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Preventing Illness Through Improved Flooring

A design and construction service provided to marginalized families, integrated with a campaign that educates communities on the link between housing and health. It tackles the problem of disease caused by dirt floors in homes where children under 5 are most vulnerable by: replacing dirt floors with new cement floors and providing educational workshops on disease prevention in the home. [Updated 12/19]

Photo of ARCHIVE Global
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Here's the Idea:
Imagine a young baby or child exploring and crawling around in their home. They may be playing with toys, and at some point are probably putting those toys and/or their hands in their mouths. Classic baby behavior, right?

Now imagine that this baby is living in a home with a dirt floor; a dirt floor that is proven to be a prime breeding ground for harmful bacteria. As you can probably imagine, the transmission of disease is rapid.  For millions of kids, their homes are making them sick.

Diarrhea is one the most prevalent illnesses young children in the developing world face, but by replacing dirt floors with impermeable and cleanable surfaces, like concrete, we can reduce the risk of diarrhea and infection by 50% and 75% respectively.
 
A User's Perspective: [Updated 12/26]
Check out our User Experience Map in our Image Gallery! [Updated 12/19]

The implementation of our pilot lasted 14 days total. Before, during and after the pilot implementation, we were able to collect valuable end user feedback. This was retrieved through a mix of focus groups, semi-structured interviews, short-surveys, and social mapping exercises conducted by ARCHIVE and ADESH. The responses showed that:

A. During Implementation:
i) More than 80% of people were interested in helping to support an expanded community program on flooring and health (Response: We plan to include a Trainer of Trainers programme in our scaled up programme);
ii) There was interest in pairing the flooring project with a sanitation project (Response: Our selection criteria means we only work with residents who agree to purchase a new toilet in the long-term);
iii) More knowledge desired about the importance of flooring to improve housing asset (Reponse: We would invest in more training sessions in any future programme with local MFIs who could advise residents on this );
iv) People wanted to know how beneficiaries were selected (Response: We subsequently made selection criteria public);
v) parents were not attributing their children’s illnesses with the presence of a dirt floor in their homes (Response: We made this connection clear in our community training);

B. Post-Pilot:
vi) Time was saved by women who no longer needed to invest in weekly floor maintenance;
vii) 70% of residents were able to make financial contribution/investment to the cost of their new floor

[Updated 12/26]
 
Prototyping the Idea: [Updated 12/26]
Check out our Design Prototyping in our Image Gallery! [Updated 12/26]

Our first pilot was launched in Spring 2014. With the help of ADESH (a local NGO in Bangladesh) and BRAC University we set out to improve the lives of 20 children under 5 in Savar district in Bangladesh. We chose Savar, which is a Hindu community (in a Muslim majority country) because our initial research suggested it has a history of unequal access to public services as a minority community. 10 families with children under 5 - 57 residents in total - received modest home improvements (replacement of dirt floors) aimed at delivering improved health outcomes. In addition, ADESH provided training to 132 residents in the community on the impact of poor housing on health, and facilitated focus group discussions on sound hygiene practices.

The training of residents in floor installation was designed by ARCHIVE, in conjunction with architects from BRAC University, and coordinated locally by ADESH. A selection of local masons and other skilled workers were identified to receive the training. At least one member of each beneficiary household received training. This was often the same person who contributed ‘sweat equity’ on the project, allowing for a unique style of ‘learning by doing’ where the benefit is not only in upskilling but results in tangible outcomes for beneficiary families. We would like to scale-up this component of the project by identifying a greater number of skilled masons in each new area we work.

In the immediate future, we expect to scale-up this project in Bangladesh through: 

1) Early consultation with new communities to localize the approach (e.g. use materials, skills, methods that might be indigenous to the area)

2) Deliver wide public awareness on the project beyond immediate end-users

3) Involve a range of key stakeholders including CBOs, private companies (such as hardware stores) and local/regional government (e.g. municipal offices on housing, environment and/or health)

4) Provide local financing opportunities for end users

5) Provide training for residents to start micro-entrepreneurship projects in floor installation i.e to reduce reliance on ARCHIVE in the long-term and to increase overall project sustainability

[Updated 12/26]

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ARCHIVE Global has piloted a flooring replacement project in Bangladesh, and here's what they've found:
+Dirt floors are a common feature of poor quality housing in both rural and urban areas of the developing world, and prove to be ideal carriers of parasites, viruses, and bacterium, which cause diarrheal, skin, and respiratory diseases. These illnesses contribute to anemia, parasitic infestation, and malnutrition. 


A family and their new floor, from our Pilot Project.

+ Replacing dirt floors with concrete can lead to significant reductions in diarrhea and other parasitic illnesses in both young children and adults. In the community where this project was piloted 0 cases of diarrhea were reported 4 weeks after construction was completed.

+In homes that received new floors, women reported spending 2-3 hours less each week cleaning their floors. This means that they have more time to work, rest, or take care of their children.

+Replacing floors in sub-standard housing also increases a families access to credit. In Bangladesh, replacing the floor can lead to an almost 50% increase in overall home value.

+By requiring that one household member participate in the construction process, individuals are receiving training in skilled labor that may result in economic opportunities in the future.

+By providing a locally run, day-long, Community Health Training, participants were able to discuss and learn about disease prevention in the home. Our post-training surveys showed that 95% of participants could identify at least one strategy to preventing diarrheal-disease in the home.

+It is a one-time, cost-effective project that does not require complex behavior modification.

+In countries such as Bangladesh, where villages are increasingly susceptible to flooding and periods of heavy rain, fecal matter, garbage, and other debris often flow freely throughout fields, roadways, and homes. By replacing the floors, families can easily and efficiently clean out any refuse or bacteria that may linger after a flood.

The big picture for children under 5? 
+1600 children die every day from diarrhea-related causes and over 200 million children under the age of 5 are not reaching their full phyiscal and cognitive potential by the age of 10. 

+Simply replacing dirt floors provides young children clean, stable and healthy foundations to grow and develop

+It means that a child can crawl, sleep, and play in a home that isn't breeding bacteria.

Who will benefit from this idea and where are they located?

This project has been tested in both Bangladesh and Mexico with households that have at least one child under the age of 5. However, given the simplicity and scaleability of the project, ARCHIVE Global believes that this project can be implemented all over the world, in communities and for children with the greatest need.

How could you test this idea in a quick and low-cost way right now?

ARCHIVE Global has already tested this idea in the Spring of 2014. It was a great success and thus ARCHIVE seeks to expand and grow this project further.

What kind of help would you need to make your idea real?

ARCHIVE Global is currently seeking new ideas for the materials used to replace floors. Although concrete is available and cost-effective in Bangladesh, this may not be the case everywhere. Recycled, local, sustainable material solutions would greatly enhance the scaleability of this project. Of course any further feedback, comments, or ideas are welcome!

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

Attachments (1)

Comments & Questions.pdf

Our responses to the comments and questions from the Amplify Team, the OpenIDEO Team, and the OpenIDEO Community. [Updated January 6]

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Photo of Taz Fear
Team

Hi All

This is a great idea to help family health but also to help increase the value of people's homes! Your boards mapping out you concept and solution look great and explain your idea really well! You mentioned the problem of flooding and I wanted to know that would this mean that work would stop during monsoon season and continue for the rest of the year? Also, if your business model is squeezing your margins to reduce costs and the flooring is to support low-income families, who pays the cost if flooding occurs during works and damages some of the flooring, I assume that it would be very expensive and difficult to get insurance against such risk in areas of high risk of flooding?

Kindest regards

Tara Fear

Photo of ARCHIVE Global
Team

Thanks for your insight, Tara! There are indeed many challenges that go along with effectively rolling out a project like this one in Bangladesh, ranging anywhere from seasonal weather constraints, to political disruptions, to social or economic instability, all of which can unexpectedly increase costs through delays in construction, labor strikes or a rise in the cost of materials.

With regards to the monsoon season and flooding specifically, we actively plan for a reduction in the pace of construction during the monsoon season and we specifically plan our construction in flood-prone communities outside of these rainy months. As for the work we do conduct during the rainy season, the cost of large tarps is included in our per-house budget, and these are utilized both to protect any household items removed from the home during construction, as well as to cover the concrete floor as it dries.

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