, Raphy Favre and Golam Monowar Kamal, 2004.