Project Name : MITIGATING THE IMPACT OF COVID-19 THROUGH COMMUNITY-LED PREVENTION PROGRAM (Bangladesh)

Doner : AMERICARES Foundation Inc.

Sector : Health

Area : Satkhira, Khulna, Barisal, Joshore, Narail

Time Line : August 2021- January 2022

Brief of activities :

1. OUTLINE OF THE PROJECT               

1.1 Background of the Project (as of project design on July 2021)

The COVID-19 pandemic in Bangladesh is a part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) causes by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was confirmed to have spread to Bangladesh on 8^th March 2020. Since then, the pandemic has spread day by day over the whole nation and the number of affected people has been increasing. Bangladesh is the second most affected country in South Asia, after India.

The situation as of July 2021 depicted, COVID-19 infections were increasing in Bangladesh, with 6,625 new infections reported on average each day. Bangladesh reported its largest number of new COVID 19 infections since the start of the pandemic last year. Health authorities of the country recorded the highest number of new Covid-19 cases since the beginning of the pandemic for the second time in three days. The test positivity rate was the second-highest since the beginning. Only on 30 June 2021, a total of 8800 new cases were identified -that’s 95% of the peak. 28 infections per 100K people reported last seven days. There have been 913,258 infections and 14,503 coronavirus-related deaths reported in the country since the pandemic began. The situation has exaggerated when new variants of coronavirus evolved - made the second wave on COVID-19 infections[1].

Hospitals in Bangladesh are under pressure, 57 districts are at high risk of increased infections. The rising number of infections has been putting hospitals across the country under extreme pressure. Hospital beds are becoming occupied at an alarming rate.  Lockdowns imposed in border districts had made some improvement, but the infection rates are still very high.  Army and BGB had been deployed alongside the law enforcement agencies to impose the lockdown. Bangladesh had gone into a strict Covid-19 lockdown on 01 July 2021, with the army and police ordered to stop people from leaving their homes except for emergencies or to buy essentials. The government said the country of 168 million people was seeing an "alarming and dangerous" rise in cases, blamed largely on the highly infectious Delta variant. The authorities warned that the capital Dhaka and port city Chittagong may be next to face the wave of Covid-19 that has been wreaking havoc in the border districts.

More than two-thirds of new virus cases in Dhaka are of the Delta variant, according to a study by the independent Dhaka-based International Centre for Diarrheal Disease Research. The first phase ground to a halt when India stopped exporting the AstraZeneca vaccine earlier this year to focus on its own needs. Bangladesh has administered at least 10,101,143 doses of COVID vaccines so far. Assuming every person needs 2 doses, that’s enough to have vaccinated about 3.1% of the country’s population. During the last week's report, Bangladesh averaged about 1,825 doses administered each day. At that rate, it would take a further 17,869 days to administer enough doses for another 10% of the population

Geographically, Bangladesh consists of eight administrative divisions. Khulna, the southern-western part of Bangladesh is one of them. The COVID-19 situation in Khulna is worsening day by day with new cases. With the fresh fatalities, the total death toll from Covid-19 reached 1,109 in the division. Besides, 1,245 people were found infected with the deadly virus during the 24 hours, taking the total tally to 57,520 in 10 districts of the Khulna division. It may become the next hotspot of infection if health measures are not properly enforced.

Hospitals struggled particularly in areas bordering India where the strain was first detected. Some rural towns recorded infection rates of 70%. A total of 7,082 infected patients had undergone treatment at different designated hospitals. Amid the worsening Covid-19 situation in Khulna, the division in 24 hours till Thursday morning registered its highest-ever fatalities with 39 new deaths. Meanwhile, the district had undergone a strict Covid-19 lockdown with the rest of Bangladesh, with the army and police ordered to stop people from leaving their homes except for emergencies.

Under the above backdrop, AMERICARES funded ASHAR ALO, a local NGO for community-based awareness against COVID-19, vaccine hesitancy, and emergency medical oxygen supply at the community level. Ashar Alo intended to implement a community-based COVID 19 prevention program in 10 locations in the coastal region of the Khulna division, Bangladesh. The need-based project idea was conceived in consultation with the government health authorities, local NGO partners and health workers, and community people. The authorities of the health facilities and managers are encouraged to impart treatment of COVID 19 patients at home unless it is in critical condition. They also encouraged community organizations and volunteers to extend support to those patients and families with counseling, precautions, and advice on where to go if an emergency arises. The health managers of the project locations asked to support more with face masks, gloves, and disinfectants- as they still need for these items are high at the health facility level. The health managers also suggested intensity the community awareness on COVID 19 prevention and support with oxygen at the community level.

1.2 Objectives of the Project

The objectives of the projects are

• Reducing mortality and morbidity associated with COVID-19 infections through augmenting emergency medical support
• To enhance the capacity of the health workers with supporting personal protective equipment (PPE) and medical supplies
• To lessen the impact of COVID-19 critical patients through supporting oxygen.
• Prevention of COVID-19 through community awareness and support 
• Coordination and liaison with local government health centers and other social

1.3. Project Period:

The Project was commenced on 1^st   August 2021 with six (6) months from 1^st   August 2021 to 31 January 2022.

The project was completed within the time and budget.

1.4 Target and Expected Outputs of the Project

Title of the Project: The title of the project is " Project Title: Mitigating the impact of COVID-19 through community-led prevention program in Bangladesh”

Expected Goals which will be attained after the Project Completion

(1) Reducing mortality and morbidity associated with COVID-19 infections through augmenting emergency medical support.  

(2) To lessen the impact of COVID-19 critical patients through supporting oxygen.

Outputs

(1) To enhance the capacity of the health workers with supporting personal protective equipment (PPE) and medical supplies;

(2) Prevention of COVID-19 through community awareness and

 (3) Distribution of Personal protective equipment and medical supplies to the health centers that provide COVID-19 treatment

Project sites are Khulna and Barisal Division in Bangladesh.

Geographically, Bangladesh consists of eight administrative divisions. Khulna, the southern-western part of Bangladesh is one of them. Barisal is the southern-central part of Bangladesh.

Beneficiaries

Beneficiaries of the project are health service providers in different hospitals and communities of Bangladesh.

• Health service providers
• Critical COVID-19 patients
• Community people

1.8 Plan and Actual Operation

The project was implemented at the community level by a group of trained community workers and volunteers. To implement, 10 work-stations were established and 10 community workers deployed. The community workers distributed PPE to prevent COVID 19 (supplied by Americares) to the concerned health facilities, mobilize the community, create awareness through volunteers (COVID19 Brigade), and supply oxygen cylinders to the critical patients suffering from COVID19 (as referred by the doctors). The oxygen support was supplied and ensured from the community-based COVID19 hub.
 

Described below the plan and actual operation of this project

2. SUMMARY OF MANUALS AND ACTION PLAN

2.1 Summary of Design Manual for Volunteers training

The summary of the manuals was

• About COVID-19
• The present situation of COVID-19
• Symptoms of COVID-19
• How to mitigate the wave of COVID-19
• Encouragement of taking about COVID-19 vaccine
• How to take oxygen properly
• When taking oxygen for COVID-19 patient  

2.2 Summary of leaflet

• About COVID-19
• Symptoms of COVID-19
• How to prevent COVID-19
• When taking treatment of COVID-19 patient

3. PROJECT ACTIVITIES

3.1 Receive and distribute the PPE and Oxygen cylinder from suppliers

At first, Ashar Alo received the PPE and Oxygen from XY Trade International then they distributed the items in medical college, district hospital, Upazila health complex, community clinic, union welfare center, social organization, and Ashar Alo established community help centers.

After the distribution of PPE, the program officer of Ashar Alo was monitored for using PPE in different levels of health facilities. Following the total number of PPE items were included:

3.2 Deployed the stuff for the COVID-19 emergency response program

Ashar Alo was deployed 1 Fieldworker for each center for 6 months (01 Aug 2021 to 31 Jan 2022. An agreement will be signed in between the employer and employees. The salary/remuneration of the Program Officer was Tk. 12,500 per month. Ashar Alo was sent salary to field worker account each month. Each Program Officer was also received Tk. 3,300 per month for communication (phone, net, travel to the field, etc.).

The Program Officer conducted risk communication campaigns, establishing contact-tracking and reporting systems, training and managing volunteers, raising awareness related to COVID-19 vaccines to increase uptake, and addressing vaccine hesitancy. The Program Officer has oriented the attendants (and also provide a leaflet diagramming how to inhale oxygen) on how to inhale the oxygen. The Program Officer was be working as a “Corona fighter” and if required will visit the patient's house at the community to orient. The Program Officer was helping online registration for the vaccine receiver and establishing support systems for at-risk persons.

The Program Officer was selected, mobilize and organize 300 COVID -19 brigade (volunteers) from their community, organize orientation for them. The Program Officer was organized community meetings, arrange public announcements on prevention of COVID 19, monitoring and reporting

Ashar Alo was deployed as the 10-program officer for 10 community help centers and 1 accounts officer and 1 project coordinator at the beginning of the project by maintaining organizational recruitment system, and then Ashar Alo was arranged a short-term training for the staff to enhance their ability and working capacity.

3.3 Establish 10 community help centers

At the beginning of the projects established the 10-community help centers on a rental basis at an appropriate location in 4 Districts at 10 Upazila in Bangladesh. This office was considered as a center, from where a program officer operates the activities and supplies the Oxygen cylinder.

3.4 Distribute PPE and medical supplies to the 10 Community Help Centers

Ashar Alo was distributed PPE at 10 Community Help Center in 10 Upazilla for the use of volunteers, program officers, attendants, or relatives of COVID-19 patients when receiving oxygen cylinder and community people in 10 community help centers which were used in the whole project period. Here we give a hierarchy that presented 10 Community Help Centers.

3.5 Select and mobilize and organize 300 COVID-19 brigades (volunteers)

Program officer of Ashar Alo selected primarily 40 volunteers in their working area, covering all unions than in special consideration of their working experience, the mentality of voluntary service and finally select 30 volunteers, 50% selected volunteers were female. They are willing to agree to fulfill the following responsibilities with Ashar Alo

• Work with Ashar Alo as volunteers to the prevention of COVID-19
• Take part in the training arranged by Ashar Alo
• Coordinate and arrange a union level awareness meeting
• Motivate people on COVID-19 awareness and supply oxygen cylinder
• Communicate with COVID-19 patients with the message on where to go for treatment
• Take part in miking and public announcement
• Ashar Alo provides a T-shirt/Polo shirt, cap, necessary PPE, and face masks
• Ashar Alo also provide a certificate after completion of the project
• The volunteer works for six months starting from August 2021.

3.6 Organize 10 orientation training on COVID-19 prevention with volunteers

Ashar Alo was Organized the 10-orientation training on COVID-19 prevention with volunteers on August 2021 in 10 Upazila.  

• The venue of the orientation program was the Upazila Health Complex conference room.
• Duration of the orientation program 10.00 am to 4.00 pm including lunch and prayer break.
• The main guest of the orientation program was District Commissioner/Upazila Nirbahi Officer/Upazila Health and Family Planning Officer
• This program also invited local public health experts, social workers, political leaders, religious leaders, civil society, and also local communities.
• In this orientation program engage local government doctors as a resource person on COVID 19, and particularly on how to use oxygen cylinder
• The training topics are awareness on prevention of COVID 19, how to supply oxygen cylinder to critical patients, use of Oxygen cylinder at home/community, roles of volunteers at the community, registration for vaccination, how to organize awareness meetings at the community,

3.7 Organized 80 community awareness meetings on COVID-19 prevention and availability of Oxygen cylinder

After the end of the orientation program, Ashar Alo organized the 80-community awareness meeting at the union level at the union Parishad hall room or campus of the union Parishad with engaging volunteers’ group.  

The total budget for each meeting is Tk 5,000. You will receive a total amount of TK 40,000 for organizing 8 meetings. The budget is for refreshments and the miscellaneous cost of the meeting.  The program coordinator was kept the record for reporting. 

Tasks:

• Organized community awareness meeting at the community level with at least 20 participants or more than
• A guest speaker was invited to discuss this topic in this meeting.
• The meeting topics were: awareness on prevention of COVID-19, availability of oxygen cylinder to critical patients, use of Oxygen cylinder at home/community, roles of community leaders at the

community, registration for vaccination, how to create awareness among the community.   

3.10 Arrange 80 public announcements on COVID-19 prevention and availability of Oxygen cylinder

The program officer and volunteers of Ashar Alo was arranged a public announcement (miking) on

• Prevention of COVID 19
• Availability of oxygen cylinder for critical COVID 19 patients
• Vaccine hesitancy
• Availability of and assistance for vaccine registration

3.11 Printing 10,000 leaflets on COVID-19 prevention and availability of Oxygen cylinder
 

Ashar Alo has printed 10000 leaflets on COVID-19 prevention and availability of oxygen cylinders. The program officer of Ashar Alo was distributed among the community people as per need and preferably in the community meeting. The main messages of the leaflet were

§  About COVID-19

§  Symptoms of COVID-19

§  How to prevent COVID-19

§  How to aware general people about COVID-19

§  How to remove vaccine hesitancy of COVID-19

§  How to help with COVID-19 vaccine registration

8.12 Printing and distribution of 350 T-shirts and caps with message and sign of COVID-19 Brigades

Ashar Alo has printed 350 T-shirts for the COVID-19 volunteers and distributed them among the volunteers before the volunteer’s orientation program. In this T-shirt, the logo of AMERICARES and Ashar Aol was added.

4. KNOWLEDGE TRANSFER

4.1 Volunteers Orientation

Ashar Alo has arranged 10 volunteer orientations from August to September 2021 at 10 Upazilla. This program was held in UH&FPO and UNP conference room with including doctor, nurse, UNO, technician, public health expert, and volunteers. The main context of these meetings

§  About COVID-19

§  Symptoms of COVID-19

§  How to prevent COVID-19

§  How to aware general people about COVID-19

§  How to remove vaccine hesitancy of COVID-19

§  How to help with COVID-19 vaccine registration

§  How to use oxygen cylinder

4.2 Community Awareness Program

The program officer of Ashar Alo was arranged a total of 80 community awareness meetings at every Union level in every Upazilla. The main subject was discussed in that meetings are

§  About COVID-19

§  Symptoms of COVID-19

§  How to prevent COVID-19

§  How to remove vaccine hesitancy of COVID-19

§  How to help with COVID-19 vaccine registration

4.3 Community Awareness by Public Announcement

In the total project period, we arranged 80 times public announcements in each Upazilla. The main message of the announcement was

v  Frequently handwashing properly before a meal, after reaching home from outside

v  Wear mask properly

v  Avoid crowed area

v  Don’t handshaking with others

v  Get message to reducing vaccine hesitancy

v  Boosting immunization by taking of COVID-19 vaccine

5. IDEAS AND LESSONS LEARNED ON PROJECT IMPLEMENTATION

 5.1 Basic ideas on Project Implementation

-          Establishing community help centers by the project with oxygen cylinders and PPE with trained community workers and volunteers was effective to reach the wider community and access the equipment. The critical COVID 19 patients were felt confident getting oxygen support from the center (24/7) when they needed  

-         Coordination and communication were key for implementing this project. Due to the existing linkage between Ashar Alo and Communities in carrying out current activities, Local Government and health authorities are positive to support Ashar Alo, as the project could establish reinforcing government initiatives. Continuous communication with the Communities and local GOB and health authorities for smooth implementation for its positive impacts.

-          Orientation, better understanding & capacity building of community volunteers, and local health workers helped facilitate to implementation of Covid-19 response policies and initiatives of the government. Engaging government health officials as resource persons for the training of community workers and volunteers enhanced the confidence of the people.  

5.2 Ideas and Lessons Learned on Implementation of Activities by Fields

The lessons learned from the project are very valuable for Asher Alo. Here are some examples is providing for project learning.
 

1) From the project we get an important lesson learning that, if we developed strong communication between health service providers and communities, it is very effective for our people and communities to prevent COVID-19. Because at first, we see that general person does not have a proper idea about this pandemic such as they do not know that COVID-19 is a preventive disease.

They believe that COVID-19 comes from God as a punishment's so that it is a non-preventive disease, but when we create awareness about COVID-19 through community awareness meetings then they understood that it is a preventable disease and recover from this disease by maintaining a proper hygienic practice, such as proper handwashing within 30 seconds, maintaining physical distance, wearing mask properly, by avoiding crowded areas, by avoiding handshake, before sneezing covering nose and mouth by tissue or cloths.

2)  At first a larger number of community people has a vaccine hesitancy because of their religious prejudices, lack of proper knowledge about vaccination, believes in mickey, the misconception of vaccine functioning in the human body, then our field staff and volunteers removing their misconception and creating proper awareness about vaccine hesitancy by community awareness meeting, distributing leaflets, public announcement and one to one communication about COVID-19.

Regarding this lesson, proper communication is used for effective implementation in this program.

5.3 Certification of Project Competition by Upazilla Nirbahi Officer (UNO)

At first, the NGO affairs bureau was approved of FD-7 then Asher Alo informed to get permission by UNO. After getting permission from UNO, was started this project in each Upazilla. In implementing period of this project UNO direct supervised this project and presented it in the orientation program. The program officer of Asher Alo has attended an NGO coordination meeting and reporting every month at the UNO conference room. The certification of this project is approved by UNO after ending this project.

6. RECOMMENDATION FOR FUTURE PROJECT IMPLEMENTATION  

On basis of the current project which was implemented by Ashar Alo titled " Mitigating the impact of COVID-19 through community-led prevention program in Bangladesh”, we include a bunch of recommendations for future project implementation.

·         Our project was implemented in a particular area especially the southern part of Bangladesh, the people of this locality are highly benefited against COVID-19 from this project. If this project will be implemented in a vast area of this country, it is very fruitful to our country's people for mitigating this pandemic situation.

·         For better performance of this project, the support of supplies should be increased like as, number of PPE, Mask, Sanitizer, Hand Washing materials, Goggles, Face Shield, Floor Disinfector, Oximeter, Thermal Scanner and also Oxygen Cylinder.

·         It will also be recommended that every Community Help Center needs to deploy two field officers for enhancing better services during COVID-19 situations.

·         Emergency ambulance services should be included in this project.

·         A registered nurse should be deployed at Community Help Center under the future project.

To mitigate and the prevention of COVID-19, the continuity of this project is highly effective for our country's people. 

Project Name : “Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh”

Doner : AMERICARES Foundation Inc.

Sector : Health

Area : Kulia and Noapara Union Under Debhata Upazilla

Time Line : 01 February, 2023 to 31 January, 2024

Brief of activities :

1.Introduction:

This report outlines the progress of our project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh" from January 1, 2023, to August 31, 2023. The goal of the project is to increase access to quality essential health services through community sensitization, capacity building of community clinic staffs and improvements to the community clinics at Debhata Upazila under the Satkhira district.

2. Summary Results in Progress Report:

The project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh" aims to increase health services through community sensitization, create capacity building of Community Clinics staffs and infrastructure development to the 7 Community Clinics at Kulia & Noapara Union under Debhata Upazila in Satkhira district. The project targets a total direct population of 50,000 and approximately 97,200 indirect beneficiaries.

During the reporting period, Community Health Workers have been actively making contact with 20,970 direct beneficiaries through home visits, community awareness meetings and community mobilization through discussion about CCs health services at the community outreach point, one-to-one awareness and counselling, Critical patient’s referral to Upazila Health Complex and district hospital, Screening of Diabetes & Hypertension through organizing camp, Formation & Organization of “Health Brigades”  and advocacy meetings. The 31500 indirect beneficiaries got benefited through television installation at the waiting room for patients of Community Clinics, Furniture distribution at the waiting room for patients of Community Clinics, Loud speakers messaging, Broadcasting general health messages through local media and printing X banners.

3. Goal and objectives of the project:

Increase access to quality essential health services through community sensitization, capacity building of community clinic staffs and improvements to the community clinics.

1. Objectives:

• To increase the capacity of community health workers and community health care providers to align with government guidelines.
• To support repairing the water, sanitation, and hygiene infrastructure of the CCs.
• To establish a clear referral pathway from the community to the UHC.

The project have undertaken different interventions such as Kick-off workshop with local health administration, Assessing need assessment of the community and health facilities, Training of community health workers and Community Clinic Providers, Development of training materials, Mapping the health services continuum for each community, Establishment of referral pathway from community to higher level, Development and printing IEC materials, Information, Education and Motivation (IEM) campaign through and cultural activities, Organization and formation of “Health Brigades”, Orientation of “Health Brigades”, Community awareness meeting by the community health workers, Community transport for sick patients, Restoring community clinic’s infrastructure and provide medical supplies, Procurement of medicines & equipment for CCs, Renovation of community clinic for improving WASH facilities, Screening of Diabetes & Hypertension through organizing camp, Blood grouping & Rh typing through organizing camp, Maternal nutritional education & support with Food Parcels distribution for pregnant women through camp, Union & Upazilla coordination meetings, Strengthening DRR workshop and advocacy meetings.

The key finding of the project so far is that through active community mobilization and intervention, the project has been able to increase CCs services among the select population in the target areas. The project has also been able to provide health education and services and aware to the target population.

4. Specific activities under strategy-1:

4.1.1. Establishment & Procurement of office furniture and deployment of Project staffs

Throughout the duration of the project, we have rented project office (office room and training/meeting room) & already purchased office equipments for project staffs such as 2 laptops, 1 printer cum scanner, 1 multi-media projector, 1 motorbike, three tables, six chairs, one shelve, Almirah, one file cabinet and office stationery (Paper, files, Scissors, Cutter, Dairy/note book, Multiplag, Paper weight, Light, Masking tape, Binding tape, Marker, Register book, Water Jar, attendance register, Movement register, Carpet, Vessel, Toilet tissue, towel, Sandles, Water Glass, Waste bin, Electricity Meter Recharge, Hand Wash, Vim, Soap, Phenyl, Kettle (water heater), Cup, the broom, shovel, toner, pen, etc.) to continue the project’s ongoing operations following organizational procurement policy & procedures. A cleaner has been hired to keep the project office clean. On the other hand, Recruitment of Project Coordinator, Project Officer, Accountant and nine Community Health workers have been deployed in accordance with the organization’s recruitment policy and procedures for running the project activities.

4.1.2. Arrange induction for all project staffs

Ashar Alo has been implementing a new project “Thriving Local Health Centre in Debhata Upazilla (sub district), Satkhira, Bangladesh” which is funded by Americares Foundation Inc. from 01 January 2023 to 31 March 2024, for increasing access to quality essential health services through community sensitization, capacity building of community clinic staffs and improvements to the community clinics. The primary focus of the project will be seven community clinics of two unions respectively Kulia and Noapara of Debhata Upazila, Satkhira. For effective implementation of the project, an induction and orientation program for all project staffs with the local government health administrators, held on 25 February 2023. In this program, Dr. Md. Abdul Latif, Upazila Health & Family Planning Officer, Debhata Upazila, Satkhira was present as the chief guest, Abdullah Gazi, Health Inspector, Debhata Upazila, Satkhira was as special guest also Community clinic representative Golam Mohiuddin, president of Community Health Care Providers coordination committee was present. This program was arranged to formally introduce the entire team to the project and with the organizational norms and policies. Besides to provide information regarding project overview, plan and objectives with the project staffs. To introduce organizational norms and Values & organization policies as HR & Gender etc, To introduce the staffs with local health system administrators. To establish a clear referral pathway from community to the Upazilla health complex/to higher healthcare facilities. To introduce jobs responsibilities & activities of project staffs. To discuss about Community Clinics activities.

4.1.3. Submission of FD6 to NGOAB and persuasion for approval

The approval from NGO Affairs Bureau of the people’s republic of Bangladesh is required for this project. In continuation, FD-6, FD-2 format with forwarding were prepared and submitted for approval to NGOAB on 19 February 2023. Also, the project overview presentation has been prepared and presented as requested by the NGOAB. Besides this, Ashar Alo has coordinated with NGOAB staffs. It is great pleasure that we have received approval from NGOAB on the 18^th April 2023. Already we have submitted the copy of forwarding, FD-6 & approval letter from NGOAB to DC office, Civil Surgeon Office, District Family Planning Office, Upazila Health Complex, Department of public Health, Upazila Nirbrihe Office and all concerned departments have submitted.

4.1.4. Conduction of health needs thorough Assessment:

The assessment questionnaire and the tools were developed to collect information from the field and conducted FGD, KII, observation with different group, individual and different CCs as well as with the management of the CCs in the project implementation site. The assessment had been conducted in the month of June 2023. There were 24 respondents have provided very key issues by using the KII tools. On the other hand, 08 FGDs were conducted where 71 participants’ attended. Among them CG & CSG members, service providers, project implementing professionals and the service seekers of the selected CCs and project area were present. The participants provided very important information and key issues, and also gave suggestion to incorporate and adopt in the tailor made module. Due to this small size of response rate, the analysis of health needs will base on the In-depth interviews (qualitative study) with different stakeholders and service providers.The assessment is being under processed by consultant.

4.1.5. Procurement of 2 auto-rickshaws/vans for critical patients referral

In order to implement ongoing project, two electric rickshaws/vans have been purchased to carry referral patients to the Upazila Health Complex & district hospital.Two auto-rickshaws (one for each union) procured for the transportation of the critical patients from the community clinics to UHC hospitals & district hospital. Two male community health workers have been deployed for two unions and they ride the auto-rickshaws for transporting the sick patients. This service is being opened on call 24/7. The continuous work throughout the year will be referral of serious patients from catchment areas to Upazila Health Complex and district hospital. For example, A critical patient Mr. Rohim, 48 years old, hailing from Kalabaria, Noapara, Debhata, suffering from excessive sweating and sudden unconsciousness has been transported to Upazila Health Complex’s emergency department by community health worker-Md. Alamin.

4.1.6. Community awareness meeting to be conducted by the community health workers

In order to implement ongoing project, Attendance sheet, Meeting Banner, Meeting Agenda, Validation tools, Handout of Guidelines have been prepared to implement Community Awareness Meeting and distributed among the CHWs. Community Awareness Meeting (CAM) is being conducted as per instruction & guideline. The community health workers have defined catchment areas and target for home visit & community awareness meeting. The community health workers organize CAM with the community people. A total of 256 CAM have been arranged, and estimated about 16,640 community members were participated. As per target, the community health workers will conduct awareness session with the community people. They will also identify the patients or people who need health services, and refer the patients to the community clinic.

4.1.7. Conduct training need assessment

Ashar Alo is intended to develop a training module targeting primarily the CHCPs working at the CCs and also other health support workers at the union and community level. The purpose of the TNA is to find out the areas of improvement for the service providers and community support service members. Through this assessment and training, it is assumed that capacity of CHCPs and other service providers will be increased and they will be aligned with government guidelines. Ashar Alo hired a Consultant (A public health professional and training expert and his team) to conduct TNA and to develop training modules based on the findings of TNA. The TNA was identified as a key element in enabling CC service providers and support group members to adapt the programmes that are being offered under this project, so that they meet the needs of the selected community people & also develop a strong and effective referral network with the UHCs for required health services. The objectives of the project are: To increase the capacity of CHCPs and other service providers  to align with government guidelines, To support repairing the water, sanitation, and hygiene infrastructure of the CCs, To establish a clear referral pathway from the community to the UHCs. The TNA consists of three elements: A comprehensive literature review, analysis existing modules to establish the broad needs of the CHCPs and service provision. A survey has been conducted for collection of large-scale quantitative data to give an overview of the needs of CHCP, FWA and other service providers, A qualitative element, comprising of individual interviews with key people, stakeholders, community elite and the service recipients (clients) through KII, FGD, observation and exit interview with the clients. Also discussed with the CC neighbouring people to get a detail insight into some of the current challenges and the skills needed to support change. This report provides an overview of the work conducted to date on the TNA, analysis of the data obtained and conclusions that are derived from the above. In summary, the TNA will draw a range of information to adapting our programmes. The literature review which consisted of detailed investigations of different training module, handout and guideline which is currently used to conduct training & capacity building as well job aid for the CC service providers and also for the CG/CSG. Most of the available documents focused on needs for curative service and counseling issues. Most of the documents focus on clinical and curative practice but there is very little part and areas focus on the prevention issues. Such available literature suggests that: Fostering professionalism and a sense of counseling are top priorities, Service providers and support group need to be encouraged to reflect and follow the guideline provided from the management to provide effective and result orient services, Guideline and handout for the CC service providers are very well articulated, but there are scope to improve and incorporate new issues, data and updated information, Good practices in Human Resource Management (HRM) need to be understood by management, Quality Assurance (QA) skills need to be developed, with service providers given enhanced skills in reflecting on service provision, counseling and IPC of a range of procedures to monitor and evaluate practice. The strategic and short term planning skills of management and service providers need to be considered to increase service seekers for the community clinic. The assessment questionnaire and the tools were developed to collect information from the field and conducted FGD, KII, observation with different group, individual and different CCs as well as with the management of the CCs in the project implementation site. The assessment had been conducted in the month of June 2023. There were 24 respondents who have provide very key issues by using the KII tools. On the other hand, 08 FGDs were conducted where 71 participants’ took part. Among them CG & CSG members, service providers, project implementing professionals and the service seekers of the selected CC and project area were present. The participants provided very important information and key issues, and also gave suggestion to incorporate and adopt in the tailor made module. Due to this small size of response rate, the analysis of training needs will be based on the In-depth interviews (qualitative study) with different stakeholders and service providers. Apart from the TNA, observation of the service provision, interview with the service seekers immediately after receiving service and discussion with the UHFPO were also done. Their opinion, views and suggestions were noted and taken care for further development of the module. The TNA findings and analysis shows and guide for update the content as well as incorporate new priority areas. In-depth interviews were also conducted with health managers to take their experts idea, view and suggestions for content/issue/area. Some of the key issue, suggestion and ideas from the TNA to prioritize by the interviewees, service providers, and the management for the module are- Refresher  training on clinical service and effective use of medicine, Training/refresher on Ante natal Care (ANC) services (check-up and referral system), Training on nutrition, Training on mental health, Counseling on ANC, children, adolescent nutrition and health issues, Adolescent health and hygiene, Communicable and non-communicable disease issue, Inter Personal Communication (IPC), Counseling, Communication, Effective service provision with medicine support from community clinic, Gender based violence and its management, Adolescent health service and their care, Management of Community Group (CG) and Community Support Group (CSG) , Effective referral collaboration, Awareness raising program for the community people on health related different issue is required, especially focus on prevention, personal hygiene and service seeking attitude is important, Disaster risk reduction (DRR) and Disaster risk management (DRM).

4.1.8. Map the health services continuum for each community

All project staffs have already received appointment letter and aware of his/her proper work. Every staffs are performing their works in coordination & collbration with UH&FPO, UFPO & CCs running staffs (CHCP, HA, FWA, FWV, FPI, AHI, HI, CHW) for mapping. A mapping exercise is conducted to identify the health services continuum for establishing a referral pathway. It will identify the roles and responsibilities of each health points. The health services continuum for each community and development of referral pathways from community to UHC & district hospital have been mapped.

4.1.9. Development and printing IEC materials 

The project is developing and printing banners, X banners, general health messages for broadcasting through local media. IEC materials printing are under processing. Community health workers will use those materials. Now we will go to deliver as below: Training modules total 50 copies are prepared for voluntary group/health brigades. Development and printing-100 pieces of Flipcharts & Diagram are under processing. Development and printing-14,000 pieces of Poster & Leaflet are under processing. Development and Printing-35 pieces of Diagram and flow chart for community clinics are under processing.

4.1.10. Organization and formation of “Health Brigades” 

For proper implementation of project activities, Bio-data of youths from each project union has been collected. Already We have organized & formed a volunteer group called as “Health Brigades” which mobilizing and engaging the local youths. They have been selected from the defined community, received orientation program & training, and will volunteer in disseminating health message, helping the project team in organizing the cultural & social events, essay competition, art competition & IEM campaigns in the community.

4.1.11. Kick-off workshop with local health administration

According to the guideline of project proposal, a Kick-off Workshop at Upazila level held on 19 June 2023. This program was arranged to provide information regarding project goal, mission, vision, objectives, plan & overview with the local health administrators and local representatives. Officially informing the local health administrators & local representatives about the project overview. To explain in details the project background, goal, objectives, activities implementation strategy & outcome. Formally introduce project staffs and details explain their job responsibilities. Discussion about the project budget details. Engage GOs & NGOs representatives about the project activities. The Program was segmented into different key areas of programmatic and organizational importance. The program started with the registration of all participants. Then recitation from holy Quran and holy geeta were performed. Next, Introductory session of participants with guests. In this program Alhaj Md. Mujibur Rahman, Upazila Chairman, Debhata Upazila, Satkhira was present as the chief guest, Abu Abdullah al Azad, Executive Director Ashar Alo as the president and Md. Rifatul Islam, UNO (Acting), Debhata Upazila, Satkhira and ABM Kamrul Ahsan, Country Representative, Americares Foundation Inc. as special guests. Besides, different local health administrators and local representatives such as Dr. Md. Abdul Latif, UH&FPO, Debhata UHC, Dr. Palash Dutta, UFPO, Debhata, Md. Asadul Hoque, Chairman, Kulia union, Md. Alamgir Hossain, Chairman, Nowapara union, Abdullah Gazi, HI, Debhata UHC, Presidents of CG committee of different Community clinics, representatives of different NGOs, Journalist, Teachers, Midwife, Imam, Priest, Union Secretary, local health receiver, CHCPs & FWV under Kulia & Nowapara Union CCs and many others were present. The program was facilitated by Dr. G.M. Imtiaz Ahmed, Project Coordinator, Ashar Alo and Md. Alamgir Hossain, Project Officer, Ashar Alo. Open Discussion: After the presentation, this session took place. All participants actively participated in this session.

4.1.12. Screening of Diabetes & Hypertension through organizing camp

For proper implementation of project, this program was arranged to systematically assess the burden of hypertension and diabetes within the population under Tiket community clinic, Tiket, Kulia union, Debhata, Satkhira, Bangladesh. In Bangladesh, according to WHO estimates, 30% of all deaths are due to cardiovascular diseases and 3% are due to diabetes. There is a serious burden of non-communicable diseases in Bangladesh. But little is known about the health status and the epidemiology of non-communicable diseases in the population under Noapara & Kulia union, Debhata, Satkhira, Bangladesh. Most importantly, scientific evidence on non-communicable disease is rather limited. This assessment will help to design and to introduce community-based intervention strategies aiming to improve the population health status and reduce the disease burden. Hypertension detection through Diagnostic Test: Blood pressure measurement (Using Sphygmomanometer), Diabetes Mellitus detection through Diagnostic Test: Blood glucose measurement (Using standard measurement device). Two camps have been organized covering total 172 people who came for screening. The camp started with registration of the interested people. Then blood pressure and blood glucose measured using standard measurement device. Participant no (total) till date–172 persons, Male-83, Female-89, Diabetes diagnosed-23, Hypertension diagnosed-35, Prevalence of hypertension-Assessment of the prevalence of hypertension, Prevalence of diabetes mellitus-Assessment of the prevalence of increased levels of fasting glucose/random blood glucose.

4.1.12. Maternal nutritional education & support and referral for pregnant women:

For implementation of the project, this program was arranged and provided Maternal nutritional education & support with Food parcels and referral for pregnant women under Nangla community clinic, Noapara union, Debhata, Satkhira, Bangladesh. There is a serious burden of nutritional anemia of pregnant women in the rural areas. This camp is helping to identify anemic pregnant women. One camp has been organized where total 15 pregnant women came for receiving food parcels containing rice, pulses, sugar, cooking oil, popatoes, iodized salt and vegetables etc. The camp started with registration of the selected women. Then a session of nutritional education conducted then clinically anemia screening was done.

4.1.13. Advocacy meeting at Noapara Union

This program was arranged to provide information regarding all project activities & progress. Moreover, program was arranged a coordination & collaboration and took feedback with the local health administrators and local representatives. Officially explaining in details the key stakeholders & local representatives of Noapara union regarding the project overview, program  implementation strategy & outcome. Coordination, Collaboration & Liaison with key stakeholders and community leaders of Noapara union. To establish trust and transparecy for both side. To collect the environmental issues and the local conditions.To take significant opinions from local stakeholders. Engage GOs & NGOs representatives about the program activities. The Program was segmented into different key areas of programmatic and organizational importance. The program started with the registration of all participants. Then recitation of verses from holy Quran and Geeta were performed. In this program Md. Alamgir Hossain (Saheb Ali), Chairman, 4no Noapara union, Debhata, Satkhira was present as the chief guest, Abu Abdullah al Azad, Executive Director Ashar Alo as the president, Abdullah Gazi, HI (acting), Debhata UHC, CHCP of Community clinics, HA at Noapara union, Honorable members of Noapara Union Parishad, representatives of different Secondary schools, students and many others were present. The program was facilitated by Dr. G.M. Imtiaz Ahmed, Project Coordinator, Ashar Alo and Md. Alamgir Hossain, Project officer, Ashar Alo. Presence of most of the stakeholders of Noapara Union, Debhata, Satkhira, Bangladesh. Precious opinion from the government & NGOs representatives, Teacher, Students, Beneficiaries, Freedom Fighter, Journalist & Anti-corruption committee. Understandable discussion about the project overview, program implementation strategy & outcome. To take positive feedback & recommendation from local stakeholders.

4.2. Specific activities under strategy-2:

We believe that “Critical Patients Referral System’’ is the prime component of the project. Through purchasing two auto rickshaws/vans, the critical patients from the remote areas of the village are able to come the Upazila Health Complex & district hospital health services. Local people named it “Mini Auto Ambulanc” a Free service that is opened 24/7. There are two community health workers for two unions and they each have Hotline phone number which have been circulated around the society.

4.2.1. Disseminating Health information through Loud speaker

For this project, community awareness is enhanced through Loud speakers particularly at catchment areas to inform the people about the full range of services provided by the Community Clinics. Apart from this, all the camps which have been organized under the project are requested to attend and take services.

4.2.2. Disseminating Health information through X Banner for workshops/meetings

As part of the project, for display of government health messages at the workshop, training & cultural events. Meanwhile, we have taken health messages from local administration as well as our health messages X banners are being given in various workshop, meeting & camps and cultural programs so that people can be aware about CCs health services.

4.2.3. Television & Furniture distribution for waiting room of community clinics

As part of the project, Procurement of television & furniture for waiting room of the patients and supply to the 7 Community Clinics. Televisions have already been installed so that patients can sit in the waiting room properly. They will get health messages while watching TV and will know a lot about health facilities.

4.2.4. Brodcasting General Health messages through local media (Community Radio & Cable TV network)

The general health messages have been brodcasting through local media (Community Radio & Cable TV network scrolling). As a result, the people in the project areas are becoming aware of their health through local media. Being informed about the various activities of the project. The Hotline phone number of the referral is being circulated in massive form.

4.2.5. Mass Awareness development through Door-to-Door Visit

Form the begining of the project , particularly Project Community Health Workers (CHWs) have been visiting, talking and building-up rapport to Community Clinics staffs and in their communities about CCs activities and facilities. They try to collect some significant information through data collection sheet in their working areas. As a result, we are able to make referral of many patients as well as able to identify prepnant women.

4.2.6. Monitoring, Supervision and Evaluation

Project monitoring is the inbuilt part of Ashar Alo’s project management, usually organization’s management and project staffs engage with the project monitoring process. Project will measure the success or results according to the set indicators in the logical framework of this project proposal. Ashar Alo has recruited project coordinator & project officer who have been providing full time support for this project through 100% salary for this position were allocated in the approved budget. As the project is passing its initial phase at this moment project coordinator & project officer involved for selection of project stakeholders & beneficiaries as like other staffs of this project. Besides this, project coordinator & project officer also performing to all the project activities and will supervise and monitored properly. The supervisors will monitor the project activities through physical visit to the field and through using mobile phones and other social media. On the other hand, we observed that a full-time monitoring officer is essential for this project to accomplish the task timely and effectively according to target and nature of work.

4.2.7. Development of organization’s Website, Collection videos and photography & internet facilities

During the project period, A complete and modern website is being developed to keep update track record of all activities of the project. As a result, everyone can get proper information about the project activities. After developing the website, videos and photographs, captured by a professional photographer are regularly being uploaded to the website. Beside,  internet facility (e-health information) has been provided for community clinics staffs so that they can use and communicate and give health information to project staffs. The website address is www.asharalobangladesh.org

5. Key Achievements for Progress Report

During the reporting period, the project has successfully provided services to a total of 20,970 direct participants. Among the direct participants, 420 persons received referral services, and 172 persons received screening of Diabetes & Hypertension through organizing camp. 15 persons received Maternal nutritional education & support with food parcels for pregnant women through camp and referral. Community awareness meetings with 16640 partcipants have been conducted and one-to-one awareness and counseling to 3580 participants have been provided. “Health Brigades” consisting of 30 participants has been formed and organized. A Kick-off workshop & advocacy meetings with 113 local administrations, stakeholders & leaders have been conducted.

In addition, the project has indirectly reached 31500 participants. Through the project, seven Television and Furniture have been distributed to Community Clinics 8500 persons are becoming aware of CCs health services. the project has reached to 12000 persons through public announcements made through loudspeakers. 11000 persons are becoming aware through broadcasting general health messages through local media (Community Radio & Cable TV network scrolling).

Overall, the project has made significant progress in achieving its goal of providing health education & services to individuals at Kulia & Noapara Union under Debhata Upazila in Satkhira district.

6. Total Number Participants Reached to Date

6.1.1. Outcome-1

The project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh" aimed at health education and sensitizing local communities in Debhata Upazila under Satkhira district about the importance of health education. The project has implemented various interventions such as Kick-off workshop with local health administration, Assessing need of the community and health facilities, Training of CHWs and CHCPs, Development of  training materials, Mapping the health services continuum for each community, Establishment of referral pathway from community to higher level, Development and printing IEC materials, Information, Education and Motivation (IEM) campaign through and cultural activities, Organization and formation of “Health Brigades”, Orientation of “Health Brigades”, Community awareness meeting by the community health workers, Community transport for sick patients, Restoring community clinic’s infrastructure and provide medical supplies, Procurement of medicines & equipment for CCs, Renovation of community clinic for improving WASH facilities, Screening of Diabetes & Hypertension through organizing camp, Blood grouping & Rh typing through organizing camp, Maternal nutritional education & support with Food Parcels distribution for pregnant women through camp, Union & Upazilla coordination meetings, Strengthening DRR workshop and advocacy meetings. the project has successfully provided services to a total of 20,970 direct participants. Among the direct participants, 420 persons received referral services, and 172 persons received screening of Diabetes & Hypertension through organizing camp. 15 persons received Maternal nutritional education & support with food parcels for pregnant women through camp and referral. Community awareness meetings with 16,640 partcipants have been conducted and one-to-one awareness and counseling to 3580 participants have been provided. “Health Brigades” consisting of 30 participants has been formed and organized. A Kick-off workshop & advocacy meetings with 113 local administrations, stakeholders & leaders have been conducted.

In addition, the project has indirectly reached 31500 participants. Through the project, seven Television and Furniture have been distributed to Community Clinics 8500 persons are becoming aware of CCs health services. the project has reached to 12000 persons through public announcements made through loudspeakers. 11000 persons are becoming aware through broadcasting general health messages through local media (Community Radio & Cable TV network scrolling).

These interventions have successfully raised awareness among communities in Debhata Upazila about the health education. The community is now more knowledgeable about maintaining proper CCs health facilities & hygiene. The project's outcome will contribute to reducing the incidence of home health facilities in the project areas and improving the health and well-being of institution health facilities and individuals.

6.1.2. Outcome-2

The project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh" aims at identifying critical patients among the local communities in Debhata upazila through providing referral services. During the reporting period, critical patients successfully identified and provided referral services to 410 critical patients from community CCs to UHC. Seven television have been distributed to CCs to provide the health education. These interventions have contributed to the recovery of critical patient’s health condition and prevented other diseases, ultimately improving the health and well-being of individuals in the project areas.

7. Challenges & Lessons Learned

The project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh"encountered several challenges during the reporting period. The challenges encountered and responses taken are summarized below:

7.1. Challenges

Skill Staffs: One of the major challenges encountered during the reporting period was the shortage of qualified staffs. To address this challenge, the project management authority should recruit and train staffs to support the implementation of the project.

Oversight: Another challenge was the lack of effective oversight and reporting & monitoring mechanisms, which led to difficulties in tracking progress and identifying areas for improvement. The project management team addressed this challenge by establishing a robust reporting, monitoring, supervision and evaluation system, which includes regular site visits, progress reviews, and data analysis.

Resource constraints: The project faced challenges in implementing certain activities due to resource constraints, such as limited time. The project management team addressed this challenge by identifying better time management and working closely with local authorities.

Community engagement: The project encountered challenges in engaging the target communities and mobilizing them to participate in the project activities.The project management team addressed this challenge by strengthening community mobilization efforts and working closely with community stakeholders & leaders to increase awareness and participation.

Coordination: The project encountered challenges in coordinating with local stakeholders and consultants, which make challenges in project implementation. To address this challenge, the project management team established clear lines of communication and strengthened coordination mechanisms with local stakeholders and consultants.

Role clarity: The project encountered challenges in clarifying the roles and responsibilities of local administrations & stakeholders, which led to confusion and delays in project implementation. The project management team addressed this challenge by developing clear guidelines and protocols for local administrations & stakeholder engagement.

Environmental factors: The project faced challenges in implementing certain activities due to environmental factors, such as hot & rainy weather. To address this challenge, the project management team developed contingency plans and established response mechanisms to ensure the continuity of project activities.

Cultural factors: The project encountered challenges in addressing cultural norms and practices that hinders community participation and engagement. The project management team addressed this challenge by working closely with community leaders and engaging in culturally appropriate outreach and awareness-raising activities.

7.2. Lessons Learned

The project "Thriving Local Health Center in Devhata Upazila (Sub-district), District- Satkhira, Bangladesh" revealed several technics and lessons during implementation that could be useful for future projects. One of the best practice was the involvement of community health workers from the target communities to facilitate trust and rapport with beneficiaries. Engaging with local stakeholders, including community administration & leaders and health centers, was also important for building community ownership and enhancing project visibility. Effective communication strategies, such as the use of multiple channels, were crucial in achieving project objectives. Based on these lessons learned, the project made changes such as expanding outreach to more remote areas, establishing stronger partnerships with community clinics, and improving the monitoring, supervision and evaluation framework to guide in decision-making.

8. Sustainability & Transition/Exit Planning

The project has implemented several plans to promote the sustainability and lasting impact of the health education and control project beyond the funding period. Strengthening community-based groups is one of the plans. The project has closely worked with these groups to create awareness about health education and improve access to health services. The project will further strengthen these organizations to ensure the continuation of project activities. Another plan is the capacity building of community health workers. The project has provided training to community health workers on health education and hygiene. The project will further train these health workers to take over the project activities after the funding period to ensure the sustainability of the project. Advocacy and awareness-raising activities will be conducted at the local and national levels to mobilize resources and create awareness about the importance of health education. Partnerships and collaboration with government agencies, health centers, and other stakeholders will also be continued to ensure the sustainability of the project. To address potential issues that may affect sustainability beyond the funding period, the project team will develop a sustainability plan to guide the continuation of project activities. The project will also involve community members and local organizations in project planning, implementation, and monitoring to stand in local ownership. The project team will explore new funding opportunities to ensure the continuity of project activities beyond the funding period. These plans aim to promote the sustainability and lasting impact of the health facilities project beyond the funding period.

9. Financial Spending Narrative Update

The project period is from 1 January 2023 to March 31, 2024, and the reporting period is from 1 January to August 31, 2023. The total budget for the project is 2,02,250 USD, with AMERICARES contributing 2,02,250 USD. In the reporting period, 25.00% of the total budget has been spent, which is 50,562.50 USD out of 2,02,250 USD.

Out of the total budget, 21.01% has been allocated for human resources, 18.13% for administrative, 31.81% for infrastructure repair & equipment, 11.87% for Training and capacity building, 7.47 % for Community Mobilization and Awareness and 6.30% for IEC meterials costs, 3.36% for coordination meetings.

All expenses have been spent as project requirements. The main cost of the budget is infrastructure repair & equipment, which have been spent 31.81% for infrastructure repair & equipment.

The expenditure has been allocated for providing human resources and administrative, distribution of television & furniture, assessment of Training Need Assessment & Health needs thorough assessment, Kick-off workshop, advocacy meetings, Health Brigades organization & formation, Website development, Screening of Diabetes & Hypertension through organizing camp, Maternal nutritional education & support with Food Parcels distribution for pregnant women through camp, public announcements, and community awareness meetings and others.

All staff members have received their salaries on time, and the funds have been used efficiently and effectively to achieve the project goals. Regular updates on financial spending and project progress will be provided in the coming months.

10. Conclusion                                                  

The first eight months of 2023 has been very successful in achieving the objectives of the project. We have made significant progress in creating awareness about the prevention of project overview and providing health and hygiene messages to the communities in Debhata Upazila. We will continue our efforts in the next quarter to reach out to more people and achieve our project objectives.