WASH in schools (and health centres) (40 reports from 26 countries)
A number of evaluations and sustainability checks were conducted at least one or two years after completion of the ‘WASH in institutions’ intervention. They were in the position to measure actual sustainability, with more or less robust and quantitative data collection methods and analysis. Interventions were mostly implemented in schools as opposed to health centres.
The analysis of these reports shows that knowledge of good hygiene and sanitation practices, gained thanks to IEC activities, sustained longer than actual practice. Typically, more than half of beneficiaries still reportedly have a good level of knowledge whereas less than half of them actually put this knowledge into practice.
Rates of functionality and use of water points are higher than functionality and use of latrines, which in turn are higher than functionality and use of handwashing stations (with presence of water and soap). The functionality rate of school water points typically ranges between 70% and 100%, against 50-100% for latrines and 0-70% for handwashing facilities. It is worth noting that the presence of a functional handwashing facility with water and soap observed tend to be higher in schools than in households. The utilisation rate of functional water points is usually 100%, compared to 50-80% for functional latrines24 and maximum 60% for functioning handwashing facilities.
These findings are evidenced by anecdotal or qualitative evidence in most reports. Quantitative data based on more robust collection and analysis methods are provided in a smaller number of reports (including Kenya and Malawi 2012, Zambia 2013, Bangladesh 2014, Mali 2015). Overall, a too small proportion of reports compare data that have been collected in both intervention and comparison schools in order to better identify and quantify the change induced by the intervention. Too few use more than one data collection method and triangulate qualitative and quantitative data: for example combining self-reporting from children with interviews of teachers, linking interview data with observation, or comparing different observation methods. There is also an urgent need to harmonise key definitions such as ‘functioning’, ‘clean’ or ‘sufficient’ latrines, water points and handwashing stations in order to be able to make cross country comparisons.
The Mali WASH in schools impact evaluation (2015) is certainly the most comprehensive and rigorous evaluation under review and also the one that found the highest sustainability indicators. More than two years after the intervention was completed, 90% of water points were still functional and all of them were used. 100% of schools still had improved and functional latrines, but 15% still had pupils practicing open defecation (no report and no traces of open defecation in 85% of them). Only 65% effectively complied with the sex-separation requirement (based on observation of children’s actual behaviour) and only 50% with cleanliness criteria. Almost 60% of schools still had functioning handwashing stations with water and soap, and almost 60% of the pupils in these schools were using them upon leaving the latrine. Almost 100% of schools still had basic hygiene equipment (at least one kettles for anal cleansing, a trash bin, drinking cup and drinking containers), 85% had soap and 70% had detergent. As mentioned, these rates tend to be lower in other countries. In the case of the Mali programme it is interesting to note that the functionality of water points continued to improve and the practice of open defecation continued to decrease in schools as time since implementation passed. This phenomenon was not observed for other WASH facilities and behaviours.
Quality of construction is highly variable across countries and within countries. When a school water point is not functional or used, it is typically due to the handpump or tap being broken or locked by teachers, to the pipes being damaged, or to the borehole, well or rainwater tank being dry. The main problems related to the functionality and use of latrines are the following: poor design and construction quality, dirtiness or bad odour, insufficient cubicles considering the number of pupils and teachers, latrines locked or set aside for teachers only, lack of sex-separation in design or in practice, and filled up pits. The most cited issues with handwashing stations are broken or stolen taps, broken or cracked structure, absence of water or soap, or water and soap not made available to children. These observations reveal that the decrease generally observed in the functionality and appropriate use of WASH facilities is due to technical, ownership, behavioural, financial and institutional issues, which are sometimes caused or exacerbated by the way the intervention was designed and implemented.
Regarding the technical failure explaining the decrease in the functionality and use of school WASH facilities over time, they can be caused by several factors. Poor planning is one of them. For example, broken handpump, taps, and structures can be due to overuse of the water point, latrines and handwashing stations, because not enough facilities were planned to satisfy the needs of the entire school population. In the case of latrines, evaluators often highlight that teachers’ needs tend to be ignored, and thus reserve for themselves and lock some of the latrines initially planned for the children. Evaluators emphasise that the standard of a low pupil per latrine ratio needs to be observed. On the contrary, the Mali experience suggests that pupils tend to have a preference for specific cubicles and not use all of them; furthermore, when the number of latrines becomes too high, their cleaning and maintenance become a burden for the school. At a certain point, adding new cubicles may threaten rather than support sustainability. Concerning school boreholes, no ratio is proposed. Given their high investment cost, only one borehole is built regardless of the school population, which explains its overuse. Sometime poor planning results in only one standpipe being installed per school when more would be needed and affordable.
Technical failure can also be caused by incomplete preliminary studies. Dry boreholes suggest inadequate hydrogeological studies or a lack of anticipation of climate change and falling water tables. Dry rainwater tanks suggest that the sizing of the tank was not well calculated and that the fact that rainy season does not cover the whole school year was overlooked. Evaluations found that rainwater harvesting does not provide water for drinking or handwashing throughout the school year and therefore can only be promoted as a complementary source of water (Lao 2010, DRC 2009 and 2012, etc.). When latrines are not being used by girls, it suggests that girls may not have been consulted during the siting of the latrines. Bad smell can also be due to improper position of latrine block to the wind preventing proper ventilation.
Broken or cracked structures, boreholes or wells being dry, damaged pipes, dirtiness or bad odour of latrines and their inadequate use can be due to poor design and lack of adequate technical guidelines for builders. For instance, dirtiness and smell can be reduced with clearer instructions on slopes for the drainage of urine and wastewater. The inappropriate use of double pit latrines in Mali justified the replacement of this technology with simple pit latrines. They were not well understood by teachers and pupils, and training efforts were ruined by turnover. The use of girls’ latrines by boys and the resulting disaffection by girls can be reduced by a clear indication or drawing on the latrines’ walls and doors. Even cases of broken or stolen taps can sometimes be reduced with an alternative design, e.g. made of more durable or less costly material, with a removable or better-fixed taps. Broken or stolen taps are one of the most widespread technical challenges in school WASH programming identified through this meta-evaluation. This issue is mentioned in approximately half of the reports and seems to have remained largely unaddressed during the period reviewed. Locally, hand-made handwashing devices that do not use taps, named ‘tippy taps’, have been promoted in a few countries including Malawi, Mali and Haiti. They are one example of low cost technology that may be more fragile and last a shorter time but can easily be replaced by the school and therefore might be more sustainable. This is the argument upheld in the Indonesia 2009 evaluation report. The Timor Leste 2015 evaluation, on the contrary, calls for “the use of low maintenance technologies, together with solid, durable designs, for water systems and school WASH facilities; although more expensive in terms of the initial investment, they are more cost effective in the long run and thus more sustainable”. Group handwashing facilities have not been evaluated during the period covered by this meta-analysis.
Finally, technical failure is often caused by the poor quality of the construction process. It is the most frequently quoted problem. The low capacity of the builders, the poor quality of material and spare parts used, and the weak field supervision can go a long way in explaining uncompleted works, broken handpumps and taps, bad slopes or cracked walls, latrine slabs and handwashing containers, or loose compaction of the backfill. Many evaluations compare various implementation models in terms of effectiveness and sustainability. While only drilling companies have the equipment and expertise to install boreholes, the question discussed is: Who should be responsible for building the latrines and handwashing stations? Available information suggest that approximately half of the WASH in schools programmes assigned part or all the works to the local school management committees (or parents-teachers associations), builders and teachers, and the other half to private construction companies. The Burkina Faso 2009 and Timor Leste and Mali 2015 evaluations list the pros and cons of both models. The first model is reported to instil more local ownership, and therefore use and maintenance of the facilities. The community and the school have the opportunity to customise their facilities to their specific needs and invest more efforts in order to make discreet improvements on the proposed design. This model also reduces costs and, according to some evaluations, improves the quality of construction. The same latter argument is nevertheless put forward by the partisans of the second model, underlining that quality, and thus sustainability and children’s safety, are better achieved through a specialised civil engineering company having the necessary technical and logistical means at its disposal. It is selected through a competitive process based on skills and experience. A contract governs its relations with UNICEF with standard rules, incentives and sanctions aiming to minimise the risk of delay or conflict. It is in a better position to supply high quality building material and equipment. In case of defect appearing in the 12 months following the substantial completion of work, the contractor is compelled to fix or rebuild at its own expenses. Furthermore, for UNICEF and its implementing partners, a single contractor is easier to train, manage, coordinate and supervise than multiple, geographically scattered local builders. This is particularly the case for medium to large-scale programmes. However, specific measures should be adopted to ensure effective involvement of beneficiaries – including during the school holidays. As an alternative to a private service provider, Timor Leste contacted local CSOs to build school sanitation facilities. The rationale behind this choice was that they were more experienced in community mobilisation and were ready to work in remote areas, which was not the case for private companies. They also had strong technical expertise whereas previously contracted companies showed poor performance. One would conclude that there is probably not a one-size-fits-all model. Each has its benefits and risks. The decision should be based on a comprehensive needs and risks assessment and appropriate capacity building and quality control measures.
Irrespective of which model is chosen, training sessions must be organised for those who will build and supervise the works. Yet, as highlighted above, this is rarely done. Private contractors in particular are often assumed to have the required competences and experience because they have been selected based on these criteria and construction is their profession. Well-thought designs and technical guidelines should be provided by UNICEF, with particular attention given to details. Corresponding quality assurance processes must be put in place including prior verification of all equipment and supplies, full-time third party supervision in the field (preferably not by ministerial departments – see section 6.3 above), checklists, regular coordination meetings and logbooks on each construction sites. Beneficiaries must be involved in monitoring. These measures enforced in the Mali WASH in schools programme may explain the high level of functionality of WASH facilities.
Cases where taps have been stolen or broken and not replaced, water and soap are present but not made available to pupils or not replaced when used up, latrines are locked or set-aside by teachers, overflowing pit are not emptied, latrines are dirty and smelly and sex-separation of latrines is not enforced, are cases where functionality and sustainability are not affected by technical failure. Engagement and ownership issues may be at play here. As stated in the Mali 2015 report and confirmed in others, “although teachers and school management committees usually recognise the need for and benefits of improved water supply, sanitation and hygiene at school, they tend to cite the lack of classrooms, fence and school canteen as more urgent priorities. Sanitation and hygiene, in particular, are lower priorities”. School fencing is quoted as a prerequisite for school sanitation and hygiene. Even after IEC activities, the level of commitment in the school sometimes remains low, as illustrated in the Ghana 2012 report: “During one school visit, while inspecting the latrine, we observed a young school boy in uniform defecating in the field some 20 meters away from our group. This did not solicit any response from the Principal and the hygiene teachers standing next to us. The boy promptly returned to the classroom, obviously without washing his hands”. Some of these issues can be overcome with technical solutions. For example placing the handwashing stations near the classrooms under direct oversight of teachers rather than near the latrines could force pupils to use them with more caution and ease the regular replenishment of soap. But other cases are purely a matter of ownership and motivation.
Some programmes have put in place specific measures to increase buy-in, listed above: selection of beneficiary schools based on a formal application process, identification and mobilisation of natural leaders in schools, involvement in construction activities, self-supply of the hygiene kit, organisation of school competitions, etc.
Interestingly, the role of children as agents of change in the community is discussed in several reports, but not the other way around: the influence of the community members, organisation, dynamics and WASH conditions on the sustainability of school WASH is largely overlooked, except in Egypt 2008, Indonesia 2009 and Mali 2015 where women’s self-help groups, young people’s associations, scouts, guides and food sellers are seen as resources that can broaden the base in the community for encouraging sustainability in schools.
Financial factors can be the reason for the lack of sustainability, for example, where schools have not repaired broken latrines, taps and handpumps or not purchased soap. The lack of a WASH operation and maintenance fund is identified as a major obstacle to sustainability in all evaluation reports. Budgetary allocation from the Ministry of Education and local authorities are found to be increasingly scarce since the transfer of educational competences to the local authorities. In Indonesia, Lao and Pakistan, funds exist but schools do not access them in a timely manner or are not aware that these can be used for WASH infrastructure. Information and advocacy were therefore needed from UNICEF. In Mali, UNICEF helped beneficiary schools leverage other sources of funding: a fund is created by the school hygiene club endowed by voluntary contributions from community members and fines levied from schoolchildren caught in a bad sanitation and hygiene behaviour; in the community, women’s savings and loan groups are established whose benefits are partly used to provide the school with hygiene supplies.
The lack of sustainability is also linked to institutional weaknesses within the school organisation and the wider national education system. When no one within the school is designated as responsible for WASH, when no system is in place for opening/closing the taps and latrine doors and regularly cleaning the latrines, when there is no clarity over who should pay for what, then the existing WASH facilities are likely to start deteriorating and subsequently be abandoned. In many countries, UNICEF participated in the development or revision of school WASH policies, strategies and guidelines (Haiti, Lao, Mali, Indonesia, Kenya, DRC, Ethiopia etc.). WASH in schools programmes also systematically include training of school management committees, training and children on good WASH behaviours and management. Quality of training is variable, however. Specific WASH action plans are sometimes developed with the school management committee and teachers, but they tend not to be updated the next year, or not used as a real planning and management tool (DRC 2009 and 2014, Indonesia 2014, Mali 2015), notably because they are separate from official administrative planning tools already in place. School management committees or parents-teachers associations tend to meet less regularly than expected. Decision-making processes and accountability mechanisms are vague or not applied. The functionality of school management committees or parents-teachers associations has been assessed in a few countries as between 0% and 50% one to three years after the intervention (DRC 2009 and 2014, Malawi 2012, Haiti 2013, Mali 2015). No routine training and supervision from the education ministries is established.
Most programmes have set up school health clubs composed of children carrying out WASH activities in the school and the community under the supervision of teachers. They are meant to empower and engage pupils in WASH issues and, in doing so, partially compensate for the weaknesses in the school management structure. Members are theoretically elected by the schoolchildren and responsible for organising regular cleaning activities in the school – but often end up being appointed by teachers and executing cleaning tasks directly. In Rwanda (2013) and Timor Leste (2015), an employee is in charge of cleaning latrines. A lot of emphasis is generally put on girls’ participation as a condition for the vitality of the club. However, more critical issues are ignored. For instance, the annual replacement of members transferred to higher grades or other schools, and training of new members are not systematic, endangering the sustainability of such clubs in the short-term. Again, as put forward in the Indonesia 2014 report, it would probably be more sustainable to work with an existing system of class representatives rather than creating new clubs for WASH specifically.
Institutional weakness of the wider national education system impacts the sustainability of school WASH improvements. The lack of institutionalised education of children and teachers on WASH is a major obstacle. One-off training and refreshers will never be sustainable given the high turnover rate of both pupils and teachers. WASH is or has been integrated in the school curriculum in some countries or even in the teacher training curriculum in Mali but not in many others (Egypt 2008, South Sudan 2009, Djibouti 2010, Malawi 2012, Indonesia 2013, Pakistan and Bangladesh 2014 etc.). The reform of the teacher training curriculum in Mali is likely to reduce the cost of capacity building for UNICEF and mitigate the problem of teachers’ turnover.
The lack of regular monitoring and inspection of WASH conditions in schools is also critical, as is the general lack of administrative supervision, incentive and sanction mechanisms for both teachers and school management committees. Clean schools competitions (Ghana 2012, Indonesia 2014, and Mali 2015) are effective incentives but not organised annually at national level. Periodic school inspections after completion of the intervention supported by UNICEF usually focus on other aspects than WASH. Regular collection of data on WASH in the administrative information management system of the education ministry is rarely observed.
Overall, UNICEF programmes attempt to tackle the issue of WASH in schools through one-off activities rather than by changing the enabling environment of the education system and influencing the institutional structures that support school WASH. “There are relevant and effective institutional systems in schools that should be built on when promoting WASH in schools. There is no need to add specific activities” with reference to teacher training, WASH clubs, school management committee’s action plans, monitoring visits etc. (Indonesia 2014).
Most of the underlying causes for limited sustainability discussed above have been provoked or could have been reduced by the action of UNICEF. Programming and implementation are again strongly influencing the prospects for sustainability of WASH in schools. Additional evaluation findings support this argument, especially findings on weak theories of change. Several countries have designed WASH in schools programmes without any hardware component – and without targeting schools that already had WASH facilities (Guinea 2009, Lao 2010, Kenya 2012, Bangladesh 2014…). Evaluations showed that purely behaviour change and training activities without the corresponding WASH facilities being available at schools can obviously not provoke a sustainable behaviour change. Similarly, limiting the hardware component to latrines and handwashing stations only – probably due to budget constraints – has the same (lack of sustainable) effect because it is extremely challenging to wash hands, clean the classrooms, latrines and handwashing stations, and use sufficient drinking water when there is no source of water in the school yard (Lao 2010, Ghana 2012, Ethiopia 2012, Djibouti 2010 and DRC 2009…). Children have to fetch water in the village from a source that is shared between the schoolchildren and the community members, increasing the ratio of users per water point and threatening its viability (Burundi 2013).
The software component should also be sufficiently well conceived in terms of length and comprehensiveness. Many programmes carry out capacity building as a series of one-off training sessions within different audiences and IEC activities covering a six month to a one school year period, when many evaluations point out that behaviour change doesn’t occur in such a short timeframe. The sustainability DRC 2014 report showed that “the length of the software component is statistically associated with the sustainability of the ‘healthy status’”. This should be planned and budgeted for in the initial donor proposal. Well thought IEC and training approaches seem to be missing in most programmes. Out of all evaluations of WASH in schools programmes, only one found comprehensive topics and sound methods. Common issues are the following:
Not enough persons are trained or the selection of participants is inappropriate;
Training of teachers and school management committees are partial, do not include facilities maintenance and repair;
Refreshers are missing;
Children are not shown how to properly use the facilities;
Training and post-material as well as educational IEC tools are not consistent with each other, especially when they have been developed by different institutions or consultants at different times without overall supervision;
They are not well adapted to a young audience, to children from different age groups or to easy use by teachers in large classes;
They are theory and knowledge oriented rather than practical and play-based; and
They are not provided in sufficient quantity, not well packaged or not covered in plastic so they quickly deteriorate.
As a result, pupils’ interest diminishes and teachers’ ability to continue WASH lessons in class and management activities in the school vanishes after a few years.
Another common weakness in the school WASH programme design is the lack of linkage with the community. It is highlighted in approximately half of the reports (Egypt 2008, DRC 2009, Lao and Djibouti 2010, Palestine 2012, Indonesia 2014 etc. as opposed to Bangladesh 2008, Ethiopia 2012, Nepal and Sierra Leone 2013, Pakistan 2014, Mali 2015). Efforts to link the school with the community take two main forms: combining WASH in schools with CLTS (or CLTS with SLTS) in the same village (only a few examples documented), and encouraging the school health club to carry out sensitisation activities as agent of change in their community. Both approaches were used in Mali. The latter, more common, is usually appreciated by children, teachers and parents. For example, the Bangladesh 2008 report notes that “student brigade activities [are] very appreciated in communities for 90% of interviewees and among the teachers and children in the same proportion”, and in Nepal 2009 that “the overall finding clearly shows the positive contribution of schoolchildren in imparting knowledge to the family members and the community about the importance of hand washing with soap and on water treatment methods”. However, the drivers and obstacles for children to effectively act as agent of change need to be better understood. As highlighted in the Kenya 2012 report “the SOPO programme activation teams encouraged children to share the activity books and messages with their families. Many children reported sharing the information with their families but fewer caregivers reported receiving the information from their child”. Remarkably, if children are often encouraged to interact on WASH issues with their families, it is unclear to what extent the opposite is true. Whether or not school-based WASH programmes encourage the community to interact with the school and to support WASH improvement in a more sustainable manner is largely unknown (with the exception of the Mali case developed above) and requires more research.
Performance related to sustainability by type of WASH intervention is summarized as follows:
