Project Name : Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh

Doner : AMERICARES Foundation Inc.

Sector : Health

Area : Assasuni Upazila, Satkhira District and Feni Sadar Upazila, Feni District

Time Line : Novembar-2024 through January-2025

Brief of activities :

1. Executive Summary

The “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project, implemented by Ashar Alo with funding and technical support from Americares, responded to the devastating 2024 flash floods that affected more than 5.8 million people across eleven districts. Among the hardest hit were Protavnagor Union of Ashashuni Upazila in Satkhira District and Kalidaha Union of Feni Sadar Upazila in Feni District, where thousands of families were displaced, health facilities damaged, and water sources contaminated. Vulnerable groups such as women, children, and the elderly faced heightened risks of disease outbreaks, malnutrition, and loss of education. Against this backdrop, the project sought to restore essential health services, ensure access to safe water, strengthen hygiene practices, and support maternal nutrition over a three-month period from November 2024 to January 2025.

By the close of the project on 31 January 2025, a comprehensive set of interventions had been successfully delivered. Six community clinics were restocked with essential emergency medicines, enabling the treatment of more than 5,200 patients suffering from flood-related illnesses, while referral rates to higher-level facilities fell by 40 percent. Access to safe drinking water was restored through the installation of 20 water purifiers across six clinics and 4 schools, directly benefiting an estimated 10,500 people and contributing to a 45 percent reduction in diarrheal cases within one month. To address menstrual hygiene challenges, 1,000 adolescent girls from ten schools received comprehensive hygiene kits, leading to a 30 percent improvement in school attendance during menstruation and a marked increase in confidence among beneficiaries.

Awareness building was another critical component, with eight one-day school sessions involving 800 students and generating a ripple effect as 82 percent of participants shared knowledge at home, extending the impact to more than 4,000 additional community members. In parallel, 20,000 illustrated WASH leaflets were distributed throughout Satkhira and Feni, helping to indirectly reach approximately 50,000 people with vital information on hygiene and disease prevention. Nutritional support was provided to 100 pregnant women through carefully designed food packages containing staples and supplements to improve dietary diversity and reduce anemia, ensuring healthier outcomes for both mothers and infants.

Altogether, the project directly reached 12,500 people including patients, students, adolescent girls, pregnant women, and healthcare workers while indirectly benefiting an additional 50,000 individuals across the two districts, bringing the total reach to 62,500 people. Implementation was completed on schedule and within the allocated budget of USD 25,650 (equivalent to BDT 3,026,700), with financial and operational systems maintained in full compliance with NGOAB and donor requirements. The project’s achievements were made possible through strong coordination with District Commissioners, Upazila Nirbahi Officers, Civil Surgeons, UH&FPOs, CHCPs, and school leaders, whose support ensured that interventions were aligned with government disaster response efforts and widely accepted by the community.

In sum, the project successfully restored access to essential health services, reduced the prevalence of waterborne diseases, strengthened hygiene practices, and improved maternal nutrition in flood-affected areas of Bangladesh. By combining direct service delivery with widespread awareness efforts, it not only alleviated immediate suffering but also contributed to longer-term community resilience in Satkhira and Feni.

Keywords (health, WASH, accountability, financial, and institutional).

2. Administrative Information

- Implementing NGO: Ashar Alo
- Donor: Americares
- Budget: USD 25,650 (BDT 3,026,700)
- Duration: 01 November 2024 – 31 January 2025
- Operational Areas: Kalidaha Union (Feni) & Protavnagor Union (Satkhira)
- Facilities: 6 Community Clinics and 6 schools
- Approvals: FD-2 & FD-7 (13 Nov 2024)

3. Context

Bangladesh, one of the most flood-prone countries in the world, faced an unprecedented humanitarian crisis in 2024 when flash floods devastated large parts of the southeastern and coastal regions. More than 5.8 million people across eleven districts were severely affected, with Satkhira and Feni among the worst hit. The floods displaced over 500,000 individuals, forcing them into overcrowded evacuation shelters, while more than one million people were left without access to essential services such as healthcare, clean drinking water, and sanitation. The sudden inundation destroyed homes, infrastructure, and livelihoods, creating cascading humanitarian challenges for already vulnerable populations.

The public health consequences of the floods were immediate and severe. Contaminated water sources triggered widespread outbreaks of waterborne diseases, including diarrhea, cholera, and skin infections. Health facilities were either damaged or overwhelmed, leading to critical shortages of medicines and medical equipment. In Satkhira, saline water intrusion compounded the problem, rendering vast stretches of agricultural land unproductive and making safe drinking water even scarcer. In Feni, the abrupt and intense flooding washed away stocks of medicines and destroyed vital health equipment, including blood pressure monitors, glucometers, and nebulizers in community clinics. This disruption severely constrained the ability of Community Health Care Providers (CHCPs) to respond to the mounting health needs of their communities.

The impact of the floods went beyond health services. Over 339,000 hectares of standing crops were destroyed, devastating rural livelihoods and intensifying food insecurity across affected districts. Families dependent on agriculture and daily wage labor were left without reliable income, making it increasingly difficult to purchase food or medicines. The crisis was further compounded by the closure of more than 7,000 schools, disrupting the education of approximately 1.75 million children. For adolescent girls, the situation was even more acute: the lack of access to menstrual hygiene products and safe sanitation facilities not only heightened the risk of infection but also forced many to miss school, undermining their educational continuity and well-being.

Vulnerable groups—particularly women, children, the elderly, and people living with chronic illnesses—were disproportionately affected by these cascading crises. Pregnant women faced heightened risks of malnutrition and complications during pregnancy due to the lack of access to nutritious food and antenatal care. Adolescent girls, struggling to manage their menstrual health in the absence of sanitary products and private facilities, faced both physical and psychological challenges. Elderly individuals and people with disabilities were unable to navigate overcrowded shelters or access health facilities, leaving them more exposed to illness and neglect.

In response to this complex emergency, the project “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” was designed to fill critical gaps in the immediate humanitarian response. Recognizing the urgent need for lifesaving interventions, Ashar Alo, in partnership with Americares, prioritized health, water, sanitation, hygiene (WASH), and nutritional support. The project aimed to equip six community clinics across Satkhira and Feni with emergency medicines, replace lost medical equipment, and distribute twenty water purifiers to clinics and schools. By doing so, it sought to restore the capacity of frontline health services and reduce the incidence of waterborne disease outbreaks.

Furthermore, the project emphasized preventive health measures and behavior change. To address hygiene and sanitation gaps, 1,000 adolescent girls received hygiene kits, while 800 students across eight schools participated in awareness sessions on safe water, sanitation, and menstrual hygiene management. These interventions were critical not only for immediate relief but also for fostering long-term resilience and reducing vulnerability to future disasters. The project also distributed 20,000 awareness leaflets to extend knowledge on safe practices to broader communities, reaching approximately 50,000 indirect beneficiaries.

Nutrition was another critical focus. Recognizing that malnutrition can exacerbate the vulnerabilities of pregnant women and endanger maternal and child health, the project provided food packages rich in protein, iron, and vitamins to 100 pregnant women in the targeted unions. This intervention was designed to reduce the risk of anemia, low birth weight, and other complications, while also strengthening prenatal care awareness in the affected communities.

The timing of this intervention was particularly significant. Implemented between November 2024 and January 2025, the project coincided with a period when flood-affected families were struggling to recover and local systems were overstretched. By intervening during this window, the project not only delivered urgent relief but also helped prevent secondary health crises, such as epidemics of waterborne diseases, nutritional deficiencies, and the long-term educational impacts of disrupted schooling.

In summary, the 2024 floods created an interlinked crisis of health, livelihoods, and education. Satkhira and Feni districts were emblematic of the broader devastation faced nationwide: damaged clinics, unsafe water, destroyed crops, and disrupted schools placed communities under severe stress. Women, children, and the elderly bore the brunt of this humanitarian emergency. The context clearly demonstrated the urgent need for integrated, multi-sectoral interventions combining health, WASH, nutrition, and awareness-building. Against this backdrop, the project provided a timely, targeted, and evidence-based response to restore services, protect vulnerable populations, and strengthen community resilience in the aftermath of the floods.

4. Objectives

• To provide essential emergency medical services to community clinics in flood-affected areas.
• To distribute water purifiers to ensure access to safe drinking water in community clinics and schools.
• To improve hygiene and sanitation practices among school-going children, particularly adolescent girls.
• To raise awareness on health, sanitation, and safe water practices among affected communities.
• To provide nutrition food support to pregnant women

5. Workplan & Chronology

The “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project was implemented over a three-month period, from November 2024 to January 2025, across Kalidaha Union of Feni Sadar Upazila in Feni District and Protavnagor Union of Ashashuni Upazila in Satkhira District. The workplan was designed to move from rapid mobilization and approvals to targeted distribution of supplies, awareness sessions, and monitoring. Below is a detailed account of each key milestone, written in chronological order.

5.1. Deployment of Project Staff

The project officially began with the deployment of staff on 05 November 2024. Ashar Alo mobilized its core implementation team, consisting of one Project Coordinator and two Program Officers, supported by twenty Health Brigade volunteers.

Project Coordinator: Oversaw overall management, liaison with stakeholders, and ensured compliance with donor and NGOAB guidelines.

Program Officers: Responsible for day-to-day operations, logistics planning, data collection, and supervision of volunteers.

Volunteers: Assisted with distribution of supplies, community outreach, and awareness activities in schools and clinics.

This deployment was critical because the floods had disrupted both government and NGO services in Satkhira and Feni. Having a dedicated team stationed in the field ensured that the project could rapidly adapt to the evolving needs of communities. The team also established field offices and coordinated closely with local government offices, including Upazila Nirbahi Officers (UNOs) and Civil Surgeons.

• Staff deployed on 05 Nov 2024.
• Core team: 1 Coordinator, 2 Officers, 20 volunteers.
• Base operations set up in Feni and Satkhira.
• Early liaison meetings with district and upazila authorities.

5.2. Field Assessments

Between 06 and 10 November, the project team conducted comprehensive field assessments in both districts. The assessments aimed to validate community needs, verify damage to health facilities, and prioritize interventions.

In Feni District, visits were conducted at North Gabindhapur, Chewria, and Jatrashidhe Community Clinics. The assessments revealed that floodwaters had destroyed essential medicines, damaged beds and WASH facilities, and washed away medical equipment. CHCPs reported a surge in patients suffering from diarrhea, respiratory illnesses, and skin infections.

In Satkhira District, assessments were conducted at North Chakala, Kurikhania, and Hizlia Community Clinics. The coastal nature of Satkhira worsened the impact of floods through saline intrusion, making drinking water unsafe. Essential medical equipment, such as blood pressure machines and glucometers, had been rendered non-functional due to water damage.

Simultaneously, the team met with local administrations, UNOs, and headmasters of selected schools, including United Academy Protavnagor and Gabindhapur High School. These meetings established local buy-in and secured support for hosting awareness sessions in schools once they reopened after examinations.

• Field assessments from 06–10 Nov 2024.
• Feni: North Gabindhapur, Chewria, Jatrashidhe CCs assessed.
• Satkhira: North Chakala, Kurikhania, Hizlia CCs assessed.
• Key findings: damaged equipment, increased disease cases, unsafe water.
• Meetings with UNOs, Civil Surgeons, school headmasters.

5.3. NGOAB Approvals

The project required formal approval from the NGO Affairs Bureau (NGOAB). From 04 to 13 November, Ashar Alo prepared and submitted FD-2 and FD-7 forms, detailing the project scope, donor funding, and implementation plan. On 13 November 2024, NGOAB officially approved the project.

This approval was crucial as it allowed the project to proceed with procurement, disbursement of donor funds, and field-level implementation. Without it, the project could not legally distribute supplies or conduct awareness activities.

• FD-2 and FD-7 submitted between 04–13 Nov.
• Approval received on 13 Nov 2024.
• Legal clearance for procurement and implementation granted.

5.4. Procurement Initiated

Following NGOAB approval, the procurement process was launched on 14 November 2024. The procurement team issued RFQs (Request for Quotations) to pre-qualified suppliers for emergency medicines, water purifiers, hygiene kits, nutrition packages, and IEC materials.

The procurement adhered to Ashar Alo’s robust, transparent policy, ensuring cost efficiency and accountability. Vendors were shortlisted based on quality, reliability, and delivery capacity, especially considering the urgency of reaching flood-affected areas before conditions deteriorated further.

• Procurement launched 14 Nov 2024.
• Items included: medicines, purifiers, hygiene kits, nutrition packages, IEC leaflets.
• Transparent vendor selection process.
• Priority given to flood-affected districts.

5.5. Nutrition Support in Satkhira

On 09 December 2024, the project began direct beneficiary interventions with the distribution of nutrition food packages to 100 pregnant women in Satkhira. The packages contained protein-rich food, vitamins, and minerals to address anemia and malnutrition.

The distribution was carried out in collaboration with the Upazila Health & Family Planning Office (UH&FPO) of Ashashuni. Pregnant women were identified through CHCP lists and antenatal care registers. Beneficiaries reported immediate relief, as many had been unable to afford nutritious food due to crop loss and rising market prices.

• 100 pregnant women received nutrition packages in Satkhira.
• Distributed in partnership with UH&FPO and CHCPs.
• Aim: reduce anemia, improve maternal and child health.

5.6. Satkhira Handovers

On 27 December 2024, Satkhira district received a major consignment of project supplies. Emergency medicines and water purifiers were handed over to three Community Clinics and the Assasuni Upazila Health Complex. School consignments, including hygiene kits and leaflets, were also staged for January distribution.

The handover was conducted in the presence of local officials, including the UNO of Satkhira, ensuring transparency. Medicines were immediately stocked in clinics, enabling treatment for over 2,000 patients within two weeks.

• 27 Dec 2024: Medicines and purifiers handed over in Satkhira.
• Recipients: 3 CCs + Assasuni UHC.
• School consignments prepared for January.
• 2,000+ patients benefited in first two weeks.

5.7. Feni Handovers

On 07–08 January 2025, similar handovers were conducted in Feni District. Three Community Clinics North Gabindhapur, Chewria, and Jatrashidhe received emergency medicines and water purifiers. Local health authorities, including the UH&FP of Feni, supervised the process.

The handover was followed by installation of purifiers in clinics and schools. Beneficiaries immediately gained access to clean drinking water, with CHCPs reporting a decline in diarrheal cases within weeks.

• 07–08 Jan 2025: Medicines and purifiers handed over in Feni.
• 3 CCs benefited, supervised by UH&FPO.
• Purifiers installed in clinics and schools.
• Decline in waterborne diseases observed.

5.8. Satkhira School Sessions

On 15 January 2025, after schools reopened following examinations, the project conducted four awareness sessions in Satkhira schools, including United Academy Protavnagor and Digilar Aiyght Ideal Secondary School.

Each session hosted 100 students, covering hygiene practices, safe water usage, handwashing demonstrations, and menstrual hygiene management. Hygiene kits were distributed to adolescent girls, ensuring they could attend school during menstruation. Teachers reported a visible increase in confidence among female students.

• 15 Jan 2025: 4 school sessions in Satkhira.
• 400 students reached; 1,000 hygiene kits distributed.
• Focus on WASH and menstrual hygiene.
• Positive feedback from teachers and students.
• Completion of 10,000 leaflet distribution.
• Broader reach to 25,000 indirect beneficiaries.

5.9. Feni Sessions and Leaflet Distribution

On 20 January 2025, four similar awareness sessions were held in Feni schools, including Gabindhapur High School and Kalidah High School. Like in Satkhira, 400 students participated, and hygiene kits were distributed to adolescent girls.

In addition, the project completed the distribution of 10,000 awareness leaflets across both districts. The leaflets used simple language and illustrations to teach communities about safe water, hygiene, and disease prevention. Teachers and volunteers assisted in distribution during school gatherings and community events.

• 20 Jan 2025: 4 awareness sessions in Feni.
• 400 students reached.
• Completion of 10,000 leaflet distribution.
• Broader reach to 25,000 indirect beneficiaries.

5.9. Project Close-out and Reporting

The project officially concluded on 31 January 2025. The close-out phase included consolidating monitoring data, compiling distribution registers, finalizing financial records, and preparing the completion report for submission to NGOAB and the donor.

An internal review was conducted by Ashar Alo’s Executive Director, who confirmed that all activities were delivered on time, within budget, and with full compliance to both donor and NGOAB requirements. Lessons learned were documented, emphasizing the importance of early procurement, strong community engagement, and flexible logistics.

• 31 Jan 2025: Project officially closed.
• Final reporting completed.
• Compliance confirmed by Ashar Alo’s Executive Director.
• Lessons learned documented for future responses.

6. Outputs

The “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project delivered a series of life-saving interventions that addressed the immediate health, water, sanitation, hygiene (WASH), and nutritional needs of flood-affected communities in Feni and Satkhira districts. Each output was carefully designed to meet identified needs, validated during field assessments, and implemented in coordination with local authorities, community health care providers (CHCPs), and school administrations. This section describes each of the outputs in detail, highlighting both quantitative achievements and qualitative impacts.

6.1 Emergency Medicines to Six Community Clinics

The provision of emergency medicines was one of the most critical components of the project. Six Community Clinics (CCs) three in Feni Sadar Upazila (North Gabindhapur, Chewria, and Jatrashidhe) and three in Ashashuni Upazila, Satkhira (North Chakala, Kurikhania, and Hizlia)—were targeted to restore essential health services.

Floodwaters had damaged stocks of medicines and equipment in these facilities. CHCPs reported an immediate rise in waterborne and skin-related diseases after the flooding, including diarrhea, cholera, respiratory infections, and dermatitis. The destruction of diagnostic tools further compromised their ability to provide care.

Through the project, clinics were equipped with essential medicines, including oral rehydration salts (ORS), antibiotics, antihistamines, paracetamol, and dermatological treatments. The supply ensured that CHCPs could resume treating common flood-related illnesses and stabilize patients before referral to higher facilities if required.

By the end of the project, over 5,200 patients were treated with project-supported medicines, significantly reducing the strain on upazila health complexes and district hospitals. Reports indicated a 40% reduction in referrals from community clinics within two weeks of receiving supplies, demonstrating the critical role of this intervention.

• Six CCs (3 Feni, 3 Satkhira) received emergency medicines.
• Medicines included ORS, antibiotics, paracetamol, antihistamines, skin treatments.
• 5,200+ patients treated during project period.
• Referral rates reduced by 40%, easing burden on higher facilities.
• Direct beneficiaries: families in flood-affected catchment areas (~10,000 people).

6.2 Distribution of 20 Water Purifiers

The floods left most water sources contaminated, leading to an immediate risk of diarrheal outbreaks. In Satkhira, saline intrusion made water undrinkable, while in Feni, sudden inundation polluted tube wells and storage tanks. To address this, 20 high-capacity water purifiers were procured and installed across six clinics and four schools.

The selection of sites was guided by field assessments and consultations with Civil Surgeons, UH&FPOs, and school headmasters. Clinics prioritized purifiers to ensure safe water for patients, attendants, and healthcare staff, while schools provided access for students and teachers, many of whom had lost safe water access at home.

The installation of water purifiers had immediate effects. Within a month of distribution, community clinics reported a 45% reduction in diarrheal cases. In schools, students reported fewer absences due to stomach-related illnesses, and teachers observed improved classroom participation.

• 20 purifiers installed: 6 in CCs, 4 in schools.
• Beneficiaries: ~10,500 people (patients, attendants, healthcare staff, students).
• Diarrheal cases reduced by 45% within a month.
• Improved attendance among schoolchildren due to better health.
• Provided resilience against saline intrusion in Satkhira.

6.3 Distribution of 1,000 Hygiene Kits to Adolescent Girls

Hygiene and menstrual health management were urgent needs in the aftermath of the floods. Adolescent girls faced challenges accessing sanitary products, which led to increased absenteeism from schools, infections, and psychological stress. The project distributed 1,000 hygiene kits across 10 schools (five per district), directly addressing these gaps.

Each kit included sanitary napkins, soap, toothpaste, toothbrush, nail clippers, and hair care items such as combs or hairbands. The inclusion of sanitary napkins was particularly impactful, as most local shops were either closed or had lost stock during the floods.

Feedback from teachers indicated that the provision of hygiene kits improved attendance among adolescent girls by 30% during menstruation, as girls felt more confident and prepared. The kits also served as tools for building sustainable hygiene habits, since awareness sessions complemented the distribution with demonstrations and education.

• 1,000 hygiene kits distributed to adolescent girls.
• Target schools: 4 (2 in Satkhira, 2 in Feni).
• Contents: sanitary napkins, soap, toothpaste, toothbrush, nail clippers, comb/hairband.
• 30% improvement in school attendance during menstruation.
• Improved confidence and dignity among adolescent girls.

6.4 Eight Awareness Sessions for 800 Students

Awareness-building was central to ensuring sustainable impact. The project conducted one-day awareness sessions in Satkhira schools (15 Jan 2025) and four in Feni schools (20 Jan 2025). Each session had 100 student participants, making a total of 800 direct participants.

Sessions covered:

• Health risks post-floods: diarrhea, cholera, skin diseases.
• Handwashing demonstrations: correct techniques with soap and water.
• Safe water practices: boiling, purifier use, safe storage.
• Menstrual hygiene management: specifically tailored for adolescent girls.

Teachers and CHCPs co-facilitated the sessions, ensuring cultural sensitivity and credibility. Monitoring data showed that 87% of students demonstrated improved knowledge, and 82% shared learning with families, indirectly benefiting 4,000 additional people.

• 8 sessions, 800 students (400 Satkhira, 400 Feni).
• Covered WASH, menstrual hygiene, disease prevention.
• 87% students improved knowledge, 82% shared with families.
• Indirect reach: ~4,000 community members.
• Teachers reported improved health behavior among students.

6.5 Nutrition Support for 100 Pregnant Women

Pregnant women were among the most vulnerable during the floods. Many lost access to adequate food, leading to risks of anemia, low birth weight, and preterm deliveries. On 09 December 2024 in Satkhira and 07 January 2025 in Feni, 100 pregnant women received tailored nutrition packages.

The packages contained rice, lentils, oil, dried fish, iron-rich supplements, and vitamin tablets. The distribution was coordinated with UH&FPOs and CHCPs, who helped identify the most vulnerable beneficiaries using antenatal registers.

Follow-up surveys indicated improvements in dietary diversity and reduced anemia symptoms among recipients. This intervention also increased awareness about the importance of nutrition during pregnancy, with many women reporting that they shared knowledge from the sessions with peers.

• 100 pregnant women supported (Satkhira: 50, Feni: 50).
• Contents: rice, lentils, oil, dried fish, supplements.
• Delivered on 09 Dec 2024 (Satkhira) and 07 Jan 2025 (Feni).
• Reduced anemia and improved dietary diversity.
• Raised awareness of prenatal care and maternal health.

6.6 Distribution of 20,000 Awareness Leaflets

Leaflets were developed as a scalable awareness tool to extend health and hygiene education beyond direct beneficiaries. Printed in clear Bangla with visual illustrations, the 20,000 leaflets covered:

• Safe water practices (boiling, purifiers, storage).
• Handwashing steps.
• Menstrual hygiene management.
• Disease prevention post-floods.

Distribution took place between December 20, 2024, and January 20, 2025, through clinics, schools, and community gatherings. Volunteers ensured that even semi-literate and illiterate populations understood the messages by conducting verbal explanations alongside leaflet handouts.

Post-distribution surveys showed that 72% of recipients retained knowledge on disease prevention, and 85% of adolescent girls demonstrated correct sanitary pad usage and disposal practices.

• 20,000 leaflets distributed in both districts.
• Content: safe water, hygiene, disease prevention.
• Simple Bangla language with visuals.
• 72% knowledge retention reported.
• Indirect reach: ~50,000 people.

Table 1. Summary of Project Outputs

7. Outcomes

The “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project generated significant and measurable outcomes across its key intervention areas. These outcomes reflect not only the immediate impact of distributing medicines, water purifiers, hygiene kits, nutritional packages, and awareness materials but also the longer-term effects on community resilience, public health, and social well-being. The following table provides a consolidated overview, followed by detailed analysis of each outcome area.

Table 2.  Summary of Project Outcomes

7.1 Improved Access to Health Services

Floods severely disrupted primary healthcare in Feni and Satkhira. Clinics lost stocks of medicines, while diagnostic tools were damaged. Patients presenting with diarrhea, skin infections, and respiratory conditions were either untreated or referred to distant hospitals, straining higher-level facilities.

By restocking six community clinics with essential emergency medicines, the project restored functionality. CHCPs received life-saving supplies including ORS, antibiotics, and antihistamines, enabling them to provide care immediately on-site.

Key Outcomes:

• 5,200+ patients treated during project period.
• Referral rates decreased by 40%, reducing pressure on district hospitals.
• Local clinics became reliable first-response facilities, restoring community trust.

This intervention had a multiplier effect. Families saved time and costs otherwise spent on travel to distant hospitals. Clinics also regained credibility, with patient attendance increasing, reinforcing the importance of decentralized care in disaster contexts.

7.2 Reduction in Waterborne Diseases

Safe water was one of the most pressing needs after the floods. In Satkhira, saline intrusion made groundwater unusable, while in Feni, floodwaters contaminated hand pumps and storage tanks. Without intervention, disease outbreaks such as diarrhea, cholera, and dysentery posed imminent risks.

The installation of 20 water purifiers in six community clinics and 4 schools transformed access to safe drinking water. Clinics reported immediate benefits, as patients, attendants, and healthcare workers relied on purified water. In schools, children were shielded from contaminated sources during critical hours of their day.

Key Outcomes:

• 45% reduction in diarrheal cases within a month of purifier installation.
• Approx. 10,500 beneficiaries gained access to safe drinking water.
• Reduced absenteeism among students linked to waterborne illnesses.

This outcome not only addressed immediate risks but also strengthened community resilience against future disasters by creating sustained access points for clean water.

7.3 Enhanced Student Hygiene Knowledge

Floods amplify hygiene risks, especially in overcrowded shelters and damaged schools. To prevent outbreaks, the project organized 8 awareness sessions (4 in Satkhira, 4 in Feni), each attended by 100 students.

These sessions combined lectures, demonstrations, and group activities. Students practiced proper handwashing techniques, learned how to store water safely, and engaged in discussions on menstrual hygiene. Teachers and CHCPs co-facilitated, ensuring credibility and relevance.

Key Outcomes:

• 87% of students demonstrated improved hygiene knowledge post-session.
• 82% of students shared knowledge with family members, indirectly reaching ~4,000 people.
• Teachers observed lasting behavior change, such as routine handwashing before meals.
• The student-focused approach ensured knowledge dissemination across households, making children effective ambassadors of health in their communities.

7.4 Improved Girls’ School Attendance

Menstrual hygiene management (MHM) is a persistent challenge in disaster-affected communities. Adolescent girls often miss school during menstruation due to lack of sanitary products, clean facilities, and supportive environments. The floods exacerbated these issues, as supply chains broke and private spaces were destroyed.

Through the distribution of 1,000 hygiene kits, the project empowered adolescent girls in 10 schools to maintain hygiene and dignity. Each kit contained sanitary napkins, soap, toothpaste, toothbrushes, nail clippers, and hair care items.

Key Outcomes:

• 30% improvement in attendance among adolescent girls during menstruation.
• Increased confidence and participation in school activities.
• Reduced risk of infections and related health complications.

This outcome illustrates the project’s gender-sensitive approach, recognizing and addressing the unique needs of girls in emergencies.

7.5 Strengthened Maternal Health and Nutrition

Pregnant women were among the most at risk during the floods. Many lost access to nutritious food, heightening risks of anemia, low birth weight, and preterm delivery.

The project provided 100 nutrition packages (50 in Satkhira, 50 in Feni), containing rice, lentils, oil, dried fish, iron supplements, and vitamins. Distributions were coordinated with local health facilities to ensure targeting of the most vulnerable women.

Key Outcomes:

• 100 pregnant women directly supported.
• Reported improvements in dietary diversity and reduced anemia symptoms.
• Increased awareness of prenatal care and maternal nutrition importance.

By strengthening maternal health, this intervention had intergenerational benefits, improving outcomes for both mothers and newborns.

7.6 Expanded Community Awareness

While direct interventions reached targeted groups, broader awareness was necessary to sustain behavior change across communities. To achieve this, the project developed and distributed 20,000 awareness leaflets covering safe water, sanitation, and hygiene practices.

Leaflets were designed in simple Bangla with illustrations to ensure accessibility for low-literacy populations. Volunteers and teachers provided verbal explanations during distribution, enhancing comprehension.

Key Outcomes:

• 20,000 leaflets distributed across Satkhira and Feni.
• Approx. 50,000 indirect beneficiaries reached through awareness campaigns.
• 72% of surveyed recipients retained knowledge on disease prevention and hygiene.

This broad-based awareness campaign complemented targeted interventions, ensuring community-wide impact.

7.7 Overall Reach

The project achieved a wide-reaching impact by integrating multiple sectors health, WASH, hygiene, and nutrition. By combining direct service delivery with community awareness, it ensured both immediate relief and long-term resilience.

Overall Achievements:

• 12,500 direct beneficiaries: patients, students, adolescent girls, pregnant women, and healthcare workers.
• 50,000 indirect beneficiaries: community members reached through leaflets, student knowledge-sharing, and school programs.
• 62,500 people impacted in total across Satkhira and Feni.

The project successfully mitigated post-flood health risks, restored primary health services, improved water and sanitation, empowered women and girls, and strengthened community awareness. Its outcomes demonstrate a scalable model for integrated humanitarian response in Bangladesh.

8. Monitoring, Evaluation & Learning

Monitoring, Evaluation, and Learning (MEL) formed an integral part of the “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project. Given the short three-month timeframe, MEL systems were designed to ensure accountability, transparency, and continuous learning. The MEL framework was rooted in evidence-based reporting and guided by NGOAB, AMERICARES donor requirements, and Ashar Alo’s internal monitoring policies.

The MEL system captured progress at multiple levels clinic-level service delivery, school-based awareness and attendance, community-level knowledge dissemination, and household-level nutritional outcomes. It also emphasized lessons for future programming, particularly on preparedness, resilience, and adaptive implementation.

Table 3. Monitoring, Evaluation & Learning Framework

8.1 Field Visits

Regular field monitoring visits were carried out by the Project Coordinator and Program Officers in both districts. These visits included observation of clinic operations, school awareness sessions, and household-level nutrition distributions. Each visit documented activities against planned timelines, collected qualitative feedback, and identified operational challenges.

In Satkhira, visits revealed that some flood-affected areas were still waterlogged, making road access impossible. This delayed delivery to one clinic by three days. Mitigation involved engaging local government to arrange boat transport. In Feni, staff observed overcrowded clinics, leading to higher-than-expected demand for medicines. Field visits allowed timely reporting to the central office and rapid reallocation of supplies.

Key insights from field visits:

• Accessibility remained a persistent challenge in waterlogged villages.
• Local volunteers proved indispensable in reaching hard-to-reach areas.
• Stronger collaboration with UNOs and Civil Surgeons improved credibility and efficiency.

8.2 Clinic Registers

Community Health Care Providers (CHCPs) were required to maintain registers documenting patients treated, types of illnesses, and medicines dispensed. These records formed the backbone of health-related monitoring.

Analysis of clinic registers showed:

• 5,200+ patients treated over the project period.
• Common conditions included diarrhea, respiratory infections, and skin diseases.
• Referrals to higher facilities dropped by 40%, confirming improved capacity at the clinic level.
• A 45% reduction in diarrheal cases was observed after water purifiers were installed.

Registers also served as verification tools for donor reporting, ensuring accuracy in data collection.

8.3 Surveys (Post-distribution)

Post-distribution surveys were administered across target groups:

• Patients and families — satisfaction with clinic medicine supply and accessibility.
• Students — retention of hygiene knowledge and behavior changes.
• Pregnant women — use of nutrition packages and perceived health improvements.
• Community members — understanding of leaflets and hygiene practices.

Survey findings:

• 87% of students demonstrated improved hygiene knowledge after sessions.
• 72% of leaflet recipients retained knowledge on waterborne disease prevention.
• 85% of adolescent girls reported correct usage of sanitary napkins.
• Pregnant women reported reduced anemia and improved diets due to food packages.

Surveys highlighted that practical, interactive demonstrations were more effective than written IEC materials alone, particularly for low-literacy populations.

8.4 Teacher Reports

Teachers acted as key informants and evaluators for school-level interventions. After awareness sessions and hygiene kit distribution, teachers tracked changes in attendance, classroom participation, and hygiene behaviors.

Their reports confirmed:

• 30% improvement in attendance among adolescent girls during menstruation.
• Routine handwashing and use of purified water increased significantly.
• Students were motivated to share health messages at home, extending the project’s impact.

Teachers emphasized the need to include hygiene education in regular curricula, ensuring sustainability beyond emergency interventions.

8.5 Procurement Oversight

Procurement was closely monitored through transparent procedures, including supplier RFQs, warehouse tracking, and handover registers at clinics and schools. Despite nationwide demand for medicines and hygiene kits, the project ensured all items were procured and distributed within schedule.

Challenges included minor delays due to flooded roads and fluctuating market prices. However, early procurement planning and pre-approved supplier lists ensured cost savings and timely delivery.

Learning: pre-positioning buffer stocks in disaster-prone regions could further reduce delays in future emergencies.

8.6 Community Engagement

The project placed strong emphasis on involving local leaders, government officials, and community stakeholders. Meetings were held with:

• District Commissioners (DCs) and Upazila Nirbahi Officers (UNOs) for approvals.
• Civil Surgeons and UH&FPOs for health-related oversight.
• School headmasters for planning awareness sessions.

Engagement ensured that interventions were locally owned and culturally sensitive. Leaders helped mobilize communities, target vulnerable beneficiaries, and build trust in the interventions.

8.7 Feedback Loops

In addition to formal surveys, the project maintained informal feedback channels. Staff and volunteers collected beneficiary opinions during distributions and school sessions. Pregnant women appreciated the nutrition support; students expressed enthusiasm for hygiene kits; CHCPs highlighted the importance of medicines in reducing referrals.

This two-way communication improved responsiveness. For instance, in one school, additional sanitary napkins were distributed after feedback indicated shortages. In clinics, demand for specific medicines (e.g., antihistamines) was quickly relayed to procurement teams.

8.8 Learning and Adaptation

The MEL process yielded important lessons:

1. Pre-positioning of Supplies: Stocking essential medicines and hygiene kits in disaster-prone areas would reduce response times in future emergencies.
2. Community Engagement: Strong collaboration with leaders improved targeting, acceptance, and sustainability.
3. Practical Demonstrations: Interactive teaching (handwashing, purifier use) was more effective than leaflets alone.
4. Teacher Involvement: Teachers amplified impact by reinforcing health practices in classrooms and encouraging knowledge-sharing at home.
5. Flexible Logistics: Alternative transport arrangements (boats, volunteers) were critical to reach waterlogged areas.
6. Continuous Monitoring: Real-time reporting allowed rapid adaptation, ensuring interventions met evolving community needs.

9. Cross-Cutting Issues

- Gender: targeted pregnant women & adolescent girls
- Accountability: verified lists, signed handovers
- Environment: safe water storage, waste management

Cross-cutting issues were integrated into all phases of the “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project. Recognizing that emergencies disproportionately affect marginalized groups, the project mainstreamed gender equity, accountability to affected populations (AAP), and environmental sustainability. These considerations ensured that interventions were inclusive, transparent, and environmentally responsible, thereby strengthening both immediate impact and long-term resilience.

Table 4. Integration of Cross-Cutting Issues

9.1 Gender Equality

Women and girls faced unique challenges during the 2024 floods. Pregnant women risked malnutrition, anemia, and poor birth outcomes due to disrupted food supplies. Adolescent girls struggled with menstrual hygiene because of damaged facilities and limited access to sanitary products.

The project directly addressed these issues by:

• Providing 100 pregnant women with nutrition packages containing iron-rich foods and supplements.
• Distributing 1,000 hygiene kits to adolescent girls, including sanitary napkins and hygiene products.
• Conducting school awareness sessions that included menstrual hygiene management (MHM), reducing stigma and absenteeism.

Impact:

• Girls’ school attendance improved by 30% during menstruation.
• Pregnant women reported improved dietary diversity and reduced anemia symptoms.
• Female students reported greater confidence and willingness to discuss menstrual hygiene.

The integration of gender-sensitive interventions not only met urgent needs but also contributed to broader goals of empowerment and resilience.

9.2 Accountability to Affected Populations (AAP)

The project ensured that assistance was transparent, inclusive, and responsive to community needs. Accountability mechanisms included:

• Preparation of verified beneficiary lists in collaboration with CHCPs, teachers, and local government.
• Use of signed handover registers for all distributions (medicines, kits, food, purifiers).
• Regular community engagement meetings with UNOs, Civil Surgeons, and headmasters to validate targeting.
• Incorporation of feedback loops, where beneficiary input shaped adaptations (e.g., additional sanitary products distributed after requests).

Impact:

• Communities trusted the process, with minimal complaints of duplication or exclusion.
• Transparent documentation ensured donor compliance and strengthened relationships with government authorities.
• Beneficiaries expressed satisfaction that their voices were heard during implementation.

9.3 Environmental Sustainability

Environmental considerations were mainstreamed to reduce secondary risks and promote resilience. Key measures included:

• Installation of 20 water purifiers, reducing reliance on unsafe water sources and encouraging sustainable safe water storage.
• Hygiene sessions emphasized handwashing, waste disposal, and water storage practices.
• Distribution of 20,000 awareness leaflets on WASH practices, highlighting environmentally responsible behaviors.
• Encouragement of safe disposal of sanitary products to prevent contamination in flood-affected areas.

Impact:

• Clinics and schools reported improved safe water handling and waste disposal practices.
• Knowledge retention surveys showed that 72% of recipients adopted sustainable hygiene practices.
• The interventions reduced the risk of contamination and secondary environmental hazards post-floods.

9.4 Lessons Learned

1. Gender: Directly targeting pregnant women and adolescent girls not only addressed urgent health and dignity needs but also improved long-term educational and maternal health outcomes.
2. Accountability: Community-verified lists and signed handovers enhanced transparency and trust, ensuring aid reached the intended recipients.
3. Environment: Linking WASH interventions with community education maximized the environmental sustainability of project outputs, reducing the likelihood of post-disaster contamination.

10. Challenges & Mitigation

- Access barriers: used alternative transport
- High demand: prioritized vulnerable groups
- MHM hesitancy: extra female-led sessions
- Tracking data: standardized tally sheets

Like all emergency interventions, the project faced operational and contextual challenges in its implementation across Satkhira and Feni districts. Flood-affected regions presented barriers to access, demand often exceeded supply, cultural hesitancy hindered adoption of new practices, and data tracking in dispersed communities required extra effort. However, the project team successfully addressed these challenges through adaptive strategies, community engagement, and innovative monitoring tools.

Table 5.  Key Challenges and Mitigation Strategies

10.1 Access Barriers

Access was one of the most persistent challenges. Floodwaters rendered certain roads impassable, particularly in Satkhira, where saline intrusion worsened waterlogging. Clinics such as North Chakala and Kurikhania were cut off for several days. Without adaptation, distributions risked delays.

Mitigation:

• Supplies were transported via boats arranged in collaboration with local authorities.
• Volunteers from the Health Brigade carried smaller consignments by hand or bicycle to reach cut-off households.
• Coordination with Upazila Nirbahi Officers (UNOs) ensured safe passage and logistical support.

Outcome: Despite barriers, all planned deliveries medicines, hygiene kits, purifiers, and nutrition packages were completed on time. Beneficiaries highlighted their appreciation for staff persistence in reaching remote areas.

10.2 High Demand vs. Limited Supply

The floods displaced thousands and disrupted supply chains, creating a surge in demand for medicines, hygiene products, and safe water. Clinics often reported queues exceeding available stock. If not carefully managed, this could have led to frustration, inequity, or duplication.

Mitigation:

• Vulnerable groups such as pregnant women, adolescent girls, and displaced families were prioritized.
• Beneficiary lists were verified by CHCPs, teachers, and community leaders.
• Stock was rationed to ensure the widest possible coverage without leaving critical groups unsupported.

Outcome: Resources were distributed equitably, with 5,200+ patients treated, 1,000 adolescent girls receiving hygiene kits, and 100 pregnant women supported. While demand remained high, prioritization minimized inequity and ensured maximum impact.

10.3 Menstrual Hygiene Management (MHM) Hesitancy

Cultural sensitivity around menstruation posed barriers to effective adoption of menstrual hygiene management. Many adolescent girls were initially hesitant to attend mixed-gender awareness sessions or to discuss MHM openly.

Mitigation:

• Separate, female-led sessions were organized in schools. Female teachers and local women health workers facilitated discussions, creating a safe environment for girls.
• Hygiene kits were distributed privately to reduce stigma.
• Practical demonstrations were conducted on pad use and safe disposal.

Outcome: By the end of the project, 85% of adolescent girls reported correct use of sanitary napkins, and school attendance during menstruation improved by 30%. Teachers also noted increased confidence among girls in class participation.

10.4 Data Tracking Challenges

Monitoring and reporting across two districts and multiple intervention sites required robust systems. Initially, inconsistent reporting formats from clinics, teachers, and volunteers posed risks of data gaps or duplication.

Mitigation:

• Introduced standardized tally sheets for all distributions.
• Required daily updates from CHCPs, teachers, and field staff.
• Conducted random verification through spot-checks by Program Officers.
• Consolidated records into a central database for donor reporting.

Outcome: Data reliability improved, ensuring compliance with NGOAB and donor requirements. This also allowed timely analysis for instance, recognizing early reductions in diarrheal cases after water purifier installation.

10.5 Lessons from Challenges

• Flexibility is critical: Alternative transport and volunteer networks ensured last-mile delivery.
• Prioritization saves lives: Focusing on vulnerable groups allowed scarce resources to achieve maximum impact.
• Gender-sensitive delivery works: Female facilitators improved adoption of menstrual hygiene practices.
• Standardization strengthens accountability: Uniform tally sheets improved transparency and trust.

11. Financials

Financial accountability was a cornerstone of the project, ensuring that every dollar spent delivered maximum value for affected communities. The total budget of USD 25,650 (BDT 3,026,700) was allocated across human resources, administration, procurement of supplies, awareness activities, and IEC material development. The project was successfully completed within budget, with no significant overruns, and adhered to AMERICARES donor guidelines and NGOAB financial reporting standards.

Table 6.  Financial Summary

11.1 Human Resources

A total of USD 1,800 (BDT 212,400) was allocated for human resources. This covered the salaries and allowances of:

• 1 Project Coordinator: responsible for overall implementation, reporting, and donor compliance.
• 2 Program Officers: managed day-to-day logistics, distributions, monitoring, and awareness sessions.

Human resource investment ensured strong field presence and effective coordination with stakeholders. The cost represented only 7% of the total budget, reflecting cost-efficiency in staffing.

11.2 Administrative Costs

The administrative budget of USD 850 (BDT 100,300) supported essential operational expenses such as communication, transport, reporting, and audits. This allocation ensured smooth coordination across two districts and compliance with financial regulations. Despite logistical challenges due to flooded roads, administrative costs were kept within the approved limit, representing only 3% of the total budget.

11.3 Procurement of Supplies

The largest share of the budget USD 20,000 (BDT 2,360,000), approximately 78% of total project costs — was dedicated to life-saving supplies. This included:

• Emergency medicines for six Community Clinics.
• 20 water purifiers installed in clinics and schools.
• 1,000 hygiene kits for adolescent girls.
• Nutrition packages for 100 pregnant women.

Procurement followed Ashar Alo’s transparent procedures: quotations from approved suppliers, warehouse tracking, and signed handovers. This ensured accountability and minimized costs while maximizing community benefit.

11.4 Awareness Activities

An allocation of USD 1,600 (BDT 188,800) funded awareness-building activities. This included eight school sessions (reaching 800 students), teacher engagement, and logistics for meetings. These awareness initiatives contributed to 87% of students improving hygiene knowledge and had a strong indirect impact on households.

11.5 IEC Materials

To ensure sustainability, USD 1,400 (BDT 165,200) was allocated for Information, Education, and Communication (IEC) materials. A total of 20,000 leaflets were developed, printed, and distributed in simple Bangla with illustrations to promote WASH practices. Surveys showed 72% knowledge retention, confirming the value of IEC investments.

11.6 Overall Efficiency and Accountability

The project demonstrated high financial efficiency by keeping administrative and HR costs low while dedicating nearly 80% of funds directly to supplies and community-facing interventions. Financial tracking was maintained through:

• Daily expenditure logs.
• Procurement registers.
• NGOAB-compliant reporting templates.
• Donor financial reviews.

No unapproved expenses or cost overruns were reported. Minor fluctuations in market prices of medicines and hygiene items were absorbed within existing allocations.

12. Success Story

Fatema Rahman (Pseudonym), Class 8, Gabindhapur High School, Feni. She received a hygiene kit and attended awareness sessions. She gained confidence in menstrual hygiene, no longer missed school, and advocated practices among peers.

Empowering Adolescent Girls Through Hygiene Awareness

Beneficiary: Fatema Rahman, Class 8, Gabindhapur High School, Feni District

Fatema Rahman, a 15-year-old student of Grade Eight, lives in a flood-affected area of Feni. Like many adolescent girls in her community, she faced severe challenges in managing her menstrual hygiene during and after the floods. Sanitary products were unavailable, her family’s finances were strained, and the stigma surrounding menstruation made it difficult for her to discuss her needs. As a result, Fatema often missed school during her periods, leading to gaps in her education and growing anxiety about falling behind her peers.

Through the project, Fatema received a comprehensive hygiene kit containing sanitary napkins, soap, toothpaste, toothbrush, nail clippers, and hair care items. More importantly, she participated in school-based awareness sessions facilitated by female teachers and health workers. These sessions created a safe space for adolescent girls to learn about menstrual hygiene management (MHM), handwashing practices, and safe disposal methods.

Fatema’s Transformation:

• She reported feeling confident and prepared during menstruation for the first time.
• She no longer missed school, contributing to the 30% improvement in girls’ attendance observed across the project schools.
• Fatema began sharing her knowledge with friends and classmates, advocating for better hygiene practices.
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In her own words:

“Before, I used to feel shy and missed school during my periods. After receiving the kit and attending the sessions, I am more confident. I don’t skip classes anymore, and I tell my friends how to take care of themselves.”

Fatema’s story demonstrates the power of gender-sensitive humanitarian interventions. By combining material support with awareness and education, the project not only improved individual well-being but also empowered young girls to become health ambassadors within their communities. Her advocacy contributed to broader behavioral change among her peers, reinforcing the long-term impact of the intervention.

13. Compliance & Coordination

NGOAB approvals secured. Activities coordinated with UNOs, DCs, health officials, and school leaders. Reports submitted to donor and NGOAB. Media releases and consent forms maintained.

Compliance with regulatory requirements and strong coordination with local authorities and stakeholders were central to the success of the “Emergency Health and Humanitarian Support to Flood-Affected People in Bangladesh” project. By adhering strictly to NGOAB guidelines and AMERICARES donor requirements, the project ensured accountability, transparency, and alignment with national disaster response priorities.

Table 7.  Compliance & Coordination Overview

13.1 NGOAB Approvals

The project began only after securing mandatory NGOAB approvals. FD-2 and FD-7 forms were submitted promptly, and final approval was obtained on 13 November 2024. This compliance step ensured that all project activities were legally sanctioned, funds were used within regulations, and reporting followed government requirements.

13.2 Coordination with Local Authorities

Effective implementation was achieved through close collaboration with local government structures:

• District Commissioners (DCs) of Satkhira and Feni provided overall administrative support and legitimacy.
• Upazila Nirbahi Officers (UNOs) facilitated approvals, logistical support, and beneficiary validation.
• Civil Surgeons and UH&FPOs approved medicine lists and supervised clinical interventions.
• Community Health Care Providers (CHCPs) directly coordinated handovers and ensured service delivery in clinics.

This multi-level coordination-built community trust and aligned project activities with district-level disaster response priorities.

13.3 Collaboration with Schools

Schools were critical platforms for hygiene and awareness interventions. Collaboration with headmasters ensured that sessions were integrated into school schedules, minimizing disruption to education. Teachers acted as co-facilitators and verified beneficiary attendance. This coordination allowed smooth delivery of 1,000 hygiene kits and 8 awareness sessions, reaching 800 students directly.

13.4 Donor & NGOAB Reporting

• The project maintained full transparency by producing and submitting:
• Inception Report (November 2024).
• Progress Report (December 2024).
• Final Project Completion Report (January 2025).

Financial accountability was ensured through detailed statements, invoices, and receipts. Donor-required success stories, MEL data, and compliance records were also submitted. NGOAB reporting requirements were met in full, strengthening credibility for future projects.

13.5 Media Releases & Consent

Beneficiary dignity and ethical communication were prioritized. For all success stories and photographs, consent was obtained using the standard Americares Media Release Form. This ensured compliance with donor communication standards and respected the rights of beneficiaries, particularly adolescent girls and pregnant women.

13.6 Outcomes of Compliance & Coordination

• All activities were legally compliant under NGOAB regulations.
• Strong collaboration with government improved logistics, targeting, and monitoring.
• Donor confidence was strengthened through timely and transparent reporting.

Ethical standards were upheld through informed consent for communication and media use.

Project Name : Provide Emergency Healthcare Support to Flood-Affected People in Bangladesh

Doner : AMERICARES Foundation Inc.

Sector : Health

Area : Feni Sadar Upazila, Feni District

Time Line : 15 August - 2025 throuhh 15 October- 2025

Brief of activities :

1. Executive Summary
In response to the severe July 2025 floods that impacted over 200,000 people across Feni District—including 3,837 fully waterlogged families—Ashar Alo, in partnership with Americares, swiftly implemented a focused health intervention to reduce morbidity and mortality and restore primary healthcare services in Feni Sadar Upazila. Leveraging its three decades of experience and previous partnership successes, Ashar Alo’s goal was to revitalize the local health system in the hardest-hit unions (Kalidaha, Fazilpur, and Shorshodi). Between the rapid needs assessment in early August and the formal handover on 12 September 2025, the project successfully restored service capacity at 11 Community Clinics, benefiting an estimated 60,000 people in the surrounding catchment areas. Key outputs included the procurement and distribution of 23 essential medicines and 8 categories of medical equipment (a total of 212,300 units of supplies), the installation of 11 water purifiers to ensure safe drinking water at the clinic level, and the dissemination of 10,000 illustrated hygiene leaflets covering flood risks, dengue prevention, and maternal care. All supplies were formally handed over at a centralized ceremony and delivered to Community Health Care Providers (CHCPs) with signed receipts, with Ashar Alo covering all transport and logistics. The design adhered strictly to WHO emergency guidance and Sphere standards. Continuous monitoring and qualitative feedback from CHCPs confirmed the restoration of clinic functionality, a perceived reduction in waterborne disease incidence, and improved household hygiene practices, exemplified by a successful emergency nebulization case that saved a child’s life. The intervention was executed with full financial accountability within the approved USD 20,000 budget. The largest allocation, $17,050, was dedicated to Direct Service Delivery for life-saving medicines and purifiers. The remaining funds covered Human Resources ($1,500), IEC Materials ($800), and Administrative Costs ($650). Key lessons learned emphasize the value of using pre-qualified local vendors, pre-positioning emergency stocks, and the central role of female health workers in outreach. Future recommendations include exploring mobile health units and strengthening government partnerships to build greater community resilience against future disasters.
Key Word: Flood Response, Emergency Healthcare, Community Clinics, Morbidity Reduction, Water Purification, Hygiene Promotion, Supply Distribution, Feni District, Ashar Alo, Americares.
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2. Introduction and Organizational Background
2.1. About Ashar Alo
Ashar Alo, established in 1994 and formally registered with the Government of Bangladesh in 2001, is a national non-governmental organization with over three decades of dedicated service in the fields of public health, humanitarian response, and social development. The organization possesses a proven track record of implementing high-impact projects in some of the most vulnerable and disaster-prone regions of the country. Our mission is to empower marginalized communities, including women, children, persons with disabilities, and the extreme poor, through sustainable development and emergency relief initiatives.
The organization's institutional capacity is demonstrated by its registrations with key government bodies, including the NGO Affairs Bureau (NGOAB), the Department of Social Services, the Department of Youth Development. Ashar Alo also holds a valid Business Identification Number (BIN) and Electronic Taxpayer's Identification Number (E-TIN), ensuring full compliance with national financial regulations. Our operational expertise spans community mobilization, public health education, emergency response management, research, and monitoring & evaluation.
Of particular relevance to this project is Ashar Alo's direct prior experience in implementing the "Emergency Health and Humanitarian Support to Flood-Affected" program in 2024, also funded by Americares. This previous partnership provided invaluable experience in rapid needs assessment, procurement and logistics of medical supplies, coordination with local health authorities, and effective delivery of services in a flood-affected context, forming a solid foundation for the successful execution of the 2025 intervention. 2.2. Partnership with Americares
The partnership between Ashar Alo and Americares is built on a shared commitment to providing life-saving health interventions in times of crisis. Americares, as an internationally recognized humanitarian organization with specialized expertise in emergency medicine and health programs, provides not only critical funding but also technical guidance. This project leveraged the strengths of both organizations: Americares's global expertise and swift funding mechanisms, and Ashar Alo's deep community roots, local knowledge, and established operational network within Bangladesh. This synergy was instrumental in ensuring a timely, relevant, and effective response to the flood emergency in Feni.
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3. Project Background and Justification
3.1. The July 2025 Floods: A Crisis Overview
In July 2025, southeastern Bangladesh, including Feni District, was hit by severe and prolonged monsoon rains, exacerbated by the release of upstream water from neighboring India. This led to intense riverine flooding, causing a sudden and dramatic rise in water levels. According to official data from the Ministry of Disaster Management and Relief, the floods impacted more than 200,000 people across Feni District. In the Upazilas of Fulgazi, Parashuram, and Feni Sadar, 3,837 families were completely waterlogged, with many areas remaining submerged for weeks. Critical infrastructure, including roads, bridges, and electricity and mobile networks, was severely damaged or destroyed, isolating entire communities and cutting them off from essential services. 3.2. Problem Statement and Needs Assessment
The humanitarian impact of the floods was multifaceted, creating an urgent public health emergency:
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Collapse of Primary Healthcare: Community Clinics (CCs), which are the first and often only point of contact for primary healthcare in rural Bangladesh, were themselves impacted by the floods. Many reported damage to infrastructure and, more critically, a 70% increase in patient visits. However, they were crippled by acute shortages of essential medicines, antibiotics, Oral Rehydration Salts (ORS), wound care supplies, and basic medical equipment. This gap left the population, especially the most vulnerable, without access to even the most basic medical care for common flood-related ailments.
•
Surge in Waterborne and Vector-Borne Diseases: Stagnant floodwater contaminated nearly all unprotected water sources, such as tube-wells and ponds. This led to a sharp increase in cases of acute watery diarrhea, dysentery, typhoid, and other waterborne illnesses. Furthermore, the stagnant water provided ideal breeding grounds for mosquitoes, leading to a surge in vector-borne diseases like dengue and malaria.
•
Heightened Vulnerability of At-Risk Groups: Children under five, pregnant and lactating women, the elderly, and individuals with chronic illnesses (such as hypertension and diabetes) faced disproportionately high risks. Disruption of routine healthcare services, including antenatal care and immunization, coupled with increased exposure to contaminated environments, placed these groups in grave danger.
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3.3. Evidence-Based Project Design
The design of this project was informed by globally recognized best practices and standards to ensure its effectiveness and relevance:
•
WHO Emergency Response Framework: The project adhered to the principles of the WHO framework, which prioritizes the rapid delivery of essential health services to meet the urgent needs of crisis-affected populations.
•
Bangladesh’s National Health Crisis Management Plan: The intervention was aligned with the national government's strategy for managing health crises, ensuring complementarity and support to national efforts.
•
Sphere Humanitarian Charter and Minimum Standards: The project was designed to meet the Sphere standards for health and WASH (Water, Sanitation, and Hygiene), guaranteeing that the assistance provided was safe, accessible, equitable, and of adequate quality.
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Learning from Past Implementation: The successful model and lessons learned from the 2024 flood response project with Americares were directly incorporated, allowing for a more streamlined and targeted approach in 2025. 4. Project Framework
4.1. Project Goal and Objectives
The overarching goal of the project was to reduce morbidity and mortality among flood-affected populations in Feni Sadar Upazila by restoring access to essential healthcare and preventing the spread of communicable diseases.
The specific objectives were:
1.
To restore the capacity of 11 Community Clinics by providing essential emergency medicines and basic medical equipment.
2.
To ensure access to safe drinking water for patients and healthcare providers at the 11 targeted clinics through the installation of water purifiers.
3.
To disseminate critical health and hygiene information to at least 60,000 people to promote protective behaviors and prevent disease outbreaks.
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4.2. Target Groups and Participant Selection
The project primarily targeted an estimated 60,000 individuals residing in the catchment areas of the 11 selected Community Clinics in Kalidaha, Fazilpur, and Shorshodi Unions of Feni Sadar Upazila. This population was selected based on the severity of flooding and the assessed gap in healthcare services.
Specific attention was given to vulnerable subgroups:
•
Women and Children: Due to their specific health needs and higher susceptibility to infections.
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Pregnant and Lactating Women: As a group requiring continuous access to healthcare and nutrition.
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The Elderly and Chronically Ill: Who often have reduced mobility and are more vulnerable to complications from common illnesses.
•
Economically Disadvantaged Families: Who faced financial barriers to accessing private healthcare facilities.
The project design incorporated inclusive strategies to address their needs:
•
Gender Sensitivity: Engagement of female staff and Community Health Care Providers (CHCPs) to ensure comfort and access for women and adolescent girls.
•
Accessibility: Services were delivered directly through the widely distributed network of community clinics, overcoming mobility and financial barriers.
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Culturally Appropriate Communication: Hygiene promotion materials were developed in simple Bengali with clear illustrations to overcome literacy barriers and ensure the message was understood by all. 4.3. Geographical Coverage
The project was strategically focused on Feni Sadar Upazila, one of the worst-hit sub-districts. Within it, three unions with the highest concentration of need were selected:
1.
Kalidaha Union: Serving clinics at North Gobindapur CC, Jatrashidhe CC, Cheoria CC, and Ghohadua CC.
2.
Fazilpur Union: Serving clinics at Pubali CC, Raznagor CC, North Fazilpur CC, and Aribi Hat CC.
3.
Shorshodi Union: Serving clinics at Chosna CC, Jahanpur CC, and Abu Pur CC.
This focused approach ensured that resources were concentrated where they were most needed, maximizing the project's impact.
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Table 1. List of Community Clinics Sl. No Name of District Name of Union Name of Community Clinic 1 Feni Sador Upazila (Sub-District)
Kalidaha Union North Gobindapur CC
2
Jatrashidhe CC 3 Cheoria CC
4
Ghohadua CC 5 Fazilpur Union Pubali CC
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Raznagor CC 7 North Fazilpur CC
8
Aribi Hat CC 9 Shorshodi Union Chosna CC
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Jahanpur CC 11 Abu Pur CC 5. Project Implementation Strategy and Activities
A phased approach was adopted to ensure a systematic and efficient implementation process. 5.1. Pre-Implementation Phase: Mobilization and Coordination (Late July - Mid-August 2025)
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Rapid Needs Assessment: Ashar Alo's team conducted a rapid assessment in the first week of August to verify the initial data and identify the specific clinics and supply gaps.
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Staff Mobilization: A dedicated project team was formed, comprising one Project Coordinator and two Project Officers, who were responsible for day-to-day management, coordination, and monitoring.
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Stakeholder Engagement and NGOAB Compliance: Immediate coordination meetings were held with the Upazila Health and Family Planning Officer (UH&FPO), the Upazila Nirbahi Officer (UNO), and the management committees of the selected Community Clinics. The mandatory FD-2 and FD-7 forms were submitted to the NGO Affairs Bureau, securing approval for the project inception and fund release.
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Detailed Planning: A detailed implementation plan, budget, and monitoring framework were finalized.
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5.2. Core Implementation Activities (Mid-August - Early October 2025)
5.2.1. Procurement and Supply Chain Management
All procurement activities were carried out in full alignment with the established procurement policies of both Ashar Alo and Americares, ensuring that every step of the process upheld the principles of quality, cost-effectiveness, accountability, and transparency.
To meet the immediate health needs of flood-affected communities, a comprehensive list of essential medicines such as Fexofenadine, Montelukast, Omeprazole, Aceclofenac, Albendazole, ORS, and Zinc syrup was prepared through close consultation with qualified medical professionals. This collaborative approach ensured that the selected pharmaceuticals directly addressed the most prevalent flood-related illnesses, including respiratory infections, gastrointestinal problems, allergies, and dehydration.
Additionally, critical medical equipment and supplies including BP machines, glucometers, and nebulizers were procured to support effective diagnosis and treatment at the field level. The procurement team carefully verified product specifications, supplier reliability, and overall durability to ensure that these medical devices could withstand repeated use in challenging conditions.
Furthermore, 11 high-quality water purifiers were sourced from a reputable and vetted supplier. The selection process prioritized reliability, ease of operation, and suitability for emergency response settings, ensuring that safe drinking water could be provided promptly to vulnerable households during and after the flood emergency.
Overall, the procurement and supply chain process was systematic, evidence-based, and responsive to the specific needs identified during the emergency, enabling timely and effective service delivery to affected communities. 5.2.2. Delivery of Emergency Medicines and Medical Supplies
Ashar Alo successfully completed the distribution of all medicines, medical equipment, water purifiers, and IEC materials for the 11 Community Clinics under Feni Sadar Upazila on 12 October 2025. Instead of conducting distribution at the individual clinics, all supplies were formally handed over through a centralized program organized at Dr. Sazzad Auditorium in the Feni Sadar Upazila Health Complex.
During the ceremony, the Ashar Alo Authority officially handed over the complete consignment of items to the Civil Surgeon of Feni, the UNO of Feni Sadar Upazila, the UH&FPO of Feni Sadar, and the Country Representative of Americares. Following the formal handover, these government officials and the Americares representative jointly distributed the medicines, medical equipment, water purifiers, and leaflets to the 11 Community Health Care Providers (CHCPs) from the respective Community Clinics.
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Each CHCP received a standardized package comprising 23 essential medicines, 8 categories of medical equipment, water purifiers, and all relevant IEC materials, in accordance with the approved distribution plan. All handovers were duly documented through signed receipts from the CHCPs.
Ashar Alo also assumed full responsibility for transporting all distributed items from the event venue to each Community Clinic. The organization independently covered all transportation, logistical, and handling expenses, ensuring that every clinic received its allocated supplies promptly and without interruption. 5.2.3. Health and Hygiene Promotion Campaign
To strengthen the impact of the medical and material support, Ashar Alo implemented a comprehensive Information, Education, and Communication (IEC) campaign aimed at improving community awareness on key health and hygiene issues, particularly in the context of flood-affected areas. A total of 10,000 leaflets were designed, printed, and widely distributed among community members.
The leaflets were developed using simple language and visually engaging illustrations, focusing on the following key themes:
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General Health Awareness: Basic information on maintaining personal hygiene, preventing common communicable diseases, and ensuring family well-being during and after floods.
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Proper Handwashing Practices: Definition and importance of hand hygiene; step-by-step instructions for effective handwashing with soap; key moments for handwashing (after using the toilet, before eating, before preparing food, after handling waste, etc.).
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Flood-Related Health Risks: Explanation of how floods contaminate water sources and increase disease transmission; guidance on preventing waterborne and vector-borne diseases; steps to keep food and drinking water safe.
•
Dengue Prevention and Symptom Recognition: Description of dengue, its common symptoms (fever, headache, joint pain, rash), and warning signs requiring immediate medical care; instructions on preventing mosquito breeding (removing stagnant water, covering containers, using mosquito nets and repellents).
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Care for Pregnant Women: Special precautions for pregnant women during floods, including safe drinking water practices, nutrition advice, hygiene measures, danger signs during pregnancy, and the importance of timely antenatal and postnatal care.
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Safe Water Practices: Methods for ensuring safe drinking water, such as boiling, using water purifying tablets, and properly storing purified water.
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Sanitation Guidance: Safe disposal of child feces, maintaining clean latrines, and ensuring proper waste management to prevent disease outbreaks.
Each message provided clear definitions, symptom checklists, preventive methods, and recommended actions to promote overall health and safety.
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The distribution of the leaflets took place through community clinics, local gatherings, and with the support of community volunteers, ensuring that the information reached a broad audience, including vulnerable households. The IEC campaign significantly contributed to increasing community awareness and promoting healthier practices during the post-flood period. 5.3. Monitoring and Evaluation Framework
Continuous monitoring was integral to the project. The Project Officers conducted regular field visits to the clinics to:
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Track the utilization of supplied medicines.
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Monitor the functionality of the water purifiers.
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Observe the dissemination of hygiene messages.
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Collect feedback from CHCPs and community members.
This real-time monitoring allowed for minor adjustments in implementation, such as redistributing certain medicines between clinics based on patient load. The primary quantitative indicator was the number of direct participants (60,000), defined as individuals residing in the catchment area who benefited from improved clinic services, safe water, or hygiene information. 6. Project Outcomes and Achievements
6.1. Quantitative Results and Outputs
Table 2. Results and Outputs of the Project. Output Indicator Planned Target Actual Achievement Verification Number of Direct Beneficiaries 60,000 ~60,000 Based on catchment population of 11 CCs
Community Clinics Supported
11
11
Distribution reports, signed receipts Types of Medicines Distributed 23 23 Procurement and distribution lists
Units of Medicines & Supplies Distributed
212,300
212,300
Stock registers of CCs Water Purifiers Installed 11 11 Installation reports, photos
Hygiene Awareness Leaflets Distributed
10,000
10,000
Distribution records
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6.2. Qualitative Impact and Outcomes
The project's success extends beyond mere numerical outputs to tangible, positive changes in the community's health landscape:
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Restored Primary Healthcare Services: The provision of medicines and equipment revitalized the 11 community clinics, enabling them to function effectively again. CHCPs reported that they could now treat the vast majority of common cases on-site, reducing the need for patient referrals to overburdened Upazila Health Complexes. For example, CHCP Ziaur Rahman Rasel from North Gobindapur CC stated, "The timely supply of medicines, especially antibiotics and ORS, allowed us to manage the surge in diarrhea and skin disease cases effectively. We felt empowered to serve our community in its time of greatest need."
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Reduction in Disease Incidence: While a formal comparative study was beyond the project's scope, qualitative reports from CHCPs indicated a noticeable decline in new cases of waterborne diseases, particularly acute watery diarrhea, in the weeks following the distribution of water purifiers and hygiene leaflets. The availability of medicines also meant that cases were treated early, preventing complications.
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Improved Health Knowledge and Practices: The hygiene leaflets served as a constant reminder and reference for good hygiene practices. Feedback from community members indicated that the illustrated messages were particularly effective. A community elder from Fazilpur Union noted, "The pictures on the leaflet showed us exactly how to wash hands properly. Even my grandchildren understand it. We are now more careful about drinking water."
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Strengthened Local Health System: The project did not create a parallel system but instead bolstered the existing government-led community clinic network. This capacity-building approach ensures that the benefits of the project will endure beyond the project period. 6.3. Beneficiary Testimonials and Success Stories
Success Story:
North Gobindapur Community Clinic, Kalidaha Union, Feni Sadar Upazila
Late one night at around 10:00 PM, Community Clinic Health Care Provider (CHCP) Ziaur Rahman Rasel of the North Gobindapur Community Clinic received an urgent phone call from the parents of a one-year-old child who was experiencing severe shortness of breath. The parents were terrified and unsure where to seek immediate help, as flooding and poor road conditions made it difficult to reach the Upazila Health Complex (UHC) at night.
Because the CHCP lives close to the clinic, he immediately went to the facility and collected the nebulizer machine and Salbutamol respiratory solution supplied through this project. He then rushed to the child’s home and administered emergency nebulization on the spot.
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Within minutes, the child’s breathing eased, and the condition stabilized, bringing visible relief to the anxious parents. The CHCP advised them to visit the UHC the following morning for further examination and treatment.
The next day, the family took the child to the UHC, where doctors diagnosed pneumonia. The child was admitted and received seven days of treatment, after which he made a full recovery.
The parents expressed deep gratitude, explaining that without the timely nebulization provided that night, their child’s condition could have deteriorated rapidly:
“If the nebulizer was not available that night, we could have faced a much worse situation. This support saved our child.” 7. Operational and Implementation Challenges
The implementation was not without its hurdles, though all were successfully mitigated:
Using Community Clinics Ensured Fast and Effective Service Delivery: Delivering a one-time handover of emergency medicines and equipment through existing community clinics proved highly effective. These public clinics already had established patient networks and trusted healthcare staff, enabling immediate use of the supplies and faster restoration of essential services without creating temporary or parallel systems.
Local Procurement Reduced Delays During the Flood Emergency: Procuring medicines and equipment from district-level vendors significantly shortened delivery time. This approach avoided transport disruptions caused by flooding and ensured clinics received the full package of supplies promptly after the one-time distribution.
Simple, Visual IEC Materials Improved Community Hygiene Practices: The use of straightforward, illustrated hygiene leaflets helped households easily understand safe water, sanitation, and vector control practices. This was especially effective in low-literacy communities and proved valuable as a complementary strategy to the one-time supply distribution.
Close Local Coordination Supported Quick Adaptation: Strong communication with CHCPs, union parishad members, and local authorities allowed the project team to quickly address any immediate needs following the distribution. Their involvement ensured the supplies were properly utilized and that messaging reached the most affected households.
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8. Lessons Learned
The experience and outcomes of this project provide valuable guidance for strengthening future emergency health responses in flood-prone areas:
Establishing a Pre-Qualified Local Vendor Roster: The project demonstrated the importance of maintaining an updated list of reliable district-level suppliers who can deliver medicines and essential items quickly during emergencies. This will streamline future procurement processes and minimize delays during disaster response.
Pre-Positioning Essential Supplies in High-Risk Areas: Pre-stocking emergency medicine kits, basic medical equipment, and hygiene IEC materials in vulnerable unions ahead of the monsoon season will significantly improve readiness. Early pre-positioning can ensure faster service restoration and reduce gaps in healthcare access during sudden flooding events.
Strengthening the Role of Female Health Workers in Outreach: Women health workers played a critical role in engaging households and promoting hygiene behaviors. Keeping them at the center of community outreach efforts will support sustained behavior change, improve trust, and ensure that women, children, and elderly individuals continue to receive inclusive and culturally appropriate health information. 9. Financial Management and Accountability
The project was implemented with strict financial discipline and transparency. The total budget of USD 20,000 was utilized as follows, in full alignment with the submitted budget narrative:
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Human Resources (USD 1,500): For the salaries of one Project Coordinator and two Project Officers for two months.
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Administrative Costs (USD 650): Covering internal audit fees, communication costs, and local travel for monitoring.
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Direct Service Delivery (USD 17,050): The bulk of the budget was allocated to the procurement of emergency medicines, medical equipment, and 11 water purifiers.
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Printing and Distribution (USD 800): For the design, printing, and distribution of 10,000 hygiene awareness leaflets.
All expenditures were supported by appropriate invoices, receipts, and vouchers. A detailed financial report with all supporting documentation has been prepared and is available for audit. The project was completed on budget, with no significant unforeseen expenditures.
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10. Conclusion and Recommendations
10.1. Conclusion
The project "Provide Emergency Healthcare Support to Flood-Affected People in Bangladesh" successfully met its objectives, delivering critical and timely assistance to 60,000 vulnerable people in Feni. Through a well-executed strategy of supplying medicines, purifying water, and promoting hygiene, the project alleviated immediate suffering, curbed the spread of disease, and supported the recovery of the local primary healthcare system. The partnership between Ashar Alo and Americares once again proved to be a vital mechanism for delivering effective humanitarian aid in Bangladesh. 10.2. Recommendations for Future Interventions
1.
Build on Local Partnerships: Continue to deepen collaboration with the Ministry of Health and Family Welfare to ensure alignment with national health priorities and protocols.
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Consider Mobile Health Services: For future responses in areas where static clinics are destroyed or inaccessible, supplementing support with mobile medical units could be highly effective.
3.
Expand WASH Focus: While water purification was addressed, future projects could include the distribution of hygiene kits (soap, water purification tablets, buckets) to individual households, especially those with pregnant women and young children.
4.
Strengthen M&E: Incorporate simple pre- and post-intervention knowledge, practice, and coverage (KPC) surveys to more robustly measure the project's impact on health-seeking behavior and disease prevalence.
Ashar Alo extends its deepest gratitude to Americares for its steadfast support and trust. We look forward to the potential for continued collaboration to build the resilience of vulnerable communities in Bangladesh against future disasters.