Project Name: Healthy Aging Promotion in Environmentally and Socially Vulnerable Areas under Stakhira District
Duration: 31st March 2026 to 30 April 2029 (3 years)
Total Budget: 57,857,091
Funded by: Asia Arsenic network Japan with the support of Ministry of foreign affairs Japan.
Project area:
| Division | District | Upazila | Unions | Village | HH | Population |
| Khula | Satkhira | Assasuni | 11 | 146 | 71,857 | 140,565 |
| Debhata | 5 | 122 | 34,254 | 66,032 | ||
| Kalaroa | 12 | 143 | 70,840 | 127,114 | ||
| Kaliganj | 12 | 263 | 78,690 | 152,678 | ||
| Satkhira Sadar | 14 | 235 | 135,452 | 261,862 | ||
| Shyamnagar | 12 | 233 | 90,117 | 182,796 | ||
| Tala | 12 | 229 | 85,542 | 162,507 | ||
| 7 | 78 | 1371 | 566,752 | 1,093,554 |
Summary of the project: This project aims to strengthen a community-based health system to effectively prevent and manage non-communicable diseases (NCDs), while also addressing critical environmental and social health risks such as arsenic contamination, salinity, and early marriage. These interconnected challenges continue to affect vulnerable populations, particularly in rural and underserved areas. The project will be implemented over a three-year period across 7 upazilas, covering a wide range of service delivery points including public health facilities, community clinics, and educational institutions.
The initiative is designed to take a comprehensive and integrated approach, combining health system strengthening, community engagement, and environmental health interventions. By working at multiple levels—from health facilities to households—the project aims to improve both access to quality services and adoption of healthy behaviors.
A key focus of the project is the development and validation of a community-based health service model. This model will be implemented in 21 selected locations (three per upazila), where it will be tested, refined, and documented. The model will integrate preventive, promotive, and basic curative services, with strong linkages between community structures and formal health systems. A comprehensive evaluation will be conducted, and the findings will be formally presented to government authorities for consideration of replication and scaling at the national level.
To strengthen service delivery and improve efficiency, the project will introduce digital health information systems in 8 public health facilities, including upazila health complexes and a district hospital. This digitalization effort will enhance patient data management, improve tracking of NCD cases, and support evidence-based decision-making by health managers and providers. It will also contribute to continuity of care and better monitoring of patient outcomes.
Capacity building is a central pillar of the project. A total of 305 healthcare providers will receive structured training on NCD prevention and management, including key risk factors such as arsenic exposure, salinity, and the health implications of early marriage. In parallel, 280 community-level workers will be trained and mobilized to conduct awareness activities, promote healthy behaviors, and support community-based follow-up of at-risk individuals. These combined efforts aim to significantly improve the knowledge, skills, and practices of both facility-based and community-based health actors.
The project will also engage the education sector to promote long-term behavioral change. A total of 460 secondary schools will be included in health awareness initiatives, reaching both teachers and students. Through orientation sessions and interactive activities, the project will build awareness on NCD prevention, nutrition, hygiene, and environmental health, helping to foster a culture of health among adolescents and future generations.
At the community level, the project will directly support 1,050 patients, particularly those at risk of or living with chronic conditions, to adopt improved self-care practices. These include maintaining a balanced diet, engaging in regular physical activity, and adhering to prescribed treatments. The project aims for at least 70% of participants to demonstrate sustained positive behavior change. Community support mechanisms and peer groups will further reinforce these practices and ensure continuity beyond the project period.
In addition, 232 community clinics will be strengthened through the provision of essential equipment such as blood pressure monitors, weighing scales, and height measurement tools. These clinics will serve as frontline platforms for early screening, risk identification, and community awareness, thereby improving early detection and management of NCDs.
The project also places strong emphasis on water, sanitation, and environmental health, recognizing their direct impact on disease burden. Arsenic testing will be conducted in health facilities, and drinking water quality assessments will be carried out in selected hospitals. Based on the findings, targeted interventions will be implemented in high-risk areas, including the establishment of safe drinking water sources.
Furthermore, sanitation facilities in selected health complexes will be renovated to ensure safe, accessible, and inclusive services, particularly for women, elderly individuals, and persons with disabilities. These improvements will contribute to a more patient-friendly environment and encourage greater utilization of health services.
Overall, the project is designed to create a sustainable and scalable model of community-based health service delivery. By integrating digital innovation, capacity development, environmental health measures, and strong community engagement, the initiative will address both immediate health needs and underlying risk factors. The expected outcome is a significant improvement in health behaviors, service utilization, and overall health outcomes among vulnerable populations, while also generating evidence and lessons to inform broader health system strengthening efforts.
Rationale
Non-communicable diseases such as hypertension, diabetes, and chronic conditions are increasing rapidly, particularly in underserved communities. These health challenges are further compounded by environmental risks like arsenic-contaminated water and salinity, as well as social determinants such as limited awareness and early marriage.
Existing health systems often face limitations in early detection, patient follow-up, data management, and community outreach. This project is designed to address these gaps by building a sustainable, community-driven health service model that can be scaled and adopted at the national level.
Project Objectives
- To develop and implement a community-based health service model.
- To improve digital health information management systems.
- To enhance the capacity of healthcare providers and community workers.
- To promote preventive health behaviors at the community level.
- To improve access to safe water and sanitation facilities.
Key Interventions and Expected Results
1. Development of a Community-Based Health Model
The project will design, implement, and validate a community-based health service model in 21 locations (3 per upazila). This model will integrate preventive, promotive, and basic curative services at the community level.
A comprehensive evaluation report will be developed, and by the end of the project, the model will be formally submitted to government authorities for consideration, replication, and scaling.
2. Strengthening Health Systems and Service Delivery
Digital Health Systems:
To improve efficiency and continuity of care, the project will introduce digital patient data management systems in 8 public health facilities (7 upazila health complexes and 1 district hospital). This will enhance record-keeping, patient tracking, and decision-making.
Capacity Building of Health Providers:
A total of 305 healthcare providers will receive training on NCD prevention and management, including risk factors such as arsenic exposure, salinity, and early marriage. The project aims to achieve at least a 60% improvement in knowledge and practices among trained personnel.
Community Health Workforce Engagement:
The project will train and mobilize 280 community-level workers to promote preventive health behaviors, conduct awareness sessions, and support early identification of at-risk individuals.
School-Based Health Awareness:
Health education and awareness activities will be conducted in 460 secondary schools, engaging both teachers and students. This will help build long-term awareness and promote healthy behaviors among adolescents.
3. Improving Community Health Practices and Self-Care
Patient Self-Management:
The project will support 1,050 individuals, particularly those at risk of or living with chronic diseases, to adopt improved self-care practices such as healthy diet, regular exercise, and adherence to medication. At least 70% of participants are expected to demonstrate sustained behavior change.
Strengthening Community Clinics:
A total of 232 community clinics will be equipped with essential tools, including blood pressure monitors, weighing scales, and height measurement devices. These clinics will serve as frontline centers for screening, risk identification, and awareness building.
Community Engagement and Support Systems:
Regular community sessions will be organized to identify high-risk populations and promote healthy lifestyles. Community groups and support mechanisms will be developed to ensure continuity of care and peer support.
4. Water, Sanitation, and Environmental Health
Water Quality Testing and Risk Reduction
The project will implement a comprehensive water quality surveillance and risk reduction strategy to address the high burden of arsenic contamination and unsafe drinking water in the target areas. Arsenic testing will be conducted in 232 health facilities, including community clinics and upazila health complexes, to identify contamination levels and ensure regular monitoring of drinking water sources.
In addition, drinking water quality assessments will be carried out in 7 hospitals, focusing on key parameters such as arsenic concentration, microbial contamination, and overall water safety standards. The results of these assessments will be systematically documented and analyzed to identify high-risk locations and populations.
Based on the findings, the project will implement targeted awareness and behavior change communication (BCC) activities to promote safe water handling practices, including the use of arsenic-free water sources, safe storage methods, and household-level water treatment where necessary. Health education sessions will be conducted at community and facility levels to increase awareness of the long-term health risks associated with contaminated water, particularly skin diseases, chronic poisoning, and other NCD-related complications.
Where necessary, risk mitigation measures such as labeling of unsafe water points, referral to safe sources, and coordination with local authorities for remediation will be introduced. Continuous monitoring will be ensured through periodic testing and reporting mechanisms integrated into the project’s overall M&E system.
Safe Drinking Water Supply
In the most arsenic-affected 3 upazilas, the project will conduct detailed geospatial mapping and vulnerability assessment to identify high-risk areas and populations with limited access to safe drinking water. This process will involve community consultations, field verification, and coordination with local government institutions.
Based on the assessment results, the project will install 8 community-based safe drinking water sources, such as deep tube wells, arsenic removal units, or alternative safe water systems depending on site-specific conditions. Site selection will prioritize schools, health facilities, and densely populated villages where exposure risk is highest.
These interventions will be complemented by community management systems, including formation of water user groups responsible for operation, maintenance, and basic upkeep of the installed water points. Training will be provided to local caretakers to ensure sustainability and proper functioning of the systems.
The interventions aim to ensure equitable and sustainable access to safe drinking water for vulnerable populations, thereby reducing exposure to arsenic and waterborne diseases and contributing to long-term improvements in public health outcomes.
Improvement of Sanitation Facilities
The project will support the renovation and improvement of sanitation facilities in the NCD corners of 7 upazila health complexes, with a focus on creating safe, hygienic, and inclusive environments for patients and visitors.
Special attention will be given to ensuring that facilities are accessible and user-friendly for elderly individuals, women, pregnant mothers, and persons with disabilities. This will include installation of handrails, non-slip flooring, adequate lighting, separate facilities where possible, and improved privacy and cleanliness standards.
The sanitation improvements will also incorporate infection prevention and control (IPC) measures, including proper waste disposal systems, handwashing stations with soap or sanitizer, and regular cleaning protocols. Health facility staff will be oriented on maintenance standards to ensure sustainability of improvements.
Community awareness activities will be linked with these improvements to promote hygiene practices such as regular handwashing, safe toilet use, and proper waste management, particularly in health facility catchment areas.
Overall Environmental Health Approach
The water, sanitation, and environmental health component will adopt an integrated risk reduction approach, combining infrastructure improvement, water safety monitoring, and behavior change interventions. Close coordination will be maintained with local government engineering departments, public health authorities, and community stakeholders to ensure alignment with national water and sanitation standards.
Project Implementation Approach, Workplan, and Management
The project will follow a structured, time-bound, and results-oriented implementation approach over a three-year period, guided by a detailed annual and quarterly workplan. All activities will be systematically scheduled to ensure effective coordination across health facilities, community clinics, schools, and field-level implementation sites in the 7 upazilas. The workplan will clearly define roles, responsibilities, timelines, and deliverables, ensuring transparency, efficiency, and accountability at all levels of implementation.
A strong emphasis will be placed on coordination and stakeholder engagement. Regular coordination meetings will be held with key stakeholders, including government health authorities, local government institutions and community leaders. These meetings will serve as platforms for joint planning, progress review, problem-solving, and decision-making. At the community level, periodic consultations will be conducted to ensure local participation, ownership, and responsiveness to emerging needs.
Field implementation and supervision will be a key operational component of the project. Regular field visits will be conducted by project management and technical teams to monitor implementation progress, provide on-site technical support, and ensure quality assurance. These visits will cover health service delivery, training sessions, community mobilization activities, digital health system use, and water and sanitation interventions. Field observations and feedback will be systematically documented and used for adaptive management and timely corrective actions.
A comprehensive monitoring and evaluation (M&E) system will be established to track progress against defined indicators, outputs, and outcomes. The M&E framework will include baseline data, performance indicators, and measurable targets for all key intervention areas. Routine monitoring will be conducted through field reports, digital health information systems, supervisory checklists, and community feedback mechanisms. In addition, a mid-term review and a final evaluation will be carried out to assess project effectiveness, efficiency, impact, and sustainability, while generating evidence and lessons learned for future scale-up.
A robust reporting system will be implemented to ensure transparency, accountability, and compliance. Monthly, quarterly, and annual progress reports will be prepared and submitted to relevant stakeholders and funding authorities. These reports will document achievements, challenges, lessons learned, and corrective actions taken. In addition to programmatic reporting, the project will strictly comply with financial reporting requirements, including yearly external audits conducted in accordance with recognized auditing standards and donor requirements.
Furthermore, the project will ensure full compliance with government financial rules and regulations, including proper tax deduction at source (TDS), Value Added Tax (VAT) payment, and submission of all statutory returns as applicable under national laws. All financial transactions will be properly documented, verified, and recorded to ensure transparency, traceability, and accountability. Necessary coordination will be maintained with relevant government authorities to ensure timely compliance with financial and regulatory obligations.
To support effective implementation, a range of management and reporting tools will be utilized. These include digital health information systems for patient and service data management, real-time monitoring dashboards, standardized training manuals, supervisory checklists, financial tracking tools, and structured reporting templates. Documentation systems will also be used to capture best practices, case studies, and lessons learned from field implementation.
Conclusion
This project presents a comprehensive and integrated approach to addressing the growing burden of NCDs and environmental health risks. By combining community-based service delivery, digital innovation, capacity building, and infrastructure improvements, the project aims to create a sustainable and scalable model that will significantly improve health outcomes in vulnerable communities and inform future health system strengthening efforts at the national level.