41030 toolkit on HYGIENE SANITATION & WATER in schools The Toolkit aims to assist anyone involved or planning to work in school hygiene, sanitation, and water. If you wish to Acknowledgements comment on or contribute to the Toolkit, please write to Lene The authors gratefully wish to acknowledge the contributions made to this Jensen at Ljensen@worldbank.org Toolkit by Vanessa Tobin, Henk van Norden, Cream Wright, Lesley Drake, Mariëlle Snel, Celia Maier, Christine van Wijk, Belinda Abraham, Jack Jones, For additional copies of the Toolkit, please contact The Water Peter Kolsky, Seung Lee, Mayling Simpson-Hebert, Cindy Joerger, and Help Desk at Whelpdesk@worldbank.org Esther de Vreede. Illustrations by Jaap Zomerplaag Unless otherwise stated, photos by Annemarieke Mooijman © The World Bank Group 1818 H Street, N.W. Washington, DC 20433, U.S.A. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, or its affiliated organizations, or to members of its Board of Executive Directors or the countries they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility whatsoever for any consequence of their use. HYGIENE SANITATION & WATER in schools Introduction to the Web-based Toolkit at www.schoolsanitation.org June 2005 HYGIENE, SANITATION, AND WATER IN SCHOOLS Introduction to the Web-based Toolkit at Foreword www.schoolsanitation.org Annemarieke Mooijman, Caroline van den Berg, Lene Odum This toolkit has been developed following the FRESH (Focusing Jensen, and Donald Bundy Resources on Effective School Health) framework, which has been created through a partnership of UNESCO, UNICEF, WHO, and the World Bank1. FRESH focuses on the development of child-friendly learning environments as an essential part of overall efforts by countries around the world to increase access to, and improve the quality of, their schools. The FRESH framework calls for four interventions in all schools to TABLE OF CONTENTS establish a child-friendly learning environment: (1) Policy: health and nutrition related school policies that provide a non-discriminatory, Foreword safe, and secure learning environment; (2) School environment: Why programming for school hygiene, sanitation, and water? access to safe water and sanitation, including provision of separate sanitation facilities for girls and boys; (3) Education: skills-based Basic principles for successful and sustainable school hygiene, education that addresses health, nutrition, and hygiene issues and sanitation, and water programming promotes positive behaviors; (4) Services: simple, safe, and familiar Contents of the Toolkit health and nutrition services that can be delivered cost effectively in schools (such as de-worming, micronutrient supplements, and snacks that alleviate hunger), and increased access to youth-friendly clinics. This toolkit deals with school hygiene, water and sanitation. To date, sector professionals in the education, health, and water and sanitation sectors have learned important lessons about what works and what does not in their respective sectors. The Toolkit on Hygiene, Sanitation, and Water in Schools draws on those lessons and insights. It is designed to help sector professionals in the education, health, and water and sanitation sectors to tap into sector-specific knowledge of practices and approaches that are likely to yield positive results as they coordinate multi-sector efforts to improve sanitation and hygiene 1More on FRESH can be found at www.freshschools.org i Why programming for school hygiene, sanitation, and water? in schools. Rather than `ready-made solutions,' the Toolkit presents Worldwide, more children are going to school than ever before in principles, tools, and experiences to help sector professionals history. An estimated 83 percent of primary school-aged children now develop the solutions that are most appropriate for their specific attend school, and of these 84 percent complete primary school.2 This program settings. development shows that initiatives aiming for `Education for All' have successfully achieved increased access to education. School hygiene, sanitation, and water can make an enormous difference in the lives of school children, particularly girls. A clean, At the same time, the challenge of providing education of good quality safe, secure, and enabling learning environment in which students stillliesahead.Thebarrierstoachievingqualityeducationaremanyand can learn and perform to their full potential is a vital start in any child's life and a basis for development. Let us make sure that every child is given this opportunity, as an investment for a sustainable future. Katherine Sierra Jean-Louis Sarbib Vice President & Network Head, Senior Vice President, Infrastructure Human Development The condition of a school toilet in Central Asia The World Bank Group The World Bank Group include,amongothers,overcrowdedclassrooms,poorlyqualifiedand/or dispiritedteachers,lackofappropriateeducationalmaterials,andpoor conditionsinthelearningenvironment.Althoughadequatesanitaryfacilities andhygienepracticesformessentialcomponentsofanenablinglearning Edwin J. Judd Director, environmentandqualityeducation,therealityisthatmanyschoolshaveno Programme Division UNICEF New York toiletsatall;toiletfacilitieswhichareheavilyusedandfilthy;ortoilets,water supply,andhandwashingfacilitieswhicharespotlesslycleanbutarenot usedorarelockedandinaccessibletothestudents. When a school lacks basic water supply and sanitation facilities and its students have poor hygiene habits, the incidence of major childhood ii 2 1 As published over 2001-2002 by the UNESCO Institute for Statistics. Basic principles for successful and sustainable school hygiene, sanitation, and water programs illnesses such as diarrhea and helminth infections among its students The basic principles that underlie successful hygiene, sanitation, will increase. The global prevalence of intestinal helminth infection and water in schools projects are to a great extent similar to those in school-aged children is high and is estimated at 35 percent for that guide sustainable community water and sanitation projects. The roundworm, 25 percent for whipworm, and 26 percent for hookworm main differences are that (Partnership for Child Development, 1997). This, in turn, adversely affects children are the primary school children's participation, lowering enrollment rates, increasing target group (rather than absenteeism, and contributing to poor classroom performance and adults) and that schools early school dropout. It also decreases learning capacity as measured in are the institutional and educational performance, outcomes, and productivity. organizational setting (instead of communities). The lack of appropriate facilities may discourage children from attending school; girls who are menstruating, in particular, would rather not go to This chapter describes six basic principles associated with key school than have to deal with the lack of privacy. components of hygiene, sanitation, and water in schools programs: Because children spend a significant amount of their time in and around · Financing options · Policy environment schools, these are environments that need to be healthy, safe, and secure · Stakeholder participation · Life skills-based in order to be conducive to learning. Provision of gender-specific sanitary · Capacity building hygiene education facilities can be one way to improve school attendance by girls. · Technology choice However, schools also offer an opportunity to reach the majority of the The basic principles outlined in the chapter should inform projects to world's children, who at one point or another are in the care of the school, help ensure their sustainability. The principles are adapted from those with a "model" for sanitation. Because the unsanitary conditions typical that apply in community water supply and sanitation, health, and edu- of many school toilets send the wrong message to students about the cation projects and are supplemented with lessons learned that ad- importance of sanitation and hygiene, schools can become ideal places dress the particular characteristics of hygiene, sanitation, and water to establish good hygiene (and other) behaviors as well as to provide in schools. The electronic version of the Toolkit, which can be found strong environmental models that can serve as examples. Children who on the accompanying CD-ROM, contains a more detailed discussion learn good hygiene practices in school can also become important health of these basic principles. promoters at home. 2 3 Policy Environment Life Skills-based Hygiene Education The existence of a positive policy environment is a central principle for the success of hygiene, sanitation, and water in schools programs. To establish a favorable policy environment that supports sustainable investments in hygiene, sanitation, and water in schools, political commitment is needed. To that effect, school sanitation needs to have its place on the political agenda. A second issue to address in the creation of a favorable policy environment is the promotion of a demand-responsive approach to the delivery of hygiene, sanitation, and water services. Under such an approach, schools make informed choices regarding their level of participation, service level, and service delivery mechanisms. This type of approach allows schools to decide whether to undertake investments in hygiene, sanitation, and water, and enables them to identify the preferred technology and level of service based on willingness to contribute. A demand-responsive approach will ensure that school staff, children, school hygiene committees, and other important stakeholders participate School children in Guyana (picture by René van Dongen, UNICEF) in the planning, implementation, operation, and maintenance of hygiene, sanitation, and water services. Experience shows that constructing water supply and sanitation facilities is not enough to improve health. Changing hygiene behavior Third, if the existing structure is not conducive to making sustainable is complex and labor intensive, but effective hygiene education can investments in hygiene, sanitation, and water, institutional reform reinforce positive attitudes and behaviors and reduce or prevent may be needed to ensure that the roles and responsibilities of key risks. Therefore, life skills-based hygiene education must accompany stakeholders are defined in such a way that schools (teachers, staff, infrastructure investments if these are to ensure a long-lasting public parents, and children) manage their own facilities, community-based health intervention. organizations, NGOs, or private sector entities provide goods and services, and the government facilitates service provision. Finally, The basic understanding guiding the life skills-based hygiene projects must be promoted and implemented in a broader context that education methodology is that new knowledge does not by definition includes the home and the community. translate into new practices. Hence, life skills-based education seeks to center hygiene practices in children's daily reality, while helping 4 5 them acquire both the knowledge of appropriate hygiene behaviors and the skills to use them. The methodology takes into consideration Adopt a gender-sensitive, child-centered approach that children's learning differs at various stages of their development. that takes into account how boys and girls learn, A hygiene education program that aims to enable children to their everyday reality, and the fact that classes translate knowledge into practice must make these developmental in many schools in developing countries include differences a key consideration in the program design. children of different ages and therefore require flexibility in the use of hygiene education methods. In schools, a life skills-based hygiene education program should Focus on developing skills and attitudes, because become the centerpiece of each school-based hygiene, sanitation, knowledge does not automatically translate and water program. To ensure the effectiveness of the program, it is into practice. important to: Plan on implementing hygiene education over the long term, rather than as a one-off program, to Establish clear objectives, performance indicators, ensure that knowledge is translated into the use and monitoring and evaluation processes. of (new) hygiene practices. Focus on changing a small set of key risk practices. Build on existing beliefs and community practices, It is also important to involve the child's home and community to and seek effective and sustained use of water make sure that the knowledge the children gain in school can be supply, sanitation, and hand washing facilities and transferred into practice in the child's home. Worldwide experience hygiene practices. shows that children can act as potential agents of change within their homes and communities. They can be enthusiastic promoters of the new hygiene skills they have learned, which can ­ depending on the cultural environment ­ promote better hygiene practices in their homes and communities. 6 7 Provide sufficient capacity to ensure minimal waiting time. Technology Choice Use appropriate locations for water supply and sanitation facilities. Four aspects of the physical environment are key: the school's sanitation facilities; its water supply; its methods for disposing of Involve all stakeholders, particularly human waste (feces and urine); and the availability of hand washing the children themselves, in the design facilities. However, the lack of hand washing, water, and sanitation process. facilities is the day-to-day reality of many poor schools in developing Use low-cost solutions without countries. Alternatively, where such facilities do exist, they often are compromising quality. of poor quality: smelly, dark spaces with just a hole in the floor, hand washing basins without soap, and water that is not safe to drink. A number of special concerns should be taken into consideration in the design, construction, and maintenance of hand washing, It is particularly important, when designing facilities, to incorporate the water, and sanitation facilities in schools. Most importantly, facility specific needs of adolescent school girls and female teachers. Toilets design should be child-friendly, gender-sensitive, and mindful of that do not accommodate menstrual management, and that are environmental sustainability. unsafe to use, increase absenteeism among adolescent school girls (a first step toward dropping out of school), offer less protection against The child-friendly approach3 to hand washing, sanitation, and water harassment at school, and reduce girls' overall enjoyment of attending supply facilities aims to design facilities that are part of the learning school. Taking gender-based needs into account from the outset is environment. The guiding principle of this approach is that facilities easy and can make a big difference. should enable, stimulate, and promote appropriate hygiene practices among children. Therefore, facility design should: Environmental sustainability should be an integral part of the design, implementation, operation, and maintenance of school facilities, as well as of the accompanying hygiene education activities. The challenge is to promote awareness of environmental issues Encourage hygienic behavior by stimulating children's surrounding school facilities while providing incentives and tools to learning and development. address them. Schoolsareperfectsettingsforteachingchildrenaboutthe Useappropriatedimensionsandmakeadjustmentssothat environment,andwhattheythemselvescandotoprotectit. facilities accommodate children (both boys and girls). 3For more details see J. Zomerplaag & A. Mooijman, (2005), Child-friendly hygiene and sanitation 8 facilities in schools, IRC, International Water and Sanitation Centre, in cooperation with UNICEF, Delft, the Netherlands. 9 The choice of school toilet technology should be guided by the suitability maintenance system should be of toilet options to local environmental conditions as well as the costs set up in coordination with the and operation and maintenance requirements. Another important school, parents, and community factor to consider is the method (wet or dry) and materials used for anal and consolidated during the cleansing by children attending the school. In areas where stones or implementation phase. corn cobs are used for anal cleansing, for example, one should be aware that these materials will quickly clog the drains of a pour-flush latrine. Operation and maintenance must be taken into consideration In most circumstances, the water supply technology used in the as an integral part of the surrounding community and the local hydro-geological conditions will technology choice: determine which water supply technology or technologies are most A schoolchild's options for anal cleansing appropriate. Cost considerations and the availability of financing options must also be taken into account. If water testing shows that the water supplied through the selected water system is contaminated, some form Consider management and O&M issues as an integral part of treatment will be necessary before students can drink the water. of the community planning and implementation process. Human feces are the primary source of disease transmission among Support formation of School Hygiene Committees for school children, particularly for diarrhea and helminth infections. The planning, implementation, and management of hygiene, degree to which children are exposed to human feces depends on the sanitation and water facilities, involving the parents, type of toilet construction and the cleansing method and materials teachers, and wider community. being used. Ensure long-term support and technical assistance for the Irrespective of the degree of exposure, children should always be management of hygiene, sanitation, and water facilities. taught to wash their hands with soap after defecation. Hand washing Recognize the importance of O&M and the need to is important for good health because it can prevent diarrhea and have a management structure that corresponds to the respiratory infections, the two main causes of school-age children's local context. morbidity. Hand washing with soap is the critical component of this behavior. Where necessary, provide training for O&M. Lack of effective operation and maintenance (O&M) is a major obstacle to achieving sustainable school hygiene, sanitation, and water programs. To address this problem, an operation and 10 11 Financing Options Stakeholder Participation Service expansion in the past has been constrained by insufficient A school hygiene, sanitation, and water project is most likely to be resource allocation and inefficient investments in hygiene education sustainable if all stakeholders participate. To foster representative and programs. Similarly, O&M of existing facilities is hampered by lack of informed participation by all stakeholders, such projects should: capacity to mobilize resources from users, lack of O&M plans, and · Ensure the participation of stakeholders ­ including children ­ at insufficient O&M training. To ensure long-term financial sustainability, all stages of the project cycle, from promotion, application, and school hygiene, sanitation, and water projects should adhere to three implementation through management and monitoring, by establishing basic principles: appropriate project rules, incentives, and social intermediation. · Ensure that the government takes responsibility for the delivery of · Ensure representative and informed participation by all stakeholders, hygiene promotion, capacity building, and training. including teachers, children, and parents. Specific attention should be · Ensure that operation, maintenance, and replacement can be carried given to girls and women to ensure that their specific needs are taken out in a sustainable manner. This implies O&M plans that clearly into account. define responsibilities and monitoring procedures should be prepared · Set rules to ensure that schools located in poorer, more isolated and that those plans should focus on preventive maintenance, with communities and informal schools in urban poor areas are targeted. lists of tasks as well as detailed task schedules. · Set rules to ensure that vulnerable groups such as children with · Establish financial policies that are sustainable, preferably ones in disabilities and children from minority ethnic and social groups which O&M and investment costs are covered by the education will benefit from hygiene, sanitation, and water in schools project budget or a budget provided through the local authorities. If this is not interventions. possible, it is important to obtain parent and school consensus for paying part or all of the investment costs associated with the different design choices. In this connection, information on the costs of the different types of facilities available under a school hygiene, sanitation, and water project will enable and empower parents and schools to make informed choices. However, any fee structure (either in-kind or in cash) should be set up in such a way that it does not hamper the ability of the poor to send their children to school. Coming to a common consensus and agreement 12 13 Capacity Building Contents of the Toolkit Appropriately targeted capacity building is essential to the planning and TheToolkitonHygiene,Sanitation,andWaterinSchoolscanbefoundon implementation of sustainable and demand-responsive school hygiene, theCD-ROMthataccompaniesthisbooklet.Itcanalsobefoundonlineat sanitation, and water projects. In this connection, projects should pay www.schoolsanitation.org.TheToolkitconsistsofthefollowingfivemain special attention to the following: sections: · Building capacity at all levels and understanding that capacity building Whythistoolkit? requires long-term support. ThefirstsectionoftheToolkitprovidesbackgroundinformationon schoolhygiene,sanitation,andwaterandtheirimpactontheMillennium · Targeting training to schools (teachers, students, and parents), DevelopmentGoals. communities, the private sector and NGOs, and different levels of government. Basicprinciples ThispartoftheToolkitdescribesthebasicguidelinesforschoolhygiene, · Defining capacity-building requirements clearly in order to enable all sanitation,andwaterprojectsinsixkeyareas:policyenvironment,life stakeholders to assume their responsibilities. skills-basedhygieneeducation,technologychoice,financingoptions, · Setting realistic objectives that build on locally available capacity and stakeholderparticipation,andcapacitybuilding. knowledge. Sectorassessment · Recognizing that, in most cases, a learning-by-doing approach works Thissectionpresentsanoverviewofthemajoropportunitiesforand best, where training is undertaken in all phases of project intervention constraintsonschoolhygiene,sanitation,andwater,andoutlinesa throughout the project cycle. strategythatdealswiththekeyissuesthatneedtobeaddressedto ensuresuccessfulimplementationofschoolhygiene,sanitation,and waterinterventions. Projectcycle Thispartcontainsastep-by-steppresentationoftheprojectcyclefor schoolhygiene,sanitation,andwaterprojects,emphasizinginteractive processesandfullstakeholderinvolvementfrompromotionthrough evaluation. Resources ThefinalsectionoftheToolkitprovidestheuserwithtools,readings,useful links,andaglossaryforschoolhygiene,sanitation,andwaterprojects. 14 Developing a complete package benefiting all 15