Project Report. July December Enhancing Community Health in Nepal

Project Report July December 2016 Enhancing Community Health in Nepal BNMT Nepal January 2017

Abbreviation BNMT BNMT UK DAO DDC D(P)HO DPHO DWO FCHV(s) HFOMC HW(s) MHM MHPSS M&EO MoH MoU NGO LDO SWC VDC(s) WASH Birat Nepal Medical Trust Britain Nepal Medical Trust District Administration Office District Development Committee District (Public) Health Officer District Public Health Office District Women Officer Female Community Health Volunteer(s) Health Facility Operation and Management Committee Health Workers Menstrual Hygiene Management Mental Health and Psychosocial Support Services Monitoring and Evaluation Officer Ministry of Health Memorandum of Understanding Non Governmental Organization Local Development Officer Social Welfare Council Village Development Committee Water, Sanitation and Hygiene [i]

Table of Contents Abbreviation... i Summary Chart... 1 1. Background... 6 2. Common Program... 7 I. Memorandum of Understanding (MoU) with MoH and SWC... 7 II. Office setup... 7 III. Staff recruitment... 7 IV. Consultative (inception) meetings with government line agencies and other stakeholders, including communities... 8 V. Pre-intervention information collection in the targeted VDCs... 9 3. Programmatic activities... 9 A. Planning and Review workshop... 9 B. Mental Health and Psychosocial Support Services... 10 i. Capacity enhancement trainings to Prescribers (Health Workers)... 10 ii. Capacity enhancement trainings to Non- prescribers... 11 C. Community WASH Intervention... 12 i. Training/orientations/ coaching to the health professionals and community leaders including FCHVs 12 ii. Strengthening the HFOMCs for improved and sustained WASH program in the community... 12 D. Health Camps and Awareness on Infectious Diseases... 13 i. Free health camps with free medicines distribution... 13 4. Outcome... 14 5. Challenges... 14 Annex... 15 a. Picture gallery... 15 b. Schedule of the workshops... 18 [ii]

ENHANCING COMMUNITY HEALTH IN NEPAL Summary Chart The grant from the Big Lottery Fund is enabling BNMT UK and Birat Nepal Medical Trust to support many people affected by the earthquake with essential health services to promote and enhance long-term restructuring of the communities. BNMT has been able to rapidly mobilize these resources and implement the programme in the most affected populations. Key achievements including deliverables completed from July- December, 2016 and its status: S.N. Name of activities Location Completed Date A. Kathmandu 1 st August Staff recruitment Number of participants 234 applied for DC, 10 shortlisted for written exam, 6 selected for interview, 3 selected and recruited. 56 applied for M&EO, 6 invited for written exam,3 selected for interview and 1 recruited. Target Achievement Status 5 5 Completed Justification/ Remarks *Program Staffs include 3 District Coordinators (DC) 1 Psycho Social Counselor and 1 M&E Officer Kathmandu 1 st September 45 applied for Volunteer Community 15 15 [1]

S.N. Name of activities Location Completed Date Number of participants Mobilizers, 15 recruited Target Achievement Status Justification/ Remarks 1a. Consultative meeting 5 districts i. ii. iii. iv. v. b. Pre-intervention information collection in the targeted VDCs c Memorandum of Understanding (MoU) with MoH and SWC d. Planning and Review workshop Makwanpur Avocado, Hetauda Kathmandu, Babarmahal Nuwakot Bidur Sindhupalch owk DHO, Chautara Bhaktapur DHO, Bhaktapur 5 VDCs of 5 districts 23 rd May 34 28 th August 17 31 st August 23 1 st September 23 30 th September 40 11 th -20 th September 1217 HH 15 HWs 130 FCHVs 624 Male & 459 Female student 5 Districts 15 VDCs 5 Districts Completed 15 VDCs Kathmandu 10 th August, 2016-1 event 1 event Kathmandu 7 th and 8 th September, 2016 Completed Completed 20 2 1 Completed Initial consultative meeting was jointly organized along with another BNMT s project District Health Office HH= Households Report of baseline survey is still in process and will be shared once it is finalized [2]

S.N. Name of activities Location Completed Date Number of participants Target Achievement Status 2. Mental Health and Psychosocial support services Kathmandu 16 th -18 th August 29 and Bhaktapur i. ii. Capacity enhancement trainings Prescribers (Health workers) Capacity enhancement trainings Nonprescribers (FCHVs, HFOMCs, Local/social leaders, teachers) iii. Conducting school counseling programme at schools iv. PSS services to earthquake affected targeting women, elderly, girls, children and marginalized v. Establishing MHPSS help desk at health institutions Makwanpur 20 th 22 nd October 24 Sindhupal 25 th -27 th November 20 Chowk Nuwakot 7 th -9 th December 21 Sankhu 2 nd December 28 Sundarijal 11 th December 27 Kavresthali 19 th December 28 Nagarkot 30 th November 27 Gundu 6 th December 27 Bhaktapur 27 th December 27 Samundratar 17 th December 25 Balkumari 21 st December 25 Hadikhola 16 th December 29 Padampokha 20 th December 30 ri Manahari 4 th December 28 [3] 5 districts 15 VDCs 60 events 60 events 5 districts Completed 11 VDCs Ongoing 0 In process 0 Ongoing Justification/ Remarks The activity has been planned to start from January Consultations are 15 0 In process ongoing with Health VDCs Facilities vi. Advocacy, 11 0 In process The Day Celebration

S.N. Name of activities Location Completed Date vii. i. ii. Communication and Social Mobilisation on MHPSS services Bottom up of referral PSS services through mobilization of FCHVs from wards to District level Construction of community toilets Training/ orientations/ coaching to the health professionals and community leaders including FCHVs iii. Promotion of MHM targeting the adolescent girls iv. Awareness and advocacy for hygiene promotion v. Formation/ reactivation and mobilization of WASH committees Number of participants Target Achievement Status events 15 individu als 3. Community WASH intervention - - - Nagarkot 1 st December 20 Gundu 7 th December 22 Bhaktapur municipality 28 th December 25 Sankhu 3 rd December 25 Sundarijal 12 th December 20 Kavresthali 20 th December 25 Balkumari 24 th December 15 Samundratar 25 th December 16 - - Samundratar, Nuwakot - - 15 VDCs 15 VDCs 15 schools 0 Ongoing 0 Ongoing 8 VDCs Ongoing 0 In process - - 21 event 0 In process 20 th December 16 15 VDCs 1 VDC Ongoing Justification/ Remarks events will be organized in their respective dates from 2017 FCHVs are mobilized in their respective area WASH committee has been formed and plans have been developed for the construction Schools have been selected in respective VDCs Designs for IEC materials have been developed A meeting was conducted and land has been approved in Samundratar VDC of [4]

S.N. Name of activities Location Completed Date vi. Number of participants Target Achievement Status Badegaun 14 th -15 th December 16 Strengthening the Sipapokhare 27 th -28 th December 14 HFOMCs for Padampokha 14 th -15 th December 21 improved and ri 15 sustained WASH Hadikhola 16 th -17 th December 23 VDCs 7 VDCs Ongoing program in Manahari 18 th -19 th December 23 communities Samundratar 1 st -2 nd December 15 Balkumari 22 nd -23 rd December 15 4. Health camps and awareness on infectious diseases (TB, HIV, diarrheal diseases) in IDPs i. Organize free health Sipaghat 6 th September 200 25 camps with free Bhaktapur 19 th November 130 events medical distribution municipality 2 events Ongoing Ongoing Screening for Tuberculosis (TB) in IDP settlements through microscopic camps Awareness on TB prevention and prevention of other diseases - - - - - - 25 events 15 events 1 event 1 event Ongoing Justification/ Remarks Nuwakot district [5]

1. Background This document presents the first half yearly report and covers the months of July to December 2016. The main objectives of the project are to: Reduce psychosocial problems in the community Decrease in diarrheal and WASH related diseases and Increase availability of health services in the community through health camps In the initial phase the following activities like approval letters from government authorities (DPHO, DDC, and DAO) and signing of memorandum of understanding with Social Welfare Council (SWC) for implementing project activities in the five districts, and consultative meetings with government stakeholders were carried out. A baseline survey related to Water, Sanitation and Hygiene (WASH), Mental Health and Psychosocial Support (MHPSS), Menstrual Hygiene Management (MHM) and Tuberculosis (TB) and other communicable diseases was also carried out in order to know the basic health situation in the earthquake affected areas. The various activities of the project like MHPSS, WASH, MHM, Tuberculosis identification and others are targeted for health workers, health facilities operation and management committees, students and community people. During the six months working period, activities related to WASH and MHPSS were conducted, A three days orientation workshop on MHPSS was organized in all the project implemented districts in participation with district level staffs including District Public Health Officer (D(P)HO) and public health and other officers from DPHO including health post in-charge. A one day orientation workshop on MHPSS was also conducted for the Female Community Health Volunteers (FCHVs), HFOMC members and community leaders. Health Facilities Operation and Management Committee members were oriented on WASH for two days and one day orientation was given on WASH for FCHVs and community leaders.\ Health camps with specialists like general physicians, obstetric and gynaecologist, orthopaedicians and a paediatrician were conducted for the community people of the 2 concerned districts. After being checked up free medicines were also given to the sick. Those that needed to be referred were referred to the concerned institutions and suspected cases of TB screening and testing was conducted. Awareness message on health and hygiene were provided to the people who came to the health camps. [6]

During this 6 months period the project has directly benefitted 692 health and non-health workers with its orientations on WASH and MHPSS while 330 community people benefitted from health camps conducted at their doorsteps. 2. Common Program I. Memorandum of Understanding (MoU) with MoH and SWC An agreement was signed with Ministry of Health and Social Welfare Council (SWC) on 10 th August 2016 as a tripartite understanding to initiate activities in the project VDCs and districts. II. Office setup Approval letters were obtained from district authorities- DPHO, DDC, DAO from respective five project districts. Three district offices were established in Nuwakot, Sindhupalchowk and Makwanpur districts with necessary logistics. District office in Makwanpur was established in District Public Health Office building whereas district health offices in Nuwakot and Sindhupalchowk were established in local health facilities. As for Kathmandu and Bhaktapur districts, all the operations were carried out from central office of BNMT UK in Kathmandu. III. Staff recruitment For the recruitments of staffs a vacancy announcement was published in the national daily The Himalayan Times and on various online job websites on 8 th June, 2016. The vacancy was for the position of District Coordinators (3 positions) and Monitoring and Evaluation Officer (M&EO) (1 position). From a roster of 234 applications, ten candidates were short listed for District Coordinators and given a written examination and then the 6 best candidates were invited for an interview. Similarly, out of 56 candidates who applied for the position of M&EO, six short listed were given a written examination and then the three best invited for an interview. The selection process involved a panel of senior staffs of BNMT Nepal and the Country Representative of the BNMT UK and was as per the rules and regulations of the organization. Furthermore, to implement the programmatic activities in the community level, 15 Volunteer Community Health Mobilisers (VCHM) were appointed at each Village Development Committee (VDCs) of the five districts out of 45 aspirants. The VCHM were selected on the basis of their academic qualification, work experience and public good standing. A five-day induction and orientation program was held for the newly recruited staffs from 1 st August 2016 to 5 th August 2016 in Central office Kathmandu. In the program, they were introduced to organization, its mission, vision, goals and objectives; programmatic activities of [7]

the project, Human Resource policies and financial forms and formats. A one hour lesson on the BLF's "Core Humanitarian Standard" was also conducted. IV. Consultative (inception) meetings with government line agencies and other stakeholders, including communities Consultative (inception) meetings with government line agencies and other stakeholders were conducted in five districts viz. Makwanpur, Kathmandu, Sindhupalchowk, Nuwakot and Bhaktapur in order to share details of Enhancing Community Health in Nepal project and to develop common understanding on implementation process of the project with the stakeholders. The stakeholders were mainly Chief District Officer (CDO), Local Development Officer (LDO), Women Development Officer (WDO), Central Regional Health Directorate (CRHD), District Public Health Officer (DPHO), representatives from District Administration Office (DAO), District Development Committee (DDC), Planning, Monitoring and Evaluation Officer, Executive Officers from municipalities, Health Facility Operational and Management Committee (HFOMC) and I/NGOs which helped to develop common understanding on implementation process of the project with the stakeholders. The following table gives a glimpse of the series of events conducted regarding the venue, dates and the number of participants. Consultative Meetings: S.N. District Date Venue Number of participants 1 Makwanpur 23 rd May Hotel Avocado, 34 Makwanpur 2 Kathmandu 28 th August Bawarchi Bistro, 17 Babarmahal 3. Nuwakot 31 st August Hotel Ocean, Bidur Municipality 23 4 Sindhupalchowk 1 st September District Health Office, Chautara 23 5 Bhaktapur 30 th District Health Office 40 September Total 137 [8]

V. Pre-intervention information collection in the targeted VDCs A baseline survey was conducted in the fifteen VDCs of the five districts of the project area from 11 th September to 20 th September 2016. The survey intended to collect health related information particularly on (WASH), (MHM), (MHPSS) and Tuberculosis. The survey involved collection of information from households, Female Health Community Volunteers, Village-WASH- Coordination Committee, Health Workers from health posts, and school students of grade 8, 9 and 10 of the fifteen VDCs. Also, secondary information on tuberculosis, diarrhea, and mental health problems was collected from health posts. The tools and techniques for data collection were designed and finalized by two external professional consultants. Prior to collection of information, two days orientation program was organized to support district staffs to acquaint them on programmatic activities, questionnaires and methodologies of data collection, recording and reporting forms and formats 15 Community Mobilizers and 3 District Coordinators were responsible to collect the baseline data. During the baseline survey, a field visit was organized in Makwanpur district on 15 th September 2016 to monitor data collection at community level as a part of the project of Big Lottery Fund (BLF). Two days visit was made by the supervisor for the baseline survey Ms. Neelu Thapa and Monitoring and Evaluation officer of BNMT Nepal, Ms. Kritika Dixit in all three VDCs of the district, namely: Hadikhola, Manahari and Padampokhari. The major objective of the monitoring visit was to ensure proper methods of data collection by community mobilizers, and to support them in difficulties while filling the survey forms and to ensure that the survey activities were carried out as planned. The visit was helpful in ensuring quality data in the survey. The survey has been completed and has collected information from 1217 households, 15 Health workers, 130 FCHVs and 624 Male / 459 Female students. 3. Programmatic activities A. Planning and Review workshop Planning and orientation workshop was conducted for the commencement of project activities and to orient the district coordinators as well as the community mobilizers of the five districts, plan programmatic and baseline survey for the project. It was organized at Hotel Tapas, Lazimpat from 7 th to 8 th September, 2016. [9]

B. Mental Health and Psychosocial Support Services i. Capacity enhancement trainings to Prescribers (Health Workers) A Mental Health and Psychosocial Support Services training was organized in all the districts following the standards and guidelines from National Health Training Center (NHTC). The main objective of the orientation was to enhance capacity of health workers working in project implemented districts and VDCs by improving their understanding on psychosocial services and counseling that helps in effectiveness of the service delivery and thereby decreasing the cases of psycho social problems in the community. The main emphasis was on identifying and referral. The orientation on MHPSS was first organized in Kathmandu district where Health workers from Kathmandu and Bhaktapur district as well as project implemented VDCs of the two districts, District Coordinators, and other BNMT staffs took part. The orientation program was facilitated by a team of distinguished and competent trainers. Ms. Sunita Shrestha, Psychologist; Prof. Dr. Saroj Prasad Ojha, Head of Psychiatry Department, Institute of Medicine and Ms. Aroja Maskey, Psychosocial Counselor, BNMT Nepal. BNMT staffs were given a one day in house refresher on ToT and facilitated the other district level MHPSS orientations in Sindhupalchowk, Nuwakot and Makwanpur districts. S.N. Districts Date Number of Facilitators participants a. Kathmandu and Bhaktapur 16 th -18 th August 29 Ms. Sunita Sh, Dr. Saroj, Ms. Aroja b. Makwanpur 20 th 22 nd October 34 Ms. Sapana Kandel, Ms. Aroja Maskey, c. Sindhupalchowk 25 th -27 th November 20 Ms. Kritika Ms.Shikha d. Nuwakot 7 th -9 th December 21 Ms. Aroja, Mr.Dipendra Total 101 [10]

The evaluation of the training was done through pre and post-test, mood chart, feedback form as well as verbal feedback from the participants. The training was successful in: Enabling the participants to identify psychosocial problems, its causes and symptoms and well-being in the communities Enhancing the participants knowledge in using basic both verbal and non-verbal communication skills Improving knowledge on identification of mental health problems Improving recording of cases and referral mechanism ii. Capacity enhancement trainings to Non- prescribers With the objective to improve case finding from the community, one day capacity building orientation for HFOMC members, FCHVs, community leaders was organized in the VDC level. The sessions focused on identification of psychosocial problems and reporting and referral of mental and psychosocial cases seen in the communities. In six months duration, the orientations have been completed in 11 of 15 VDCs. S.N. District VDC Date No. of participants 1 Kathmandu 2 Bhaktapur 3 Nuwakot 4 Makwanpur Sankhu Sundarijal Kavresthali Nagarkot Gundu Bhaktapur muncipality Samundratar Balkumari Hadikhola Padampokhari Manahari 2 nd December 28 11 th December 27 19 th December 28 30 th November 27 6 th December 27 27 th December 27 17 th December 25 21 st December 25 16 th December 29 20 th December 30 4 th December 28 Total 301 No. of Male (M)/ Female (F) F-24 M-4 F-19 M-8 F-23 M-5 F-15 M-12 F-20 M-7 F-25 M-2 F-13 M-12 F-16 M-9 F-17 M-12 F-20 M-10 F-13 M-15 F- 205 M- 96 [11]

C. Community WASH Intervention i. Training/orientations/ coaching to the health professionals and community leaders including FCHVs The WASH orientations were provided to the health professionals and community leaders including FCHVs. The sessions were delivered on safe water and total sanitation; water borne diseases and preventive measures of water borne diseases; hand washing practices; techniques of water purification; promotion of healthy behaviors; household waste management and raising community awareness for proper use of toilet. The duration of the orientations was one day. S.N. District VDC Date No. of participants 1. Kathmandu 2. Bhaktapur 3. Nuwakot Sankhu 3 rd December 25 Sundarijal 12 th December 18 Kavresthali 20 th December 25 Nagarkot 1 st December 20 Gundu 7 th December 22 Bhaktapur municipality 28 th December 25 Balkumari 24 th December 15 Samundratar 25 th December 16 Total 166 No. of Male (M)/Female (F) F-24 M-1 F-17 M-1 F-22 M-3 F-15 M-5 F-18 M-4 F-23 M-2 F-12 M-3 F-13 M-3 F-144 M-22 ii. Strengthening the HFOMCs for improved and sustained WASH program in the community WASH orientations for members of HFOMC were conducted in seven of the intervention VDCs. The orientations covered sessions on safe water and total sanitation; water borne diseases and preventive measures of water borne diseases; hand washing practices; techniques of water purification; promotion of healthy behaviours; household waste management and raising community awareness for proper use of toilet and environmental sanitation. The duration of orientations was two days. [12]

S.N. District VDC Date 1. Sindhupalchowk 2. Makwanpur 3. Nuwakot No. of participants No. of Male (M)/ Female (F) Badegaun 14 th -15 th 15 F 8 December M 7 Sipapokhare 27 th -28 th December 14 F 4 M 10 Padampokhari 14 th -15 th December 19 F 10 M 9 Hadikhola 16 th -17 th December 21 F 15 M 6 Manahari 18 th -19 th December 22 Samundratar 1 st -2 nd December 18 Balkumari 22 nd -23 rd December F 2 M 20 F 5 M 13 15 F 5 M 10 Total 124 F- 49 M- 75 D. Health Camps and Awareness on Infectious Diseases i. Free health camps with free medicines distribution Two health camps were conducted in Sindhupalchowk and Bhaktapur districts. A free health camp was organized by BNMT Nepal in Sindhupalchowk District at a Internally Displaced Population (IDP) settlement on September 6, 2016. A general physician, a paediatrician, a gynaecologist and an orthopaedician checked the people at the camp and gave free essential medicines to the sick. Those that needed referrals were referred to the concerned institutions. Additionally, awareness program was conducted for communicable and non-communicable diseases especially on Diarrhea and Tuberculosis. A total of 200 people of all ages directly benefitted from the camp. Similarly, another free health camp was organized in Basu School, Bhaktapur Municipality on 19th November 2016. The camp provided general check up, orthopedics; and Gynae/ Obstetrics service and distributed essential medicines free of cost. Awareness program was conducted for communicable and non-communicable diseases especially on Diarrhea and Tuberculosis. A total of 130 people benefitted from the camp including 95 women and 35 men. [13]

4. Outcome Established strong coordination with government line agencies (MoH, DOHS, CRHD, NHTC, DPHO, PHC, HP) from center to periphery level in project implemented districts. Improved knowledge of Health workers of all project implemented districts and VDCs on Mental health problems and Psychosocial Support Services Improved knowledge of Health workers and HFOMC members on Water, Sanitation and Hygiene of project implemented VDCs in Nuwakot, Makwanpur and Sindhupalchowk Increased access of health services through health camps to the IDPS and community people of Sipaghat VDC and Bhaktapur municipality. 5. Challenges S.N. Challenges Addressed 1. Large sample size in baseline survey caused prolonged data collection in Bhaktapur Municipality which delayed implementation of the planned activities in five districts 2. Unavailability of health workers in their working area caused delay in implementation in programmatic activities. 3. Health workers in MHPSS orientations were from various levels with different levels of knowledge which stood as a challenge during the orientations. The project activities were geared once the baseline survey was completed. Frequent communication and coordination was done with Health Post In charge and other staffs to initiate the activities Various energizer, group activities and presentations, questions and answers session, peer supporters were organized to improve understanding of the participants. [14]

Annex a. Picture gallery MHPSS orientation in Kathmandu Dr. Saroj Ojha Participants of MHPSS orientation Group Work Session [15]

District Consultative meeting, Kathmandu District Consultative meeting, Sindhupalchowk Community Mobilizer collecting pre-intervention information from school students Community Mobilizer collecting pre-intervention information from locals MHPSS orientation in Bhaktapur Municipality MHPSS orientation in Balkumari, Nuwakot [16]

WASH orientations in Sipapokhare, Sindhupalchowk WASH orientations in Handikhola, Makwanpur WASH orientations in Padampokhari, Makwanpur WASH orientations in Balkumari, Nuwakot WASH orientations in Badegaun, Sindhupalchowk WASH orientations in Nagarkot, Bhaktapur [17]

Health Camp at Bhaktapur Municipality Health Camp at Sindhupalchowk b. Schedule of the workshops District level Training on Mental Health and Psychosocial Support Services (MHPSS) Programme BNMT Nepal Training Schedule Day- One Time Activities [18]

10:00-10:15 Registration 10:15-10:30 Pre- Test 10:30-10:50 Opening Session Chairing Introduction, Welcome, Objective, Briefing on BLF's Core Humanitarian Standard Format of the training 10:50-11:00 Closing remarks by Chairperson of the program 11:00 11:10 Introduction to BNMT 11:10-11:20 Technical Session: Expectation collection, Ground rules and Objectives of the program 11:20-11:40 Psychosocial and psychosocial well being 11:40-12:30 Causes, Signs and Symptoms of Psychosocial problems 12:30-1:15 Lunch break 1:15-1:45 Qualities of Health Workers for Psychosocial support 1:45-3:00 Psychosocial Support Framework: Counseling 3:00-3:30 Communication skill 3:30 3:40 Relaxation 3:40-4:00 Evaluation and wrap up Day Two Time Activity 10:00-10:15 Review of the first day 10:15 10:45 Introduction and importance of communication skills 10:45-11:45 Non-Verbal communication skills 11:45-12:00 Verbal Communication skills 12:00-12:30 Verbal communication skills: question asking skills [19]

12:30-1:00 Verbal communication skills: Repetition of key words 1:45-2:15 Verbal communication skills: Summarization 2:15-3:30 Role play and practice of both communication skills 3:30-3:40 Progressive relaxation 3:40-4:00 Review of whole day session and wrap up Day three Time Activity 10:00-10:15 Review of the second day 10:15-10:30 Deep breathing exercise 10:30-11:30 Introduction of Mental health 11:30-12:15 Stigma and discrimination 12:15-1:00 Self Care 1:45-2:15 pm Referral 2:15-2:30 pm Wrap up 2:30-2:40 pm Relaxation exercise 2:40-3:00 pm Concluding remarks 3:00-3:15 pm Post test 3:15-3:30 pm Review of the program 3:30-4:00 pm Closing session/ Administrative works Health Facility level Training on Water, Sanitation and Hygiene BNMT Nepal Training Schedule Time Duration Activities Tools/ Methodology Opening and Welcome 9:00-9:30 30 minutes Registration Registration sheet 9:30-10:00 30 minutes Introduction of participants 10:00-10:15 15 minutes Expectation collection Metacard 10:15-10:30 15 minutes Welcome and objective sharing [20]

Briefing on BLF's Core Humanitarian Standard Introduction to WASH 10:30-11:15 45 minutes Game activities Group work 11:15-12:00 45 minutes - Status of National, Districts and VDCs facts and figures of diarrheal cases, toilet construction, ODF VDCs 12:00-1:00 1.5 hour - Safe water - Water borne diseases - Preventive measures of water borne diseases 2:00-3:00 1 hour - Cholera Video show - Methods of hand washing - Hand washing with Soap or Cleaning Agent at four critical times - Challenges of hand washing Discussion 3:00-3:45 45 minutes - Safe handling and treatment of Household Drinking Water - Techniques of water purification - Community behavior Practical exercise And Participatory discussion Presentation and discussion Presentation Group work and Discussion Video show Group Work Group work Presentation 3:45-4:00 15 minutes Total sanitation: 5+1 Indicators Presentation Day Two Time Duration Activities Tools/ Methodology 9:00-9:30 30 minutes Review of previous day Review Game activity 9:30-10:30 1 hour - Strategies adopted by Nepali government Role play / Songs - Discussion on problems caused by open defecation [21]

and ways to improve use of toilet and hand washing 10:30-11:00 30 minutes Environmental sanitation Presentation and group discussion 11:00-11:30 30 minutes Waste management sanitation: Composting Presentation and group discussion 11:30-11:45 15 minutes Various types of toilets 11:45-1:00 1.15 hour 2:00-3:00 1 hour - Wastes from Health facilities - Waste disposal - Principles of waste management in Health facilities - System of waste management in Health facilities - 3R technique Presentation and group discussion Presentation and group discussion Presentation and group discussion 3:00-3:30 30 minutes Concluding remarks 3:30-3:45 15 minutes Post test Questionnaire 3:45-4:00 15 minutes Closing session [22]