Health from the Ground Up

Dhaka, Bangladesh

The converging pressures of global climate change and urbanization have a devastating effect on Bangladesh’s most vulnerable populations. At this moment, millions of people in the country are exposed to extremely high food and water-borne disease risks such as bacterial and protozoal diarrhoea, Hepatitis A and E, and typhoid fever. Bangladesh’s disease burden is further exacerbated by unsanitary living conditions that underscore the poor economic conditions of both urban and rural home dwellers. Sadly, these poor health outcomes disproportionately impact children under the age of five years, causing widespread morbidity and mortality; the second leading cause of death in children under five is diarrheal disease.

Deprivations in living standards such as flooring and sanitation contribute to nearly half of all multi-dimensional poverty experienced in Bangladesh. Therefore, ARCHIVE believes that simple housing improvements represent a unique solution that has the potential to have a large impact and create responsive and lasting changes in vulnerable communities.

To overcome the burden of unhygienic and unsanitary housing conditions among those most vulnerable to infectious diseases, ARCHIVE has collaborated with ADESH (Association for Development of Economic and Social Help) to establish a pilot-flooring project, Health from the Ground Up. The Health from the Ground Up initiative serves to replace dirt/mud floors with concrete flooring in Bangladeshi homes and, through this intervention, target a major transmission pathway for gastrointestinal and parasitic pathogens.

Project Beneficiary Demographics:

· The mean monthly income for an average household of 7 people is $130 USD/month (Less than $4.30 per day!)
· The average home in the Nayapara and Panpara communities is 389 square feet.
· The houses have an average of 7 people.
· 60% of the households reported that at least one of their young children had recently suffered from diarrhea.

Household Selection Criteria:

In order to be selected for a flooring replacement project, each household must meet the following criteria:

· Have at least one child less than five years old living in the home.
· At least one woman deemed “poor and destitute” must live in the home.
· Must be located in a rural or semi-urban village.
· Must have a mud or dirt floor as the primary floor of the house.
· The house floor measurement does not exceed 350 sq ft.
· Agreement for at least one household member to participate in construction.
· Ownership of the house.

Design Rationale:

Although flooding during monsoon season (June – October) is typical, recent changes in the climate in Bangladesh has resulted in more frequent and intense periods of flooding and high levels of humidity. Humidity provides a prime environment for bacteria to grow and survive while heavy rains intensify the spread of bacteria.

In combination with open defecation and commonly backed-up sewer systems, fecal bacteria and other diarrhea-causing bacteria tend to thrive during the monsoon season. Consequently, diarrhea related hospital visits often reach new all-time highs during monsoon season.

A combination of low-cost and local construction materials: sand, brick, and concrete, are used to replace dirt floors.

The flooring design adds at least 20-30 inches to the foundation of a home and a 10-inch thick brick retaining wall, which provides significant protection for flooding and the spread of bacteria from flood waters.

The concrete finish provides an impenetrable barrier to disease. It is easy to clean and maintain, and can last for decades with minimal care.

Construction Details:

Upon selection and funding, each home will undergo a one week construction period. This includes 4 days of construction, and 3-4 days to allow concrete to fully dry.

The existing mud/dirt floors are partially excavated and then filled with layers of sand, brick, crushed brick and sand mixture and topped with concrete and a red oxide finish. A brick retaining wall is built around the outside of the home to protect the foundation and floor. This provides a solid and durable foundation, and a smooth, impermeable concrete finish.

Each house renovation is lead by a head mason and is supported by hired assistants and at least one household member who subsequently is trained in basic construction skills.

Project Achievements:

· Over a period of just 2 weeks, 70 people, including 13 children under the age of 5 years, received cement floors and 140 community members participated in 2 health training sessions.
· One or more members of each of the 10 pilot households assisted in the construction process.
· ARCHIVE Global, ADESH, and the families are ready to do more, collaborating with the public to complete 500 more homes and positively impact the health of 1000 kids.
· With the first round of houses completed, families in the community are collaborating with ARCHIVE and ADESH to prepare for expanding health benefits to every child in the community.

Health and Socioeconomic Impacts:

· In the 4 months after installing the floors, none of the households reported recent episodes of diarrhea, compared to 27% of households with dirt floors.
· 4 months after the completion of the renovations and community training, 95% of trainees were able to name one of more practices to prevent diarrhea disease transmission.
· On average, Hindu women in Bangladesh spend 6-8 hours per week cleaning their floors. Women who received new concrete floors through HGU now spend an average of 1 hour per week cleaning their floors.
· Our surveys show that average spending on medications was reduced by over 85% in families with concrete versus dirt floors.

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

Health from the Ground Up was funded by ARCHIVE’s own fundraising initiatives. Support ARCHIVE’s continued work in Savar, Dhaka through the High Fives Campaign.