Peer-to-peer education on hygiene in schools

Recognizing that access to safe drinking-water and sanitation is a human right and that young people are at the core of action on water, sanitation and hygiene, the European Environment and Health Youth Coalition (EEHYC) has been working on engaging youth in daily hand washing promotion, menstrual hygiene education and raising awareness about the importance of safe, functioning sanitary facilities in school settings.

Under the framework of the Protocol on Water and Health and in cooperation with WHO Regional Office for Europe and its partners in Austria, EEHYC developed a youth-friendly brochure “HYGIENE MUCH”. The brochure addresses students of all ages and aims at encouraging good hygiene practices by providing health facts, memorable tips and tricks in a humorous way. It also discusses different problems that young people are facing when using WaSH facilities in schools, such as no privacy and bad smell in toilets, lack of toilet paper and soap for hand washing and similar. Special attention has been given to menstrual hygiene management. “Menstruation – full disclosure!” chapter talks about the importance of breaking the taboos around this topic and the need for adequate menstrual hygiene education together with regular access to sanitary menstrual materials in schools.

To ensure wide dissemination, the brochure has been translated in 3 different languages (English, Germany and Russian) and made available for free download at the EEHYC website www.eehyc.org .

Dear all,

I have just submitted this post under the other theme but I presume that it may be relevant in this discussion too.

Many thanks Katrin and Vielen Danke Susana for this much needed opportunity to share our reflections on these important issues.

I find it very stimulating to read the introduction of this discussion and the emphasis it puts on the need for leadership in relation to WinS. For sure, we are not merely talking about top down leadership from the Ministry of Education, but also about the kind of pervasive leadership needed amongst school, community and district level stakeholders for WinS to work. The introduction also refers to the promise of inter-sectoral collaboration in relation to SDGs with clear implications on WinS. Let us also consider the growing trend in development agencies to better integrate WASH-health, and food security, and notably in schools. How to better manage WinS? That is a big issue too, and it only takes a few visits to schools in areas of intervention of WinS programmes to realise how challenging it is to anchor new hygiene habits and to set up sustainable WinS O&M systems.

So this thematic discussion really addresses the big issues in relation to WinS. Where shall I start? Well, I would like to tell you about WaterAid recent WinS research - In view of its long-running concern about the state of WinS, and against the background of its extensive programmatic and policy work on the topic, WaterAid took the initiative in 2015 to undertake a programme of research. I joined the research team led by Richard Carter and was tasked to undertake four country case studies in south Asia (Bangladesh, India, Nepal and Pakistan). There were also several case studies in East Africa.

Much of the work consisted in reviewing and deepening existing WinS bottleneck analyses, or in the case of countries with no such analysis, undertaking them. In the four Asian countries, the research not only provided us with an opportunity to undertake comprehensive bottleneck analyses, but it allowed us to dig a bit deeper and explore the underlying causes of strengths and weaknesses. A wide range of political economy factors, often well-known by practitioners but unfortunately rarely factored in programmes, have thus been uncovered and analysed. The case study reports deliver interesting insights into WinS dynamics at central, district and local levels. Good practices from various organisations are also extracted and recommendations made to improve WinS programming.

Indeed, we cannot reasonably go on implementing business-as-usual approaches when we know deep inside the gap between the impact of most WinS programmes and the rosy pictures of WinS brochures. WinS programmes gives great pictures, which are real sources of inspiration for many of us. WinS also deliver the big numbers of beneficiaries that donors often look for. All great. But in the real world WinS is tough work and not many organisations can take pride in achieving decent levels of sustainability. My personal view is that collectively, we need a deeper, shared understanding of the problem. Many issues and obstacles are known but not made explicit. New strategies are needed, which address the underlying hindering factors and activate the potential for change.

Sharing the findings of our research - At this stage the case study reports are not yet in the public domain, and I think it is just a matter of weeks now. That being said, given the relevance of our findings to this thematic discussion, I am allowed to share here the executive summaries of the four reports. Hopefully they can help fuel exchanges. I am attaching the files to this post and I shall post a link to the full reports as soon as they are in the public domain.

Best wishes,

Jacques

Great discussion so far.

I am working with the Finland-Nepal bilateral WASH projects in Nepal (RVWRMP and RWSSP-WN). Probably the biggest difficulties with school WASH that we see is access to water (in the rural hill areas). Water is needed for washing during toilet use, and for flushing the toilet (sulav style toilets). Without sufficient water the toilets will block up and become unused quickly. Schools often employ an assistant to cart water, but it may be insufficient. Consequently it is critical that school needs are considered when planning new rural water schemes.

In addition, some schools have a shrine within the school perimeter. Particularly in the far west of the country, menstruation is a taboo issue, and if there is a shrine at the school the teachers may say that girls can't attend during menstruation, as it would be disrespecting the gods. This is both a community and Department of Education issue to resolve.

Earlier, girls weren't attending school anyway during menstruation as there wasn't a separate toilet where they could wash, with lockable doors and privacy. However, that is now improving, as the education department is beginning to understand the problems and are making a big push to build separate girls' toilets.

School teachers and children have played an important role in the national sanitation campaign. Children's clubs have been very active in monitoring of Open Defaecation and are very important actors regarding behaviour change.

Hello Belinda,
I would like to introduce the current work i am engaged in as an UNICEF WASH State Consultant in Govt of Maharashtra, India. I am currently working with the Tribal Development Department. The main objective of the program is to start the first line of discussion of the importance of WASH in Residential Ashramshalas( schools). The tribal populations are facing issues which ranges from Poverty to health. The department have been engaging in developing the education of the tribal population from the last 40 years by opening residential schools. This reservation policy for tribal children is to only ensure quick impact.
However the current status of WASH in these Ashramshalas are in questionable condition.It is evident that all the old buildings had WASH facilities developed ,but the major challenge that the dept had faced is plainly with Operation and Maintenance. The kind of practices in these belts support open defecation still now. Also the lack of facilities in the surrounding villages makes it a very common thing to continue.
As I was reading through the various comments in this link, I found that Three Star approach has been utilized in similar programs. So the department had engaged into creating a bench-marking study on basis of the three star approach and further it was realized that a demonstration model three Star School will help the department to initiate the WASH dialogue. But here I would like to say that unless there is a constant operation and maintenance done at the school level, even the three star schools will go back into Poor WASH condition.
In a govt system with such huge and constant change in Leadership, one of the key issues is about the priority of the department. Unless there are some robust mechanism to constantly monitor the WASH conditions, the equation hardly changes.
So besides ensuring adequate facility the thrust is to constantly develop ownership of the various stakeholders within the department. There are state level direct training done with school Principals, Wardens, teachers. Along with this intervention needs to be triggered within the students and the village level. Currently there are SMC bodies and guidelines are issued for them to engage in repairing of WASH facilities as and when required.
Also I believe certain bottlenecks at Central and State level to channelize funds for facility development, needs to be taken up seriously. It is important that there is a comprehensive process that is followed in constant loop. These are a) WASH facility development/up-gradation b) Motivation of the grassroots stakeholders like HMS, wardens, teachers, etc, c) Constant sensitization at Dept level and of students d) Operation and Maintenance that includes funds and required mechanisms.
There are various small kick-start activity also constantly being taken up to keep the momentum.
I would request you to suggest if there are some interesting engagement that can be done at large scale by the department for quickening the impact. Would like to hear from you.

Dear Belinda,

you raised some valid points and my post was of course a quite provocative one. You are very correct, we of course provide external technical support and I was not intending to say that external support is not needed. The question for me is more what kind of support we provide in which context.

Since the second phase of the regional Fit for School program focusses on supporting partners in their attempt to scale up previous achievements we adjust our support and focus more and more on system strengthening (capacitate sub-national structures, include Wins in monitoring and incentive systems of the eduction sector etc) and reduce our active involvement in implementation related processes (e.g. trainings for schools are conducted by sub-national partners compared to the pilot phase where we conducted those trainings; partners develop their own scale-up and roll-out plans etc.). This works better in some countries than in others and has to do with the level of ownership of course. Philippines and Laos are two good examples where the joint efforts of WASH partners helped to move forward with a more system oriented support approach for WinS. Maybe some of our government partners can share some of their experiences here.

In other countries/context the support might be different and even substitute where the situation requires, simply because there are no systems in place yet or other structural hurdles exist. However in that case it would of course be favorable to have longer program periods and to plan for the time after the support will end (phase-out periods, exit strategies) in oder to avoid things to collapse completely as soon as the external support ends. Sometimes I feel this falls a bit short in the reality of WASH program planning and implementation but if we ambitiously aim for sustainability and scale we have to take these aspects into consideration.

Are we expecting too much of education to take on WASH in schools fully?

An importnat question. Functional toilets, access to (drinking-) water and hygiene material should be part of every school by definition. Since schools are run by the education sector there is for me no question that this falls under the responsibility of the education sector, not saying that support from other sectors and stockholders is not important to support them in this role. But for me the education sector should be in the lead in this multiple-partnership set up.

WASH has for me a different priority over some of the other aspects you listed. Prioritization is crucial and you have to start somewhere and countries that have sophisticated and comprehensive school health programs often started off with WASH and added other aspects later (e.g. South Korea or most of the european countries). Especially for systems that are rather weak still it is important to focus and prioritize first, strengthen them and build up from there instead of expecting all at the same time.

I believe that one of the key factors is to provide approaches that do not overwhelm the education sector and make it easy for them to start with some simple, focussed and effective interventions instead of super comprehensive programs that include everything but no one on school level dares to start without external support since it is so far away from their reality. Stepwise approaches that start with some doable aspects (like the Three Star Approach) and build up from there have the potential to overcome this paralysis and dependency and create some sense of ownership. This is why it is so important to make the interventions on school level simple and not too time consuming and to integrate program management on district and provincial level in existing systems and to strengthen organizational and individual capacities (on school and sub-national level).

But I agree that there might be other options to address these issue and it would indeed be interesting to hear a few voices from other countries/continents and their experiences on how they addressed these issues that are so well known to all of us.

Dear Colleagues,

Some information about the school situation in Kenya.

The Kenyan education sector has made significant progress in the pursuit of universal education through the implementation of free primary education, however the development of water supply and sanitation infrastructure has not kept pace with increased pupil enrollment.

Below are some pictures I took in a school in Isiolo, Kenya








Some of the challenges faced are as follows:

- Education is a national function that is not devolved (Kenya has a devolved government structure). Challenges experienced, who is responsible for the operation and maintenance of infrastructure in schools?

- National data on the status of sanitation infrastructure in schools is not available

- In the past funding of sanitation infrastructure has largely been dependent on development partners.

- Unclear responsibilities in the past and lack of cooperation between the sectors (water, health and education)

- Insufficient funds allocated to construction of sanitation infrastructure by the government. Huge huge investment gap.

Current situation is unacceptable.

Best regards,

Doreen

It would be really great to hear some examples more from other regions! I would love to hear from practitioners in Africa, and Latin America. I will also love to follow-up with Rickson, on what his team did to 'rescue' the schools in his words.

I am very aware of the success of the Fit for Schools model, but I would like to play Devil’s Advocate in its replicability in other contexts.
From the comments from Fit-for School Manilla, now Laos and from SEAMEO INNOTECH, the idea of having head teachers or other members in school as WASH champions is good idea but not a new idea. However when we speak about institutionalisation, we should not speak about individuals but rather a systematic approach to giving head teachers or district teams incentives to include WASH in schools in their monitoring or daily affairs. I think the comments from Fit for School in Laos is alluding to the need for institutionalisation.
The Fit for School model does offer a template for Education to take on WINS and in some cases it is scaled up nationally. However, it still requires significant an external support, i.e. a small team of dedicated individuals only on this subject working with Education officials to keep things in order, monitor and pull schools along if they are falling off track. In essence, the Fit-for School models presents an external support to Ministry of Education for WINS . . .no?
In this line, there was an earlier proposal for privatized model for WASH in schools. Are we expecting too much of education to take on WASH in schools fully?
Beyond the Fit for School model, what other models that might work? Education officials increasingly have a more responsibilities and expectation- looking at any EMIS will tell you . . . psychosocial care, child protection, nutrition, health, capacity development, building, playgrounds for pay, etc.. Are we asking too much for them to assume hats as WASH managers?

Hello everyone – greetings from Phnom Penh!

My name is Alex and I am working for GIZ in the regional program “Fit for School”. I am based in Vientiane, Lao PDR and work closely with our teams in Lao and Cambodia – so most of what I will talk about below is of course heavily influenced by my experiences in working in these two education systems on the topic of WASH. In close collaboration with SEAMEO INNOTECH and the Ministries of Education of Cambodia, Indonesia, Lao PDR and the Philippines the program operates in these four countries to support education systems in taking crucial steps in improving the WASH situation in schools at scale.

As most of us have witnessed over the years, many WASH programs start out with great enthusiasm and implement pilots that change communities and inspire people. However, as a wide-spread saying goes “there are many successful pilots that never go to scale”.
So in my post I´d like to tackle the question of how, from an implementation point of view, does one take a successful water and health intervention to scale within the education sector?

In my opinion, the major implementation challenges when taking WASH initiatives to scale are related to two dilemmas.
Dilemma no. 1 is that virtually all initiatives start out with models to test and verify their approach and assumptions. For WASH in schools this usually means setting up model schools. Which is of course a very hands-on micro-level intervention.
But then, when that critical point in time of going to scale comes, initiatives are required to engage with structures and processes on meso- and macro-level. The work on these levels is much less hands-on and much less tangible – harder to understand and harder to advocate. On top of that, processes then suddenly follow not only a different administrative logic but on many levels also a political logic that probably wasn’t present during the model-school phase.

Dilemma no. 2 is what I consider the “dilemma of the individual”.
Going to scale means working on structures and processes. But starting with model schools, even with the aim of institutionalization and a parallel investment in strengthening capacities in governmental (or other service delivery) structures from early on, initiatives in their initial stages are often dependent on sympathetic individuals (sympathetic to the initiative´s approach) and interventions often start out with a strong focus on individual capacities through e.g. trainings.
When the shift from model schools to strengthening or building up management, steering and monitoring structures occurs, also the focus needs to shift away from helpful individuals and individual capacities to institutional processes and structures.
But this is hard. Hard, because the intervention itself didn’t operate like this so far and the involved staff usually did not work like that to achieve success in the model schools.

From a very micro level (school) and very macro level (policymakers on national level) initiative suddenly the subnational structures take the center stage. It becomes all about province and district offices and officials. But do we know how to meaningfully engage them? Have we already engaged them? Have we thought about their role? These structures and officials will be unsure of their new role in the new initiative and may not know what is expected and how to meet those expectations. Oftentimes, the national level doesn’t really know what the subnational roles will be either. Especially provincial levels often have a hard time (and subnational offices have the added stress of having to engage with local power structures that might follow fundamentally different interests).

In the regional Fit for School program we try to address these difficulties through relatively traditional approaches. Cascade training structures, in which provincial officers take responsibility for training district officials and these in turn orient school principals and school communities on the program approach. When we plan a cascade training we try our level best to use existing meeting structures wherever possible to minimize training costs and work with standardized training materials (manuals, videos) in order not to dilute the messages (a potential 'weakness' of cascade trainings). But how can we make sure that beyond the training of individuals the provincial and district offices will continue to orient new staff and new school principals?

The answer in part lies in M&E. By establishing monitoring structures and creating reporting responsibilities (and pressures) the offices and structures have to find ways to produce answers to the monitoring questions. But even more so – and M&E feeds into that – I consider accountability to be the key. This implies that M&E should be based in the education sector to which the schools are accountable to. This issue of accountability is even more challenging in the case of WinS which is "owned" by several sectors but not one sector is accountable for. Or as a colleague of mine put it: "everybody's friend but nobody's lover". Again, this highlights the need for education to OWN WinS as an issue and see it as a key strategy for achieving the vision, mission, and goals of the education sector. There is a tendency for Ministries of Education to convene the other players and ask them what they can do for WinS – but they don't clearly define how education will play its part (only vague statements like "hygiene education").

Furthermore, through learning exchanges the program tries to train individuals and foster exchange and mutual learning between provincial and district offices. Here, too, we face the question of individual learning versus how can this tool become part of the repertoire of a Ministry of Education? Here in Lao, the Ministry of Education and Sports currently invests its own budget in orientation trainings on the program for district staff. Provincial education offices have started to use their own budget to allow certain districts to visit districts in other provinces that already successfully implement the program with their own budget. Thereby the learning exchanges not only introduce participants to the initiative, they also train provincial offices in prioritizing, require them to coordinate and actively organize learning and knowledge management.

I would be very interested to hear from others in the field what their perspectives on these issues are. How are you working with subnational government structures? What strategies do you employ to take a working intiative to scale without just pouring additional extrenal funding into the sector?

Looking forward to discuss these questions further!

Alex

Recently I visited a school. I discussed with the teacher with regard to issues related to water and sanitation. She told me that their major concern is operation and maintenance of the toilets in the school. She then continued whether we can help them to maintain the infrastructure created by them. This is the issue in India. Everywhere huge investment is done to construct toilets, pipelines, tap connections, storage tanks etc, but there is no money to maintain it and also to run it. School management feels that there is no adequate fund allocated to maintain it and neither the governing board nor the government allocate adequate fund for operation and maintenance of the structures already created. The irony is that they can still allocate fund for constructing new infrastructures for sanitation but have no fund for the up keep of the existing infrastructures. The challenge is to find a solution to this to ensure WASH security in schools.

Dear all,

The pictures shared by Rickson via Thomas are shocking but unfortunately not an exception and we need to look at them carefully and take time to reflect on how we address and support WASH in Schools.

It's not new at all if we say 'hardware is not enough'. We say that for many years already but how does that reflect in our work and our approaches to support WASH in Schools? Since many years we talk about the fact that 'software' is needed as well but what do we mean by that and is 'software' really enough? A little bit of health education, a poster on hand washing and we hope it will all work. Approaches that focus on hardware only (maybe plus a little bit of 'pseudo software'), approaches that are not integrated in the education system in terms of structures and processes and that are not addressing accountability and ownership in an honest attempt are bound to fail. We can't be surprised anymore if we don't consider these well-known facts and see such pictures in the end.

Part of the responsibility is with WASH partners - international and national organizations supporting the implementation of WASH in Schools worldwide. It is our responsibility to stop working like that. If we continue to write proposals that promise to cover 400+ schools with WAHS facilities, including toilets in very short program periods (and ironically calling that 'scale-up') we can nothing but fail and we will knowingly create more of those pictures.

We have to work towards systematic approaches from the very beginning (not only after the pilot phase), e.g.:

- understand the education sector and work towards accountability
- integrate WASH in the education sector monitoring and other relevant processes
- facilitate the use of available funds (in many cases funds are available but not used or not used properly) or develop feasible models for resource mobilization according to the local context
- link WASH with school-based management and
- truly work with sub-national structures in the education sector (just having them sit in the back of the meeting room is not the right level of involvement) to make sure roles and responsibilities are clarified (including O&M)
- support the education sector to strengthen (intersectoral-)partnerships on sub-national and local level (with local authorities, communities, civil society and private sector).

Most important, we actually can't take over this work as 'outsiders/temporary programs' but instead we have to support government partners and other local partners to take the role in leading these change processes. This is all about change management in a cooperation system – a complex task that needs new approaches and time and we don't have that time since we are busy building all those toilets that we promised to build…

Looking forward to a fruitful discussion here over the next few days.

Greetings from Manila!
Nicole

Dear Thomas,

These pictures illustrate very well the challenges of implementation and the issues of operation and maintenance (including management, capacity and money).

Could you tell us more about Mr. Rickson Wachira? Can he join the discussion directly?

I see that he is from Nairobi Water. Does Nairobi Water have the responsibility of school facilities for water and sanitation?

According to him what are the possible solutions to improve the situation ?