Max Value for WASH is a 4 year program to reduce child mortality in the most cost effective way in the South coastal areas of Bangladesh. We offer an integrated approach of Water, Sanitation, Hygiene (WASH) and HEALTH interventions, including safe motherhood, nutrition, health services and reproductive health. Since these WASH and HEALTH elements are strongly linked, the effect of integrating them into one program is expected to be greater than managing each part separately. With this program, Max Foundation strives to maximize its impact, saving as many child lives as possible with its limited resources. The Max Value for WASH program is innovative in its strong focus on monitoring outputs ánd outcomes, in its continuous efforts to reduce costs, and in multiplying program subsidies through resource mobilization and local business development.

Max Value for WASH

OutcomesMax Foundation Monitoring goes beyond traditional output monitoring. We developed a S.M.A.R.T. monitoring system to continuously measure behavioral change and other outcomes of the program. We monitor the outcomes of our program on a daily basis surveying hundreds of households every working day.

# Households / students able to reproduce the key Max-WASH messages;# People (male/female) / students having access (have and use) to hygienic latrine facilities;# Households / students practicing safe drinking water management;# Households / students practicing appropriate hand washing behavior;# Pregnant women / young mothers having access to and make use of professional ante- and post-natal care;# Under 5 children suffering from stunted growth.

Main Partners: Embassy of the Kingdom of the Netherlands, Blue Gold, Worldbank, World Health Organization, Akvo and the Gender and Water alliance.

Implementation partners: • Aungkur Pali Unnayan Kendra

(Aungkur)• Bangladesh Development

Society (BDS)• Dhaka Ahsania Mission (DAM),

Friendship• Shariatpur Development Society

(SDS)• Shushilan• Society for People’s Actions in

Change and Equity (SPACE)• Stichting Land Ontwikkelings

Project Bangladesh (SLOPB)• Unnayan Shahojogy Team (UST)

Max Value for WASH program

BangladeshSince 1990, child mortality in Bangladesh has, as in other parts of the world, declined drastically. Despite these good results, Bangladesh still ranks 60th in the under-five mortality rating, with a child mortality of 41 per 1,000 live births. Infectious diseases like pneumonia and diarrhea contribute to respectively 18% and 6% of all under-five deaths in Bangladesh. UNICEF estimates that 58% of diarrhea-related diseases are caused by a lack of safe water, adequate sanitary facilities and proper hygienic practices. The World Health Organization (WHO) estimates that better hygiene practices, such as washing hands with soap after defecation and before eating, could cut the infection rate of pneumonia and other acute respiratory infections by 25%.

Bangladesh has made remarkable progress towards access to drinking water and sanitation. Specifically open defecation has been brought back to only 3% from 34% in the 1990s. The remaining challenge, is to secure sustainable access to improved and hygienic sanitation.

Overal objective: Reducing child mortality by providing access to safe drinking water, sanitation and hygiene education (WASH), including primary healthcare for 800.000 people in the rural areas of the coastal districts in the south of Bangladesh.

Total cost: € 6 million (50% financed by the Government of the Netherlands, 50% financed by Max Foundation)

Duration: 4 years (2012 - 2016)

Program Area: The coastal area of South Bangladesh (including the Blue Gold Polders): Barguna, Patuakhali, Madaripur, Shariatpur, Bhola, Bandarban

Target group: Rural communities with emphasis on the hardcore poor, minorities, (pregnant) women & children.

Outputs (by the end of the program)• 400,000 people in the Max-WASH area have access to safe water supply.• 800,000 people in the Max-WASH area have and use latrines/toilets in their

houses.• 70,000 school children in 200 primary/secondary schools receive school

sanitation and hygiene promotion.

With the same budget we will serve approximately over 90.000 (12%) more people as planned, totaling to 890.000.

Max Value for WASH 2014

Who is Max Foundation

Employees Netherlands

5Employees Bangladesh

6Local partners

11Field workers

250

Partnerships

Expenses 2014 ThemesKey components as % of budget

Innovation

Safe motherhood

Sexual reproductive health

Nutrition

Wash in communities

Wash in school93% spent on objective

4% spent on fundraising

3% spent on management & administration

WASH (Water, Sanitation and Hygiene Education)

Nutrition

Safe Motherhood

Sexual Reproductive Health (SRH)

Results 2014, WASH Results 2014, Safe motherhood & Nutrition

115,000People with improved access to safe drinking

water

470,000People reached through

education on hygiene and health

145,000People gained access to

adequate sanitation

40,000Students gained access to

adequate sanitation

60Postnatal care

counselors trained

8,000Children monitored

on growth

S.M.A.R.T. Charity

Bene�ciaires 2016

1.6 mm

€ 1How do we maximize our impact per euro? E�ciency and e�ectiveness are at the heart of our organization. We believe that charity pro�ts from a business driven approach. Or: we believe in S.M.A.R.T (Speci�c, Measurable, Achievable, Relevant, Time bound) charity.

The mission of Max Foundation is to save as many children’s lives in the most e�cient and e�ective way. We envision a world in which easily preventable diseases are no longer a cause for child mortality amongst children under the age of �ve.

Mission, vision & ambition MAX value for WASH 2014 Result demand creation latrines

Local partners

9Projects

11Focus ImpactApproach

€ 5.6Investment in household latrines

Subsidy on latrines

Max Value for WASH 2014

Who is Max Foundation

Employees Netherlands

5Employees Bangladesh

6Local partners

11Field workers

250

Partnerships

Expenses 2014 ThemesKey components as % of budget

Innovation

Safe motherhood

Sexual reproductive health

Nutrition

Wash in communities

Wash in school93% spent on objective

4% spent on fundraising

3% spent on management & administration

WASH (Water, Sanitation and Hygiene Education)

Nutrition

Safe Motherhood

Sexual Reproductive Health (SRH)

Results 2014, WASH Results 2014, Safe motherhood & Nutrition

115,000People with improved access to safe drinking

water

470,000People reached through

education on hygiene and health

145,000People gained access to

adequate sanitation

40,000Students gained access to

adequate sanitation

60Postnatal care

counselors trained

8,000Children monitored

on growth

S.M.A.R.T. Charity

Bene�ciaires 2016

1.6 mm

€ 1How do we maximize our impact per euro? E�ciency and e�ectiveness are at the heart of our organization. We believe that charity pro�ts from a business driven approach. Or: we believe in S.M.A.R.T (Speci�c, Measurable, Achievable, Relevant, Time bound) charity.

The mission of Max Foundation is to save as many children’s lives in the most e�cient and e�ective way. We envision a world in which easily preventable diseases are no longer a cause for child mortality amongst children under the age of �ve.

Mission, vision & ambition MAX value for WASH 2014 Result demand creation latrines

Local partners

9Projects

11Focus ImpactApproach

€ 5.6Investment in household latrines

Subsidy on latrines

Max-WASH Innovations Innovation is at the core of our Max-WASH approach. We always explore, try and review new ideas, interventions and partnerships. Max Foundation believes innovation is the way to continuously improve the effectiveness and impact of development interventions. Business as usual is not good enough. We want to continuously improve our programs and share lessons learned with other parties and experts in the sector.

Demand creating business approachMax-WASH’ demand creating business approach where program subsidies are multiplied through resource mobilization is very successful. The vast majority of people in Max-WASH villages buys its own improved latrine without any form of program subsidy. Each euro of program subsidy is multiplied by local communities and governments to an investment of €5,60 in sanitation. Data suggest that sanitation coverage in Max-WASH areas increases almost 13 times faster than in non Max-WASH areas.

Monitoring & EvaluationMonitoring & Evaluation is an important element of Max Foundation’s operations, aiming at real-time monitoring of behavioral change, continuous learning and data sharing. Max-WASH monitoring goes beyond traditional output monitoring and focuses on measuring the real outcomes of the program. This systems also links finance to its monitoring system. Max Foundation uses smartphones and the Akvo FLOW app to operationalize its S.M.A.R.T. monitoring system and envisions a future of data sharing.

Max value for MoneyMax Foundation continuously strives for maximum value for money -> helping a maximum number of beneficiaries per euro. We do this by benchmarking the budgets of each of the implementing program partners, by mobilizing beneficiaries to invest their own money and by working actively together with local entrepreneurs to reduce program costs.

Max-WASH Approach: What we do!Joke and Steven Le Poole founded Max Foundation in 2005, after their son Max died from a viral infection. Max Foundation believes that no child should die from an easily preventable disease. It is our mission to provide a healthy future for as many children as possible in the most effective and efficient way. We offer an integrated approach of Water, Sanitation, Hygiene (WASH) and HEALTH elements, including safe motherhood and nutrition, to the poorest communities in Bangladesh.

Safe water, Sanitation and Hygiene educationWe supply communities in Bangladesh with safe drinking water by installing safe water options, like deep tube wells. In order to increase ownership and sustainability, Max-WASH tube wells are always built with at least 20% contribution from the community.

We motivate the local communities to buy simple, good quality latrines at an affordable price (or on monthly payments) and to keep the latrines hygienic. We joined forces with the Water & Sanitation Program of World Bank to stimulate sanitation marketing. Sanitation marketing focuses on the development of the marketplace and helps entrepreneurs to produce and supply multiple sanitation products and services at an affordable price, leading to increased sanitation purchases.

Without hygiene education, the installation of wells and latrines has a limited impact only. We educate local communities on the importance of hygienic practices, such as washing hands after defecation and before taking food. With trainings and working groups we create awareness on the importance of the importance of hygiene. We established courtyard groups within communities to create behavioral change through awareness raising and education.

Safe motherhood We raise awareness on family planning and the prevention of early marriages and pregnancies. Still too many girls in Bangladesh become pregnant, and deliver their first baby at a young age, which is extremely risky and dangerous for them and their babies. Safe motherhood also means linking pregnant women and young mothers with local health professionals.

NutritionScientific evidence suggests there is a strong linkage between WASH and stunted growth (children being too short for their age). Main causes of stunting are diarrhea related diseases and chronic exposure to fecal contamination. Stunted children are more vulnerable for infectious diseases, diabetes and heart diseases. In order to prevent stunting among children, we have integrated elements such as growth monitoring, early breastfeeding and child nutrition and worm control in our Max-WASH program.

GenderGender is a cross-cutting theme in the Max-WASH program. Awareness raising about equal rights between men and women is an integral part of the program.

Innovation in Hygiene: low-cost hand washing devicesWe promote low-cost hand washing devices in local communities and schools. Having a hand washing device near or around the latrine and kitchen is expected to increase hand washing behavior after defecation and before taking food. The assumption is that people will be more likely to wash their hands when it is comfortable to do so. Hand washing devices make it possible to wash your hands relatively quickly and without help. Low-cost hand washing devices can be made of low-cost materials like empty bottles, buckets or jars. This way it is affordable for everyone. We increase the cost effectiveness further by promoting the use of liquid soap which requires less water and less soap compared to solid soap blocks.

Innovation on stunting: Stunted Free VillagesWithin our program, we developed a pilot project aiming to mobilize communities to achieve a ‘stunting free village’ status. The pilot combines WASH and nutrition interventions with continuous growth monitoring of U5 children. The ‘Stunted Free Villages’ approach is based on the successful CLTS approach and aims at creating behavioral change on a large scale with the ultimate goal to eradicate stunted growth.

Max Foundation, the NetherlandsJoke Le Poole, director E: joke@maxfoundation.org M: + 31 6 24505000

Gyroscoopweg 142 1hg 1042 AZ Amsterdam, the Netherlands NL36ABNA0505107333+31 (0)20 611 76 74

www.maxfoundation.org

Max Foundation, BangladeshRiad Imam Mahmud, Country DirectorE: riad@maxfoundation.orgM: +88 01711232093

Apartment B1, 1st floorDomino-LLUVIA23/16 Khilji Road, Block BMohammadpur, Dhaka – 1207, Bangladesh

Innovation in Sanitation: 12-step approachEach newly constructed latrine will be no further away than 12 steps from the houses. Common practice in rural Bangladesh is to build latrines relatively far away from the house to keep unpleasant odors away. As a result, women often do not use the latrine after dark, fearing teasing, sexual harassment and other risks. The odors given off by improved latrines are significantly less than the ones emitted by the unimproved latrines. Therefore, the new latrines can be built closer to the houses increasing its usage by both men and women. Another advantage of the 12-step latrine is that it can be reached during floods, which is not always the case for far-away latrines.

Innovations examples