School Water, Sanitation and Hygiene: Myths Proved and Disproved

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
9 August 2011, CARE USA Headquarters
Presenters Malaika Wright, Shadi Saboori
Brooks Keene
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SWASH Basic Facts
School Water, Sanitation and Hygiene Myths
Proved and Disproved

• What SWASH is a five-year applied research
  project started in 2006
• Goal To identify, develop, and test innovative
  approaches to school-based water, sanitation and
  hygiene in Nyanza Province, Kenya
• Partners CARE, Emory University, the Great Lakes
  University of Kisumu, the Government of Kenya,
  the Kenya Water for Health Organisation (KWAHO),
  and Water.org (formerly Water Partners
  International)
• Where Research and implementation conducted in
  Nyanza Province, Kenya

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Why School WASH?
School Water, Sanitation and Hygiene Myths
Proved and Disproved

• At baseline, approximately 49 of schools
  provided drinking water to pupils
• Only 11 provided water for handwashing.
• In schools selected, there were 79.5 pupils per
  latrine on average (GoK ratios are 251 for
  girls, 301 for boys)

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The Three Components Of SWASH
School Water, Sanitation and Hygiene Myths
Proved and Disproved

• 1) Direct implementation 2) Research 3) Advocacy/
  collaborative learning
• Direct implementation and research were started
  first
• Advocacy and collaborative learning were
  incorporated later

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
The Research Context

• Widely acknowledged need for school WASH
  investments
• Yet scant evidence base for impact
• Evidence necessary to justify allocation of
  scarce resources
• Myth vs. fact

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
Background and Methods

• Cluster randomized trial 2007-2009
• Base package (45 schools)
• Hygiene promotion Water Treatment
• Base package Sanitation (45 schools)
• HP WT Sanitation
• Water package (25 schools)
• HP WT Sanitation Water
• Control (70 schools) to receive improvements in
  third year of project

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Does school water, sanitation and hygiene (WASH)
  interventions make a difference in educational
  achievement?
• Which kids benefit more from school WASH?
• Can school WASH do more harm than good?
• What types of investments in school WASH yield
  the most returns?

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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Does school water, sanitation and hygiene (WASH)
  interventions make a difference in educational
  achievement?
• Which kids benefit more from school WASH?
• Can school WASH do more harm than good?
• What types of investments in school WASH yield
  the most returns?

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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Significant reduction for HWWT (OR0.43) and HW,
  WTSan (OR0.47)
• Six days less absence per year for girls
• No effect for boys

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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Does school water, sanitation and hygiene (WASH)
  interventions make a difference in educational
  achievement?
• Which kids benefit more from school WASH?
• Can school WASH do more harm than good?
• What types of investments in school WASH yield
  the most returns?

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
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School Water, Sanitation and Hygiene Myths
Proved and Disproved
Effect of WASH Helminth Re-infection

• Followed re-infection rates for Ascaris,
  Trichuris and Hookworm
• Ascaris
• 45 reduction in odds overall even greater among
  girls
• Trichuris
• No effects
• Hookworm
• Significant reduction in intensity of infection
  for boys

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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Does school water, sanitation and hygiene (WASH)
  interventions make a difference in educational
  achievement?
• Which kids benefit more from school WASH?
• Can school WASH do more harm than good?
• What types of investments in school WASH yield
  the most returns?

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
What if key WASH components are missing? Hand
Contamination

• Hand Rinse sampled pupils hands for fecal
  contamination
• Measured for E. coli
• Compared intervention and control schools

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
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School Water, Sanitation and Hygiene Myths
Proved and Disproved
What happened?
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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• Does school water, sanitation and hygiene (WASH)
  interventions make a difference in educational
  achievement?
• Which kids benefit more from school WASH?
• Can school WASH do more harm than good?
• What types of investments in school WASH yield
  the most returns?

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
Reduction in Diarrheal Disease

• Water Package schools showed a 66 reduction in
  diarrheal disease and days of illness.
• This result was not gender specific.
• There was no effect seen for the Base and Base
  Sanitation schools.

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
Reduction in Girls Absenteeism

• Significant reduction in girls absenteeism in
  schools where hand washing and treated drinking
  water were present (irrespective of sanitation
  improvement)
• Software components must not be overlooked
• Vital recurrent costs (i.e. soap, water treatment
  products) must be regularly budgeted and provided
  in order to ensure sustainability of WASH services

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
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School Water, Sanitation and Hygiene Myths
Proved and Disproved
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School Water, Sanitation and Hygiene Myths
Proved and Disproved

• 2008 provision of soap over 30 of schools
• 2010 provision of soap under 8

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School Water, Sanitation and Hygiene Myths
Proved and Disproved
Sustainability Successes WASH components not
requiring expenditures by schools are still
sustained in a majority of intervention schools
(nearly 3 yrs after implementation) Sustainability
Challenges WASH components requiring expenditure
by schools decreased dramatically (nearly 3 yrs
after implementation)
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Using the Evidence and Learning Advocacy
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The policy environment

• Current and planned investments in school WASH
• Interested development partners
• Many policies
• Low capacity for implementing them
• Corruption in the Ministry of Education

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Advocacy

• 3 High-Level Objectives
• Increase funding for operations and maintenance
  costs in schools
• Improved monitoring and evaluation for
  accountability
• Improved knowledge and behavior change

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Specific Policy Goals

1. Increase OM Funding 3.30/pupil/year
2. Improve ME Downward, decentralized and
   supportive
3. Knowledge and behavior New curriculum
   (co-developed with CDC)

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An inside player
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Advocacy Activities

• Learning presentations
• Sign-on letters with other civil society
• Media work
• Submitted policy briefs
• Sustainability charter
• Day to day badgering
• International level publishing in academic
  journals, issuing briefing notes and presenting
  at relevant fora

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Measuring Our Progress Outcome Mapping
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Monitoring Our Progress (cont)

• Progress Markers
• Expect to see MoE and MoPHS engage SWASH as a
  learning partner on school WASH
• Like to see MoE, MoPHS, and MoPW adopt
  monitoring tools with focus on not only hardware
  but also OM of hardware and software, behavioral
  change, and indicators of future sustainability.
• Love to see MoE increases budget request to MoF
  for school WASH software to at least 33
  KES/pupil/year and creates an independent budget
  line for school WASH software.

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Monitoring Our Progress (cont)
1,2,6 Charles Kanja (in-service department) Briefing him on policy issues where SWASH has interest. Kanja is interested in working with SWASH on training manuals. January 25th, 2011
3 - Kanja his office has a limited budget and cannot support training or printing of the manual SWASH is creating. No budget for for zonal level to do monitoring. January 25th, 2011
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Results to Date

• 3.4 million allocated for sanitary pads for
  school girls this year
• Piloting and openness to new ME systems,
  including agreement on need for unified
  monitoring tool between ministries
• Doubling of funds for school WASH (840,000/year)
  with potentially more to come
• Adoption of WASH curriculum and materials for
  in-service teacher training
• Agreement to develop a school WASH sustainability
  charter
• International level Uncertain impact

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Thoughts on the Process

• Evidence-based advocacy works
• Getting to scale through learning advocacy (not
  direct service delivery)
• Trying to do implementation, rigorous learning
  and advocacy simultaneously is hard (not
  necessary?)
• Cant be internally-focused
• In-country policy staff are essential

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