BRAC: Village Health Workers Can Test Tubewell Water For Arsenic (1998)
- By Mushtaque Chowdhury, Md. Jakariya, Md. Ashiqul H. Tareq, Jalaluddin
- Bangladesh Rural Advancement Committee
The discovery of arsenic in groundwater in several areas of Bangladesh
has aroused widespread concerns. BRAC, a Bangladeshi development organisation,
has been active in determining the level of arsenic contamination in tubewell
water. This is presented here highlighting the suitability of village-based
health workers in carrying out large scale testing campaigns of tubewell
Arsenic is an element with metalloid property and is known for its toxicity.
It is relatively soluble in water and occurs naturally in the environment.
There are several hypotheses about the sources of arsenic contamination
in groundwater of the Ganges delta region, and like most countries, it
is thought to be geological. Studies have shown a high level of arsenic
in pyrite (a type of rock) in the alluvial regions of Bangladesh. When
ground water is extracted, the pyrite is exposed to air and the arsenic
becomes free and contaminates the water table. Thus, a high rate of water
withdrawal by humans causes the problem of contamination.
Arsenic occurs in different forms, organic and inorganic, with different
toxicity. Humans are exposed to arsenic mainly through eating, drinking
and breathing. The World Health Organization (WHO) has set 0.05 mg/L as
the upper permissible limit for arsenic in drinking water. An excess of
arsenic leads to serious human health problems.
It may take 8-14 years after starting to drink arsenic contaminated
water for symptoms to appear. This period depends on the amount of arsenic
ingested, the length of exposure and immunity level of the person. People
with poor socio-economic and nutritional status are also more vulnerable
to arsenic poisoning. Although arsenicosis, the disease caused by arsenic
contamination, is not an infectious, contagious or hereditary disease,
but it creates many social problems for the victims and their families.
In Bangladesh, the arsenic problem was first detected in 1993 at Barogharia
union of Chapai Nawabgonj district and has been found to be quite extensive
affecting most regions of the country. Most of the cases of arsenic poisoning
appear to be caused by contamination of the tubewell water. More than 90%
of both rural and urban populations in Bangladesh depend on groundwater
as a source of drinking water and are thus exposed to risks associated
with arsenic contamination.
The issue of arsenic poisoning in groundwater in Bangladesh has received
considerable attention from the media, government, non-governmental organizations
and international agencies. BRAC works closely with the poor in improving
their health, education and economic well-being. For example, BRAC has
encouraged the use of sanitary latrines and hand tubewells as a source
of drinking water. The discovery of arsenic in groundwater indicates that
drinking tubewell water is no longer safe, particularly in areas where
arsenic contamination is severe.
BRAC has initiated a programme on arsenic mitigation. It conducted two
testing programmes to determine the nature, extent and magnitude of the
problem. Firstly, tubewells in all of BRACís 802 field offices were tested.
Secondly, all the tubewells in one thana that was thought to be highly
affected were tested. The testing programme was implemented in collaboration
with the Department of Public Health and Engineering (DPHE) of the Government
The overall purpose of the BRAC arsenic programme is to mitigate the
arsenic problem in any of the villages served by it that are affected.
The broad objective of the testing programme was to determine the level
of arsenic concentration in hand tubewells of all BRAC field offices across
the country and all tubewells of Hajiganj thana, in order to develop a
simple, inexpensive and rapid arsenic testing methodology.
The specific objectives of the testing programme were to :
- assess the capability of BRAC-trained village health workers in testing
the tubewells in their own villages;
- test the reliability of the field kits used in ground water testing;
- assess the capacity of BRAC in undertaking a large scale testing programme
through its countrywide network.
Materials and Methods
For testing the tubewell water, Health Programme Organizers of BRAC
and Shasthya Shebikas (village health workers or VHWs) were given
two-day training on how to operate the field testing kit. The POs visited
the field offices closest to their own stations and tested the tubewells
located in those office premises. The VHWs based in the Hajiganj thana
of Chandpur district tested water of all the tubewells in their own villages.
VHWs are illiterate women who had earlier been trained by BRAC to treat
selected common illnesses in the village. All the 156 villages of Hajiganj
thana were distributed among the 40 VHWs who identified and tested
all tubewells in their villages. They were also trained on what to advise
the villagers if they tested any contaminated tubewells which included
- Arsenic cannot be removed from water by boiling or by using normal
- Arsenic cannot produce an infectious, contagious, or hereditary disease.
- Arsenic poisoning can be reversed by drinking arsenic free water and
by eating nutritious and vitamin rich food.
- Increased use of surface water from rivers, ponds, canals, lakes, and
rain water for all daily needs including those for agriculture should be
- In areas where arsenic-free tubewell water is not available, river/pond/lake/dugwell
water can be used for drinking after proper boiling. Or alternately,
seventy percent of the arsenic can be removed by keeping the arsenic contaminated
water in a pot for at least twelve hours and stirring the water three to
four times with a piece of alum and then taking the upper 2/3 portions
of the water.
Field kits promoted by National Institute of Preventive and Social Medicine
(NIPSOM) in Dhaka were used for testing. This kit costs Tk. 1,000 and can
test up to 100 water samples. It was claimed to be user friendly and able
to detect arsenic contamination as low as 0.01 mg/L. Different reagents
are used in the field kit procedure and the test is based on chemical reactions.
A total of 802 tubewell water samples were tested from BRAC offices
and 11,954 were identified and tested in Hajiganj thana. From the latter,
193 water samples were selected randomly for further testing at the laboratories
of the DPHE, Comilla, using spectrophotometre, and the results from two
tests (viz., the field kits and spectrophotometre) were subsequently matched.
- The tubewells of BRAC field offices
Of the 802 field offices of BRAC, tubewell water of 94 offices (12%)
were found to be contaminated with arsenic. Examination of the status of
arsenic in tubewells of BRAC offices by region shows that proportion of
tubewells found contaminated was more in the south of the country. Out
of 61 districts from which data was available, arsenic was found in 34
- The tubewells of Hajiganj
Table 1: Summary of test results from Hajiganj thana
Total population of the thana
Number of unions
Number of villages
Number of tubewells tested by field kit
Number of tubewells contaminated with arsenic
Number of villages with all tubewells contaminated
Number of samples tested by spectrophotometer
Field test results confirmed by spectrophotometer (% cases)
Out of the total of 11,954 tubewells at Hajiganj thana, arsenic concentration
in 859 tubewells were found to be within the acceptable limit set by WHO.
The remaining 11,096 or 93% tubewells were found to be contaminated with
arsenic concentration greater than the acceptable limit. In two of the
11 unions, over 99% of the tubewells were contaminated. When the test results
were examined by village, the percentage of villages where all tubewells
were contaminated was 53. In other words, 53% of the villages had no access
to safe water.
A strong relationship was found to exist between depth of the tubewell
and arsenic contamination. Very deep tubewells (100 feet or more) and shallow
tubewells (less than 50 feet) were less likely to be contaminated.
A total of 193 randomly selected water samples from Hajiganj were analyzed
by spectrophotometre to determine the validity of the field kit results
and they were found to agree in 178 of the cases or 92%. Results of arsenic
testing by spectrophotometre indicated the presence of a high level of
arsenic concentration in the hand tubewells of Hajiganj thana. Only 8%
had arsenic content which is considered safe (£
0.05 mg/L). Sixty four tubewells (33%) had contamination of over 0.25 mg/L,
which is alarmingly high.
Time and Cost
The fieldwork in Hajiganj was undertaken between 23 November and 23
December 1997. A total of 45 VHWs and volunteers took part in the operation,
each testing 20-25 tubewells per day.
An important objective of this programme was to accomplish the testing
at an affordable cost. An average of Tk. 18 was spent to test each tubewell
for arsenic contamination. VHWs and volunteers were paid Tk. 50 per work
The source of arsenic contamination is considered to be geological,
and a result of high withdrawal of underground water. In Bangladesh most
of the drinking water is tapped from ground water with deep and shallow
tubewells. There are more than 2.5 million such tubewells in the rural
areas, covering 95% of the total population. The indiscriminate use of
groundwater for irrigation, lack of proper water management, and inadequate
recharge of the aquifer is believed to have led to the progressive decline
of ground water all over the country. As a result, the arsenic problem
in Bangladesh is growing very rapidly and appears to be a threat to public
health, and was confirmed by this study. It is a matter of grave concern
particularly for specific affected areas such as Hajiganj. To mitigate
this problem in Bangladesh, rapid detection of arsenic contaminated tubewells,
provision of safe water, treatment of affected persons and health awareness
in the community is essential. There is no user friendly, low cost, and
simple method available for arsenic removal. The detection of arsenic contaminated
tubewells and provision of arsenic related information appear to be critical
in the present situation.
The number of tubewells to be tested is very large, necessitating development
of a simple, low cost, low key, and community acceptable system of tubewell
testing. BRAC has shown that rural illiterate women can effectively be
trained to carry out testing of tubewells in their own villages very quickly
and at a reasonably low cost.
The other advantage of involving the community in this task is the creation
of awareness about the problem, as a by-product of the testing programme
itself. It is expected that a mitigation programme, if implemented following
such testing, will have high success rate.
Several field kits for arsenic testing are available in Bangladesh.
The field kit used in the present research was cheap, easy to handle and
gave reasonably accurate results. Continuous monitoring of the kit itself
and the reagent used in this process must, however, be ensured.
NGOs are working closely with community people, meeting and interacting
on a regular basis to implement various programmes and disseminate related
messages. For example, BRAC workers meet with 2.2 million women, representing
the same number of families, every week. messages on arsenic and arsenic
hazards can easily be transmitted through such network. These networks
also offer the potential for effective implementation of any mitigation
programme. BRAC has worked with the Department of Public Health and Engineering
(DPHE) of the government in this testing experiment which shows that effective
collaboration between the government and NGOs can be forged to address
a huge problem such as the arsenic contamination in tubewell water in Bangladesh.