Water, Sanitation and Hygiene Needs Assessment

Laghman , Nangarhar, and

April 2019

0 | P a g e ABBREVIATIONS

BPHS Basic Package of Health Services EPHS Essential Package of Hospital Services DG District Governor DoPH Directorate of Public Health DoRR Directorate of Refugees and Returnees EPHS Essential Packages of Health Services FGD Focus Group Discussion HF Health Facility HP Hygiene Promoter IOM International Organization for Migration IDP Internally Displaced People IEC Information Education and Communication INGO International Non-Government Organization IMC International Medical Corps KAP Knowledge Attitude Practice KIIs Key Informants Interviews M&E Monitoring and Evaluation MoPH Ministry of Public Health MRRD Ministry of Rural Rehabilitation and Development NGO Non-Governmental Organization OFDA Office for Foreign Disaster Assistance UNHCR United Nations High Commissioner for Refugees UNOCHA United Nation Office for Coordination of Humanitarian Assistance WASH Water, Sanitation and Hygiene

1 | P a g e Table of Contents

Major findings of the Assessment are: ...... 5 1. Assessment Objective ...... 9 2. Training of Enumerators: ...... Error! Bookmark not defined. 3. Coordination: ...... 9 4. Ethical Consideration: ...... 10 5. Gender Mainstreaming...... 10 6. Questionnaires and Assessment Tools: ...... 10 7. Methodology Adapted...... 10 8. Survey Limitations:...... 10 9. Challenges faced in data collection: ...... 11 10. Surveyors Teams:...... Error! Bookmark not defined. VI -Data Collection Methods:...... 11 1 Desk Review / Secondary Data Review:...... 11 2 Key Stakeholders Meeting: ...... 11 3 Community Influential Meeting:...... 11 4 Needs Assessment :...... 11 Daily Debriefing:...... 12 Data Analysis and Reporting:...... 13 V: Stakeholder Analysis...... 13 VII: MAIN FINDINGS ...... 17 General Observation:...... 17 Potable Water:...... 17 Sanitation and Hygiene:...... 17 Hygiene Promotion ...... 18 Environmental Health:...... 19 DATA TRINGULLATION:...... 19 BENIFICIARIES TO BE TARGETED:...... 20 RECOMMENDATIONS: ...... 20 Water Supply Infrastructure: ...... 20 Sanitation Infrastructure:...... 20 Hygiene Promotion: ...... 20 Environmental Health:...... 21 Detailed Beneficiaries Data:...... 22

2 | P a g e I. Need Assessment Summary and Justifications continues to face immense humanitarian, environmental, social and political challenges. Continuous armed conflict, insecurity and recurrent disasters have resulted in large scale of internal displacements with in Afghanistan. As of December 31, 2018, IOM ’s Displacement Tracking System (DTS) has recorded a total of 95,970 people as being displaced in the 3 Eastern provinces of Nangarhar, Kunar and Laghman. The overall WASH infarastructure coverage remains cahllanging for the newly displaced and hosting communities in terms of quanitity and quality. The eastern provinces, especially Nangarhar is among the provinces that houses the majority of the returnees, remains the highest for the WASH needs for the returnees. Lack of improved sanitation coverage and are at the highest risk of disease outbreaks including Acute Watery Diarrhea (AWD). Moreover, the conflict, drought and poverty is affecting the capacities of the communities to maintain necessary basic WASH infrastructure in the targeted hard-to-reach areas. The current spill of drought, resulting from low rainfall and snowpack melt in 2017 and 2018, has worsened the water availability in 2018 and part of 2019.

As per the Humanitarian Needs Overview (HNO) 2019, the water supply and sanitation in Afghanistan is one of the worst in the world with almost 60% of Afghans have limited to none access to improved sanitation and over 36% still using unprotected water sources. The continued returnees from Pakistan and Iran has added pressure on the already overwhelmed and dilapidated WASH infrastructure and has stretched the available local resources posing extreme health risks to an already vulnerable communities and overwhelmed health system. Moreover, Poor and unsafe WASH practices adopted among the displaced populations has resulted in increased open defecation hence diarrheas among children.

Based on WASH cluster data, the families of both documented and undocumented returnees, especially those coming from Pakistan, face a higher risk of poor access to improved WASH infrastructure, with more than 60% of the returnees living in informal settlements with limited or no services. Kabul, Kandahar and Nangarhar are the provinces with the highest gaps in WASH needs for the returnees. IOM and UNHCR estimate that over 163,000 undocumented and 60,000 documented refugees will return from Iran and Pakistan in 2019 and a significant percentage of these People will be in need of WASH assistance.

Based on past trends, an estimated 150,000 people will be affected by sudden onset natural disasters (e.g. floods and avalanches) with the potential to damage and destroy assets and livelihoods, generating additional needs. Communities living in insecure and remote and hard to reach districts that repeatedly suffer from the impacts of disasters and conflict are often not adequately assisted by humanitarian actors. Those communities hosting considerable numbers of IDPs/returnees will suffer severe shortages of basic services unless additional assistance is provided. Conflict, drought and poverty is affecting the capacities of the communities to maintain necessary basic WASH infrastructure in the targeted hard-to-reach areas.

The eastern provinces, especially Nangarhar is among the provinces that houses the majority of the returnees, remains the highest for the WASH needs for the returnees. Lack of improved sanitation coverage and are at the highest risk of disease outbreaks including Acute Watery Diarrhea (AWD).

On 22 April 2019, an intra-NSAG conflict in the Zawa area of Khogyani and Wadisar in district led to large scale conflict based displacement. As of 30 April 2019, reportedly 56,329 people (8,047 families) have been displaced from both the districts. The people have mainly been displaced from the (Haider Baba Kalai, Chakaw, Star Kalai, Kadalai, Shekh Neka, Chenargai, Khadarkhil, Asman Kalai, Soor Ragha, Tawda Chena, Bagicha) and (Wadisar, Stara Tormai, Chapari, Markikhil, Bulelkhil, Leshakai, Kodikhil, Totoo, Gandomak and Ashfan). According to

3 | P a g e the initial information, 63% (5,073 families) of the displaced people have moved to Surkhrod district, followed by Behsud (1,145 families), while 981 families have settled within the Khogyani district (Chamtala settlement and district center). A number of people have moved to city, Kama, .

As per the nature of the movement due to conflict the IDPs left in a hurry used whatever transport means available and were unable to carry their belongings. The IDPs are currently face, lack of clothing, shelter, hygiene materials and cooking materials. However, these districts have received substantial displacement from within Nangarhar as well as from neighboring Kunar and Laghman provinces in recent past, 70-80 % of the returnees from Pakistan have also settled in these districts. There is pressure buiding on the existing and overstretched available local housing market, with houses and shelters getting scarce, and rental prices sprang higher.

Three health facilities (Zawa, Mamakhil and Belal Ahmadkhil) in the conflict areas remains non functional, according to the health cluster. There were 4 schools (Miagan, Sekandari, and Zawa Boys and Girls schools) already closed before this conflict in the district, which already had a negative impact on the education and health service access for some displaced people. With pressure on the existing water resources (wells), there is a need to reinforce the WASH service provision in the targted villages and districts hosting the IDPs, as the increased population is putting strain on the current resources. On the afternoon of March 23, 2019, combatants affiliated with Islamic State Khorasan (ISK) launched simultaneous attacks on positions in Digal, Korangal and Manar villages of Chapadara district, resulting in heavy fighting that has displaced over 21,000 people (3,112 families) within Kunar and Nangarhar provinces. This includes over half of the population of Chapadara district who have fled the area. Other people in affected areas may be unable to leave due to restrictions on movement, checkpoints or the challenges in moving over mountainous and remote areas. Displaced people have mostly relocated to nearby safe villages from the Taliban controlled areas; closer to the district center and the Dara E Pech areas controlled by the Government or to the Provincial capital of Asadabad. While numbers cannot be determined accurately, several civilian casualties and injuries have been reported.

Location:

Nangarhar:

Nangarhar has 22 districts, including Spinghar district Achin (Batikot, Chaparhar, Haska Mina, Khewa, Khogyani, Sherzad, Pachiraga, Hisarak, Koot, Nazyan, Spingghar, Ghanikhel, Goshta, Momand Dara, Lalpora, Bihsud, Sorkh Roud, Dara-i-Noor, Door Baba, Rodat and Kama). The city of Jalalabad serves as the capital of the province, which is among one of the 5 major cities of Afghanistan and is highly populated town. Total population of is estimated to be around 1,635,873.

Following districts have been selected and covered by the assessment: Rodat, Batikot, Behsud, Mohmandara, Goshta.

Kunar:

Kunar is a mountainous province of the country bordered with in north, south with Nangarhar province, west with and also bordered with Pakistan in its east. Currently, Kunar has 15 administrative units, including Asadabad the provincial capital , Khas Kunar, Noorgul, Sawkai, Narang, Sarkano, Marawara, Shegal, Dangal, Asmar, Ghazi Abad, Nari, Watapur, Manogai and Chapa Dara districts. Kunar Province (Chawki, Khas Kunar, Shegal and Chapa

4 | P a g e Dara Districts). Total population of the province is estimated 48,211. The assessment mainly covered 3 following district of Kunar Province (Shegal, Sakaney and Khas Kunar Districts).

Laghman:

Laghman is among the eastern provinces of the country. Nangarhar is located to the south and southeast of Laghman, Kunar to its northeast, Nuristan to its north, Panjshir to its northwest and Kabul and Kapisa provinces to its west. Laghman province has six administrative units including the capital; Mehtar Lam. Alishing, Alingar, Dawlat Shah, Qargayi and Bad Pukh are the districts. Total population of the province is estimated around 476537. The assessment has covered the following districts of the province: Laghman Province (Mehterlam the capital city and Qargayi Districts)

Major findings of the Assessment:

Nangarhar:

Safe Drinking water: The 49.4% of people in Rodat, 63.2% in Bati Kot, 43.1% people in Mulavi Khalis Families, 39.11% people in Dara district, 59.12% people in Goshta, 39% people in Mehterlam, 44.12% people in Qargayi, 59.7% in Khas Kunar, 55.3% people in Sarkani and 44.5% people in Shegal district have no access to safe potable drinking water and use the unprotected water sources.

Sanitation: 5% people in Rodat, 0% in Bati Kot, 0% people in Mulavi Khalis Families, 11% people in Mohmand Dara district, 8% people in Goshta, 0% people in Mehterlam, 15% people in Qargayi, 23% in Khas Kunar, 45.2% people in Sarkani and 51.6% people in Shegal district have no access to hygienic latrines and open defectaion was observed by the assessment team as common exterta disposal practices.

Hygiene promotion: Overall the education level revealed to be lower among these communities. More than 71% families reported that they didn’t receive Hygiene Kits and those who have received it while they have been settled in returnees camp acknowledge that they received the hygiene kits. Open defecation practice has been noticed as one of the very common phenomena particularly among returnees and IDPs who live with the host communities inside the villages. Hygiene promotion activities are carried out only in planned settlements and the rest areas (mostly scattered) were left out.

Hand washing practice: The hand washing practices reported, to be in a very poor condition. The assessment shows that 42.1% of people in Rodat, 39.12% in Bati Kot, 29.9% people in Mulavi Khalis Families, 42.4% people in Mohmand Dara district, 16% people in Goshta, 13% people in Mehterlam, 43.79% people in Qargayi, 55.3% in Khas Kunar, 41.1% people in Sarkani and 46.7% people in Shegal district were reported as not using soaps as safe hand washing practice at the critical times. Similarly, during the assessment the teams visited randomly few schools in every district and none of them were found to having hand washing facilities as well as the knowledge identified limited about safe hand washing practices and majority of them were not washing their hand during critical times.

5 | P a g e WASH Access in Nangarhar Province

350

300 69% Goshta 250 59.12% Mohmand Dara 200 72.1% 39.11% Mulavi Khalis Families 150 43.1% 65% 49.7% Bati Kot 100 63.2% 34% Rodat 56% 50 29% 49.4% 8% 56.8% 0 11%5%0 64% No accesst to 26.7% safe driniking Unhygienic latrines Access to water hygienic Not using soap latrines for hand washing

Kunar: The issues of security and returnee’s repatriation seem to be the same as Nangarhar. International Medical Corps conducted the need assessment in Khas Kunar, Sarkani and Shegal Districts of Kunar Province where the returnees and IDPs are most likely to stay because of its location and satisfactory security condition. These IDPs were displaced from neighboring villages and districts due to security concerns and arm clashes between government and anti-government opposition in most location of Kunar specifically in Chapa Dara where the armed clashes have started recently.

It has been revealed from the Assessment that a large number of returnees and IDPs are living in Kunar province. The returnees are currently faced with multiple challenges and especially the WASH needs are identified as higher with limited support being currently in place. In addition, unavailability of potable safe drinking water, unsafe hygiene and sanitation behavior and practices, prevalent open defecation practices, and poor personal and environmental hygiene and sanitation conditions are some of the serious WASH challenges for the returnees, IDPs and host communities that need to be addressed urgently. The key highlights from the Assessment reveals that 59.3% of people in Shegal, 71% in Sarkano and 42.1% people in Khas Kunar districts has no access to safe drinking water.

6 | P a g e WASH Access for Kunar No accesst to safe driniking Province water Unhygienic latrines 26.7% 49.4% Access to hygienic latrines

64% 5% Not using soap for hand washing

Laghman: The need assessment conducted in the 2 districts of Laghman province Qargayi and Mehterlam, where 3,715 IDPs and returnees have been settled due to security threats, arm clashes between government and anti-government groups. The IDPs have been displaced from neighboring districts and villages as they are assuming that in summer mostly the incidence of armed conflicts go higher and may cover wider territory. On the other hand, most districts also have been hit by severe drought and people have been displaced, during assessment it has realized that these IDPs, returnees and local families were having the highest need for humanitarian assistance of WASH sector. Their knowledge regarding hygiene, sanitation and clean water was considerably less. Moreover, in surveyed location specially in targeted locations of Qargayi no any humanitarian organization worked so far. During the survey we found that, 69.7% of people in most locations of Qargayi, 53.1% in Mehterlam district were not having proper access to safe and potable water. Moreover, 22.1% people in Mehterlam and 32.5% people in Qargayi were using unhygienic latrines. The survey reveals that 76% in Qargayi and 69% in Mehterlam were not washing their hands with soap at critical times.

7 | P a g e Not using WASH for soap for 76% Laghman hand 69% Province washing

Access to 43% hygienic latrines 73% Qarghayee Mihterlam Unhygieni 32.5 c latrines 22.1%

No accesst to safe 69.7% driniking 53.1% water

0 10 20 30 40 50 60 70 80

II. International Medical Corps Background

International Medical Corps is a global, humanitarian, nonprofit organization dedicated to saving lives and relieving suffering through health care training and relief and development programs. International Medical Corps has been working in Afghanistan since 1984. During this long period of existence in the country, International Medical Corps has implemented several projects in different sectors including Health (EPHS/BPHS), Capacity Building, Gender Base Violence (GBV), Disaster Risk Management, Shelters, WASH and others. International Medical Corps is very reputed and respected in the provinces where it is delivering the lifesaving interventions by the local communities for its outstanding performances, transparent implementation of projects and achievements.

International Medical Corps currently implementing EPHS through the Sharana Provincial Hospital, Community Base Disaster Risk Reduction(CBDRR) in Laghman, Nangarhar and Kunar provinces being funded by OFDA, Emergency Shelter project in eastern provinces in partnership with ACTED funded by OFDA, several emergency WASH Projects in Barmal and Urgon districts, Torkham border and Behsud district of Nangarhar funded by UNICEF Community lead total sanitation project in Paktika and Emergency health Project in Nuristan and Paktika Provinces with the support of UNOCHA. International Medical Corps is familiar with the areas, its needs, and the living conditions of the returnees, IDPs and local communities. International Medical Corps’ experiences and exposure to these areas surely prepare it for appropriate interventions to address those WASH relevance needs as identified by the Assessment.

The provision of WASH services as integrated package will significantly contribute to the improvement of current Health and Livelihood status of the targeted population. It will also reduce future prevalence of communicable diseases caused by poor water supply, bad hygiene behavior and lack of appropriate sanitation.

8 | P a g e III. Assessment Description:

1. Assessment Objective To have an in-depth knowledge on current WASH service provision and the gaps for Afghan returnees, IDPs and local communities particularly who have returned back to Afghanistan in the past 18 months. The Assessment result will invariably guide International Medical Corps to provide short and medium- term WASH supports to these impoverished communities.

International Medical Corps’ main objective for this Assessment was to identify the critical gaps and needs of the returnees and IDPs, and to prioritize future short and medium term emergency WASH. However, in the process, we have also identified the emergency Shelter needs in our targeted areas, which is being analyzed and reported separately for future interventions

International Medical Corps conducted need assessment and the final report to designed contextually appropriate, innovative and effective program to promote WASH and Health through the following primary tasks. a. Complete a desk review; b. Conduct a series of meetings with key stakeholders; c. Train the surveyors of International Medical Corps on how to conduct the assessment, using the pre-constructed assessment tool, in the relevant geographic areas; d. Analyze the primary and secondary data being collected; e. Assessment report including recommendations. International Medical Corps’ main objective for this Assessment was to identify the critical gaps and needs of the returnees and IDPs, and to prioritize future short and medium term emergency WASH. However, in the process, we have also identified the emergency Shelter needs in our targeted areas, which is being analyzed and reported separately for future interventions.

Furthermore, based on the meeting held with community health workers and health services providers as well as with Education department workers (School Teachers and Headmasters) inside the community, gaps and needs of these important sectors also has been identified and concluded in the assessment report’s relevant sections.

2. Coordination: International Medical Corps believes in coordination and always struggles to establish good coordination with all key stakeholders at all levels. During the Assessment, International Medical Corps met with key stakeholder such as DoPH, DoRR, DGs, BPHs and EPHS implementer NGOs, MRRD, MoPH and other WASH related actors in the targeted areas. International Medical Corps informed them about the Assessment and its purpose and sought their coordination during the assessment and about the expected future project.

3. Training of Enumerators: For necessary data collection, International Medical Corps used the WASH cluster assessment tools and conducted a one-day training session for the staff in the field. The training session on these tools was facilitated by M&E officer, WASH Coordinators and project manager of WASH OFDA project. The one day training in each province included practical works, a complete briefing session on need assessment particularly on conducting KII and FGD.

9 | P a g e 4. Ethical Consideration: The Survey teams took all ethical consideration into account and explained the purpose of the assessment to the target population. The teams were also given proper training on data collection before conducting the field visit. The beneficiaries were informed prior to the field visit. After getting their verbal consent of the beneficiaries, the survey teams visited their houses and filled the questionnaire through conducting FGDs and KIIs.

5. Gender Mainstreaming International Medical Corps always try to reach to the underserved and most vulnerable population of the affected communities. It maintained gender balance in the Assessment as well as in the services provision. International Medical Corps has strictly considered this point in the Assessment and has taken below steps:

. The assessment has been conducted by the local male and female surveyors. . FGDs and KIIs both has been planned and conducted with all communities including male, female, youth and disabled. . Schools and HFs has been included in the assessment to find out the current status of WASH and other hygienic aspects.

6. Questionnaires and Assessment Tools: International Medical Corps adapted the Afghanistan WASH cluster assessment tools as the principle data collection tool for the assessment. The tools and questionnaire have been shared with International Medical Corps WASH Advisor for the review and update. The WASH Advisor at the HQ reviewed the tools and for enrichment of data and assessment helpful comments and instruction has been added to the assessment process and into the questionnaires.

Methodology International Medical Corps opted for qualitative and quantitative methods to triangulate the collected information through Key Informants Interviews (KIIs) and Focus Group Discussion (FGDs) methodologies and this is how the primary data has been collected from the field. Moreover, a detailed desk review was conducted to collect the secondary information through relevant assessments reports, IOM weekly and monthly updates, and reports, UNOCHA, UNHCR and other resources.

Beside KIIs and FGDs, the teams were also trained on how to collect data during direct observation. It is worth mentioning here that there were multiple challenges limited the data collection process such as security, gender consideration, women’s participation or availability and others. However, fortunately, the team managed to reach out to all the groups which are the most vulnerable such as women, children and disabled.

Survey Limitations: International Medical Corps always utilize the best efforts to reach out to the un-covered areas in terms of all services. Fact remains that most of the un-covered areas have been left unserved due to insecurity in those areas. In Nangarhar province, in some areas of the 6 districts, the security situation was not satisfactory and had negatively affected the Assessment. International Medical Corps has however, tried to maintain the gender and mainstreaming issues although it was hard to find women surveyors for the Assessment. Women’s interest and participation in common activities, education level among women, and family restriction among them mostly effect the activities where women participation is a must .

10 | P a g e Challenges faced in data collection: Un-availability of professional staff, low education level, women’s lower interest and participation in FGDs and KIIs, security and limited access to the most vulnerable areas were noticed as key challenges faced by the surveyor during the data collection process.

VI -Data Collection Methods: 1 Desk Review / Secondary Data Review: The Assessment team conducted a detailed desk review of all the available key documents, survey reports, journals issued by DoRR, MRRD and UN agencies pertaining to respective districts of the province prior to holding the Assessment. The desk review provided the team with basic knowledge of the current humanitarian situation, and plight of IDPs, returnees, school and hospitals.

2 Key Stakeholders Meeting:

A proposed list of key stakeholders and main questions to be asked were shared with the team for review and comments for finalization. A total 35 32 29 of 4 organizations/offices (8 persons) were 30 interviewed mainly on gaps of services and 25 capacities in relation to WASH, Health and Kunar Shelters. The key stakeholders included 20 15 12 12 Nangarhar representatives of directorate of returnees 10 and refugees (DoRR), Districts Governors 10 Laghman (DGs), Representative of provincial Health 5 2 sector and representative of implementing 0 NGOs for Basic Packages of Health Services. FGDs KII

3 Community Influential Meeting: The Assessment included, and was planned to have, a quick meeting with community influential who were well aware about the geographical locations of returnees and IDPs, as well as about the current situation of the districts, security concerns, and local and community behaviors and believes.

4 Needs Assessment : a) Key Informants Interviews (KIIs): The KIIs were conducted with community representatives and influential individuals of returnees, IDPs and host communities in various locations of the 10 districts (Goshta, Mohmand Dara, Rodat, Bati Kotand and Behsud districts of Nangarhar, Mehterlam and Qargayi districts of Laghman province and Khas Kunar, Sarkani and Shegal districts of Kunar province). The questionnaires enabled the team to collect both quantitative and qualitative information and data. The qualitative part of the assessment covered the type and magnitude of needs, challenges, access and quality of services available, while quantitative data included numbers and figures of IDPs, returnees and host communities who have access to WASH (safe drinking water, hygienic latrines, and percentage of families using soap and practicing hand washing behaviour). Information collected from the Assessment will provide a broader picture that will inform us to design appropriate interventions for short and medium term periods. (The details of Settlements covered by assessment are as follows):

11 | P a g e b) Focus Group Discussion (FGDs): District Province Villages / Sites # of #of KIIs FGDs

Goshta Swro Ghoudi, Arkhy Dag, Khwezo, Aka Baba 8 8 Daman, Mama Khail, Saifullah Jor, Khwezo Daman Dag, Khas goshta Bati Kot Barikab, Qala e Awal, Barikab Ali Khail, Barikab 8 7 Maktab Kaly, Barikab Raghah Kalay, Chahardi, Koz Kalay, Chahardi, Manz Kalay, Chahardi, Lar Kalay, Chahardi, Qala e Sar Rodat Kuz Dag, Sachi Qala, Manz Kaly, Mirza Kaly, Koza 8 6 Nangarhar Qala , Roghani Loy Kaly, Roghani Manz Kaly Mohmand Dara Hazar Nawo Hadizee, Gardi Ghous, Nawe Kaly, 4 4 Gardi Ghous Kaly

Mulavi Khalis Families Site 1, Site 2, Site 3, Site 4 4 4

Khas Kunar Chandravi, Zargaran , Mangwal, Waly 4 4

Sarkani Dosaraka, Pashad, Tango, Sarkani Markaz 5 5 Kunar Shegal Mora Kaly, Shangar Shah, Morai kaly 3 3

Mehterlam Omerzaee, Katal Muskeen Abad, Deh Ziarat, 4 4 Hajyaan Kaly Qarghay Charbagh, Nawabad Qalatak Sulfa, Aziz khan kas 6 6

Laghman returnees camp, Aziz khan kas Farash ghani camp, Mandrawar, Suleiman Khel Nud Mara The FGDs were conducted with community elders, different local committee members, religious leaders and influential community members considering gender and mainstreaming principles. FGDs were conducted with both male and female community members to collect broader information about WASH / Health and Shelters, personal hygiene issues in targeted areas. The sessions have been conducted separately with females by female survey teams. c) Direct Observations: Direct observation was a part of the survey and all groups were instructed to look around the areas they visit and collect data and information. The teams were also instructed how to place the data in their checklists or either to write the qualitative/quantitative information in separate papers and submit it to the survey supervisor. During the analysis, the data was properly analyzed and processed from direct observations as well and the information included in the report. d) Daily Debriefing: Each day, after finishing field works, a daily debrief meeting was conducted with surveyors to discuss all problems, challenges and constraints they faced in the field and in order to assure the validity of collected data. The meeting also discussed about next day’s plan and areas that were supposed to be covered by the teams.

12 | P a g e e) Data Analysis and Reporting: Data collection, transcription and translation were planned to be completed each other day, and by 28 March 2019 this process was completed by M&E department. For data analysis, a brief orientation of encoding procedures was provided by M&E department for the International Medical Corps team members in Jalalabad. The team developed a preliminary codes list for qualitative data analysis and for qualitative data analysis the program Excel were used. Data for each code was summarized and examined in any marked differences such as Sex, Age groups and Locations.

V: Stakeholder Analysis International Medical Corps tried to avoid any duplication of activities and resource wasting and promotes good coordination and cooperation with stakeholders. Therefore, a stakeholder analysis was done by the team. Some key actors in the field were determined in all or some areas of the targeted locations. Below Chart shows the key actors with their specific roles and interventions.

13 | P a g e Organization Sectors Projects Donors District

International WASH- Provision of Humanitarian WASH Assistance to OFDA, Nangarhar ( Khiwa, Surkhrood, Pacher Wagram, Bati Kot, Medical Corps OFDA, Afghan Returnees, IDPs and Vulnerable Local UNICIF Rodat, Kot and Mohmandara) WASH Communities in Nangarhar and Kunar Provinces. UNICIF,

ZOA WASH AFGR 2019 DRA Nangarhar ( Khogyani, Surkhrood and Kot)

NCRO WASH DRA- AFJR Pase 4 OXFOM Nangarhar ( Chaparhar, Khogyani, Behsud and Surkhrood)

UNHCR Relief Provision of essential relief assistance to returnees UNHCR Nangarhar(all 22 districts of Nangarhar)and Kunar(in all 14 Assistance mostly covering shelters and cash assistance. districts of Kunar) to returnees and IDPs. DACAAR WASH Emergency Response and Mechanism, WASH . ECHO, Under ERM project DACAAR works in all 22 districts of construction Emergency DANIDA Nangarhar Province and under Emergency WASH project and works in Khiwa and Surkhrood districts. Emergency

AADA Health Provision of primary/basic health services in MoPH and Nangarhar (in all 22 districts of Nangarhar) (BPHS) Nangarhar province. World Bank.

14 | P a g e Solar water network system, Gravity water Nangarhar ( Kama, Khiwa, Dara e Noor, Dor Baba, Ghani Khel, CCNPP WASH and network system and boreholes Would Bank Chaparhar and Khogyani) Water Supply

COAR WASH WASH in School UNICIF Surkhrood, Khiwa, Kama, Dara e Noor, Behsud and City)

WHH Shelter, Improving access to clean water sanitation and AA Nangarhar ( Surkhrood and Behsud) WASH and hygiene DRR

ORCD/Health Health BPHS Ministry of Sarkani, Shaigal and Khas Kunar Net Public Health

THRA Women Women empowerment program Sarkani and Shaigal Emp. ACTED Shelter Emergency resilient shelter for Returnees USAID OFDA Khas Kunar

Shaigal, Khas Kunar and Sarkani ﺑﺪﯾﻞ ﻣﻌﯿﺸﺖ ﺑﺮای رﻓﺎه اﻧﮑﺸﺎف AALWD Training

WAW Women Women empowerment program UN Women Shaigal, Khas Kunar and Sarkani Emp.

OCHR Training Christian Aid Khas Kunar

ASIO Livelihood Livelihood NHLP MAIL Sarkani and Shaigal

15 | P a g e BLUMONTT Assistance First aid to war affected people USAID Shaigal, Khas Kunar and Sarkani

HADAAF CLTS CLTS FHI Shaigal, Khas Kunar and Sarkani 360/USAID DACAAR, GNI, WASH Water, Sanitation and Hygiene NA Mehterlam and Qargayi NCRO, NRC,OCHR,

16 | P a g e VII: MAIN FINDINGS General Observation:

The targeted 11 districts are close to the capital cities of Jalalabad, Mehterlam and Asadabad in each of the province, as well as having easy access to other districts as well. Locally constructed markets are available in each district. The capital cities Jalalabad of Nangarhar and Asadabad of Kunar have bigger markets and livelihood opportunities to some extent and the Assessment revealed that some of the affected population are working on daily wages in Jalalabad, Mehterlam and Asadabad with monthly income of around 5,000 to 8,000 AFGs (USD 80-125).

Potable Water: Limited access to potable water considered the main problem of the households. The Assessment revealed that in 49.4% people in Rodat, 63.2% in Bati Kot, 43.1% people in Mulavi Khalis Families, 39.11% people in Mohmand Dara district, 59.12% people in Goshta, 39% people in Mehterlam, 44.12% people in Qargayi, 59.7% in Khas Kunar, 55.3% people in Sarkani and 44.5% people in Shegal district have no access to safe potable drinking water. However, some INGOs have already worked in some planned returnee settlements like Shikhmisry, Chamtala but could not full-fill the needs of potable water of majority of these people as most of these returnees also have been settled inside host communities where the percentage of this indicators falls down significantly.

On the other hand, there are already exisiting boreholes reported to be not-functional due to lack of good maintenance systems in place. Based on the Assessment report, about 58% of these population stated that they have to walk around 15-30 minutes to reach to the water points, while in some areas, particularly in Bati Kot, Goshta and Rodat of Nangarhar, this time is even more than an hour, and people are using water tankers to fulfil their needs for potable water. People frequently complains about lining up for at water points for long hours and 44% of them stated that they normally wait for more than 30 minutes to collect water, while 37% of them are used to wait for 15 to 30 minutes at water collecting points.

Women are mostly doing the house-hold chores as their gender and socially routine assigned tasks, while water collecting responsibility is also being given to them in almost all areas. This indeed put extra burden on women and girls while they are exposed to risk of harassment. Also, the Assessment revealed that average need of water per person per day is around 20 litters, while the FGDs participants also pointed out that the average daily usage of water per person increases significantly in hot weather during summer season.

Sanitation and Hygiene: Overall the poor condition of hygiene and sanitation revealed, one of the main causes of increased water borne diseases among these needy communities. The assessment revealed that most of these population have very limited or no information about safe hygiene and sanitation practices and on the other hand limited access to hygienic latrines and other sanitation facilities keep the population away from safe hygiene practices. Although, in most mentioned locations, CLTS program has been implemented but the result were not satisfactory at the field level. In Rodat district, there are number of families who constructed latrines for themselves and most of these latrines have been built privately by individuals. Point to note here that only those families who have built the latrines have access to it. Assessment report revealed that there are hundreds of families that have 3-5 latrines inside one house and also families were reported who used open defecation practices due to lack of simple vaults.

17 | P a g e As per the Assessment, open defecation is commonly practiced among these communities. About 44% of the assessed families either were using unhygienic sanitation facilities or go for open deification and 17% did not have any latrine at home. The male members of these families practiced open defecation, while the female members used latrines at the neighbouring homes. Only 37% of this population were using improved sanitation facilities.

The Assessment team identified the higher need for provision of safe and hygienic sanitation facilities (latrine) as the most urgent need of the returnees to avoid open defecation and, on the other hand, to control water born or communicable diseases among children and women.

Gender balance has been maintained zero in almost all the locations and none of these facilities were separately constructed for females. Access to flush and septic latrines reported below 2% in both districts (less than 30% of families in above listed location of Nangarhar province). About 43% of families in mentioned location of Laghman province were using soaps during hand washing practice in most critical times, 10% of families received a hygiene kit during last one year in listed villages of Nangarhar province while less than 10% received it in Laghman and 0% in Kunar province. It is worth mentioning here that large numbers of these families have been newly arrived and settled in the areas and did not receive any assistance from any organization. Less than 20% people knew about how to keep and prepare food safely in all districts and 80-90% of families have limited access to bathrooms.

Open defection practices were more common particularly among those returnees who are settled inside local communities and villages. During the assessment, the team identified that functioning latrines and water sources were available in the schools and health facilities in the targeted areas. The health facilities are having proper hand washing facilities, while handwashing facilities and practice of handwashing reported as one of the urgent needs among schools.

Hygiene Promotion Access to health facilities and hygiene promotion sessions revealed to be not satisfactory. According to interviews with community health workers, the new returnees plus IDPs are an extra burden on current health services and facilities. Returnees are either interested to stay inside the secured areas of these 11 districts (Khas Kunar, Sarkani, Shegal in Kunar, Bati Kot, Rodat, Mohmand Dara, Mulavi Khalis Families, goshta in Nangarhar & Mehterlam and Qargayi districts in Laghman province) or in planned camps such as (Shikhmisry and Chamtala in Nangarhar, Aziz khan kas in Laghman and Khas Kunar camp in Khas Kunar), it is mentionable that in some planned camps the government and BPHS implementing NGOs established fixed and mobile health facilities for them. However, those who have been settled inside the villages with host communities have no fixed or mobile health services and only have hard access to those HFs and services which are designed only for a particular population of host communities and this puts an extra burden on them.

The Assessment reported that around 34 different types of HFs located in different location of these districts with having around 311 technical staff including Medical Doctors, Nurses, Midwives and others while 340 of them will be targeted in the project. Hygiene Promotion activities seemed to be in poor condition. None of the areas has taken these campaigns.

Over all knowledge regarding WASH, personal and environmental hygiene and hygiene promotion noticed to be in a very lower level among the inhabitants of the camps, settlements, school and hospitals. Hand washing practice and other initial hygiene promotion activities were not practicing by the majority of the population.

18 | P a g e Environmental Health: Observations and qualitative data of the Assessment informed us that safe environmental hygiene practices among these communities is a major environmental health issue. Proper solid waste management system is reported to be a common problem inside these communities and no proper waste collection system is in place. Families are mostly collecting their wastes individually and putting it in an area which is called dumps.

Refuse pits, safe collection system or any other safe practice or system do not exist, thus, they need to be paid a special attention to prevent communicable and other infectious diseases in children and women. Moreover, none of these areas have any constructed canalization system for draining wasted water, but still families have solved the issue individually for their houses and the spoiled water is either washed or drained by rain water.

DATA TRINGULLATION: During the Assessment, the M&E department triangulate the data with many other reliable secondary data sources. Health data of MoPH has been comparatively analyzed for this purpose, communicable and water borne diseases in targeted provinces shows slight increase. Based on the information from HFs, the general OPD also has been significantly increased in areas where the conflict effected , returnees and IDPs population have been settled.

1480 124807 2018 83834 83614 314148 2510

Nangarhar 125586 2017 82278 80822 308106 385 34063 2018 28539 29972 101541 87 Laghaman 26030 2017 27777 25396 75205 147 45342 2018 49367 37628 109854

Kunar 177 41932 2017 36651 36483 HMIS Data of MoPH in three98240 Provinces (Kunar, Laghman, Nangarhar)

0 50000 100000 150000 200000 250000 300000 350000

Viral Hepatitis Skin Infection Gastro-Intestinal Worms Eye Infections Acute Watery Diarrhea

19 | P a g e BENIFICIARIES TO BE TARGETED: Beneficiaries: Direct beneficiaries (returnees, IDPs and vulnerable local communities): 667,100 individuals (95,300 families), 346,892 male and 320,208 female and plus 30 schools the targeted areas. Indirect beneficiaries (surrounding communities): 178,622 individuals (25,517 families).

RECOMMENDATIONS:

Water Supply Infrastructure: Improve access to sufficient quantity of safe drinking water by the returnees, IDPs and vulnerable local population.

Proposed activities:  Development of new water sources (drilling of boreholes), equipped with hand pumps, for IDPs, returnees and the local communities.  Construction of water supply networks generated by solar systems.  The Water Point sitting will be inclusive of consultative process and will consider the voices of women, as per gender roles they are the primary beneficiary to fulfill the domestic and personal water needs at household level thus, ensuring that they feel safe and comfortable to fetch the water.  Ensure the maintenance and sustainability of hand pumps through trainings and tools distribution.  Water quality analysis and disinfection of water systems to maintain the required FRC at all times.

Sanitation Infrastructure: Improve access to adequate and gender sensitive sanitation for the returnees, IDPs and vulnerable local population.

Proposed activities:  Construction of Ventilated Improved Pit (VIP) Latrines for eligible returnees and IDPs families.  Distribution of latrine kits to the selected latrine beneficiaries.  Installation of hand washing facilities in schools in the targeted areas.  Construction of safe drinking water systems in targeted schools.  Excreta management (vector breeding & awareness to the targeted families on proper disposal of excreta).

Hygiene Promotion: Reduce the risks associated with unhygienic practices and conditions by the returnees, IDPs and local population.

Proposed activities:  Baseline and final KAP Survey to benchmark the interventions and to know the knowledge on WASH.  Hygiene promotion at household level through female IMC Hygiene Promoters (HPs).  Training Community Hygiene Promoters (CHPs), and health and school staff on key health, hygiene and sanitation topics.  Distribution of Water Kits (jerry cans) to the selected households.  Community meetings and awareness sessions in communal areas (mosques, public gatherings, schools).  Formation & capacity building of gender sensitive WASH committees in the targeted areas (19 villages).

20 | P a g e Environmental Health: Ensure the collection and safe disposal of domestic waste in targeted areas in Nangarhar and Kunar Provinces in collaboration with the relevant stake-holders.

Proposed activities:  Design and implementation of the solid waste disposal programs in targeted areas.  Ensure that household waste is disposed of into containers for regular collection - to be burned or buried in specified disposal pits, being identified by the community.  Organize six-monthly solid waste clean-up campaigns at village/school levels to encourage the returnees, IDPs and schools to remove solid waste from the settlements/schools before it becomes a health risk.  Distribution of IEC materials.  Construction of garbage centers on community level.

21 | P a g e Detailed Beneficiaries Data: Table :Final Overview of Nangarhar Province Need assessment Families Needs Solar System N# N° District Village N# Hand Hygiene IDPs Returnees Local water supply hygiene Latrine pump Promotion pipe scheme kit 1 Bati 8 450 1160 4070 0 0 6 116 39760 2 Mulavi Khalis families Behsud District 4 1200 2010 6440 0 63 0 38 67550 3 6 660 696 6720 0 0 6 111 56532 4 Rodat District 7 647 6230 40740 110 30 0 0 333319 5 Mohammad Dara District 3 330 1200 3800 0 17 0 48 37310 Sub Total 12.00 3,287.00 11,296.00 61,770.00 110.00 110.00 313.00 534,471.00

Table: Final Overview of Laghman Need Assessment Families Needs Solar System N# N° District Village N# Hand Hygiene IDPs Returnees Local water supply hygiene Latrine pump Promotion pipe scheme kit 1 Qargayi 6 1505 1600 1675 0 63 0 81 33460 2 Mehterlam 4 245 365 1484 0 11 2 50 14658 Sub Total 1,965.00 3,159.00 - 2.00 1,750.00 74.00 131.00 48,118.00

22 | P a g e Table: Final Overview of Kunar Need Assessment Families Needs Solar System N# N° District Village N# Hand Hygiene IDPs Returnees Local water supply hygiene Latrine pump Promotion pipe scheme kit 1 Sarkani 4 330 535 1550 0 45 0 80 16905 2 Shegal 3 220 175 1668 0 0 3 60 14441 3 Khas Kunar 3 512 68 2010 0 32 1 49 18130 Sub Total 1,062.00 778.00 5,228.00 - 77.00 4.00 189.00 49,476.00

Total Need for 10 District 48 6099 14039 70157 110 261 18 633 90295

23 | P a g e WASH Rapid Assessment Questionaire

24 | P a g e وﻻﯾﺖ Province Date of Assessment وﻟﺴﻮاﻟﯽ District ﺗﺎرﯾﺦ Surveyor د ﺳﺮوﯾﺮ Name ﮐﻠﯽ Village ﻧﻮم Name of GPS Location Observer دﮐﺘﻮﻧﮑﯽ ﻧﻮم

Village / Host IDP Refuge ﺑﯿﺮﺗﮫ Returnee د Description population ﻣﮭﺎﺟﺮ e ﺷﻮی ﺳﺘﻨﯿﺪوﻧﮑﯽ ﮐﻠﯽ ﻧﻔﻮس د ﮐﻮرﻧﯿﻮ ﺷﻤﯿﺮه G1. Number of HH

G2.Total number female

G3.Total number male

G4.Total number of boys ﺷﻤﯿﺮه G5.Total number of girls ﺷﻤﯿﺮ ه

G6.Income of the families

G7.The place of Origin (Village and Province) )

25 | P a g e ھﻐﮫ اداری G8.Any INGO working here ﭼﮫ دﻟﺘﮫ ﮐﺎر ﮐﻮی G9.Contact person Name and phone د ﮐﻮرﻧﯽ د ﻣﺸﺮ ﺷﻤﯿﺮه او ﻧﻮم number

Status Remarks (Funct ional Population or Yield including during) ھﻐﮫ covered Non- dry season, hand ﻧﻔﻮس ﭼﮫ ﺷﻤﯿﺮه Water source Number functio د اوﺑﻮ ﺷﺘﻮن ﺣﺘﯽ (…pumps اﺳﺘﻔﺎده ﺗﺮی nal) ﮐﻮی ﮐﯽ ؟ ﻓﻌﺎل ده ﮐﮫ ﻏﯿﺮ ﻓﻌﺎل ﻻﺳﯽ (W1. Hand dug well (Un protected Explain: ﻏﯿﺮ ﻣﺼﻮن ﭘﻤﭗ ﻣﺼﻮن (W2. Hand dug well (Protected Explain: ﻻﺳﯽ ﭘﻤﭗ W3. Shallow well (equipped with hand Explain: pump) W4. Drilled bore well / equipped with Explain: hand pump د ﭼﯿﻨﯽ ، ﺳﯿﻨﺪ او W5. Spring/ River/ Pond Explain: ﯾﺎذﺧﯿﺮی اوﺑﮫ

:Explain د ﻧﻠﻮﻧﻮ ﺳﯿﺴﺘﻢ W6. Piped water system

:Explain د ﺗﺎﻧﮑﺮ ﭘﮫ واﺳﻄﮫ اوﺑﮫ W7. Water Trucking

26 | P a g e :Explain ﯾﺎ ﻧﻮر / W8. Other

ﻏﯿﺮ ﻣﺼﻮن او اوﺑﻮ W9. Unsafe water point Explain: ﻣﻨﺒﻊ

Chlori Boiling د اوﺑﻮ دﭼﺎل ﭼﻠﻨﺪﻻری ﭼﺎری W10. The treatment method adopted by community ne to 5 اوﺳﻄﮫ اﻧﺪازه د اوﺑﻮ د ﻣﺼﺮف د ﯾﻮ W11. Average quantity of water used per person per day <5 15> ﻧﻔﺮ ﭘﮫ ورځ ﮐﯽ 5 to W12. Average time to access to a safe water point <5 <15 to 5 اوﺳﻂ وﺧﺖ د اوﺑﻮ ﻣﻨﺒﻊ (W13. Average time at water point to collect water (queuing time <5 15> ﺗﮫ د رﺳﯿﺪﻟﻮ

Observations to 5 د اوﺑﻮ د ذﺧﯿﺮه ﮐﻮﻟﻮ ﻗﺎﺑﻠﯿﺖ ﭘﮫ :W14. Total water storage capacity per person at HH level <5 25> ﮐﻮرﻧﻮ ﮐﯽ د ﻧﻔﺮ ﭘﮫ ﺳﺮ Open Jerry Can د اوﺑﻮ د ذﺧﯿﺮه ﮐﻮﻟﻮ طﺮﯾﻘﮫ او ﻗﺎﺑﻠﯿﺖ W15. Household level water storage type and capacity bucket د اوﺑﻮ د ذﺧﯿﺮه ﮐﻮﻟﻮ ﻟﭙﺎره د W16. At least one narrow necked container for drinking water د ﻧﺮی ﻏﺎړی ﻟﺮوﻧﮑﯽ ﮐﺎﻧﺘﯿﻨﺮ

Type and number of sanitation facilities

Number ﺗﺸﺮﯾﺢ Description

27 | P a g e Remarks ﻣﻼﺣﻈﺎت ( ﻓﻌﺎب/ﻏﯿﺮﻓﻌﺎل، ﻋﻤﻮﻣﯽ ﺣﺎﻟﺖ ﯾﯽ ، د ﺧﺎک اﻧﺪاز د Population Mainte ﺧﺎﻟﯽ ﮐﯿﺪو covered nance (اﻣﮑﺎﻧﺎت ﺑﯿﺎ (%) functionality) ﺗﺮی اﺳﺘﻔﺎده رﻏﻮﻧﮫ general , ﮐﻮی state, possibility to empty the pit, dislodging...) Explain: ﺳﺎده ﺑﯿﺖ اﻟﺨﻼ S1. Simple pit/vault latrine ﺗﺸﺮﯾﺢ اﺻﻼح ﺷﻮی S2. Improved pit/vault latrine Explain: ﺑﯿﺖ ﻟﺨﻼ ﺳﯿﭙﺘﯿﮏ او ﮐﻤﻮد S3.Flush to septic tank Explain: ﺳﯿﺴﺘﻢ ﮐﻤﻮد او S4.Flush to sewer system Explain: ﮐﺎﻧﺎﻟﯿﺰﯾﺴﯿﻮن اﯾﮑﻮ S5.Eco-San latrine/Compost latrine Explain: ﺳﻦ ﺑﯿﺖ اﻟﺨﻼ

:Explain ﯾﺎ ﻧﻮر (S6. Other (specify

Yes No % S7. Observation of open defecation

% ﻧﮫ No ھﻮ S8. Observation for Cleanliness Yes د ﭘﺎﮐﻮاﻟﯽ ﻣﺸﺎھﺪه (Hygienic)

28 | P a g e S9. Gender consideration for ﭘﮫ ﻟﺤﺎظ د د ﺟﻨﺴﯿﺖ ﺑﯿﻠﻮاﻟﯽ sanitation ﭘﺎﮐﻮاﻟﯽ ﺳﯿﺴﺘﻢ ﻟﯿﺪﻧﮫ

ﻧﮫ No ھﻮ SWM1. Is accumulated solid waste a problem? Yes

Designate d area د ﮐﻮر Outside HH ﻣﺸﺨﺼﮫ د ﺑﺎﻧﺪی ?SWM2. How do people dispose of their waste ﺳﺎﺣﮫ ﮐﯽ

SWM3. What is the normal practice of solid waste disposal for the affected refuse Compost pits دھﻐﮫ ﮐﻮرﻧﯿﻮ ﭼﮫ ﻋﺎدی ﭘﺮﮐﺘﯿﺲ د ?population

ﻧﮫ No ھﻮ Yes اﯾﺎ د اوﺑﻮ د وﺗﻠﻮ ﻣﺸﮑﻼت ﺷﺘﮫ ?SWM4. Is there a drainage problem

SWM5. Are water points and bathing areas well drained? ﻧﮫ No ھﻮ Yes

25 to %25> د ھﻐﻮ ﮐﻮرﻧﯿﻮ ﺗﻌﺪاد ﭼﮫ ﺻﺎﺑﻮ ن اﺳﺘﻌﻤﺎﻟﻮی H.1. Proportion of HH possessing soap <50%

H.2. Proportion of people washing hands with water and soap or substitute after 25 to %25> د ھﻐﻮ ﮐﺴﺎﻧﻮ اﻧﺪازه ﭼﮫ د ﻏﺎﯾﻄﮫ ﻣﻮادو ﺳﺮه د contact with faeces and before contact with food <50%

H.3. Access to appropriate bathing facilities None Limited ﻻس رﺳﯽ ﻟﯿﺮی

29 | P a g e to 25 د ھﻐﻮ ﮐﻮرﻧﯿﻮ ﺗﻌﺪاد (H.4. Proportion of HH that received an hygiene kit (last 12 months <25% %50> ﭼﮫ ﭘﮫ ﺗﯿﺮ ١٢ ﻣﯿﺎﺷﺘﻮ ﮐﯽ ﯾﯽ د ﭘﺎﮐﻮاﻟﯽ ﺑﮑﺴﮫ ﻣﻮﻧﺪﻟﯽ to 25 د ھﻐﮫ ﮐﻮرﻧﯿﻮ ﺗﻌﺪار ﭼﮫ د H.5. Proportion of HH where food is safely stored and prepared <25% %50> ﻏﺪای ﻣﻮادو ﺻﺤﯿﺢ ﺳﺎﺗﻨﮫ ﮐﻮی

اﯾﺎ د ﭘﺎﮐﻮاﻟﯽ ﭘﮫ اړه ﮐﻮم ﮐﺎﻣﭙﺎﯾﻦ H.6. Here is conducted any hygiene Campaign. If yes by who Yes No

H.7. HP sessions conduced on Menstrual hygiene Yes No ﻣﻌﻠﻤﻮﻣﺎﺗﻮ د ډﯾﺮواﻟﯽ ﮐﺎﻣﭙﺎﯾﻦ ﺷﻮی ؟

H.8. They have information on Menstrual hygiene Yes No ﻣﻌﻠﻮﻣﺎت ﻟﯿﺮی؟

H.9. Please inquire about WASH borne diseases in village. Please rank the top 3 1 2

30 | P a g e