August 2000 as (gd-uhmA iaago This Field Note highlights lessons learned and recommendations for promotion of school sanitation and hygiene, using Uganda as a case. This case study was ~~~~~~ ~~~~commisioned by the Wager and Sanitaion Program for East and Southern Africa The opuon n Unda scool, scifwil at (WSP-ESA) in partnership with UNICEF. It was conducted in collaboration with the The ppuIa X Ug anschots,specifIall a Ministy of Health, and NETWAS in Uganda. primary level, has increased from 2.5 million in 1995 to 6.5 million in 1999, representing a 62 percent increase. This is mainly due to the recent implemeantation of Universal Primary Educaition *UPE) policy, which entiles ol school age children to tre primnary education. While most schools are aldy lacng in basic sanitary facilitNes, this sudden increase has aggravated the situatisn further, causing thm numban ou sudents - a per latrine stance to exceed 700 in same schools. The Government, UNICEF, DAUIDA and other pariners are making all efforts to meet this high denmnd thromgh schoa sanitalion The study aimed at puiting together existing experiences and lessans learned on school sanitation programming and implementation Uganda. The study was based mainly on the Water and Enviromental Sanitation (WES) and the Rural Water and S anitauion (RUWASA) ____ programs supported by UNICEF and DANIDA respectively. The study attempted to: o Create awareness on the need far use af public funds for school sanitation; a " A ; o Review the institutional arrangements in place (policies, strategies, institutions . > - 4 and actors); - ohAnalyze the nature of the interventions, l , which have been put in place, and; oDocument the experiences, lessons learned and recommendations in promoting school sanitation and hygiene. United Nations Children's Fund NIE1FWAS A. Study Methodology This study focussed on the average rural primary school in * Field visits and observation checklists used in Hoima, Uganda. The study looked mainly at classes from primary one Mpigi, Mbale, Maseka and Mbarara districts; and to primary seven; the age range covered can vary between * A review of secondary sources undertaken to confirm some 6-16 years old. To meet the objectives set by the study, both of the information collected by the authors. quantitative and qualitative data were required. Secondary sources used included surveys reports, policy The methods that were used to collect data included structured documents, supervision and monitoring and evaluation interviews with key informants, i.e. government officials, reports as well as written conference papers. donor and private sector representatives, district leaders, extension staff and school management. Other methods Workshops were also organized for key stakeholders to get included: an overview of school sanitation and to corroborate information Focus group discussions led by children, teachers and parents; obtained from other sources. B. Justification for the use of Public Funds in School Sanitation and Hygiene School sanitation and hygiene is a worthwhile investment in absent, or are badly maintained and used, schools become a Uganda for many particular reasons. They include: health hazard. During the 1997-98 cholera epidemic, the Sanitation is a basic human right. convention of the Ugandan government spent 4.3 billion Ugandan Shillings (US Rights of the Child (CRS), which has been ratified by most $3.5 million) in health care costs. The schools were rapidly countries of the world, including Uganda, states that children becoming a place for disease transmission and 560 schools have a right to a safe environment for enhanced leaming, heakh had to be closed due to lack of adequate and acceptable and development of good cifizens. facilities. Schools provide an excellent opportunity to create School dropout and low literacy rates, especially life-long changes in behavior. In Uganda, the among the girl children can be attributed to poor population of students (6.5 million of children, 1999) spends sanitation and health conditions in schools. Girls, on average 180 days in schools, eight hours a day. Other than who are already marginalized in accessing education keep the family environment, schools are the most important places suffering because of inadequate sanitation facilities which of learning for children. Childhood is also the best time for allow them no privacy especially during their menstruation children to learn hygiene behaviors. What children learn in period. The lack of private sanitary facilities for girls primary schools is likely to be applied for the rest of their lives. discourages parents from sending girls to school, contributes to the drop out of girls at puberty, and a contributing factor to Children are effective change agents. What children fewer women teachers who are needed to encourage girls to learn at school they can transfer to their homes, communities attend schools. The low level of literacy among women, as a and to other children at home who are unable to go to school result of girl push-out aggravates prejudices based on for various reasons. These children will later become parents inferiority and superiority complexes between men and women. and will be duty bound to provide a safe and clean By promoting girls' attendance and retention in school, the environment for their own children's development. If children sanitation project influences sound cultural patterns of conduct are brought into the development process as active in future. participants, they can become change agents within their families and catalysts for community development. School sanitation prgrams offer opportunities for participation. It has other socio-economic advantages such Improved hygiene and sanitation is critical to health as empowerment, independence, decision-making, of school children and the community at large. In self-reliance, confidence building, creative development, life reality, schools are often more than just places for learning and skills development and sustainability. behavior change. If school sanitation and hygiene facilities are 2. IMPLEMENTATION STRATEGY AND PROGRESS The political climate in Uganda is now held on 16-17 October 1997. With discussing the issue of sanitation. The encouraging better sanitation as the theme: "Better Sanitation, A culmination of the forum was the attested by: Responsibility for All", the forum signing of The-- Kampala 1.The holding of the National brought together the leadership of all Declaration on Sanitation Sanitation Forum: The most 45 Districts in Uganda who, together (1997) by the Chairmen of the important achievement in the evolution with Members of Parliament, donors, District Councils. of sanitation in Uganda has been the Non-governmental agencies and national Sanitation Forum, which was concerned citizens spent two days The main output of the fonum was the 2 Safe drinking water Washing hands been the subject of over 600 newspaper articles in the national press since the beginning of 1998. \ h W.J)>,,,,,,,,d Home and school improvement. competitions are being held. Schools have build latrines and hand washing facilities; teachers have been trained in t the establishment of sanitation and health clubs. Private entrepreneurs are a isposal of efuse setting up businesses to recycle 5 Disposal of refuse /g285\g garbage. The visit of President Bill Clinton of the United States of America led to a massive clean up Kampala campaign led personally by the First Lady, Mrs. Janet Museveni. Sanitation promotion also features high in the manifestos of all the Kampala City Pit latrine with hand washing facility mayoral aspirants. Box 1 4. Redefinition of Sanitation: 10-point strategy program of which develop new approaches and a Working in close collaboration with school sanitation was a priority in the concept paper entitled "Promotion of DANIDA, UNICEF, WHO and the action point number 5, which states that: Sanitation in Uganda". This concept Water and Sanitation Program Group paper is the most comprehensive in Nairobi, the approach to sanitation "We shall ensure that every primary statement on sanitation ever written in for the entire country was redefined. school and all other institutions of the country. It covers the global The definition of sanitation was learning have adequate sanitation situation and the history of sanitation in broadened from the mere provision of facilities (latrines, safe drinking water Uganda. latrine slabs to a wider concept of supply and hand-washing facilities; environmental sanitation (excreta with separate facilities for girls) by the 3. Sanitation remains high on disposal, solid waste disposal, liquid end of 1998" the national agenda. waste disposal, hygiene control and The President's 1996-election vector control). Box 1 above shows the 2.The formation of a sanitation manifesto promised the electorate main components of school sanitation task force: The force was set up to improved sanitation. Sanitation has definition in Uganda. 3. INSTITUTIONAL ARRANGEMENTS A. Public Institutions involved in School Sanitation: centralized department with environmental health officers It has always been a policy in Uganda, as far as possible, to posted in each district and urban authority. At present, integrate water source development, sanitation promotion and the role of the division is being redefined with a view of community empowerment for sustainable community ownership, strengthening its capacity to support local governments to ufilizafion and maintenance of installed facilifies/services. As a result improve environmental sanitation. Officers who used to there exist a number of line ministries involved in sanitation. The belong to the division now belong to their District co-ordination is done at national level through the Inter- LocalGovernments. These officers and assistants are trained Ministerial Steering Committee (IMSC) and Project in the Schools of Hygiene as Health Inspectors and Management Teams (PMTs) to provide an enabling HealthAssistants and their job is to carry out mobilization environment in aspects of policy devel-opment, technical assis- and training activities at community level, including mobilizafion tance, quality assurance and monitoring and evaluation. These for school sanitafion and hygiene education. frameworks have greatly assisted/promoted the multi-sectoral collaboration and lobbying needed for policy reforms. The * The Ministry of Gender, labour and Social IMSC comprises the highest-ranking civil servants, i.e. Development through the Directorate of Gender and Permanent Secretaries from each of the ministries mentioned Community Development and district staff is responsible for social earlier with their technical heads of department as ex-officials mobilization and promotion of the role of women in sanitation do. Below are outlined the main responsibilities of each institu- improvement inifiatives. District level officers for the rural water tion: and sanitafion sub-sector are mainly traine by the Institute of Social Development, as Community Development The Environmental Health Division in the Assistants. Ministry of Health has the overall responsibility for environmental sanitation improvement. Before the ongoing * The Ministry of Education through its Inspectorote policy reforms, the division had operated as a traditional Department plays a role in enforcement of Government policy 3 through guidance, supervision and monitoring. It also plays is mainly an executive committee in charge of the day to day a role in the promotion of national syllabus that supports and running of the school. Problems occur between communities teaches sanitation and hygiene. and schools when a shared water source is left to the school to repair or when community members come to use * The Ministry of Water, Lands and Environment the school latrines and foul them. (MWLE) is also, to date, is the main institution involved in sanitation promotion and it is represented by its Directorate B. Private Sector Involvement of Water Development (DWD) through its two main programs The private sector is both one of the main strategies as well namely, as being an institution that the program is using. This is insupport of the Government policy on privatization.The use i) WES/UNICEF (1995-2000) covering 34 districts with a total of the private sector for school sanitation is a very new venture, budget of US$ 27 million; and of not more than a year old. ii) RUWASA/DANIDA (1996-2000) covering 10 districts with Initially the public sector was in charge of constructing the a total budget of US$ 40 million. school facilities. However, some problems were encountered. They included latrine construction in most cases was very slow * Other Government Projects include Small Town Water and inefficient and some latrines collapsed due to the fact that and Sanitation Project (STWSP) and Eastern Centers,which they were sited badly and because technical staff did not are involved in sanitation improvement programs in both supervise construction of the latrines. rural and urban settlements. NGOs such as ActionAid, AMREF, WaterAid, AVIS and Uganda Community Because of these reasons, there was a need to build capacity for BaseHealth Care Association (UCBHCA) are also the private sector to get them involved both in latrine construction involved insanitation improvement programs, including and latrine construction supervision. The private sector is community capacity building. also involved in development, production, and dissemination of appropriate sanitation materials as well as skills development for * At the District level ,the responsibility is borne by the sanitation service delivery and advocacy. Department responsible for health services competing with Under the school sanitation program, private contractors under- other health services like immunization, HIV/AIDS, take all latrine construction work except digging the pit, which nutrition,andMCH. At district level, sanitation activities are is done by the school community. The District Tender Boards coordinated through respective sectoral committees of LCV e.g. advertise and invite tenders following the Government Works, Social Services, Health and district management tendering procedures. Sub-counties are encouraged to employ teams with responsibility far planning, budgeting, supervision and local contractors to take up construction work. The role at the nation- monitoring implementation. The water components come uondeoring themterSection, whiheis usually hopousedn te al level is to support districts to strengthen the tendering processes, Woerk DhepWartmr Sent. on, which is usually housed in the assist in preparation of tender documents for certification and Works Department. payment and supervision. * At sub-county level, the responsibility for water and C. Implementation Arrangements for School sanitation falls mainly on the extension staff, namely health Sanitation assistantsand community development assistants. There are Below is the implementation frame work of the program. also sectoral committee members for health and education as well~ aslclNO nC . Thru-onycifas The following key issues are made sure all throughout the as well as local NGOs andCBOs. The sub-county chief also poes plays an important role by mainly enforcing by-laws and government policy. * Continuous involvement of all stakeholders (central and local * At parish and Village level, woter and sanitation is the governments, bilateral and multilateral agencies, private sec- responsibility of PDCs, local council secretariesfor tor and community members) ensuring the confinuity of both the health,school management committees and water and sanita- process and benefits arising from the school sanitation promotion. teionsho mngmn committees.adwtran aia tion committees. * Ensuring that sanitation promotion remains a highly political • At schooLs and community levels, Parents-Teachers process. The target is to reach and mobilize resources of all elected officials in Uganda from the President and the Associations (PTAs) form the interface between the community eetdofcasi gnafo h rsdn n h Aoandtieschoons.(PTA orm exsth insterface naltrust between thecCabinet, to village chairpersons secretaries. The local councils and the schools. There exists institutional trust between are recognized as vital institutions with their main role being in schols ad PTs sown y th fac tht insomecommni- planning, monitoring and resource allocation. ties,when given a choice of where to locate a water source, they choose the school compound or a place near the schol. omecomuniiesoffr lnd ar xpasio ofthe * Applying a demand driven and bottom up approach. This school and contribute labo fr the exponsion. Although the approach is proven by the fact that the school expresses their demand by filling in application forms and sending PTAs role, especially in paying teachers was redefined in 1996, them to the district. It also ensures that all partners commit they still operate alongside the School Management themselves to play their roles, such as digging the pit for Committees (SMC). There are also good relations between I the School Management Committees and the schools.The SMC example. 4 Implementation Framework school sanitation activities. Some - -. ~ ~ of the materials developed are: Advocacy and Information Phase School sanitation guidelines Meetings are held to distribute application forms to schools through - Teachers training facilitators the local councils ILCIII) chairpersons and sub-county chiefs. The mass media are also utilized in disseminating information about guide. the program _ _ Posters and hygiene and sanitafion - _~ _ _ ______participatory tools. Application and Vetting Head teachers apply to the Chief Administrative Officer (CAOQ through their Sub-county Chiefs. The CAO submits the list of application to the District Vetting Committee (District Technical Committee and Sectoral Standing Committee for Health . _ and Education) for approval. .- LII7 1171 . Approval and Workplanning A list of approved schools is then sent to the Director-DWD and copied to the focal point officers in the line Ministries (i.e. Health, Education, Lacal Government, Gender and Finance). The director compiles submissions into quarterly requests to the Ministry of finance, Planning, Economic Development to release 1_ * - Release of Funds X 4 ., aMinistry of Finance and Economic Development releases funds to the - s 1 respective districts. The CAO infarms the Sub-county Chiefs who advises - The districts hire the private contractors to undertake construction. . * .....i The County Health Inspector and the Sub-county LCIII Chairperson are also made aware. f __i ioftware l l ' Construction of Hardware 2 Output 2: Development of a more Teachers' Training: The Two blocks of 5 stances latrine for boys sanitation sensitive school curriculum. I CAO invites three school and girls teachers from each selected Handwashing facilities A u school for a one-day sanita- I Rainwater tanks Actvities undertaken to achieve output: tion ond hygiene workshop. a -- Sanitation messages have already been National Mass Media Quality Assurance | incorporated in the national school Campaign When the pit has been dug, the District Health science curriculum. There has also been Inspector and the District Engineer are responsi- an attempt to integrate hygiene and ble for certification and quality assuranc ._____._____.__ ______________ sanitation into other subjects and ll Follow- up and Monitoring examinations. Nationol and district teams carry out regular spot checks, follow-up and monitor activities for both hardware and software aspects. Auditors Output 3: Development of effective monitor progress on a quarterly basis. In addi- monitoring systems and indicators. tion, sub-country chief and political leaders mon- itor quality and the progress of the work. Activities undertaken to achieve output: Monitoring indicators have been 4. EXPECTED OUPUTS OF THE developed and are being used by the inspectorate of education staff. ONGOING ACTIVITIES Monitoring is being done at four levels: * Management information systems, The Government, UNICEF, DANIDA and other partners have initiated school spot checks, surveys, reviews are sanitation programs countrywide. Below are some of the desired outputs with respect used at the national level to the various activities: * Spot checks and supervisory visits Output 1: Better hygienic practices at attempt to inform, persuade and by District Health Inspectors, various levels and higher level of parficipation. motivate sanitation and hygiene District Education Officers, District behavioral change in children, Inspector of Schools, District Water Activities undertaken to achieve output teachers and decision-makers. The Officer at the District level * Ptimary school teachers' development of a sanitation news * Spot checks and report verification tmining with an emphasis on page for advocacy was started in from the politicians. providing them with participatory tools three of the leading daily newspapers. * Monthly reports done by the to teach children in a more * Mobilization of political extension staff at sub-county level. effective manner. Teachers leadership for school sanitation are taught where and how to apply as a process of passing on salient for assistance, how to ensure pupils information to relevant stakeholders Output 4: Provision of Sanitary facilities practice hygiene behavior and in order to solicit their support, to the schools. how to mobilize community participation and commitment to members. school sanitation activities. Activities undertaken to achieve output: * School sanitation mass * Development of sanitation The programs mainly support the media campaigns as an materials in support of the provision of latrines while taking into 5 consideration the gender perspectives. In UNICEF supported programs, two blocks of five stance latrines are provid- ed (with urinals for boys and no urinals for girls), alongside with hand-washing facilities of two hundred litres each. .^.-; I Rainwater tanks are provided to schools O that are distant from other visible water * sources. The difference between RUWASA and UNICEF programs is the provision of extra stance for girls. The UNICEF program aims for 25 per cent coverage of UPE supported schools for 34 districts and RUWASA covers 50 percent for 10 . I districts. a lb The dimensions and design criteria are mainly bosed on what is common usage around Uganda to ensure optimum use of the facilities. The construction is Sanitation activities in a school yard carried out by private contractors selected through a competitive tender Activities undertaken to achieve output. latrines, hand washing and water system by the District Tender Board and * Software activities are planned to supply facilities. local masons in some districts selected precede the hardware ones and * The convergence between software by the School Management Committee are designed to support hardware and hardware takes place at planning Chairman, the Head Teacher and LC II activities. Far example, mobilization meetings where both hard Chairperson. Some schools provide activities that entail advocacy ware and software personnel share bathrooms for girls on their own and information awareness, mass their plans and to try to harmonize initiative. media campaigns, training of them. At district level, this happens teachers. at the district management team Output 5: An Integrated Software and * Hardware activities entail providing meetings. Hardware Approach. assistance for construction of __ 5_ FINANCIAL ASPECTS OF THE PROGRAMS The main funding sources include donors, like SIDA, DANIDA, UNICEF and the World Bank. The Central Government, district local governments and donors pay for all materials, skilled labor, and hand washing facilities and rainwater tanks. Below is the breakdown of the unit costs of the sanitation and hygiene package used by WES-UNICEF. The costs are based upon the assumption that the latrines are constructed on stable soil formations. Table 1: Unit Costs used by WES-UNICEF (February 2000) Decils Ugandon Shillin US Dolars Donor Community /Govenment /School One block of 5 stances latrines 2,085,484 1,600 85 % (UNICEF) 15% Hand washing facilities 91 % (RUWASAI 9% ( RUWASAI Roinwater tonks 110,000 litre) 1,800,000 1,200 87% 13% Training for 3 teachers 150,000 100 100% 0% Production of materials for 3 45,000 10 100% 0% teachers Nationol mass media compoign 100,000 67,000 100% 0% 6 6. RESULTS AND IMPACTS Impact assessment has not been done yet This shows that they are beginning to reviewed. because the program is still in the early appreciate the importance of sanitation. * The monitoring checklists at the stage. However, internal and external * Involvement of the politicians in the school level though effective have monitoring exercises are on going and sanitation program has resulted in proven to be time consuming. the results outlined below are based on better physical and financial When used, there is insufficient the stated activities in the study: accountability as well as increased feedback for appropriate actions to * The teacher-training program was implementation in some districts. be taken. reported to be good in terms of content and delivery, and very * Some districts have gone ahead to * Integration between software and relevant to the school sanitation recruit more staff to fill in vacancies hardware components exists needs. After the training, the of health and community although priority and resources are teachers reported to have been development staff so as to give more still skewed towards hardware able to convince their head teachers to water and sanitation activities such as latrine ers to buy hand-washing facilities. development. construction and borehole drilling. However it was observed that the Funds are for use on tangible, physical one-day duration of the training is * Latrines that UNICEF and RUWASA outputs whereas software activitiies not sufficient for the teachers to provided have a life span of 5 rarely have physical outputs to internalize and share diverse years and there are no mechanisms claim in the short run. experiences that exist in different set in place to ensure they are schools. The teachers trained felt either emptied or replaced. * Integration becomes difficult when that the training was beneficial and hygiene lessons on sanitation are they proposed that it should be * Communities have been mobilized given in class, but the school does extended to two days and should to play their roles as is evidenced not have the required facilities. For include more teachers. by the contributions that they make example, many lessons emphasize towards the construction of latrines. washing hands but most schools do * Monitoring checklists used by the It must be said however, some not have water nearby. Drinking educational staff have revealed communities contribute unwillingly water is not available let alone for some behavior change in the or often not all as they have often washing hands because very few community overall. There has been the wrong understanding of their schools have water within a reasonable an increased appreciation of the responsibilifies in the school activifies. distance (0.5 km). Others have habit of hand washing, and an water latrines that are very understanding of the safe water * In general, there is insufficient dangerous structurally and hazardous chain. However, the hardware part monitoring and supervision at the hygienically. So such messages like of the program is more appreciated national level. Monitoring and 'use the latrine' become difficult to and requested. evaluation unit in the Directorate of translate into practice. The reverse is Water Development developed a true for hardware installations without * The study confirms high levels of set of survey tools for WES - supportive software inputs. For pupil knowledge of hygiene and Management Information System in example, many schools have sanitation issues with the main 1998. However, it is a very handwashing facilities locked up in source of information being the comprehensive tool but its efficient their stores because they fail to schools. However, translation into and effective use needs to be understand the value of washing behavior still remains too low to hands. show significant results. In all the _ schools visited, the pupils were LESSONS LEARNED FROM generally clean, and those interviewed DY were aware of the problems associated THE STU with poor sanitation and how to improve on the school environmental Lessons are to be extracted from the benefits alone. They also promoted sanitation. In addition, hygiene weaknesses and successes of the values of self-esteem, recognition knowledgewas very high, although Ugandan approach to school sanitation and accepted status in the society. practice is still low,.n hyiene. High level political commitment * Schools have to be considered in a established through advocacy is holistic perspective, where * The teachers also reported some the key to successful implementation classrooms, urinals, latrines, hand linkages and impact on the surrounding of SSH interventions. washing facilities and water supply rounding community. The said that sources are all dassified as sanitary if they observe pupils with problems * High level of pupils' knowledge of requirements. like being always dirty or with hygiene and sanitation issues does jiggers and lice, they investigate not ensure change in behavior. * Follow up and supervision is further by going to the children's necessary for the progress of home. Very often they would link * Regular supervision, follow up and activities, as well as ensuring that up these results with poverty or a monitoring are essential for proper the teachers applied the weak family structure (old grand operation and maintenance. participatory tools that were used parents). * Gender-sensitivity is essenfial when during the training. implementing school sanitation and * Working through existing institutions * It has also been established that hygiene activities. rather than creating specific districts and sub-counties are now structures ensures ownership, beginning to plan and budget for * Sanitation and hygiene promotion capacity and sustainability of the sanitation from their own resources. messages did not focus on health activities.Institutions that exist are -7 more legihmate becouse they have encourage girls to a-tend school01.s.; ; statutory powers and are governed by laws of Uganda. This makes * The participation and willingness East and Southern ¶I;.w them more accountable and of the schools, school management The World Bank reliable. teams, and teachers especially head teachers to take part in the * There are too many players project are crucial. involved in sanitation leading o to' Ig.b3Y weakness in coordination and * Political interference in the tendering i assumption of responsibility. process results in delays and quality Telephone: iP TWIKIFF control problems. Facsimile: zfMrM * There is need for a decentralization of resources. Resources are not * Effecfive participation ensures project Web site www.wsp.org reaching the intended beneficiaries activities relevancy and sustainability. E-mail vm.iorc lll " ITTMI in the amounts expected to make a Communities should contribute in difference. There is need to further whichever way that they can to the decentralize resources so that they acquisition of new sanitation can move from the district level to facilities. the sub-county. * Monitoring and Evaluation tools in * Training of teachers should include the school should be simple to use at least one female teacher in each and should take very little time. school, as they are needed to 8. THE WAY FORWARD Based on the results of the study, a concemed, number of recommendations were - Invest more in the private sector for made to improve the current school cost-effective implementation and sanitation and hygiene promotion, capacity building, and using Uganda as a case study. - Reinforce the Local Government Act which prohibits political interference 1. More advocacy and social in the tendering process should also nmriceting is needed to: enhance private sector involvement. - Ensure that political support and commitment continues, 3. Sustainability and use of hard i - Enhance effective hygiene and ware should be achieved sanitation promotion in schools and through: the community at large, - Exploration of technological options I - Increase sector partners support for that could be more children friendly I school sanitation programs if cover as well as giving choices to I age is to be realized and sustained, schools, and Provision of technologies for the I - Ensure that communities are aware disabled children in all schools, and of their roles and responsibilities in - Availability of physical facilities UPE implementation activities. for teachers to assume their I responsibilities as role models. 2. More capacity builcing acivities Written by: should be undertaken to: 4.Software and participatory Agnes Bitature - Increase coverage of teachers approaches should be integrtated trained with a special focus on the - In order to prioritize them at all levels Myriom Sidibe female teachers, since behavioral change calls for - Develop mechanisms that ensure continual reinforcement of hygiene Reviewed by: that students are involved in school messsages, and sanitation activities in order for them - Diversification of approaches and Rose Lidonde to adopt improved hygiene target groups is required to promote John Odolon behaviors. and sustain good use, operation and at schools and at household level, maintenance of facilities. - Develop strategies that involve Design Concept by: beneciaries in national level 5. Monitoring and evakution should Drile Victor management to ensure sustainability focus on: Timothy Kiwala and local capacity building, - The development of simpler monitoring - Develop a multi-sectoral approach checklists for educational staff and Njeri Gicheru to enhance impact as educafion, nutrition ensuring that quality control mechanisms ! and health are linked to water supply are established at all levels, and Producton by. and sanitation, - The provision of more staff at the Grod hct - Work on the syllabus to incorporate sub-county level in order to accomplish Kul Graphics gender sensitivity and emphasis on the monitoring activities. using soap where hand washing is August 2000 8