Note: I have copied this reply email from the original discussion of WG mailing list (see internal area of WG7 on this forum).

Sent: Thursday, March 08, 2012 2:45 PM

Dear all,
Thank you for the valid points made on handwashing. From what I know children should not use towels for hand drying in schools since this is a point of contamination. Ideally paper towels are most hygienic but far too costly in most situations. Drying the hands in the air (by shaking and waging hands) should be the right behavior. If children learn this during their daily routine of hand washing they will continue practicing it. This is also promoted in the Philippines during the daily group handwashing routines (Fit For School) and seems to work well.

The other issue mentioned was on anal cleaning with water or paper. It certainly depends on religion or sometimes regions and if water is available or not. In general I would think that anal cleansing with water is more hygienic considering the fact that people naturally have water also available for handwashing and usually do it also as a habit (e.g. India). If with soap or not I do not know, however Mugal as mentioned soap is used. This would mean that handwashing with soap in Muslim countries is less of a problem that in other cultures? Is that so?

Many cultures also have the concept of left and right hand, whereby they always use the same hand for washing or wiping and always use the other hand for eating or shaking hands. That is a very effective way to prevent spread of diseases.

Since anal washing depends on the culture and religion, it cannot be forced upon other cultures or religions that are used to wiping. If people cannot afford to buy toilet paper, they use leaves, newspaper or other materials for wiping. Without handwashing this method of anal cleansing surely bears more health risks than anal washing.

@ Ikem: What many practioners have realized over the years is that hygiene education has only little impact on behaviours if it is not accompanied at the same time with exercising it (skills). Was there also a strong component of practical handwashing in Benin?
@ Omotola: Please see the infos given in the emails below (links to Fit For School) and the website of washinschoolsmapping with valuabe infos.

Best regards,
Christian

Note: I have copied this reply email from the original discussion of WG mailing list (see internal area of WG7 on this forum).
Sent: Friday, March 02, 2012 6:07 PM

Dear all,

I have been given a report by my colleague Elisabeth von Muench concerning the issue mentioned by Patrick Chalwe about the lack of toilet paper and the related increased risk of faecal contamination of hands. The report from Susanne Herbst (2006) on “Water, sanitation, hygiene and diarrheal diseases in the Aral Sea area” states the interrelation of diarrhea episodes and lack of toilet paper. So contaminated hands do in fact lead to diarrhea episodes in the absence of handwashing with soap (as expected).

Quote “The analysis revealed that visible contamination of drinking water during storage and absence of anal cleansing material were associated with the number of diarrhea episodes per household”. I have not read the report myself but I am sure it can be helpful to make the argument. www2.gtz.de/Dokumente/oe44/ecosan/en-eco...ment-series-2006.pdf

Of course if people would wash hands with soap diarrhea incidents would be less likely. But the reality shows that only 5% of students are actually washing hands with soap, even when facilities are available as stated by Murat Sahin from UNICEF in the SWASH+ paper “Getting School WASH Right”. So it is clearly a serious health issue (risk) if we provide sanitation facilities but forget to cater for basic toiletries and are not able to enforce handwashing with soap.

Wishing you all a nice weekend
Christian

Note: I have copied this reply email from the original discussion of WG mailing list (see internal area of WG7 on this forum).

Sent: Thursday, March 01, 2012 11:47 AM

Dear Patrick and others,
Thank you for the valuable comments. As the example from Patrick concerning the lack of toilet paper and from other with lack of water and soap shows it that infrastructure alone is not enough and can even do more harm than good in same cases. But in order to create safe and healthy learning environment it seems just so obvious that besides providing the necessary infrastructure it is equally important and even far more challenging to ensure the continuous provision of water, soap and toilet paper (if required) as the basic toiletry items. This seems to be the greatest challenge from my point of view. How to create sufficient budget lines for O&M and to make sure parents, communities, children and headteachers all together value WASH and in particular handwashing with soap as one of the main priorities. As long as this shift in priorities and the necessary behavior change does not take place within the entire local communities I do not see a positive pictures in providing funds for O&M (wherever they may come from). As I stated earlier in my mail the Philippine project of Fit for School has somehow achieved this priority change through a set of incentives and learning of skills through daily routines which seems to make a difference. The costs for providing sufficient soap, toothpaste and toothbrush as well as 2 deworming pills per year per child is about 0.50 US $. This seems manageable or?

Someone mentioned DRY WASH - do you mean to completely work without water? Please clarify this term!

I also found the comment on open defecation versus toilets without handwashing or toilet paper relevant. It might be the question in some projects whether to spend the money on toilets or on handwashing stations if there are limited funds. What to do - what is more effective intervention, provides dignity or is most demanded by the people? I am not sure.

Best regards,
Christian

Note: I have copied this reply email from the original discussion of WG mailing list (see internal area of WG7 on this forum).

Sent: Tuesday, February 28, 2012 9:35 AM

Dear Kitch and other colleagues,

Let me make you aware about the skill-based approach of the Fit for School program in the Philippines that shows a successful approach. They make a whole school class wash their hands together at the same time every day at the same time as a daily routine. This routine creates skills of proper handwashing and finally also leads to behavior change. The issue of water and soap supply needs to be addressed through incentives to schools, parents and government to keep the supply up and running. This incentive structure is however very complex and needs to be thought through very carefully. Please have a look at the webpage www.fitforschool.ph/ and the teacher manual www.fitforschool.ph/resources/info-mater...mentary-schools.html .

Cheers
Christian

Note: This topic was initially discussed through the mailing list of working group 7. The archive of the mailing list can be retrieved from the internal area of the WG7 forum.susana.org/forum/categories/75-wor...or-logged-in-persons. If authors like to move their post from the internal area to this open discussion please post it again.

Dear working group on community, rural and schools,

I am forwarding you the report of 'Getting School WASH Right' conference held at Emory University in December which might be interesting to you.

There is one of the findings that I find quite astonishing and very relevant to mention. The SWASH+ program in Kenya found from the impact evaluation that schools receiving new latrines had a higher risk for children to contaminate their hand with faecal matter (see attached report). In the absence of proper handwashing this naturally leads to higher disease load of children than of children in schools without sanitation facilities where kids rather defecate at home with higher changes of washing hands at some point. In my own words this means that if toilets are constructed in schools and handwashing with soap is not practiced it may lead to deterioration of health at school. This puts many efforts of WASH in schools into a totally different picture. Matt Freeman from SWASH+ has informed me that the team will publish an article about this issue very soon. Please mind if I have made wrong assumptions.

Please see the SWASH+ website for further information www.swashplus.org.

Additionally let me mention to you the new mapping website of WASH in schools with interesting information of various UNICEF programs worldwide www.washinschoolsmapping.com .

Best regards,
Christian