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Cox’s Bazar WASH Sector Hygiene Promotion Strategy Guiding Framework

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Manual and Guideline
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1. Introduction

This section aims to provide a general brief background of the Rohingya WASH response, its gender aspects as well as to present the main public health risks affecting camps and host communities.

WASH brief context

Access to water

54% of refugees in the camps are accessing chlorinated water through piped distribution networks. 102 water networks are finalized and other 68 are under construction at the moment. Communities in camps rely as well on a high number of deep or shallow tube wells. Analyzing the water quality results from 2020, the 88% of sampled water sources (including production boreholes, tap stands and tube wells) are free from contamination. At HH level, however, 20% of the sampled water shows some form of bacteriological contamination .

Notwithstanding some water shortages during dry season (January-May), especially in Teknaf area, the recent Multi-Sector Needs Assessment (MSNA) reported that 88% of households consider having enough water to meet all domestic necessities. Disparities, however, persist; for example, in host communities, only the 77% of the population reported accessing enough water according to their needs.

Access to sanitation

Despite 84% of households reporting using pit latrines in the camps and acceptable quantitative standards reached (18 persons per latrine and 37 persons per bathing cubicle), many qualitative challenges remain with 22% of sanitation infrastructures requiring O&M. Sanitation coverage remains challenging due to lack of space in the camps with the highest density (e.g.: 1E, 1W, 2E, 2W, 3, 9, 1012). Use of toilets, especially by women, girls is a constant challenge13: many reports have underlined the persistent risks of accessing sanitation facilities because of lack of privacy, gender segregation or related to GBV risks accessing latrines and bathing areas. This is considered being one of the main reasons why the 68% of households reported having a private space inside or attached to their shelter for bathing but those bathing places sometimes associated with laundry (56%) and dishwashing places (52%).

Those makeshift sanitation installations if, from one side represent a GBV preventive measure, at the same time can be identified as potential public health risks, especially if those are used for defecation purposed (there are anecdotal reports but not systematic analysis/research on this topic). With 500 cubic meters of solid waste produce daily in the targeted area, SMW remains one of the main challenges as only 51% of the refugee households are disposing waste in designated area and 27% are reporting the presence of garbage near their houses.

Hygiene promotion

Hygiene promotion effectiveness has been improving a lot in the last 3 years, moving from an “emergency mode”, focused on messaging and distribution of hygiene items, towards a community engagement approach.

However, there is a clear asynchrony among different implementing partners in terms of understanding and implementing effective community engagement mechanisms (already flagged by S. House). This is due to a series of reasons, laying mainly in uneven capacities and resources, prioritization given to water and sanitation programming as emergency response in the first years, limited understanding of what community engagement and inclusion really mean, language barriers among national staff and Rohingya volunteers impacting knowledge transmission and capacity building, limited efforts to engage women and other under-represented parts of the communities in the programming.

Recent MSNA study suggests that appropriated hygiene practices remain low even though progress has been observed partly due to fear from COVID-19 and focus on hand-washing promotion: indeed, 98% of the refugees increased handwashing practices since the COVID-19 outbreak.However, knowledge and practices like handwashing before feeding a child/breastfeeding or after scooping children feces appear to be still low. Similarly, menstrual hygiene awareness is poorly prioritized.

WASH partners have also expressed the need to better cooperate with relevant sectors such as Nutrition, CWC, Education, to enhance the impact of hygiene promotion activities towards behavior change.

Regarding community engagement structures, such as WASH committee, MHM Groups/Committees, latrines committees/latrines’ users’ group, youth committees and all the various committees’ and groups partners have established to ensure O&M of WASH facilities, members are not supposed to be subsidized. Those committees should ensure sustainability of WASH interventions and, as such, run on voluntarily participation and community engagement.

For communities to be able to practice correct hygiene behavior, availability of basic hygiene items should be granted; at the beginning of 2020, the WASH SAG has validated the minimum standard for hygiene kits and MHM kits.