- The Water, Sanitation and Hygiene (WASH) sector of international development works to increase access to sustainable, safe water and improved sanitation. Currently, at least 780 million people live without clean drinking water and 2.5 billion without access to improved sanitation (UNICEF & World Health Organization, 2012). Lack of access to these human rights is a major cause of diarrheal disease, which annually kills nearly 760,000 children under the age of five. Many institutions, including the United Nations (UN), non-governmental organizations (NGOs), and local governments are working to resolve this inequality by increasing safe water access, providing sanitation facilities, and improving knowledge and practice of healthy hygiene behaviors. Implementing agencies often self-monitor their efforts and, due to funding challenges, only through the life of the project. This study attempts to evaluate the longer-term effectiveness of an NGO's WASH program in Balkh Province, Afghanistan by investigating five questions, post program 1) was access to safe drinking water improved; 2) how is the spatial distribution of households relative to water sources related to safety of stored drinking water; 3) was there an increase in WASH knowledge; 4) was there an increase in WASH practices; 5) was stored household drinking water safe for consumption? In August to September 2012, an evaluation was conducted of the longer-term effectiveness of a 2009 WASH program in northern Afghanistan. A total of 59 households from four villages took part in the follow-up survey that collected information regarding drinking water, sanitation, health behaviors, and storage or treatment of drinking water. With permission of the participants, drinking water samples were collected and tested for any presence of E. coli, an indicator of fecal contamination. Additionally, samples were taken and analyzed from 15 drinking water sources, 13 of which were public boreholes. Lastly, a Garmin GPS device was used to collect latitude and longitude location of important points during the field research. This information was used to conduct a spatial analysis of well distribution throughout the villages. Survey results showed increases in several beneficial health behaviors, such as using boreholes as the main source of household drinking water, having a specific place to wash hands after using toilet facilities, and having soap in that specific area. Also, based on results of the spatial analysis, access to improved water sources was increased. The practice of treating water in the home dropped significantly. Biosand Filter technology introduced during the WASH program had been adopted by only a small percentage of households. Of the 54 surveyed households that gave permission to sample, 40 had drinking water that tested positive for presence of E. coli. In contrast, a majority of borehole samples provided water that was free of E. coli. Lastly, by examining the spatial distribution of households, it was found that all households beyond 300m from a borehole had drinking water with a presence of E coli. These outcomes make two suggestions. One is that using "1000m from an improved source" as an indicator of accessibility may be too great a distance for households that must collect and carry water, especially when a closer, though contaminated, water option exists. The second is a need for longer term follow-up, especially as behavior change is one of the main goals of the program. More investigation into why families have not adopted handwashing and in home water treatment to a greater extent would be beneficial in creating a stronger WASH program that has greater health impacts. Extended programming is challenging when NGOs are reliant on external funding for program costs. Advocating to funders the importance of longer term monitoring and evaluation as well as reoccurring education programs, could be a vital next step.