Health, Hygiene, and Housing

Savar, Bangladesh

7% of total deaths in children under the age of 5 in Bangladesh in 2016 were caused by diarrheal disease.

3.5% of total deaths in Bangladesh in 2016 were caused by diarrheal disease.

Project Goal: Health, Hygiene, and Housing in Bangladesh aims to contribute to evidence that targeted household and community infrastructure improvements can reduce the burden of diarrheal disease.

Direct Beneficiaries: 166

Indirect Beneficiaries: 535,000

Cost per Home: $500

Homes Impacted: 57

Community Workshops: 7

Implementing Partners: Grimshaw Architects, Association of Development for Economic and Social Help (ADESH), BRAC University

Scale Up: ARCHIVE will be scaling up Health, Hygiene, and Housing by reflooring 150 more homes this summer.

Project Components:
An estimated 3 million children die each year from parasitic infections associated with diarrhea, malnutrition, and micronutrient deficiencies, and diarrheal disease is the second leading cause of death globally for children under 5 years old. Vulnerable communities in particular are subject to high risks of waterborne diseases linked with low-quality, substandard housing and sanitation infrastructure in addition to a lack of education on hygiene and disease prevention. In the region of Savar, many villages suffer seasonal flooding, which brings contaminated water and liquid waste flowing through roads, walking paths, and living environments.
In many homes, a wide range of daily activities are conducted on the primary floor, such as cooking, playing, and sleeping. In this environment, floors made of dirt are ideal carriers for bacteria that contribute to anemia, parasitic infestation, malnutrition, and diarrheal disease. Fecal matter in particular is difficult to detect and remove from dirt flooring and is the highest contributing factor to such illnesses, putting young children at high risk as they are more likely to involuntarily ingest fecal contaminants concealed in the floors.

In June 2014, with the support of ADESH (Association of Development for Economic and Social Help), ARCHIVE conducted the Health from the Ground Up pilot project directly reaching 130 people in Savar, Bangladesh. The project consisted of replacing dirt floors with cement flooring systems in 10 homes of children under 5, paired with health and housing training for 130 community members. Four months after the project implementation, beneficiaries had no recent episodes of diarrhea in their home compared to nearly 30% of homes who still had dirt floors, and households experienced an 85% reduction in average spending on medical costs. Immediately following the pilot project, 80% of people surveyed expressed interest in helping to support an expanded community program on flooring and health. The successful delivery of this pilot flooring project encouraged further application of this project in the cultural and social context of Savar. This pilot also provided a tested framework for the project’s construction timeline, strategies for the mobilization of individuals and households around the importance of health and hygiene, and finally our field partner’s capacity to successfully deliver large-scale community workshops. Beginning January 2018, ADESH, Gimshaw Architects, and ARCHIVE teamed up to replace 56 more dirt floors with concrete floors, using an innovative, low-cost, and sustainable flooring design.
ARCHIVE also teamed up with BRAC University, a private Bangladeshi university, to conduct research on the health impact of the change in flooring in the community. To understand the extent of endemic parasites and bacterial contaminants living on the ground of the homes, soil samples were taken from the dirt floors before the intervention and will be compared with samples taken after the intervention.


The following project activities will take place over a 6-month period:

  1. Replace dirt floors with new flooring systems in at least 55 homes as an innovative, high-impact, and sustainable solution for improved family health outcomes, especially for children under 5.
  2. Deliver beneficiary training on hygiene and health behaviors in the home to sustain long term impact of project.
  3. Design and implement 7 community awareness workshops.
  4. Deliver public awareness campaign through TV broadcast, public service announcements, and roundtable discussions

    with government and civil society stakeholders.


  1. Construction and training objectives show the multi-dimensional approach aimed at creating a long-term impact.
  2. Beneficiary participation through financial contributions and sweat equity create an increase in beneficiary buy-in, contributing to the long-term impact.
  3. Public service campaign to raise health and hygiene awareness community-wide and increase local demand for sanitation systems.
  4. Replicability of housing implementations ensures that the improvements can continue to be taught and implemented in surrounding communities by local stakeholders

These sustainability objectives will contribute to developing a self-sustaining local market which will continue to lower the burden of disease while raising the quality of housing and housing standards. The housing improvements will be low-cost/low-tech, creating visibility within the community and surrounding communities.

Project Components:

The project is built to confront the vital link between health, hygiene and housing. Complete substitution of dirt floors by cement floors in a house can lead to a 78% reduction in parasitic infestation, 49% reduction in diarrhea and 81% reduction in anemia. Replacing dirt floors with improved flooring systems is an innovative, high-impact solution for delivering disease reduction to children under 5 and long-term improvements in family health outcomes. Additionally, training beneficiaries on good hygiene and health practices can reduce diarrheal disease morbidity by 35% and is therefore a necessary component of achieving long-term impact in beneficiary homes. Finally, we argue that knowledge pertaining to the risks of disease and infection connected to housing must reside on the collective level since disease transmission often transcends the boundaries of the home. Public awareness will be delivered directly through community awareness workshops, multi-media broadcasts and roundtable meetings with influential government and civil society stakeholders.

Project Goal:

Within the landscape of development initiatives focused on disease control, this project is innovative in its unique housing-centered approach. “Health, Hygiene, and Housing in Savar Bangladesh” aims to further contribute to evidence that targeted household and community infrastructure improvements can reduce the burden of disease, particularly diarrheal disease, in Bangladesh. This goal is the foundation for a truly preventative intervention that is more culturally responsive, socially integrated, and more easily replicable at the local level than typical treatment-based approaches.

Project outcomes:

1. Reduction of diarrheal episodes in children under 5 of beneficiary families.

  • Indicators: lower levels of parasitic or bacterial contaminants detected in home post- intervention compared to pre- intervention levels, verified via soil sampling or other laboratory testing; fewer reported incidents post- intervention compared to pre- intervention reports, verified via survey items.

2. Beneficiaries able to identify correct strategies for preventing diarrheal disease in the home.

  • Indicators: number of beneficiaries able to identify strategies increases and/or number of strategies identified increases post- intervention compared to pre- intervention, verified via survey items.

3. Health literacy is improved in the community following health and hygiene workshops.

  • Indicators: workshop attendees able to identify at least 2 correct strategies following workshop, verified via post- workshop surveys or interviews.

4. Increase in local demand for health and hygiene home upgrades.

  • Indicators: number of community members requesting home upgrades increases post- project compared to pre- project, verified via community surveys or polls throughout project.

Implementing Partner:
Association for the Development of Economic and Social Help (ADESH)


Design Partner:

Grimshaw Architects


Health, Hygiene, and Housing was funded by ARCHIVE’s own fundraising initiatives. Support for ARCHIVE’s continued work in Savar, Dhaka came from United Bank of Switzerland.