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RESEARCH ARTICLE
Institutional capacity assessment in the lens
of implementation research: Capacity of the
local institutions in delivering WASH services
at Cox’s Bazar district, Bangladesh
Mahbubur RahmanID
1
*, Mahbub-Ul Alam
1
, Sharmin Khan Luies
1
, Sharika Ferdous
1
,
Zahidul Mamun
2
, Musarrat Jabeen Rahman
3
, Debashish Biswas
1
, Tazrina Ananya
4
,
Asadullah
1
, Abul Kamal
1
, Ritthick Chowdhury
5
, Eheteshamul Russel Khan
5
,
Dara Johnston
6
, Martin Worth
7
, Umme Farwa Daisy
1
, Tanvir AhmedID
4,8
1Environmental Health and WASH, Health System and Population Studies Division, icddr,b, Dhaka,
Bangladesh, 2WASH Section, UNICEF, Cox’s Bazar, Bangladesh, 3Johns Hopkins Bloomberg School of
Public Health, Baltimore, Maryland, United States of America, 4International Training Network (ITN),
Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh, 5Department of Public
Health Engineering (DPHE), MOLGRD&C, Dhaka, Bangladesh, 6WASH Section, UNICEF, Juba, South
Sudan, 7WASH Section, UNICEF, Port Moresby, Papua New Guinea, 8Department of Civil Engineering,
Bangladesh University of Engineering and Technology (BUET), Dhaka, Bangladesh
*mahbubr@icddrb.org
Abstract
Background
The influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal
district of Cox’s Bazar with one of the greatest contemporary humanitarian crises, stressing
the existing water, sanitation, and hygiene (WASH) resources and services. This study
aimed to assess the existing capacity of local institutions involved in delivering WASH ser-
vices and identify relevant recommendations for intervention strategies.
Methods
We used a qualitative approach, including interviews and capacity assessment workshops
with institutions engaged in WASH service delivery. We conducted five key informant inter-
views (KII) with sub-district level officials of the Department of Public Health Engineering
(DPHE), Directorate General of Health Services (DGHS), Directorate of Primary Education
(DPE) and Bangladesh Rural Advancement Committee (BRAC) to have a general idea of
WASH service mechanisms. Seven capacity assessment workshops were organized with
the relevant district and sub-district level stakeholders from August 2019 to September
2019. These workshops followed three key areas: i) knowledge of policy, organizational
strategy, guidelines, and framework; ii) institutional arrangements for service delivery such
as planning, implementation, coordination, monitoring, and reporting; and iii) availability and
management of human, financial and infrastructural resources. Data were categorized
using thematic content analysis.
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OPEN ACCESS
Citation: Rahman M, Alam M-U, Luies SK, Ferdous
S, Mamun Z, Rahman MJ, et al. (2024) Institutional
capacity assessment in the lens of implementation
research: Capacity of the local institutions in
delivering WASH services at Cox’s Bazar district,
Bangladesh. PLoS ONE 19(2): e0297000. https://
doi.org/10.1371/journal.pone.0297000
Editor: D. Daniel, Gadjah Mada University Faculty
of Medicine, Public Health, and Nursing:
Universitas Gadjah Mada Fakultas Kedokteran
Kesehatan Masyarakat dan Keperawatan,
INDONESIA
Received: July 6, 2023
Accepted: December 22, 2023
Published: February 13, 2024
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication of
all of the content of peer review and author
responses alongside final, published articles. The
editorial history of this article is available here:
https://doi.org/10.1371/journal.pone.0297000
Copyright: ©2024 Rahman et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Results
The majority of stakeholders lacked awareness of national WASH policies. Furthermore,
the top-down planning approaches resulted in activities that were not context-specific, and
lack of coordination between multiple institutions compromised the optimal WASH service
delivery at the local level. Shortage of human resources in delivering sustainable WASH ser-
vices, inadequate supervision, and inadequate evaluation of activities also required further
improvement, as identified by WASH stakeholders.
Conclusion
Research evidence suggests that decision-makers, donors, and development partners
should consider learning from the WASH implementers and stakeholders about their exist-
ing capacity, gaps, and opportunities before planning for any WASH intervention in any par-
ticular area.
Introduction
Despite having the burden of high population density, Bangladesh has attained steady progress
in ensuring access to improved safe water and sanitation facilities in the past decade [1,2].
However, the south-eastern coastal district of Cox’s Bazar is one of the most historically under-
performing districts in Bangladesh in terms of access to water and sanitation practices and facil-
ities, human development index and child and gender inequities indicators [3]. In August 2017,
there was an influx of more than seven hundred thousand people in Cox’s Bazar, who fled from
Myanmar, and until October 2022, a total number of 943,000 Forcibly Displaced Myanmar
Nationals (FDMNs) took refuge around the south-east region of the district, especially in the
Ukhiya and Teknaf Upazilas [4,5]. This resulted in a humanitarian emergency that continues
to stress the resources and coping capacity of the local communities and systems until today [6].
This might have affected the developmental progress regarding water, sanitation and hygiene
(WASH) service requirements of the overall district of Cox’s Bazar [7,8].
Improving the public health situation by providing WASH service to the population of the
relevant Upazilas throughout the district is critical for the WASH Sector at Cox’s Bazar. To
achieve the goals pertaining to public health, including the preventive and promotion compo-
nents of health for Universal Health Coverage, appropriate WASH services must be made
available in all contexts (such as homes, communities, workplaces, schools and to all people)
[9]. However, failure to recognize governance’s influence on the availability and accessibility
of WASH services and infrastructure hinders progress toward better WASH service delivery
[10]. Robust institutions with the capacity to prioritize WASH services are crucial. Assessment
of such institutional capacities are required in understanding the dimensions of WASH service
coverage for analysing the factors influencing the provision of WASH services [11]. Such
assessments could provide an insight into the gap between physical infrastructure and inter-
nalization of sanitation and hygiene habits, the quality and quantity of WASH services, the
availability of sustainable water supplies, operation and maintenance related challenges, and
health-related repercussions of low quality WASH services [11]
In Bangladesh, the Department of Public Health Engineering is the national lead agency for
drinking water supply, sanitation and waste management other than the areas in which Water
Supply and Sewerage Authority (WASA) operates [12]. WASH services are provided and
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Data Availability Statement: Due to research
ethics (data confidentiality), the data investigated
during the current study are not made publicly
accessible, however they are available from the
corresponding author upon justifiable request.
Additionally, ICDDR,B data policy supports the data
availability upon request. Request for ICDDR,B
research data should be addressed to Ms. Shiblee
Sayeed, Senior Manager of Research
Administration, at shiblee_s@icddrb.org.
Funding: Initials of author who received award: MR
Grant number awarded: GR-01809 Full name of
funder: United Nations Children’s Fund URL:
https://www.unicef.org/ Funder’s role: YES.
Contributed substantially to conception and design
of this study.
Competing interests: The authors have declared
that no competing interests exist.
maintained in the Cox’s Bazar district by DPHE and other Local Government Institutions
such as the Health and Family Planning Departments, Primary and Secondary Education
Departments, in accordance with their specific areas of responsibility [13] However, these
institutions are struggling to provide adequate services due to a lack of robust planning, coor-
dination and feedback mechanism, as well as resource constraints, both human and financial.
Additionally, local government, the private sector, WASH service providers, and community
leaders lack awareness of the national policies, plans, and frameworks concerning water and
sanitation, which further hinders the implementation of WASH service delivery [13]. Hence,
we conducted a WASH related institutional capacity assessment of organizations engaged in
delivering WASH services in Cox’s Bazar district. Findings from this research can not only
improve the institutional capacity of organizations in Cox’s Bazar but can also inform develop-
ment strategies in other districts of Bangladesh to enhance the overall WASH service of the
country in order to achieve the SDGs target 6.2 and 6.3.
Methods
Study setting and participants
Following the discussion with our main collaborators, the Department of Public Health Engi-
neering of Cox’s Bazar district and UNICEF (donor), we identified the key institutions and the
officials for the assessment considering their involvement in Upazila Water and Sanitation
(WATSAN) Committee. A convenient sampling method was used to identify potential partici-
pants from those institutions. Participants were contacted by directly visiting or through
emails, letters, and phone calls. Efforts were made to engage all relevant institutions consider-
ing their organizational hierarchy, distinct principles, and accountability. Upazila-level offi-
cials from the respective institutions were invited to participate along with the district-level
officials.
Data collection
A team of anthropologists that included one assistant scientist, a senior research officer and 6
research assistants who have qualitative research experiences performed the qualitative assess-
ment. The assistant scientist led to implementing the overall assessment and all were involved
in data collection, analysis and interpretation. Having a team of researchers would minimize
the possibility of biasness, and such a team would also be able to handle the high volume of
data better.
Key informant interviews. We began by conducting five key informant interviews with
officials from three government organizations which were DPHE, DGHS and DPE, as well as
non-government organizations, to get a preliminary understanding of WASH service mecha-
nisms at the sub-district or Upazila level. These key informants also assisted us in identifying
other potential WASH stakeholders from NGOs and other private sectors, as well as guided
our approach and key discussion areas of the capacity assessment. KIIs were conducted and
audio-recorded after obtaining written informed consent from the participants.
Workshops. Then, we conducted seven capacity assessment workshops during August-
September 2019, with personnel from other government, non-government and private organi-
zations engaged in WASH-related activities in Cox’s Bazar (Table 1). The government organi-
zations included DPHE, DPE, DSHE (Directorate of Secondary and Higher Education),
DGHS, DGFP (Directorate General of Family Planning), LGIs such as Upazila Parishad and
Union Parishad. The non-government organizations included were BRAC, Dushtha Shasthya
Kendra (DSK), the Village Education Resource Center (VERC), iDE, formerly known as Inter-
national Development Enterprises) and private organizations included were RFL, Gazi Tanks,
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National Polymer and Bengal Plastic. We ensured participation of all designated officials and
stakeholders from each Upazila. Nominated alternatives were present in case of the absence of
any participants.
The workshops were led by an experienced moderator with knowledge of the local lan-
guage. A guideline was prepared in Bengali to support facilitation and later translated into
English for documentation. The guideline was generated to identify institutional capacity fac-
tors, such as: i) knowledge of policy, organizational strategy, guidelines, and framework, ii)
institutional arrangements for service delivery such as planning, implementation, coordina-
tion, monitoring, and reporting, and iii) availability and management of human, financial and
infrastructural resources.
Each workshop consisted of only participants from one institution. This allowed the partici-
pants to speak freely and avoid conflicting opinions about their collaborative work. The ses-
sions were audio-recorded with verbal consent from the participants to avoid missing or
misinterpretation of data. Moreover, two team members took detailed notes and listed major
points on flipcharts. The duration of each workshop was approximately 2–3 hours.
Data analysis
The team prepared transcripts by summarizing the data from notes and audio recordings
shortly after each interview and workshop. A coding framework was developed using the key
components of institutional capacity assessment as broad themes and underlying questions as
sub-themes which was discussed and agreed upon with the wider study team before analysis.
Elements of these broad themes and sub-themes were then extracted from the data by two
team members trained in qualitative research methodology. The method of thematic analysis
was employed, which helped to identify, analyze, and interpret the patterns of meaning within
the qualitative data. Fig 1 shows the institutional capacity assessment data collection and analy-
sis process.
Results
Local institutions and programs related to WASH service delivery in Cox’s
Bazar
DPHE is the national agency for water sanitation and hygiene initiatives and provides services
in both urban (except in the four areas where Water Supply and Sewerage Authority supports)
and rural areas. DPHE provided WASH infrastructure and services at the district level, such as
Cox’s Bazar. DPHE also coordinates with DGHS, DGFP, DPE, DSHE, and LGIs) such as Upa-
zila Parishad and Union Parishad, to support the WATSAN Committees. WATSAN Commit-
tees are established by the Government of Bangladesh at all administrative levels—district,
Table 1. Participants of the capacity assessment workshops and KII.
Institutions Number of participants in the workshop Number of participants in the KII
Department of Public Health Engineering 12 2
Directorate General of Health Services 18 1
Directorate General of Family Planning 17 0
Directorate of Primary Education 15 1
Directorate of Secondary & Higher Education 12 0
Union Parishad 14 0
NGOs/Civil Society 14
Private sector representatives, dealers, and entrepreneurs 3 1
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sub-district, unions, and wards to ensure safe water supply, sanitation, and development of
personal health care for the community people. These committees comprise the respective dis-
trict, sub-district, union and ward-level officials and representatives from DGHS, DGFP, DPE,
DSHE, and other LGIs, as illustrated in Fig 2.
The Union WATSAN committee includes respective frontline workers from DGHS and
DGFP, the Headmaster or any teacher of Primary and Secondary Schools, all Union Parishad
Members, the Union Parishad Secretary, Tubewell Mechanic of DPHE, a religious leader and
an NGO representative (if available). The Union Parishad Chairman acts as the Chairman of
that Union WATSAN committee. The Upazila WATSAN Committee and other respective
WATSAN Committees coordinate to ensure improved WASH facilities and promotion activi-
ties in their jurisdiction. Upazilas or Union Parishads are referred to as a body of people
elected to manage the affairs of an Upazila or union level.
Other than the WATSAN committees at different administrative levels, other committees
coordinated or managed institutional activities in many ways. Standing and School Manage-
ment Committees (SMC) are important to mention among them. Standing committees were
formed to support the Union Parishad in planning and implementing services on different
issues such as education, health, family planning, social welfare and disaster management,
agriculture etc., with transparency, accountability, and people’s participation. The SMCs
engage local people to monitor school management to ensure the development activities of the
school. Upazila-level officials from DPE and DSHE guide headteachers and SMCs to ensure
safe drinking water for the students. DPHE allocates budget and constructs WASH blocks in
Primary Schools under the Primary Education development program-4 (The government’s
flagship initiative in the education sector for FY2019–FY2023) [14]. WASH blocks are gender-
segregated, safely-managed sanitation facilities or latrines with running water sources. In addi-
tion, the School Learning Improvement Plan (SLIP) initiative provides modest funds to
Fig 1. Flow chart of institutional capacity assessment through workshops.
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schools to manage and implement activities according to their own identified needs to
improve the quality of education at the school level. DPHE also constructs WASH blocks in
cyclone shelters. A cyclone shelter is an elevated building providing security from disasters
such as cyclones and associated storm surges. Most cyclone shelters in Bangladesh are elemen-
tary schools [15].
In Bangladesh, community clinics and family welfare centers (under DGHS and DGFP,
respectively) in rural areas provide primary-level healthcare and family planning services to
the community. Although constructing WASH facilities in community clinics and family wel-
fare centers is not linked with DPHE or WATSAN committees, DPHE’s responsibility for
water supply indirectly affects the construction works at the community clinics and family wel-
fare centers.
NGOs have their priorities and goals of service delivery as per donor requirements, which
are time- and area-limited and may differ from the Government Institutions’ responsibilities;
however, NGOs usually offer their services by co-coordinating and collaborating with LGIs.
Private sector representatives, dealers and entrepreneurs manufacture and sell sanitation prod-
ucts based on the choice, customers’ budget, or economic status. In some cases, they work
jointly with Union Parishad and NGOs, maintaining a private-public partnership to work
towards hygiene promotion as a part of their marketing policy. Some NGOs (e.g., BRAC) pro-
vide loans to dealers to manufacture specific sanitation products and to sell those products in
the open market. The institutional responsibilities of the active organizations in the context of
Cox’s Bazar are provided in Table 2.
Fig 2. Structure of Upazila WATSAN committee.
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Table 2. Institutional responsibilities on drinking water supply, sanitation and hygiene.
Institutions Key responsibilities
Drinking water supply Sanitation Hygiene
Department of Public Health
Engineering (DPHE), Local
Government Division,
MOLGRD&C
◾DPHE ensures clean water, establishing
iron and arsenic removal plants.
◾DPHE identifies underprivileged
populations and unsuccessful areas, where a
safe water layer is unavailable.
◾DPHE allocates water sources as per
demand and installs them at community
and primary schools.
◾Coordinate and maintain liaison with the
Upazila Administration, Upazila Parishad,
Union Parishads and other relevant
government and non-government
organizations.
◾Test water quality during installation.
◾Assist community people/education
institutions to repair water sources.
◾DPHE allocates budget and constructs
WASH block in Primary Schools under
PEDP (Primary Education development
program)-4.
◾Facilitates and organizes sanitation-
month observation program with the
participation of different organizations.◾
DPHE has Water Supply and
Environmental Sanitation Project (Phase-
2)
Facilitates and organizes hand hygiene
related programs with the participation of
different organizations.
Directorate of Primary
Education, Ministry of
Primary and Mass Education
◾Department of Primary Education guides
Head Teacher and School Management
Committee (SMC) to ensure safe drinking
water for the students.
◾Monitors construction work of WASH
block, toilets, and water supply system in
the schools.
◾Provides budget for WASH block repair
and maintenance to the schools.
◾Monitors to ensuring the cleanliness of
school toilets, WASH blocks and
availability of soap and water by the school
authority.
◾The Department of Primary Education
(i.e., Upazila Education Officers and
Upazila Assistant Education Officers) guide
Head Teacher and SMC about WASH
activities along with other hygiene issues.
◾Support to organize day observations
events at schools.
Directorate of Secondary
and Higher Education,
Ministry of Primary and
Mass Education
◾Department of Secondary Education
guides Head Teacher and Chairman of
School Management Committee (SMC) to
ensure safe drinking water for the students.
◾Monitor WASH facilities to keep clean,
hygienic and functional and conduct
feedback session according to the
identified situation.
◾Follow-up about the fund-raising of own
institution and its use in the cleaning of
WASH facilities.
◾Ensure disseminating WASH-related
message during the assembly session.
◾Ensure cleaning of school premises every
Thursday at every school.
◾WASH issues are discussed during
meetings of school management
committees.
Directorate General of
Health Services, Ministry of
Health and Family Welfare
◾Ensure safe drinking water in HCF
through Health Engineering Department
(HED).
◾Ensure sanitation facilities in HCF
through Health Engineering Department
(HED).
◾Sanitation Inspectors motivates
community people about hygiene and
conduct regular meetings on hygiene issues
at the marketplaces.
◾Monitor waste management at
marketplaces including slaughterhouse and
fish markets. In addition, they monitor
food safety and hygiene of food courts and
food shops.
◾Health staff are supposed to discuss
WASH issues during routine Expanded
Program on Immunization (EPI) sessions;
however, this is often overlooked due to the
workloads of EPI.
Directorate General of
Family Planning under the
Ministry of Health and
Family Welfare
◾Family Planning staff conducts
handwashing sessions with the students at
secondary schools.
◾Conducts courtyard meetingsabout
personal hygiene (one per union per
month).
Local Government Institutes
(Upazila Parishad)
◾Upazila Parishad engaged with the Union Parishads and other national organizations under its jurisdiction to coordinate water,
sanitation, hygiene, and waste management initiatives.
Local Government Institutes
(WATSAN Committee)
◾The union level WATSAN committee is responsible to implement and monitor WASH activities in union level. Union Parishad in
collaboration with Upazila Parishad and other national agencies is mandated to coordinate those activities.
(Continued)
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WASH conditions in the context of Cox’s Bazar
Participants reported inadequate WASH practices in public areas, marketplaces and commu-
nity clinics. For example, a few participants expressed that people are less aware of personal
hygiene, and some do not use soap for regular handwashing due to poor economic conditions.
For instance, in one union, participants from the LGI reported that half of the population used
soap after using latrines, and some did not practice handwashing at five critical times during
the day. About fecal sludge management, DGFP participants mentioned that many latrines
overflow during floods and people practice manual emptying and open disposal of fecal sludge,
which causes an unhealthy environment for all. Participants from both DPHE and DGFP
reported that unclean toilets and the lack of gender-segregated toilets in cyclone shelters pre-
vented many people from using them. This maintenance problem is also revealed in one of the
Bangladesh Government projects (Ashrayan Prokolpo), where disadvantaged poor people
from different places take shelter. Mentioning the situation from a particular Upazila, one key
informant stated that each Ashrayan project accommodates about 120 families, with two toi-
lets for every six families and separate bathing facilities. However, the users struggle with
proper maintenance and cleaning of the toilets. As a result, the toilets become unusable
quickly. Lack of proper coordination and appropriate budgeting for maintenance, inadequate
design provisions against disaster (e.g., placing the WASH facility below flood level), lack of
consideration for water quantity and quality (e.g., unavailability of running water, absence of
Iron Removal Plant) and poor construction materials have rendered most of the WASH blocks
damaged or unusable, as reported by the Primary School Officials.
Participants from DGHS and DGFP mentioned that they face problems in maintaining and
renovating WASH facilities at the many community clinics and family welfare centers because
they do not have a running water supply and electricity. DGFP participants mentioned that
about 20% of their family welfare centers have no running water supply. Also, there is no
maintenance plan for WASH facilities at the family welfare centers and due to the lack of
proper cleaning and maintenance, DGFP own study findings showed that nearly 40–50% of
facilities are unhygienic. DGHS participants mentioned that approximately 90% of tubewells
at the community clinics are not functional. They added that they do not get water from the
tubewells in the hilly areas since the groundwater levels have declined.
DPE participants mentioned that many WASH blocks in Pekua, Kutubdia and Chakaria
Upazila constructed during 2013–2015 were not functional due to the unavailability of electric-
ity and running water supply. High concentration of iron in the water also leaves a stain in the
sanitary ware, damaging the WASH blocks. They also mentioned that consideration of the
flood level for constructing WASH blocks is important and should ensure good quality con-
struction materials for WASH blocks for the longevity of those facilities. Lack of menstrual
hygiene management (MHM) facilities at school toilets may have been a reason behind the
absence of female students during menstruation, as attributed by DSHE participants.
Table 2. (Continued)
Institutions Key responsibilities
Drinking water supply Sanitation Hygiene
NGOs and Private Sectors ◾Different NGOs in Cox’s Bazar works in Rohongya camps and host communities to support water, sanitation, and hygiene activities.
This includes free materials for construction of latrine, emergency WASH services, hygiene campaigns, menstrual hygiene management
support etc.
◾Different NGOs and private sector program offers different product variations of the latrine solution: i) Sato Pan, ii) a slab for a direct
pit (SanBox), iii) the pan and a slab for an offset pit (Sanbox). NGOs train local entrepreneurs to meet demand for sanitation products.
One NGO (IDE) also created Sato pan upon teaming up with RFL Plastics Ltd (a private company).
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Private sector participants mentioned that there is inadequate availability of need-based
sanitary ware or products that are appropriate for different geographical contexts. Also, people
are unaware of quality or sustainable products; for example, plastic slabs are less durable than
ceramic slabs, but considering cost, people buy less sustainable products. Therefore, local
entrepreneurs and private sectors may collaborate to ensure quality products at a low cost.
Knowledge of policy, organizational strategy, guidelines, and framework
Bangladesh has several national policies, plans and strategies related to water supply, sanita-
tion, and hygiene. Our findings revealed that most participants had not heard about those poli-
cies and were unaware of their roles and responsibilities. For instance, one participant
explained the policy in the following manner
’Policies include ensuring clean water,managing advanced sanitation system,plant for
removing arsenic and iron from water.’
Another participant explained that they identify poor and unprivileged people through
locally elected members and then provide latrines or tube wells. However, he remained unsure
about any clear guidelines regarding this. Representatives from other government institutions
(DGHS, DGFP, DPE, DSHE and LGIs) also could not mention the institutional policy, strat-
egy, organizational mandates, and regulatory framework that support delivering WASH ser-
vices at their level. However, they all acknowledged the necessity of training in this regard.
Although private sector participants mentioned receiving ’hygienic latrine’ training from
NGOs, most of them never received any training or guidelines from the government on other
WASH issues such as iron and other pollutant-free safe drinkable water and sustainable and
environment-friendly sanitation products.
Inadequate consideration of bottom-up feedback
DPHE local teams implement programs after consultation with Upazila Executive Officer and
local government institutions as per their allocation received from the DPHE Head Office.
Every year Union Parishad chairmen collect information through their respective Union Par-
ishad Members at the ward-level WATSAN committee. Similarly, the Upazila WATSAN com-
mittee collects information from all Union Parishad Chairmen, informs the district WATSAN
committee, and later gives the compiled demand to DPHE, but when DPHE allocates, it does
not match the bottom-up recommendation. Besides, the allocation procedure deprives mar-
ginalized people of becoming beneficiaries of the intervention. A key informant mentioned:
’We usually receive the allocation for construction of tubewells in this Upazila 3 times a year
from the ’Polly Onchole Pani Sorboraho Prokolpo’ (Village Water Supply Project) and is dis-
tributed through the Upazila WATSAN committee.50% of this allocation is received by the
Upazila Chairman and 50% by the local Member of Parliament (MP).’
The participant mentioned that the budgeting system must be changed, adding that:
’Around 40% should be decided by the MPs,40% by the WATSAN committee members,and
the rest 20% should be kept preserved for the demand from the institutions itself,to decide’.
Also, this type of top-down approach suggested for the budgeting system is not always con-
text-specific. For example, different areas have different requirements. In certain areas of the
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district, decreasing groundwater levels and high concentrations of iron and salinity in surface
and groundwater were reported as key challenges. Another key informant mentioned that
there are some areas with a high concentration of iron, stating that:
’If an iron treatment plant or water plant can be set up in different union parishads and piped
networking system can be ensured for water supply,that will be an effective step.Also,purified
surface water should be used,and constant running water sources should be closed to stop
wasting natural sources and avoid water scarcity in the future.’
Insufficient coordination between organizations
There is absence of effective coordination among DPHE and other members of the WATSAN
committee. Meetings are not arranged regularly. Although Upazila WATSAN committee
meetings are supposed to be organized once every two months, they are arranged only in cases
of emergencies and priority issues. One key informant mentioned that yearly only one or two
meetings of the WATSAN committees are organized. Since the members of this committee are
regularly connected for work purposes, he thinks the work is usually done properly even if
there is a lack of regular meetings held by the WATSAN committee.
We found inadequate coordination between the Upazila and Union WATSAN Committees
or Union Standing Committee. In a workshop, a few participants reported that,
’Lack of coordination between WATSAN and standing committees hamper taking effective
measures for WASH facilities.To make it more effective at the Upazila and union levels,a few
members could form a new committee that is only responsible for monitoring WASH services.
Since the WATSAN committee is mainly responsible for WASH,this committee should be
activated to make it more accountable and effective in carrying out coordination meetings.
Monthly meetings need to be arranged at both Upazila and union levels.’
Participants mentioned that the lack of inspection for waste management in marketplaces,
such as fish markets and slaughterhouses, makes these places unclean and unhygienic. Partici-
pants also reported that the lack of coordination between the Upazila WATSAN committee
and SMC has affected the implementation of WASH activities at secondary education
institutes.
The local Government has no separate or specific WASH reporting and monitoring system
for Union Parishad. Despite the fact that Union Parishad and DPHE work collaboratively,
there are no operations or monitoring systems that are systematically designed to ensure the
sustainability of infrastructure.
Since there are no systematic arrangements for quality assessment from the government or
NGOs, some local traders or entrepreneurs profit from selling low-quality sanitary ware or
products (e.g., toilets and basins). The entrepreneurs recommended training, provision of
loans with low-interest rates, and quality assurance mechanisms for attaining quality WASH
products in the market.
Inadequate resources (human resources, financial resources and
infrastructural resources) hampered WASH service delivery
DPHE has representation at the national and sub-national levels to ensure WASH services.
However, DPHE participants mentioned that due to the high influx of Rohingya refugees in
Cox’s Bazar, there is a shortage of manpower to work in the host community of Ukhiya and
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Teknaf Upazila. In the district, optimal service delivery is hampered due to less skilled human
resources and inadequate financial resources. One participant mentioned that to increase the
skills of the mechanics, they need to be trained on issues such as appropriate places for tube
wells to be installed, the water level, suitable technologies etc. Inadequate financial resources
for transport costs and technical logistics supply are other constraints for optimal WASH ser-
vice delivery. DPHE receives the same amount of allocation for transport allowance of their
staff for all Upazilas. This amount is often inadequate for larger Upazilas, such as Chakaria
having 18 unions.
DPHE mentioned lack of transport support sometimes hampered their regular activities
and made them unable to render the services at remote unions on time. They mentioned that
they can make a specific number of limited visits in a year to a remote area due to a limited
budget, and for these visits, they do not get any vehicle support. One key informant
mentioned,
’vehicles’ should be arranged for the mechanics of this office (Upazila DPHE).There is an
allowance of BDT 5,000 for such travel,which is divided among four mechanics.This alloca-
tion is insufficient,so often these mechanics must go to different places at their own expense,
making it impossible for them to work well’.
Another key informant revealed that in some remote areas, such as in Ramu Upazilla, deep-
layer digging is required for deep tubewells. However, the DPHE cannot provide the appropri-
ate technology, such as submersible pumps or drilling equipment, to install such tubewells due
to the absence of electricity in areas such as Gorjonia. Sometimes they can manage the electric-
ity through generators, which results in high costs. In addition, some areas of Teknaf and
Ukhia Upazila of Cox’s Bazar have an excessive rocky layer where installing tubewells is inap-
propriate, and alternative ways, such as pipelined water supply system, need huge investments
and bigger plans. DPHE participants also mentioned that rocky layers make it difficult to
install deep tube wells, and there is not enough budget for cutting or drilling through those lay-
ers. One participant from DPHE mentioned that the budget allocation should be increased for
the hilly areas according to the rate of hilly areas. Regarding implementation challenges by the
private contractors and mechanics, one key informant mentioned that,
’Contractors and mechanics are not government staff but are rather ’private’ workers.They
often do not want to go to work in some ’hard-to-reach’ areas like Gorjonia and Kocchopia.
To hire them,they need to pay some extra ’tips’,which also raise the overall cost of the
installation’.
In general, budgets are prepared using a top-down approach. Local officials do not have
any role or engagement in budget preparation and planning. In the workshops, participants
could not inform anything about the budget allocation of the current fiscal year. Participants
also reported not having a specific budget allocation to implement WASH-specific activities
(e.g., for providing inclusive wash blocks in secondary education institutes).
Both DPE and DSHE have an adequate workforce at the Upazila level, and they visit the
schools following their monitoring protocols. DPE participants mentioned they have an ade-
quate workforce to perform WASH activities. Upazila Education Officers regularly visit the
schools and inform the principal regarding the maintenance and usage of toilets. Besides, they
sent a proposal for the new construction of required WASH blocks in the school with the help
of DPHE.
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In addition, participants from the DGHS mentioned having a separate workforce to ensure
the quality of WASH activities/services and maintenance of WASH facilities in the healthcare
centers. But there is no exclusive staff for WASH service delivery. Frontline workers/commu-
nity health workers do activities related to issues around WASH service and practices at the
community level (e. g. courtyard session, one-to-one session etc).
Similarly, frontline workers of DGFP perform some awareness-raising works related to
hand washing and personal hygiene. Participants from DGFP mentioned having an allocation
of only TK 700 per year to maintain the cleanliness of each Family Welfare Centre.
Excess workload
WASH counseling activities are often compromised due to the existing workload of the front-
line workers of DGHS caused by the large population of FDMNs in the area. The health cen-
ters, such as community clinics, lack functional WASH facilities and maintenance capacity,
resulting in inadequate WASH practices by both health service providers and patients or care-
givers. However, one key informant mentioned that Upazila Health Complex (Upazila level
health facility) arranges different programs in schools, such as "National Worm Control Week
(krimisoptaho)" and "Jatiyo Sastho Seba Soptaho" (National Health Service Week), where the
Health Assistants spread awareness among the students regarding hygiene practices. Hand-
washing campaigns are also organized in the "Little Doctors (Khude Doctor)" program, where
the students are instructed to demonstrate handwashing properly. This creates an opportunity
for the Upazila Health Complex to raise awareness among people about WASH.
Recommendations from DPHE
DPHE participants recommended including disabled or physically challenged people while
planning or budgeting for any WASH facility construction. They also recommend biofil-toilet
technology to ensure safely managed sanitation facilities at the cyclone shelters. Biofil toilets
have an environmentally friendly digester system, which treats organic waste through aerobic
decomposition. The arrangement of separate toilets for the disabled and physically challenged
people at the cyclone shelters was also another recommendation. They mentioned that the
Union WATSAN and SMC meetings should be regularized, and the committee should inform
the decisions to the Upazila DPHE. Moreover, the WATSAN committee should prepare
monthly reports.
DPE participants recommended determining water extraction techniques and installation
design based on local realities. They also recommended using surface water to ensure a pipe-
line water supply network to each school or group of schools. They mentioned the require-
ment of a concise and integrated policy and strategic guideline for conducting WASH
activities at the local level that will include health, education, and WASH together.
DPE and DSHE participants recommended that MHM be considered during the construc-
tion of WASH blocks in schools and for cyclone shelters. Emergency sanitary napkins can be
promoted with the support of the SLIP fund, as recommended by one DPE participant. Teach-
ers, SMC, and scout groups could be trained to raise awareness of the WASH needs and
requirements of the students.
Recommendations from the private sectors
Private sector participants recommended building awareness among the community people
about sustainable WASH products at the household level for market promotion and collabo-
rating with local NGOs and Union Parishad. They also mentioned that relevant institutions
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might collaboratively develop and share the context-specific plan with the private sector. The
private sector or entrepreneurs can follow that plan within their capacity.
Discussion
The study may not fully reflect other areas of the country which have not experienced a similar
level of investment. Nevertheless, the current findings revealed certain areas of improvement
expressed by WASH stakeholders which should be considered by decision-makers, donors,
and development partners for improving the performance of effective WASH service delivery.
Recently, an increasing number of international and local organizations have taken an interest
in strengthening WASH services in the overall host community of Cox’s Bazar, and not only
to the FDMNs [16,17]. This analysis helps the policymakers to understand their key strengths
and weaknesses to allow for targeted interventions and sustainable progress in the future. It is
also essential to identify the key stakeholders and explore and understand their roles and
capacity in service delivery and policy decisions [18]. Our study provided evidence supporting
close engagement with public providers who are involved in service delivery [19] and has
helped to understand how existing WASH interventions work in "real world" settings [20].
In general, all institutions have an average capacity to deliver WASH services in their spe-
cific jurisdiction. Although, other institutions did not have any dedicated program for WASH
service delivery, except DPHE. The findings indicate a lack of knowledge of the different stake-
holders of legal and organizational strategy, guidelines, and framework, specifically the institu-
tions not directly involved in providing WASH services at the community level. The results of
this study strongly suggest the specific raising of awareness for all relevant staff/officials of
each relevant institution on WASH, technologies related to safely managed water and sanita-
tion facilities, SDG targets, and WASH policies.
A strength of our study lies in the fact that we spoke to WASH implementers, relevant
shareholders, institutional managers, policymakers, and the private sector, even though their
potential roles are often ignored by the (WASH) development sector [21]. It’s crucial to com-
prehend how the private sector may contribute to the development of water and sanitation
infrastructure as well as increased water system efficiency. WASH stakeholders are now
encouraged to engage the private sector more for achieving the Sustainable Development Goal
6 (Clean water and sanitation), which may pave the way for improvement [22]. The capacity of
the private sector should be enhanced, especially on diversified technologies and promotion of
WASH products, considering their role in the sustainable improvement of the WASH market.
Many institutions within the private sector had limited capacity to deliver WASH services,
and they do not perceive WASH as their prioritized responsibility. In addition, the ineffective
implementation of a bottom-up work plan is another challenge due to the top-down budgetary
system. Despite the plans being developed with the active participation of local-level elected
members and chairmen, while implementing these plans, political interference and insufficient
funding often hindered the projected outcome. A study on governing WASH in Malawi also
reports that WASH governance and service delivery are significantly impacted by insufficient
financial resources and a lack of organised funding systems [10]. Therefore, our suggestion is
to promote bottom-up, participatory and long-term plans at Union and Upazila levels, and
these strategies should be developed by the lead role of DPHE in coordination with the local
government, education, health and private sector. This plan should include installation of
WASH facilities and promotion of WASH practices at all levels.
We identified a deficit of effective coordination among the key WASH stakeholders; WAT-
SAN committee meetings were not held on time. Coordination and collaboration are required
to help the WASH stakeholders achieve quality decision-making, specifically policy
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formulation and implementation. It will help the WASH stakeholders identify their mutual
interests and increase the opportunity for working together to facilitate investment planning
in the short- to long-term [23]. The study suggests activating the WATSAN committee at all
administrative levels with regular meetings and establishing joint monitoring mechanisms and
report-sharing at the local level [24]. Private Sector representatives could be co-opted on the
WATSAN committees.
Sustainable WASH service delivery in a particular area requires the planned allocation of
financial and human resources [25]. We found that many of these institutes engaged in
WASH services delivery lack dedicated funds or workforce to deliver WASH services in Cox’s
Bazar [26]. We identified a lack of knowledge of context-specific problems and, thus, the
implementation of top-down, insufficient financing as a barrier to service delivery [27]. Hav-
ing an explicit understanding of the context is essential for planning implementation research
in a particular sector [28]. Similar arguments were made in a study on South Africa where
insufficient allocation of finances into WASH resources due to a lack of political will at the
governmental levels have resulted in poor implementation of plans around water safety [29].
Hence, to achieve safely managed/advanced water and sanitation, an upazila-level implemen-
tation guideline that takes into account the context is necessary. WASH service delivery can be
accelerated through a range of interventions beyond training, including policy alignment and
strengthening of monitoring systems and coordination mechanisms through existing inter-
sectoral platforms.
Implications for research and policy
Capacity assessment helps to improve the capabilities of individuals and organizations to func-
tion efficiently to attain sustainable results [30]. Our findings can help service providers or
implementers to get evidence of strengths and weaknesses and the private sector to focus on
demand-based production and marketing of contextually appropriate WASH products/tech-
nologies. In combination, these findings will help all to improve the current condition in
WASH service delivery in a particular area by improving the existing capacities of the institutes
and coordination among the relevant stakeholders. Strengthening institutional capacity collab-
oratively will improve several areas of service delivery [31–33]. The assessment of institutional
capacity shows the gaps in delivering WASH services and opportunities to improve the
WASH sector at the district level. Engaging the private sector and researchers in the WASH
sector networks is a prerequisite for continuous improvement. Further studies and periodic
monitoring and review of the WASH situation should be done to evaluate the effectiveness of
interventions in achieving the SDG targets.
Conclusion
Institutional capacity assessment and sustainable improvement of the existing WASH program
is an integrated approach for effective WASH service delivery. This paper generates evidence
for the scope of required improvement that could help the entire WASH sector of Cox’s Bazar
district to gear them up to reach the SDG target of achieving access to adequate and equitable
sanitation and hygiene for all by 2030. Key stakeholders recognised that if plans could be devel-
oped at the local level, then the implementation strategy would be more context-specific and
appropriate. Average milestones were set to achieve the goal, although the respective Upazila
team determined their milestone considering their WASH situation and local context. The
research evidence suggests that decision-makers, donors, and development partners should
consider learning from the WASH implementers and stakeholders about their existing capac-
ity, gaps, and opportunities before planning for any WASH intervention in any particular
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area. This strategy could also be implemented in other low-and-middle-income countries to
reach the SDG target by 2030.
Limitations
After initial three workshops, we experienced difficulties in assembling all of the Union Par-
ishad Chairmen on a particular day, due to busy schedules around various working agendas.
In addition, interruption in the actual schedule caused dropouts of other participants/officials
as well. Moreover, it was often difficult to retain them for such a long period of time. There-
fore, strategy of participatory planning was modified to reach out to all respective Union Par-
ishad Chairmen from those unions which were not included in the sample of qualitative data
collection of this current study. In addition, assigned team collected the required information
such as, availability, accessibility and requisite for safe water, improved sanitation and hygiene
services at their corresponding communities and institutions, prior to the day of workshop.
Acknowledgments
The authors are grateful to the study participants for their valuable time, and team members
who were involved in data collection. The authors also acknowledge with gratitude the com-
mitment of UNICEF and the Department of Public Health Engineering (DPHE) to its research
efforts. icddr,b is thankful to the Governments of Bangladesh and Canada for providing their
core and committed support.
Author Contributions
Conceptualization: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Zahidul
Mamun, Musarrat Jabeen Rahman, Tazrina Ananya, Dara Johnston, Martin Worth, Umme
Farwa Daisy, Tanvir Ahmed.
Data curation: Sharmin Khan Luies, Asadullah, Abul Kamal, Umme Farwa Daisy.
Formal analysis: Sharmin Khan Luies, Asadullah, Abul Kamal, Umme Farwa Daisy.
Funding acquisition: Mahbubur Rahman.
Investigation: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Sharika Ferdous,
Debashish Biswas, Tazrina Ananya, Abul Kamal, Umme Farwa Daisy, Tanvir Ahmed.
Methodology: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Zahidul Mamun,
Debashish Biswas, Tazrina Ananya, Asadullah, Abul Kamal, Dara Johnston, Martin
Worth, Umme Farwa Daisy, Tanvir Ahmed.
Project administration: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Sharika
Ferdous, Debashish Biswas, Tazrina Ananya, Asadullah, Abul Kamal, Umme Farwa Daisy,
Tanvir Ahmed.
Resources: Mahbubur Rahman, Mahbub-Ul Alam, Zahidul Mamun, Tanvir Ahmed.
Supervision: Mahbubur Rahman, Mahbub-Ul Alam, Debashish Biswas, Tanvir Ahmed.
Validation: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies, Sharika Ferdous,
Debashish Biswas, Umme Farwa Daisy, Tanvir Ahmed.
Visualization: Sharmin Khan Luies, Sharika Ferdous, Musarrat Jabeen Rahman, Abul Kamal,
Umme Farwa Daisy, Tanvir Ahmed.
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Writing – original draft: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies,
Musarrat Jabeen Rahman, Debashish Biswas, Tazrina Ananya, Asadullah, Abul Kamal,
Dara Johnston, Martin Worth, Umme Farwa Daisy, Tanvir Ahmed.
Writing – review & editing: Mahbubur Rahman, Mahbub-Ul Alam, Sharmin Khan Luies,
Sharika Ferdous, Zahidul Mamun, Musarrat Jabeen Rahman, Debashish Biswas, Tazrina
Ananya, Asadullah, Abul Kamal, Ritthick Chowdhury, Eheteshamul Russel Khan, Dara
Johnston, Martin Worth, Umme Farwa Daisy, Tanvir Ahmed.
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