Amena Begum lives in Chotobighai Union, Sadar Upazila, Patuakhali District, Bangladesh. Her household is classified as ultra-poor. In May 2022, she joined the Hat Bhabaranjan Doctor Bari Courtyard group under Tuskhali Community Support Organisation (CSO) — a women-led structure through which the Right2Grow programme delivers nutrition and hygiene sessions to households across the district. 

The Courtyard ignition sessions Amena attended are designed to build demand for improved Water, Sanitation, and Hygiene (WASH) and nutrition practices at household level. They explain what improved sanitation looks like, what it costs, and what difference it makes to children’s health. The sessions also cover the link between hygiene and nutrition — how faecal-borne and waterborne diseases undermine a child’s ability to absorb nutrients, and how improving WASH conditions at home directly reduces that risk. For Amena, the sessions were a prompt to act. 

In May and June 2023 — about a year after she first joined the Courtyard group — she installed an improved off-pit latrine and a Maxi-basin at her home. Both were paid for with her own money. The improved off-pit latrine replaced whatever sanitation arrangement the household had before. The Maxi-basin supports handwashing at the five critical times: before food preparation, before eating, before feeding a child, after using the toilet, and after cleaning a child. 

For a household classified as ultra-poor, the calculation matters: fewer waterborne and faecal-borne illnesses means fewer treatment costs. Better hygiene conditions support better nutrition outcomes for children. Under Right2Grow, WASH and nutrition are addressed together because disease burden and poor diet reinforce each other in stunting children’s growth. Amena’s investment addressed both at once. 

Her decision was noticed by other members of her CSO. They began using her household as a practical example when encouraging other families in Chotobighai Union to make similar investments — a visible demonstration that the improvements described in Courtyard sessions were achievable, affordable, and real. All 779 CSOs under Right2Grow in Bangladesh are women-led and focused on community advocacy. Peer motivation is central to how the programme works: one household acting on what it learned becomes an argument for others to follow. Amena continues as an active Courtyard group member, attending sessions that reach other women with the same information that led her to act in the first place. 

Nasir Uddin, 48, is the elected Chairman of Golkhali Union Parishad — the lowest tier of local government — in Patuakhali District, Bangladesh. In May 2022 he attended the Right2Grow programme’s union inception meeting, an introductory session bringing together local government officials and community structures. He left with a clear commitment: to use his position to act on child malnutrition in the union using the resources already available to him. 

In June 2022, Nasir announced the open budget of Golkhali Union Parishad. For the first time in the union’s history, he included a budget line specifically for children’s nutrition. He also requested a list of malnourished children from across the union’s nine wards. Aware that a list prepared internally by his own council could be biased, he asked Right2Grow to compile it independently. Right2Grow Union Coordinator Md. Saiful Islam identified ten children from the poorest households across all nine wards and submitted the list to the Chairman. 

Nasir committed to distributing food to all ten children for at least six months. The first month’s package included rice, lentils, soyabean oil, eggs, milk, and sugar — covering the dietary diversity young children need to recover from or avoid acute malnutrition. The funding came from the Union Parishad budget: local government money, directed at child nutrition, through a formal and public process.

The Right2Grow programme works to strengthen the connection between community demand and local government action on nutrition, Water, Sanitation, and Hygiene (WASH), and maternal and child health. Its 779 women-led Community Support Organisations (CSOs) in Bangladesh advocate with Union Parishads for improved services and budget allocations. Nasir’s decision is the kind of outcome the programme works toward: a local official using existing mechanisms and budgets, without waiting for external resources. 

The community response was visible. Golkhali residents began calling him Shishu Bandhab Chairman — Bengali for ‘child-friendly chairman.’ The label reflects a shift in how his role is understood locally: not just as an administrator, but as someone publicly accountable for child welfare in the union. The significance of what Nasir did is not only what he distributed, but how he structured it. By using the Union Parishad budget rather than ad hoc contributions, and by having the list compiled independently, he created a precedent: child nutrition as a formal line item in local government planning, with accountability built in from the start. 

In 2019, when her youngest daughter Maisha was one year old, a Community Health Promoter (CHP) from Max Foundation visited Hasi Akter’s household in Purba Hethalia village, Kalikapur Union, Patuakhali District, Bangladesh, and identified Maisha as stunted. Hasi, 34, was raising three daughters alone after her husband left the household following Maisha’s birth. The CHP explained that Maisha’s growth could improve with better nutrition and hygiene practices, and encouraged Hasi to attend Courtyard sessions — community meetings focused on nutrition and Water, Sanitation, and Hygiene (WASH). She started attending regularly. 

The sessions introduced her to homestead gardening as a practical way to improve what her family ate. She started small, growing vegetables on the land around her home. Over the following years, the garden expanded. She now grows pumpkin, wax gourd, bitter gourd, papaya, Malabar spinach, capsicum, lady’s finger, and bath sponge. She has added a small poultry unit — three hens and two ducks — selling eggs and surplus poultry for additional income. “With the idea of a homestead garden, I can meet my family’s nutritional needs,” Hasi said. “Even I can earn some extra money by selling eggs and hens.” The garden now meets most of the family’s vegetable needs year-round. Maisha has grown up with consistent access to a more diverse diet than she had as an infant. 

In 2021, Hasi offered her land to host the Max TapWater Purba Hethalia grid — a safe water supply point for the community. She understood the connection between clean water and child health. As a grid operator, she now earns a monthly income from the water service alongside income from the garden. “As a grid operator, I am proud to be a part of providing safe water service to my community,” she said. 

In 2022, she was elected president of the Purba Hethalia Community Support Organisation (CSO) under the Right2Grow programme — a role that recognised her consistent engagement and her reach in the village. She now visits households across Purba Hethalia, checks on children’s nutritional status, and encourages mothers to attend the same Courtyard sessions that shaped her own practices six years earlier. 

Hasi’s involvement spans three interconnected parts of the Right2Grow model in Bangladesh: she is a Courtyard participant who applied what she learned at home; a Max TapWater grid operator who contributes to safe water access in her village; and a CSO president who extends the programme’s reach to other families. Right2Grow works through 779 women-led CSOs in Bangladesh that advocate with local government for improved nutrition, WASH, and child health services. The Courtyard sessions, the water grid, and the CSO structure are designed to reinforce each other — and in Hasi’s case, they have.

Mossa Alemu, 42, lives in Tebet Village,  Amhara Region, Ethiopia. He farms a mixed holding of crops and livestock and has five children, one under two years old. Before the Healthy Village programme arrived, the household drew as little water as possible from the hand-dug well in their compound. Lifting water by hand from depth was slow and exhausting. What they did drink made the children ill. “We — especially our children — were usually sick in the stomach,” Mossa said. “When we went to health centres, health workers said it was a waterborne disease.” The family had no vegetables in their garden and could not afford to buy them. His children ate cereals and legume sauce year-round, with no variety. 

The Healthy Village programme, implemented by Plan International Ethiopia in consortium with Max Foundation, selected the household for support. The programme installed a rope and washer pump (RWP) on the existing well and provided a Tulip water filter to treat the water drawn from it. Mossa was trained on operating and maintaining both. The programme also supplied vegetable seeds — cabbage, Swiss chard, beetroot, and carrot — and Mitin, a nutritious food supplement for the child under two. Mossa and his wife joined a Village Economic and Social Association (VESA) group, and they bought additional onion seeds to grow for sale. 

The pump transformed how much water the family could collect. Where hand-lifting meant taking as little as possible, the RWP made larger volumes practical — enough for drinking, cooking, handwashing, laundry, livestock, and irrigating a backyard garden. The Tulip filter removed the contaminants that had been making the children ill. “Now we are drinking the water with good appetite,” Mossa said. The surplus onion harvest earned ETB 6,000 (~€33), which the family spent on cooking oil, salt, and soap. 

The household built an improved latrine with a handwashing facility. “The main thing is having a latrine. Now we can walk everywhere in our home compound,” Mossa said. Health centre visits now happen only for vaccinations and Growth Monitoring and Promotion (GMP) check-ups — not for waterborne illness. The pump also redistributed labour: with the RWP, older children can now collect water themselves, something that was not possible before. 

The programme’s gender sessions reached Mossa directly. He now takes care of the youngest child when his wife is cooking or managing other household tasks. His wife was direct: “Previously he was saying ‘do it yourself’ but now he has some improvements.” Mossa plans to irrigate additional land and grow more vegetables for the market. His longer-term aspiration is a piped water connection at home. For now, the family has clean water from a functioning pump, a productive garden, a proper latrine, and a more varied diet than they had before.

Mousumi Khatun knew physiotherapy existed for her son Shaon. The District Disability Service and Support Centre (DSSC) was 25 kilometres from their home in Lalmonirhat, Bangladesh. Shaon, now 16 months old, has severe cerebral palsy — his hands grip tightly and involuntarily, making it impossible for him to grasp food, hold a toy, or feed himself. Mousumi carries him everywhere. Her husband works as a daily labourer. The round trip to the DSSC cost more than the household could absorb. “We knew therapy could help, but the bus fare was impossible,” she said. 

The Healthy Village Urban (HVU) programme database identifies 570 children with disabilities in the Lalmonirhat area. Of these, 190 are considered recoverable with consistent physiotherapy. Before HVU introduced a transport allowance, only 76 of those children — 40% — were attending therapy at least once a month. The therapy was there. The barrier was the cost of getting there. 

In April 2024, Mousumi attended a Courtyard (CY) session where HVU staff explained the DSSC and what it offered. From June 2024, she began receiving a monthly transport allowance of BDT 1,000 (~€7). She started taking Shaon to the DSSC regularly. The allowances are distributed in person at community gatherings, with the Mayor, Union Parishad (UP) chairpersons, DSSC officials, and social protection staff present. The child must attend each distribution. 

After five months of regular physiotherapy, Shaon can grasp lightweight toys. He can bring a spoon to his mouth with guidance. He turns toward familiar voices and makes sustained eye contact during play. Regular attendance also opened a second pathway: HVU’s social protection officers supported Mousumi in applying for a Suborno Card — a government disability registration that provides a monthly disability grant and priority access to health and education services. In November 2024, Shaon received the card. The travel allowance had not just enabled physiotherapy; it had created the conditions for the family to access a support system they were entitled to but had never been able to reach. 

Between July 2024 and April 2025, 150 children with disabilities across the programme area received transport allowances, with a total disbursement of BDT 1,50,000 (~€1,065). Monthly therapy attendance among recoverable children has doubled — from 40% to over 80%. The mechanism was straightforward: a reliable, small, regular cash transfer that addressed the specific barrier families themselves identified. The families hardest to reach are those facing compounded hardship, where transport costs sit alongside food insecurity and lost wages. The programme is exploring distance-adjusted amounts and home-based visits to extend coverage to them. 

Local government institutions in Bangladesh have long faced public scepticism about service delivery. In Dumuria, Union Parishads (UPs) — the lowest tier of elected local government — often operated without meaningful input from the communities they served. The Right2Grow programme’s Transformative Leadership initiative, implemented by The Hunger Project (THP) Bangladesh from 2022 to 2024, set out to change that: building the capacity of both UPs and civil society organisations (CSOs) to plan together, hold each other accountable, and direct public resources toward nutrition, Water, Sanitation, and Hygiene (WASH), and maternal and child health priorities. 

The initiative began with a community situational analysis and a CSO Strengthening Assessment to identify capacity gaps. Separate training was then delivered to UP representatives and CSO leaders, covering participatory governance, advocacy and lobbying, leadership, transparency, and social auditing through the Citizen Voice and Action (CVA) approach. THP provided ongoing coaching between training cycles. A central mechanism was the Ward Shava — the ward-level community meeting established under the UP Act 2009 — through which residents formally raised service delivery priorities that CSOs then carried into UP planning and open budget meetings. THP also trained UP secretaries and chairpersons on the Budget Monitoring and Evaluation Tool (BMET), a digital platform that makes budget allocations and expenditures visible to both government staff and CSOs in real time. 

The shift in planning practice produced measurable results. UP budget allocation for WASH and nutrition rose from BDT 83,24,000 (~€59,100) in financial year 2022–23 to BDT 1,40,05,841 (~€99,441) in 2023–24 — a 68% increase. The expenditure rate against allocation improved from 90% to 100% over the same period, meaning increased budgets were being fully spent. All UPs in the programme area now use the BMET platform to track their finances, making accountability structural rather than dependent on individual goodwill. 

Ten UPs collectively provided food packs — including rice, pulses, soybean oil, oral rehydration salts (ORS), and Monimix micronutrient supplements — to 680 families identified as having malnourished children, at a total cost of BDT 6,15,045 (~€4,367). The targeting was based on household lists compiled by local CSOs, a practical demonstration of the UP–CSO partnership directing resources to where they were needed. 

Forty-two villages were declared Healthy Villages in ceremonies organised by their respective UPs, with health and nutrition established as standing agenda items at Union Development Coordination Committee (UDCC) meetings. CSO advocacy also produced improvements in specific services: breastfeeding corners were established on all UP premises, menstrual hygiene management corners were set up in schools with sanitary pads distributed by UPs, and health equipment was provided to community clinics through sustained CSO lobbying. Ten of 14 UPs now hold regular meetings with chairpersons and secretaries, and 10 of 14 have implemented Ward Shava participatory planning in line with the UP Act 2009. 

Women’s entrepreneurship in Bangladesh more than doubled over the past decade. The 2020 Wholesale and Retail Trade Survey counted approximately 1.5 million active women entrepreneurs nationally. Right2Grow — a multi-country programme implemented in Bangladesh by Max Foundation alongside five partner organisations — built on this trend by equipping Health Promotion Agents (HPAs) with business skills, supply chain access, and advocacy tools, and channelling their work into measurable WASH and nutrition outcomes at community level. 

HPAs were recruited through a structured mapping and selection process across unions in Patuakhali and Khulna. Max Foundation prioritised women with social acceptance, communication skills, and experience in WASH, nutrition, or healthcare, placing one HPA in each union ward. A Training Needs Assessment (TNA) conducted through Focus Group Discussions (FGDs) with 58 HPAs — 36 from Patuakhali and 22 from Khulna — shaped a tailored training programme covering business management, WASH and nutrition products and services, bookkeeping, demand creation, and Growth Monitoring and Promotion (GMP) for children under five. Monthly follow-up meetings and quarterly reviews with Max Foundation and partner NGO teams provided ongoing coaching beyond the initial training. 

Access to affordable products required structural support beyond training. Max Foundation facilitated Memoranda of Understanding (MoUs) between HPAs, sanitation Local Entrepreneurs (LEs), and sweepers, and established supply partnerships with private companies including SMC, RFL, Meghna Group, and MXN — giving HPAs wholesale access to WASH and nutrition products. Trade licences were obtained through lobbying with Union Parishads (UPs), the elected local government bodies, reducing a longstanding barrier to formalising women’s businesses.

HPAs organised into union-level associations that consolidated procurement, enabled peer learning, and gave members collective bargaining power with suppliers. 

The associations also connected HPAs to Civil Society Organisation (CSO) platforms and UP development coordination committees, giving women a direct role in local governance and service delivery decisions. New entrepreneurs were being created by existing association members as the network grew, and private companies were proactively linking to the associations to access the community market. 

HPAs conducted regular growth monitoring sessions for children under five alongside courtyard meetings and household visits targeting mothers, caregivers, and adolescent girls. Their combined role — selling products, delivering behaviour change communication, and mobilising communities — contributed to villages reaching the standards required for a Healthy Village declaration, awarded when over 90% of households consistently meet indicators across WASH, nutrition, and maternal and child health for at least one year. In South Ballavpur village, documented outcomes include 100% of households with access to safe drinking water, 100% using sanitary latrines, 93% handwashing with Maxi Basins, and all households meeting nutrition standards through household practices.

Behafta Redai leads one of the strongest Village Economic and Social Association (VESA) groups in Emba Alaje woreda. Behafta Abrha chairs the Water, Sanitation, and Hygiene Committee (WASHCO) in Meda Ayder village and has overseen community contributions of ETB 65,000 (~€356) to maintain the local water scheme. Both were elected to their roles through the Healthy Village programme — and both are among 11 WASHCO chairpersons across the district who are women. 

The Healthy Village programme, implemented by Plan International Ethiopia in consortium with Max Foundation, works in Emba Alaje district, southern zone of Tigray region. Water, Sanitation, and Hygiene Committees (WASHCOs) were established to manage constructed water schemes, and VESA groups were formed to give community members access to savings and financial products. The programme engaged government partners to ensure equal representation of women in both structures and provided leadership training to elected women leaders. Across Emba Alaje, all 11 WASHCOs are chaired by women, who hold 48% of WASHCO leadership positions overall. Women account for 50% of VESA membership and hold 45% of VESA governance roles. 

Behafta Redai, 42, lives in Mender Misreta village, Atsela Kebele, Emba Alaje district. Community members elected her to lead the 30-member VESA group formed in her village in June 2024, recognising her as someone known for mediating disputes. She initially hesitated — concerned that her inability to read and write would prevent her from managing the role. The group resolved this by appointing a vice-chairperson to handle reading and writing, and she received VESA methodology training through the programme. “At first, I was happy to be nominated, but I was hesitant because I cannot read and write,” she said. “But they assured me that the vice-chairperson would help me with writing, and I eventually agreed to take on the leadership.” 

Her VESA is now one of the strongest performing groups in the woreda. “I encourage all women not to limit themselves to household roles,” she said. “They should seize the opportunity to participate in leadership positions in social structures, such as VESA groups. Women are capable of leading and managing groups effectively.” 

Behafta Abrha, 37, is the WASHCO chairperson in Meda Ayder village, Egri Albe Kebele. After her nomination, she organised community labour contributions to build a protective fence around the local water source. Community members contributed ETB 45,000 (~€247) in labour and deposited ETB 20,000 (~€110) in a dedicated maintenance account. The WASHCO now operates the scheme on a financially sustainable basis, collecting regular user fees to cover upkeep and spare parts. 

With the water scheme maintained, Meda Ayder village has reliable access to safe drinking water. “Now, we have clean water, my children are healthy, and I feel proud to lead our community in taking care of it,” said Behafta Abrha. The woreda is working to scale the model — with equitable representation of women in leadership — to additional kebeles, using the Healthy Village approach as a reference. 

Dr. Bashir Uddin Gharami practises medicine in Pyarpur village, Bangladesh, and serves as the elected General Secretary of a local Civil Society Organisation (CSO). His focus on children’s health is personal as much as professional — he has a young daughter. Through Right2Grow, a multi-country alliance in which Max Foundation is a consortium partner, Gharami attended Budget Monitoring and Expenditure Tracking (BMET) training that gave him the tools to engage with government budget processes for Water, Sanitation, and Hygiene (WASH) and nutrition services. 

Before the training, Gharami found it hard to believe that community members without political affiliation could engage with Union Parishad (UP) committees — the smallest rural administrative unit in Bangladesh — and make demands on public services. “It was unbelievable to me that without political identity people could go to the UP to claim or avail any service,” he said. 

Following Right2Grow courses on BMET, CSO capacity building, gender, and leadership, he began organising community meetings on WASH, health, and nutrition, focused on children and young mothers.

He was subsequently appointed to the standing committees of his Union Parishad and represented his community at the open budget meeting for 2022–23. He now has a formal role in monitoring how WASH and nutrition budgets for children are allocated and spent. “This course enabled me to raise my voice in the presence of government officials. Together with other CSO members we are now jointly working to raise our voices for the rights of children under 5,” he said. 

In Bangladesh, Right2Grow is working across 40 Union Parishads, reaching more than 165,000 people. To date, 21 UPs have increased their annual budgets by 2.6%, resulting in improved access to WASH and nutrition and better mother and child care. Gharami’s work in Pyarpur is part of that broader pattern: community members equipped with budget knowledge engaging government as informed participants. 

When Max Social Enterprise installed a piped water grid in Krishnakathi village, Bangladesh, Khadiza Begum, 45, was among the first to connect. Her family invested BDT 20,000 (~€141) in a water connection, basin, and bathing chamber. Five neighbours followed. Within 16 months, 62 households across the village had collectively invested BDT 660,000 (~€4,664) in upgraded WASH facilities.

That scale of household investment did not happen by chance. Before the Building Water Business (BWB) programme arrived, Krishnakathi had almost no sanitation infrastructure: only 11 of its 164 households had any toilet facility, and none had basins or bathrooms. Groundwater sits as deep as 800 feet, making private boreholes unaffordable for most families. Seasonal flooding regularly contaminated ponds and tube wells with iron, arsenic, and salinity. Women carried the primary responsibility for water collection — a daily task that was time-consuming and brought significant health risks. 

In January 2023, Dhaka Ahsania Mission, a partner in the BWB programme, facilitated courtyard sessions with the Dakshin Krishnakathi Community Support Group (CSG), of which Khadiza was a member. Using the RAINBOWS community engagement approach, facilitators led discussions on water scarcity and health risks, and the community voted collectively to adopt a piped water system. CSG members mapped the area and set shared standards for water use and hygiene. 

Max Social Enterprise then installed the Max TapWater grid with a one-time connection fee of BDT 5,000 (~€35) and a monthly tariff of BDT 200-300 (~€1).

The investment decisions that followed were made household by household. Across Krishnakathi, 25 families upgraded pit latrines to offset latrines, 33 built new latrines, 47 installed basins, and 4 built new bathrooms — all within 16 months of the grid going in. Data from across Bharpasha Union’s 27 Community Support Groups shows what grid access makes possible: 88% of households in the 8 grid-connected CSGs met the programme’s Rank-1 standard for safe water access, compared to 5% in the 19 non-grid CSGs. 

Md. Ashrafuzzaman Khan, Union Parishad Chairman of Bharpasha Union, has supported the grid’s expansion directly — collecting fees, arranging trade licences for local entrepreneurs, and coordinating with Dhaka Ahsania Mission. The Max TapWater grid operates under Max Social Enterprise’s tariff-funded maintenance model. The latrines, basins, and bathrooms that households built remain. Khadiza’s household, and the 61 others that connected, made those investments with their own resources — based on infrastructure they could see working around them. 

Tiruye Lakew has worked as a Health Extension Worker (HEW) for four years, the last two at Gedaeyasu health post in Gedaeyasu Kebele, Ethiopia. She and one colleague cover 1,722 households, 1,001 children under five, and 374 children under two. She trained at Debre Birhan Health Science College, earning a Level 3 certification over one and a half years after completing grade 10. The work is structured around eight health packages covering maternal and child health, and 18 hygiene packages covering everything from toilet construction to safe food preparation — all reached through regular home visits. 

Tiruye registers pregnant women and advises them to begin antenatal follow-up before 16 weeks. They receive iron supplements, meningitis vaccination, and nutrition counselling throughout pregnancy. From birth, children receive BCG (Bacille Calmette-Guérin, a tuberculosis vaccine) and polio vaccinations, followed by a full schedule from 15 days old. Growth Monitoring and Promotion (GMP) continues to six months, after which Mid-Upper Arm Circumference (MUAC) screening is added alongside weight and height measurement to assess nutritional status. Children identified with acute malnutrition are enrolled in the programme; those who recover within eight weeks are discharged. 

Since July, 15 children with Severe Acute Malnutrition (SAM) and 17 with Moderate Acute Malnutrition (MAM) have been enrolled. Nine of the 15 SAM cases have recovered and been discharged; six remain in the programme. None have required referral to a higher facility. “We get very sad when we find malnourished children even after all the awareness creation we have done. Including these children in the programme cannot be the only solution — we need to work on creating awareness and solving related problems here in the kebele,” she said. 

On infant feeding, Tiruye teaches exclusive breastfeeding for the first six months — including colostrum, which mothers previously discarded without knowing it provides natural immunisation. From six months, she recommends a mixed grain porridge: one cup of legumes combined with two cups of cereals, with eggs, milk, or butter added where available. Breastfeeding continues alongside solid food until age two, and mothers are encouraged to eat four to five times daily. 

Vegetables are not reliably available in the kebele. The reason is water. “It is a water problem that hinders us from exercising proper nutrition. We have reported this but still no solution,” Tiruye said. Without irrigation water, households cannot grow cabbage, spinach, or kale, and the diet stays narrow — injera with shiro, teff without mixed grains. The constraint reaches the health post itself: Tiruye buys three 20-litre jerry cans of water daily at 2 birr (~€0.01) each, paying 60 birr (~€0.33) a month to have it fetched. Water placed outside the toilets for handwashing is taken by community members facing the same shortage, so staff go home to wash their hands after using the toilet. 

“I wish the water problem to be solved in the kebele, for a clean water alternative created in the area so that my child can live happily,” she said. She is the mother of a five-year-old boy. “My wish for all the children of the kebele is the same wish I have for my son.” 

Biyadige Ayalew, 40, farms one hectare in Tejbahir kebele, Goncha Woreda, East Gojam, Ethiopia, growing teff, wheat, corn, horsebean, peas, and vegetables. He uses half his harvest for his household and sells the rest. He has also recently started beekeeping. Alongside farming, he has been volunteering as kebele administrator for nearly three years — unpaid. In that role, he oversees health and education services, mobilises residents for natural resource conservation, and facilitates tree planting. Tejbahir kebele has around 2,200 residents, most of them farmers. 

Biyadige works alongside government-assigned Development Agents, including Yinges Biyadego, 32, a specialist in Natural Resource Conservation and Utilisation Management. Together they promote scientific farming methods — terracing, traditional irrigation — and coordinate environmental work across the kebele. Most residents collect drinking water from a river or spring. Around 50 hand-dug government wells exist in the kebele, though some are not functional. Health extension workers run regular hygiene and sanitation education, and Biyadige extends this by raising the issues at religious gatherings, one of the few settings where the broader community comes together. 

His main challenge is not what people know — it is what they do. “I wish people practice what we teach them — that they build toilets and use them properly; that there will be a habit of proper handwashing, using soap, and practice of proper waste disposal. We teach the people how to dispose of solid and liquid waste, but they rarely practice it,” he said. 

Nutrition follows a similar pattern. The most common meal in Tejbahir is injera with shiro stew. Eggs, meat, and vegetables are not regularly part of children’s diets, and pregnant women typically do not eat differently from the rest of the household. Men eat first; women and children eat after. Cooking and childcare are considered women’s work; men’s roles are primarily on the farm, with the exception of planting and weeding. “We don’t have the habit of eating nutritious food. I want to see a change in this area,” Biyadige said. 

His response to slow change is to model it himself. “I can’t tell people to do something that I don’t practice myself. I need to be an exemplary leader, so I make sure I practice the hygiene and sanitation guidelines,” he said. He raised his four children — now aged 8, 13, 17, and 20 — on diversified food. He does not receive payment for his role as administrator. “I do all this not because I get paid — I don’t. But I want to leave my mark in my community,” he said. 

Andualem Anteneh, 38, grew up in Enebre Kebele, Enebsae Woreda, East Gojam, Ethiopia — a village without clean water or toilets. He completed a bachelor’s degree in Educational Planning at Debre Markos University, is currently studying for a master’s degree by distance, and has spent the past eight months living at the compound of Enebre Primary School, where he works as a supervisor. His wife and two young children live in the nearest town; he visits at weekends. Enebre Primary School has 407 students. 

Water and sanitation at the school are severely constrained. There is one hand-dug well, restricted to teachers and staff. Students are told to drink water at home. Of the eight toilets — four for girls, four for boys — only three of the boys’ toilets are functional, and students cannot use them because there is not enough water to maintain them. If students need a toilet during the school day, they go home or to the fields. “One hand-dug well is not enough for all the students, so we tell the students to drink water at their homes. We can’t also let the students use the few functional toilets because we don’t have enough water,” Andualem said. 

Andualem was part of a small group — two other teachers, a club representative, and the school director — who received hygiene and sanitation training from ORDA, the Organisation for Rehabilitation and Development in Amhara, a Max Foundation partner. He passed what he learned to 24 students and is re-establishing the school’s gender club, which had been inactive.

“The training made me aware that our girl students face a lot of challenges during their menstrual cycle. Early marriage is also common practice in our community. The school administration has now drafted a new plan to create awareness on early marriage, hygiene, and sanitation to bring about sustainable change through the gender club,” he said. 

He is also renovating a room to serve as a menstrual health management space where girls can rest or change sanitary pads during school hours. “I wish to see that girls stop missing class due to menstruation,” he said. 

Beyond the school, Andualem describes a community where diet is narrow — mostly injera with shiro stew — and where farmers tend to sell eggs and vegetables rather than eat them. The dry climate limits what can be grown, and poor harvests are common despite the cost of fertiliser. Handwashing before meals is practised, but rarely with soap. He includes himself in this: “Even if I have awareness of handwashing, I rarely wash my hands with soap. Even those who know don’t put it to practice.” He sees the connection between nutrition and behaviour as fundamental: “I wish people be aware of proper nutrition because healthy eating leads to a healthy mindset.” 

Tenaw Merkebu Alamirew grew up in Margechina Borebore area, Shebel Berenta Woreda, East Gojam, Ethiopia. After completing grade 10 without passing the national examination, he began working as a daily labourer in construction. When health professionals engaged by iDE — International Development Enterprises, a Max Foundation partner — came to the area looking for someone to produce model toilet slabs, his construction background made him the right person. “With the help of the health extension workers, I came here and started working on building toilet slabs. My job now is to build the toilet slabs and make them accessible to the community,” he said. 

The slabs Tenaw produces are designed to be removable. When a pit fills and collapses — a common reason households in the area revert to open defecation — the slab can be detached and fitted to a new pit rather than discarded, saving both money and labour. He visits communities to explain how the system works and demonstrate the product. “Having a clean toilet is a matter of self-respect. So I want the whole community to be motivated and work to get this done,” he said. 

The commercial dimension matters to him as much as the sanitation one. He is married and has a two-year-old son. “I want to have many customers and I want to change my life. First, I want to help my family. Second, I want to be able to send my child to school and support my wife,” he said. 

 He and his wife share household work equally — there is no division of labour at home — and she followed health professional guidance throughout her pregnancy, eating a varied diet. 

Shebel Berenta Woreda is one of Ethiopia’s largest producers of teff, but the woreda relies entirely on natural rainfall with no irrigation. Only teff and peas are grown; vegetables are not produced locally. One borehole serves 400 to 500 people in Tenaw’s area, and when it falls short, residents draw from shallow wells. The diet across the woreda is narrow: shiro at breakfast, lunch, and dinner. “If there was access to water in our area, there would be fruits and vegetables, and the pregnant women could eat from their backyard,” Tenaw said. 

He is direct about the connection between sanitation and child health. “Infectious diseases often occur in children — diarrhoea, vomiting, and stomach cramps. Those babies are not infected for no reason. It is because of poor sanitation,” he said. His wish for the woreda covers both problems: a toilet in every neighbourhood and irrigation ponds so that the fertile but dry land can produce food year-round. 

After attending a three-day training organised by the Building Water Business (BWB) programme in 2023, Md. Ismail Hawlader became the first sanitation worker in his area to adopt safe faecal sludge management practices. His annual turnover grew from 25,000 Bangladeshi Taka (BDT) in 2020 to BDT 530,000 (~€3,745) in 2024. The change was not just in his methods — it came from a structured market that the BWB programme built between trained sanitation workers and Health Promotion Agents. 

Ismail, 50, has worked as a sanitation worker for over 30 years in Bakerganj Upazila, Barishal District, Bangladesh. He started at Grameen Bank, worked a period with Dhaka City Corporation, and currently works under Bakerganj Paurashava while taking freelance pit-emptying work in Rangasree Union. Before the training, he and other sanitation workers used traditional manual desludging methods — without protective equipment or structured disposal practices. Faecal sludge disposed of incorrectly contaminates soil and water sources, raising the risk of waterborne diseases including diarrhoea, cholera, and typhoid. Workers themselves faced serious health risks: infections, skin diseases, and respiratory problems. 

The three-day training covered personal protective equipment (PPE) — gloves, boots, protective clothing, helmet, mask, and goggles — and environmentally sound disposal techniques. All participants received PPE at the end of the training. Ismail now follows a structured process: preparing a safe disposal site, applying disinfectants before and after sludge transfer, using dry ash for odour and pest control, transferring sludge with a bucket and rope to minimise spillage, and sealing the site with soil once the work is complete. 

The BWB programme also trained Health Promotion Agents (HPAs) — local entrepreneurs who go door-to-door to raise awareness about the risks of self-managed desludging and to promote trained sweepers’ services. A Memorandum of Understanding (MoU) formalises the arrangement: HPAs receive a commission from sweepers for each confirmed client after the job is completed. This structure links demand creation directly to professional service delivery. 

Rangasree Union has 5,057 households, with nearly a quarter facing economic constraints that make hiring professional services difficult. Many families have historically managed pit emptying themselves, without training or safe disposal methods. The HPA-sweeper model addresses this by making professional desludging more visible and accessible — and by building the case, household by household, for why it matters. 

Ismail supports his wife, two daughters, and three sons through his work. Despite his income growing substantially, sanitation workers in Bakerganj continue to face social barriers — excluded from community events and engaged by neighbours only when their services are needed. The BWB programme is running community outreach sessions and working with local leaders to address these perceptions and recognise the public health role that professional sanitation workers play. 

Walelign Yilak, 28, starts each day at 6:00 am at a spring in the middle of yellow teff fields outside her village in Tej Bahir Kebele, Goncha Woreda, East Gojam, Ethiopia. She makes the trip twice a day, collecting 50 litres in total. Thirty-two households depend on the same spring. Goats drink from the upper section where the water collects. It is the community’s only water source. “If we lose this spring, we don’t have any water source. Let alone raising our children, we can’t go by a day without this spring,” her husband Wale said. 

After fetching water, Walelign prepares breakfast for their four children: Demeku (10), Habtamu (5), Shewanesh (3), and Atinkut (6 months). The daily meal is shiro stew — made from chickpea powder, spices, onion, and garlic — served with injera. Some evenings they eat boiled potato, lentil stew, or beans. Walelign buys cabbage and beetroot from the market once a week and gives the children kolo (roasted sorghum) as a snack. They have two chickens, so eggs are also part of the children’s diet. 

Walelign breastfed each child until age two and began solid food at six months — a mixed porridge of teff, sorghum, fenugreek, and peas. She completed grade 8 and learned about child nutrition from a poster at the local health centre. 

“I learned what I should feed my children from a poster at the health centre,” she said. Wale has no formal schooling and cannot read. “I can’t even read a sign at a health centre. I always have to ask people for information,” he said. Water collection and childcare are considered women’s work in Tej Bahir; Wale helps Walelign with both when farming allows, and she helps him with seed planting and weeding. 

For seven years, Wale farmed his parents-in-law’s land under a sharecropping arrangement — covering all costs for fertiliser, seeds, and labour and sharing a portion of the harvest in return. Last week, without stated reason, they took the land back. The couple have two oxen, two cows that supply milk for the children, two calves, and two chickens. They have no land to farm. 

“Those who have land have an easier life. Those of us without a land struggle a lot. I don’t have land, and I am not certain of my future,” Wale said. His immediate concern is water access: with more reliable sources, he believes the household could grow vegetables in their backyard to sell at the market. His longer-term aspiration is his children’s education. “I want to send all my children to school so that they will have a better life,” he said. 

When the Healthy Village Urban programme began working in Lalmonirhat and Aditmari, Bangladesh, most women in the area had no route into economic activity. Access to start-up capital was scarce, business training out of reach, and cultural norms restricted mobility and public engagement. There was also no reliable local supply of health and hygiene products — no one selling sanitary napkins, nutritional supplements, or hygiene items within reach of households in remote areas.

Lata Debi was one of 63 women trained as Health Promotion Agents (HPAs) across six Union Parishads. The programme linked them to suppliers — including Unilever, SMC, RFL, and Square — at wholesale rates, and gave them a practical foundation in health, hygiene, nutrition, and entrepreneurship. The courtyard sessions they co-facilitate three times a week serve a dual purpose: building community knowledge about hygiene and child health, and creating direct access to the products that support those practices.

Lata’s store now stocks more than 50 products and generates a monthly turnover of approximately 45,000 taka (approximately €315), with a monthly profit of 15,000–18,000 taka (approximately €105–€126). Across the 63 HPAs, most started with no prior business experience and initial investments between 500 and 5,000 taka (approximately €3.50–€35). In more remote areas, limited purchasing power and slow-shifting norms around women’s mobility continue to constrain some HPAs — challenges the programme keeps working on.

The market for health products in these communities is still growing. So are the businesses of the women who built it.

Watch the video of Lata’s story on YouTube. 

When HVU facilitator Afrin weighed Rajin at a courtyard session in Sardertari village, Lalmonirhat district, Bangladesh, he was eleven months old and weighed just 5.2 kg. His mother Fensy Akhtar, 20, had noticed he was small and that feeding was difficult because of his cleft lip. She had not known the situation was critical.

“I thought he was just small,” Fensy recalls, “until the HVU team explained to me how serious it was.”

Fensy’s household depends on her husband’s earnings as a farm labourer and her father-in-law’s work as a van driver, bringing in approximately 14,500 taka (approximately €102) per month. Before the Healthy Village Urban (HVU) programme began working in her community, no one had reached the family with information about nutrition support or the possibility that Rajin’s cleft lip could be treated. In many communities in Lalmonirhat, congenital conditions like a cleft lip carry stigma and are often accepted as fate — the belief that treatment is impossible or unaffordable keeps families from seeking help even when they sense something is wrong.

Fensy began attending courtyard sessions in October 2023. These sessions brought caregivers together for practical learning on nutrition, hygiene, and child health, and used home visits and personal invitations to reach families who had not previously engaged with health services. When Afrin measured Rajin and found him in the red zone — severe acute malnutrition — she followed up at home and found his condition worsening. He had a fever and diarrhoea. She referred the family to a clinic the same day. Rajin then received specialised nutritional care at the hospital’s dedicated unit for children with acute malnutrition.

At home, the family built a hygienic latrine, cemented their tubewell platform, installed a motor pump for safe water, and set up a handwashing station. Fensy began washing hands before every feed and preparing nutritious meals for Rajin, including khichuri, a traditional Bangladeshi rice and lentil dish commonly recommended as complementary food for young children.

Rajin’s growth chart tells the story month by month. At eleven months: 5.2 kg, severe acute malnutrition. At fifteen months: 6.6 kg, moderate malnutrition. At twenty-one months: 7.8 kg, on a healthy growth curve. The progress came from surgical treatment, nutrition support, and improved hygiene practices working together — not any single intervention on its own.

The costs throughout were a real strain. Medical fees and WASH improvements stretched a tight household budget. And stigma had meant the family did not reach out earlier, even as Rajin’s condition worsened. These barriers — fatalism around congenital conditions, financial pressure, limited access to information — are not unusual in Lalmonirhat, and they are what the programme’s community outreach and dialogue work is designed to address.

Fensy now co-facilitates courtyard sessions in her community and encourages neighbouring mothers to set up handwashing stations at home. Rajin continues to be monitored through the programme’s growth tracking system.

Muluwork Tesfaw runs a small shop in Mergech kebele, East Gojam, Ethiopia. When health extension workers—government employees who provide primary health education and services at village level—approached her about selling complementary food for infants, she saw an opportunity. This isn’t just about one entrepreneur. It’s about building the market systems that make nutrition services sustainable and accessible long-term.

Selam Tesfaw, 40, now walks to Muluwork’s shop to buy complementary food for her youngest daughter, Hanna. “Instead of preparing it myself, I’d rather buy it from the shop because it saves me time and energy,” she said.

Health extension workers teach mothers how to prepare complementary food for infants and young children. Some mothers implement what they learned, but most do not buy all the ingredients and prepare it themselves. This is the gap that programmes often miss: knowledge doesn’t automatically translate into practice when the enabling market infrastructure doesn’t exist.

Muluwork saw this gap as a business opportunity. She started with 15 kilos of complementary food and sold it all in a couple of months. She did not make the profit she expected because the community does not yet have full awareness of complementary food. “I don’t want to worry about the profit now, because I know I am selling something beneficial to the community,” she said. “The more people get accustomed to it, I know I will be able to make a profit then. And I will increase my production to 50-100 kilos.”

Muluwork did not have awareness of nutrition before health extension workers approached her. “Having this nutritious meal helps children to be healthy and it prevents stunting. I want to learn more about raising healthy children,” she said. “In my community, I wish to see children being fed proper nutrition so that they can grow physically and mentally healthy.”

Selling the complementary food has created an additional source of income. Beyond her shop, she also has livestock (one ox, three sheep, one donkey) and two chickens whose eggs she sells at the shop.

Muluwork is not focused on immediate profits. She understands that building demand for nutrition products takes time. As awareness increases, she expects sales to grow. “When individuals’ lives are changed, the country as a whole can change,” she said. “If healthy children are raised, they will have a better future.”

Max Foundation’s Healthy Village approach in Ethiopia, implemented in partnership with Plan International in Tigray region, and with iDE in East Gojam, s strengthens child health outcomes by combining nutrition, WASH, and maternal health interventions with systems strengthening,including through local entrepreneurship—so that sustainable delivery infrastructure remains embedded in community economies.

Shahera Khatun is a single mother of 3 children. She also runs her own sanitation business. It requires hard labour, and is more commonly done by men.

Shahera started small a few years ago, and steadily grew her business. She now has expanded to sell a variety of sanitation and hygiene products.

Last year during COVID-19, her business suffered as people couldn’t afford to invest in sanitation. Luckily business is picking up again.

We are happy to see Shahera’s business grow!

No community development effort will be
sustainable unless local government is involved.
In the case of Bangladesh, we work with the Union Parishad (municipality).

We are happy that our Healthy Village Tracker, developed in 2020, is already adopted  by the Chairman of the Jainkathi Union Parishad.

“For achieving a Healthy Village, it is crucial to know the real-time progress of the community and to be aware of the challenges they are facing to achieve their target regarding WASH and Nutrition. With the Healthy Village Tracker, this data can be tracked automatically. Based on this data, the Union Parishad can easily determine what actions need to be performed to improve the health status of the community.” 

– Chairman of the Jainkathi Union Parishad.

Rubina Begum lives in Chalitabunia village in Patuakhali, Bangladesh. Her first child is 6 months old. His name is Hasib. Rubina is so happy since the pregnancy and birth of her child. She signed up for growth monitoring.

Soon after, Rubina participated in a courtyard meeting about stunting. Her son’s height and weight were measured in the session. The results were not good. Hasib was in the yellow zone in both height and weight charts. Rubina became very concerned. She heard from the meeting that it is possible to change this within the first 1,000 days of a child’s life (from pregnancy to 2 years).

Rubina took steps immediately: washing her hands with soap and water before feeding her child and after cleaning his bottom. Washing the  family’s clothes and sheets regularly. Cleaning her baby’s hands and trying to keep him from putting dirty objects into his mouth.

Since then, Hasib has moved from the yellow zone to the green zone on the growth charts. Rubina is now quite happy. She will continue monitoring Hasib’s growth through visits to the nearest health clinic.

Kanchan Khan and his friends collect water at the new well in Golachipa Upazila in Patuakhali District (Bangladesh).

Before the well was installed, people from the community used water from the next closest well – an hour walk from the village.

This water was often contaminated and the iron level too high. Many people in the community suffered from water related diseases.

The village chief says: “The clean water we now have access to contributes to a healthier community. We see many positive changes”

Jibon is the youngest of three brothers living in the north-east of Bangladesh. His mother has her hands full running the household and looking after her children. Jibon’s father leaves the house early in the morning to seek work. As a day laborer, he has a hard time providing for his family. When his parents found out Jibon was severely stunted during a growth monitoring session, they realized they had to improve their baby’s health.

Together with other family members, they improved their hygiene habits to help Jibon grow healthy.

His mother attended courtyard sessions of the community health promoter. There she learned about good sanitation, hygiene and nutrition habits. Jibon loves to eat foods like eggs, milk, and khichuri, which have high nutritional value. Jibon’s health is gradually improving, from severely to moderately stunted, and on the right track.

Jibon’s parents saved money to build a latrine. Later on, the family invested in a handwashing device and soap. These healthy practices improved the well-being of the whole family.

Suisaya is in class four of the Yangsa School in Golkhali (Bangladesh). One year ago, there were no water and sanitation facilities at her school. She did not have anything to drink all day and when she had to go to the toilet, she walked into the field. As a girl, she always felt vulnerable. Max Foundation worked with school management to fix this.

Now, there is a water well in the school yard and separate latrines for girls and boys. Children at her school suffer less from diarrhoea. Hygiene education also helped: all children know to wash their hands after using the toilet.

Suisaya says with a big smile: “I wash my hands when I have visited the latrine. You get ill if you don’t. I like to wash my hands.