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The WASH in Schools

Situation across the East


Asia Pacific Region:
A preliminary look
BRIEF ON THE WASH IN SCHOOLS SITUATION
EAST ASIA PACIFIC REGION
Acronyms

ACRONYMS III

BRIEF ON THE WASH IN SCHOOLS SITUATION IN THE EAST ASIA PACIFIC REGION IV
School and Community WASH Linkages v
Life Skills Based Education v
Technology vii
Institutional Setting & Co-ordination vii
Financing Options vii
Partnerships & Stakeholder Participation viii
UNICEF WASH in Schools viii

SUMMARY OF THE UNICEF WASH IN SCHOOLS PROJECT COUNTRY STATUS SURVEY XI

ii Brief on the WASH in Schools Situation in the East Asia Pacific Region
Acronyms
AI Avian Influenza
ARI Acute Respiratory Infection
CFS Child Friendly School
EPRP Emergency Preparedness and Response Plan
FRESH Focusing Resources on Effective School Health
IEC Information, Education, and Communication
INGO International Non-governmental Organisation
JICA Japan International Cooperation Agency
LSBE Life Skills Based Education
LoA Letter of Agreement
MDGs Millennium Development Goals
MNE Multinational Enterprise
MoE Ministry of Education
MoET Ministry of Education and Training
MoH Ministry of Health
MoPH Ministry of Public Health
MoU Memorandum of Understanding
MTSP Medium-term Strategic Plan
NGO Non-governmental Organisation
PBA Programme Based Approach
PTA Parent Teacher Association
UNICEF United Nations Children's Fund
UNESCO United Nations Education, Scientific, and Cultural Organization
WASH Water, Sanitation, and Hygiene
WES Water and Sanitation
WHO World Health Organization

iii Brief on the WASH in Schools Situation in the East Asia Pacific Region
Brief on the WASH in Schools Situation in the East Asia Pacific Region
The positive effects of maintaining child-friendly standards of water, sanitation and hygiene in school
abound. Water and sanitation-related diseases including diarrhoea and worm infections among school
children, staff and family members decrease; healthy environments add to the quality of education and
enhance the learning environment, girls are more likely to attend and complete a full cycle of schooling,
and children learn positive hygiene practices that can influence sustainable changes in the community.

In spite of the anecdotal and quantitative evidence proving the benefits of water, sanitation and hygiene
(WASH) in schools, the East Asia Pacific (EAP) region is characterised by inadequate water supply,
sanitation and hygiene education in schools, particularly in rural and impoverished communities. While
the Millennium Development Goal (MDG) targets of increased school enrolment and gender parity are on
track in some countries, the number of school children with access to an adequate amount of safe water
and clean, private latrines lags far behind. This has to change. Water, sanitation and hygiene in schools is
a pre-requisite for meeting and sustaining the MDGs of achieving universal primary education, promoting
gender equality and reducing child mortality. ‘Vision 21’ includes a target of 80 per cent of primary
schoolchildren receiving hygiene and facilities for sanitation and handwashing by 2015. Strategy 8 of the
‘Dakar Framework for Action’ produced at the World Education Forum in 2000 is to create safe, healthy,
inclusive and equitably resourced educational environments.

According to the UNICEF ‘Water, sanitation and hygiene strategies for 2006-2015’, the overall objective
of UNICEF in WASH is to contribute to the realisation of children’s rights to survival and development
through global and national promotion of sector investment and support to programmes that increase
equitable and sustainable access to, and use of, safe water and basic sanitation services, and promote
improved hygiene. UNICEF aims to work in close partnership with UN sister agencies in support of
nationally identified priorities evolving from national development plans in support of accelerated
achievement of the MDGs.1

For the 10-year period 2006 to 2015, UNICEF support for WASH in schools will be guided by two
overarching targets, which have been widely recognised by governments and the international
community:

h Target 1: Halve, by 2015, the proportion of people without sustainable access to safe drinking water
and basic sanitation (Millennium Development Goal 7: Target 10).

h Target 2: Ensure that all schools have adequate child-friendly water and sanitation facilities and
hygiene education programmes (now widely recognised as a sector priority — endorsed at the World
Summit for Sustainable Development and by the Commission for Sustainable Development).2

The revised WASH strategies have been developed in tandem with the formulation of the ‘UNICEF
medium-term strategic plan (MTSP) 2006-2009’ and are designed to directly contribute to the MTSP
targets in the focus areas of young child survival and development and basic education and gender
equality. Children commonly miss school because they are too busy hauling water or are at home sick
with a water-related disease. Girls, particularly those who have reached the age of menses, often drop
out of school when toilet and washing facilities are not private, are unsafe or non-existent. Even when
children attend school, they scarcely reach their full learning potential because of development problems
caused by worm infections and diarrhoea.

As a key strategy in meeting children’s rights to quality education and ensuring the attainment of core
learning outcomes, UNICEF has long supported the provision of water, sanitation and hygiene education

1
United Nations Children’s Fund, UNICEF water, sanitation and hygiene strategies for 2006-2015, UNICEF, New York, 2006, p. 7-8.
2
The Plan of Implementation of the World Summit on Sustainable Development emphasises sanitation in schools as a priority
action. The 13th Session of the United Nations Commission on Sustainable Development in 2005 reiterated this position and also
emphasised the need for hygiene education in schools.

iv Brief on the WASH in Schools Situation in the East Asia Pacific Region
in school systems across the EAP region. In recognition of the impact of school-based water and
sanitation interventions on educational access, attendance and learning environment and process,
UNICEF’s ‘Education Strategy for 2006-2015’ clearly highlights ‘life-skills based’ water, sanitation and
hygiene education as a global priority. Furthermore, the provision of appropriate hygiene facilities and
supplies in schools is identified within the strategy as an important contribution to achieving a holistic
Child Friendly School model. Water and sanitation (WES) programmes across the region have set aside
resources to improve the health of children through increased access to facilities for sanitation and hand-
washing in schools.

The UNICEF East Asia Pacific Regional Office conducted a survey on WASH in Schools activities in 11
EAP countries. The following are summaries of the key findings in the areas of School and Community
WASH Linkages, Life Skills Based Education, Technology, Institutional Setting & Co-ordination, Financing
Options, Partnerships & Stakeholder Participation, and UNICEF WASH in Schools projects.

School and Community WASH Linkages


Putting school WASH policy into practice demands stronger linkages between WASH in schools and
WASH in communities. In areas such as Mongolia the schools are connected to community water
sources, hence when the community is lacking in water supply so are the schools. Whenever Myanmar
supplies WES to schools it supplies the same to communities. In Viet Nam parents contribute to the
operation and maintenance (O&M) costs of sanitation facilities. In the tsunami-affected areas of Thailand,
hygiene promotion campaigns targeted school children and their communities. In Bangladesh, school
girls from the slums participated in monitoring the sanitation situation in their neighbourhood. These are
all good examples of how UNICEF country offices have successfully linked school and community WASH.

Still, more needs to be done. An untapped force lies within parents and Parent Teacher Associations
(PTAs). According to the 11 EAP countries that participated in an EAPRO survey to summarise the
WASH in schools efforts across the region, 70 per cent reported functioning PTAs – however, the main
function was the operation and maintenance of facilities. PTA meetings can be an optimal place to get
parents involved in planning school hygiene activities for children, while educating and motivating them to
adopt positive hygiene behaviours that can impact the community on a larger scale.

In Myanmar the community has been involved in, and exposed to hygiene messages through the mass
media. The country office collaborated with the film censor Boards to make an agreement for short
advertising spots in every picture on WASH, free of charge. The Motion Picture Association also agreed
that when artists shoot films, they would contribute some time to producing a short advertising spot on
health and hygiene issues. Myanmar has kept artists involved and interested in this initiative by inviting
them to the opening of, for example, water systems.

In the case of Myanmar, linking community and school WASH was done through a public-private
partnership in which services where donated. Commonly, a challenge countries face forming school and
community WASH linkages is funding. How can school and community WASH be jointly implemented
when projects funds/plans for the two are separate? Some possible solutions are piloting a holistic
approach to school and community WASH on a decentralised level; getting households actively involved
in assessing and monitoring the WASH situation in the community and school, balancing the investment
in technology for schools and communities; plan for schools ability to provide water to the community; and
aligning external plans and investment on school and community WASH.

Life Skills Based Education


Life skills based education (LSBE) with a hygiene focus is one element supporting the behaviour change
communication component of WASH in schools. It is often referred to as the “software”, while water
supply and sanitation is the “hardware”. Life skills based education increases school children’s knowledge
on hygiene and encourage them to form new attitudes and adopt positive hygiene behaviours. In the 11
EAP countries hygiene is most commonly taught in Hygiene and Health classes, in the primary school

v Brief on the WASH in Schools Situation in the East Asia Pacific Region
level. The most popular risk practices targeted are handwashing with soap and the safe disposal of
human excreta.

While children are exposed to hygiene messages it does not always translate to a demonstration of
knowledge – internalised learning based on fact, experience or traditional belief – or behaviour change.
Some key knowledge challenges in addressing the priority hygiene behaviours of school-age children
reported include the safe disposal of human excreta not practiced at home; and that children don’t know
handwashing with soap prevents diseases. The key practice challenges include an inadequate amount of
clean water and soap at school. In this case the knowledge and practice challenges are inextricably
linked: Children cannot internalise the concept that handwashing with soap is an important hygiene
practice, if soap and clean water is not available. Hygiene promotion through LSBE has to be supported
with supplies and services. A component of routine (and more recently Avian Influenza) support to WASH
in schools, are the supply of Hygiene Kits to schools (some include soap), which countries such as Lao,
Thailand, and Myanmar have refined or developed to include teaching aides for teachers and students.

Children’s participation in LBSE is overwhelmingly reported as attending hygiene classes (73%). This
participation can be meaningful depending on the teaching methodology and learning materials used. In
Indonesia, 200 school WASH programmes have established child health clubs where students monitor
the hygiene behaviours of their community. Every sixth grader is responsible to monitor a dozen
neighbouring households. Students developed indicators of hygiene practices through school-level
hygiene assessment and planning. In Viet Nam, children actively participate in monitoring for correct use,
maintenance and advocacy. These are good examples of child participation in hygiene-related LSBE.
Another factor in participation is the chosen communication channels. For hygiene promotion in schools
the most common are flip charts and story cards. Thailand is the only country that uses puppets, a
tremendous tool for education. Because of the puppet’s independence from the human agent, it can
convey emotion without causing embarrassment, it can deal with taboo issues without causing shame,
and it can overcome stigmas linked to discussing sensitive and controversial issues without incurring
blame or recriminations.3

Some countries are tying school sanitation to Avian/Pandemic Influenza (AI) preparedness. Thailand
recently launched its school AI campaign using posters and textbooks for various grade levels. The
implementation process began with a series of workshops and trainings to 1) develop Emergency
Preparedness and Response Plans (EPRPs) for schools, 2) develop life-skills based hygiene education
curriculum for Grades K-12 on Avian influenza and an EPRP, and 3) orient and train on EPRP. The pilot
took place at 39 schools in 17 provinces was followed by a 10 October 2006 launch with the Ministry of
Education, and Ministry of Public Health. This process took from eight to nine months and targeted risk
practices such as handwashing with soap, which not only helps prevent Avian Influenza, but dramatically
reduces incidences of diarrhoea and other sanitation-related diseases.

A challenge with LBSE is that it is difficult to maintain students’ interest especially with the ‘taught’ and
‘caught’ curriculum common to hygiene promotion in schools. We expect a lot from LBSE (in terms of
behaviour change) and perhaps we need to be more realistic in what can be accomplished within the
confines of the school. Many of the country offices recognise the need to improve school hygiene
education and are doing so through teacher training on child-centred learning methodologies. We have
identified a great need to develop hygiene education curriculum based on competencies expected in
children by age, which requires a more unit-based planning of lessons rather then the planning of
separate lessons. The UNICEF East Asia Pacific Regional Office has collected “early learning standards”
from eight countries in the region to initiate this process.

Besides health and hygiene education in the curriculum, it also important to have the same included in
the teacher training curriculum. In Viet Nam, this shortcoming was identified, and the WES & Education
sections are working with Ministry of Education & Training (MoET) for the development of a teacher’s
guidebook on this. In Myanmar, LSBE training has been incorporated into the standardised- and follow-up

3
AREPP: Theatre for Life Trust, Introduction to simple puppetry techniques: Participatory Puppet Projects for Classroom and
Community Activities, Capetown, 2004, p. 7.

vi Brief on the WASH in Schools Situation in the East Asia Pacific Region
teacher training at teacher’s colleges. In Indonesia, information, education and communication (IEC)
materials (some based on competencies) have been developed for WASH in schools. In the Democratic
People’s Republic of Korea (DPRK), where the WASH programme is relatively new, UNICEF assisted the
Ministry of Education with a workshop introducing the concept of life skills based education.

Technology
Choice of technology depends on available financial resources, national and local standards,
implementation of the Child Friendly School model, and climatic conditions. In the DPRK, winter
temperatures range from -0°C to 25°C. Mongolia and China have similarly low temperatures. Materials
used for constructing wells, the size and shape of water storage tanks, the treatment of water, and types
of concrete used for latrine pits vary from cold- to warm-weather areas. Supplying heaters to warm water
for handwashing is an issue as children are more likely to wash hands at critical times if the water is not
cold. In the southern part of the EAP region, droughts and monsoons affect technology choice. Myanmar
receives about 5,000 mm (197 in) of rain annually. The country office has capitalised on this climatic
condition by installing rainwater collection equipment to provide water in schools and communities. Even
with the many variables in technology choice the most common water sources to schools are hand
pumps and tap water. Several countries have experience with the use of simple water quality tests kits
such as H2S strips, which were used in Viet Nam.

Some countries fully implement the UNICEF Child Friendly School (CFS) model in their technology
choices for school water and sanitation design. The CFS model is the gold standard but has implications
of cost, cultural relevance, and stakeholder preference. In Viet Nam children reported that a child-friendly
latrine was one that is safe to access, well-lit and ventilated, nice and safe to use, and at the right place.
Consultations with children, teachers and technical staff led to the design and implementation of a child-
friendly latrine design which the Ministry of Education and Technology (MoET) plans to adopt as a
national standard. This design is more costly than the general school latrine, but is an outcome of
stakeholder consultations. The benefits are twofold: the latrines are more likely to be used, and the
participatory process helps create an informed demand for WES facilities in Viet Nam.

Institutional Setting & Co-ordination


Co-ordination and creating an enabling environment poses specific challenges for WASH in schools as it
is a cross-cutting initiative. Of the 11 EAP countries, most reported that national water and sanitation
policies exist; only 20 per cent reported that none were in place. The most common co-ordination
mechanisms are local organisations and inter-ministerial groups. Co-ordination must emerge as a priority
in order to bridge the Ministry of (Public) Health, Ministry of Education, and other relevant governmental
departments in the planning, implementation, and sustaining of WASH in schools. We must define the
roles and responsibilities of key ministries either through a formal Memorandum of Understanding (MoU),
Letter of Agreement (LoA), or verbal acknowledgement of who does what. New partners must be
engaged in the government, private sector and community as the first step in facilitating co-ordination.

Financing Options
Capital costs includes the construction of new schools and rehabilitation of existing schools; and
purchasing and installing furniture, equipment, heaters, latrines, water connections and hand pumps.
These costs vary from school-to-school but are mostly covered by UNICEF project funds. In Myanmar the
PTA splits the financing of capital costs with UNICEF. Advocacy with donors must take front-and-centre in
the event that the construction of a CFS latrine costs more than a general school latrine, and to promote a
balance between funding for WASH in schools and communities. In addition, public-private partnerships
should be further explored to diversify the capital structure of water and sanitation financing. A good
example of this is the Coca-Cola Philippines ‘Little Red Schoolhouse’ project, in which not only schools
were built but water and sanitation facilities were provided. While UNICEF may not be funding WASH in
schools in all areas, it’s still the role of the agency to influence policy, build capacity and create enabling
environments.

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Funding for operations and maintenance (O&M) is also a factor in WASH in schools financing. It is
important to consider what has to be paid and who can contribute. These questions are vital to planning
as the O&M of water and sanitation facilities is typically not included in a school's annual plan and
therefore does not appear as a line item in the budget. One way to facilitate greater linkages between
school and community WASH and instil a sense of ownership is through the community’s participation in
the O&M of facilities. This can be done a number of ways including PTA contribution to O&M costs as
done in Myanmar, the Philippines and Viet Nam.

Partnerships & Stakeholder Participation


The MDGs provide a framework for the entire UN system to work coherently together towards a common
end. Of the 11 EAP countries, 50 per cent reported no active support from, or partnerships with sister UN
agencies for WASH in schools. This trend has to reverse if we are to meet the MDGs of achieving
universal primary education, promoting gender equality and reducing child mortality. The UN agencies
partnering with UNICEF for WASH in schools in the 11 EAP countries are the World Health Organization
(WHO), UNESCO, United Nations Environment Programme, and the United Nations Department of
Economic and Social Affairs.

On the national level we should work in partnership with the government to ensure integration, and link
facility design into the budget programme in the initial stages. Supporting governments should be our
continued focus in the context of their Poverty Reduction Strategy Plans and sector-wide/programme
based approaches. Programme based approaches (PBAs) – with or without basket funding – is the short
answer to advocating WASH in schools at the highest levels. With a PBA, pilot projects can be shared
and its impact and processes demonstrated for mainstreaming and scaling up. Even in the absence of a
PBA, professional sectors such as education, health, water supply and sanitation, and planning and
construction must co-ordinate human, intellectual and financial capital. Some means to achieve this
include joint planning, technical training, financial support, the provision of equipment and supplies, and
networking and knowledge management. In a majority of the 11 EAP countries partnerships and
capacities were built and sustained through technical training, and networking and knowledge
management.

Stakeholder participation in WASH in schools should include school children, teachers and headmasters,
households (including women and children), and the wider community. Meaningful participation
transforms individuals from beneficiaries to active participants in their personal health and well being of
their communities. School children in the 11 EAP countries participate in WASH in schools by attending
hygiene class; monitoring for soap in school latrines; engaging in role plays, wall paintings, games, and
puppetry; and keeping sanitation facilities clean. PTAs participate by assisting with the capital investment
(Myanmar) and O&M costs of sanitation facilities. This list can be expanded, and whatever means of
participation is pursued should take place throughout the entire project cycle. Such participation is a
prerequisite for sustainability and is a basic requirement of the human-rights based approach to
programming.

UNICEF WASH in Schools


WASH in schools falls under the Education, Health and Nutrition, and/or Water and Sanitation sections
(WES) depending on the country. In the DPRK and Myanmar the WES section implements WASH in
schools. In Mongolia and Timor-Leste, the Health and Nutrition sections are responsible for WASH in
schools. In Thailand, the Education section implements WASH in schools. Only in Cambodia, Lao, and
Viet Nam is WASH in schools represented by the WES and Education sections. This is a strong indication
of the need for internal co-ordination and joint planning before UNICEF can facilitate co-ordination
externally.

The primary UNICEF-assisted WASH in schools activities are cash support and operations and
maintenance of facilities. The least implemented activity was de-worming possibly due to de-worming
activities of the Japan International Cooperation Agency (JICA) and WHO in some schools. A challenge
facing WASH in schools is that many of the projects are pilots while there is a global push for going to

viii Brief on the WASH in Schools Situation in the East Asia Pacific
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scale. The feeling of being stuck in demonstration mode can be a result of the level the country is at
regarding experience in the WASH sector, the pressure to spend funds designated for WASH in schools
in a short amount of time, and not enough in-country co-ordination and advocacy. Costing is also an issue
as quality WES designs can be more expensive. A debate is brewing on how to build to scale with quality
but limited financial resources. One side of the debate posits that we should focus more on building on
success than going to scale, or go to scale with partners rather than going to scale alone.

Improved supply of safe water in schools and improved access to sanitary latrines in schools was the
most common cited key result of the WASH in schools project. While the hygiene education component
conveyed through LSBE improved knowledge of children regarding sanitation and hygiene, and improved
knowledge among teachers/educations regarding sanitation and hygiene. The least commonly cited key
result was reduction in childhood diarrhoea and other water-related diseases due to a lack of baseline
data and a more standardised approach to WASH in schools monitoring. This is a challenge as WASH in
schools initiatives should be evidence-based, and support the MDG of reducing child mortality, which is
increased by sanitation-related diseases such as diarrhoea and acute respiratory infections (ARIs).

Though ‘hardware’ gains are easy to measure, i.e. number of latrines and hand pumps installed,
‘software’ gains such as knowing and demonstrating positive behaviour change is more difficult to
measure. Sixty four percent (64%) of the 11 EAP countries reported that teachers monitor/assess
hygiene behaviours, and the most popular monitoring method was observation. An informal discussion
with students and self-report of child tied as the second most common monitoring tool. In Myanmar, the
country office uses Knowledge, Attitude and Practice (KAP) surveys to undertake some behaviour
change monitoring.

The UNICEF commitments to WASH in schools that were highlighted at the East Asia Pacific Water,
Sanitation and Hygiene Workshop include:

DAY 1 Objective To view the intersections between various education/WES


frameworks and their potential in guiding WASH in Schools.

Session I: Objective To strengthen commitment and joint understanding between


Education and WES country teams from the region on ‘WASH in
Schools’.

WHAT UNICEF IS COMMITTED TO IMPLICATIONS FOR GOOD


PROGRAMMING
FRAMEWORKS Full partnerships within FRESH • Close and regular
initiative. communications and co-
ordination with WHO, UNESCO,
the World Bank and NGO
partners on global, regional and
national levels.

UNICEF STRATEGIES New WASH strategy has two • Seeking new partners in public
targets: 1) contributing to and private sectors.
achieving MDG Goal 7: Target • Internal co-ordination between
10, and 2) ensuring water, relevant sections.
sanitation and hygiene in • Fund-raising, advocacy to
schools. implement renewed WASH in
schools service focus.

Session III: Objective To identify the factors which hinder effective joint WES +
Education programming and provide recommendations on how to
overcome.

ix Brief on the WASH in Schools Situation in the East Asia Pacific Region
ISSUES & Scaling up WASH in schools • Providing leadership for building
CHALLENGES with quality (post-Oxford national partnerships to scale up
Roundtable Proceedings and with quality.
Framework for Action, 2005) • Pooling funding or inter-sectoral
fund raising allows for a
comprehensive WASH in schools
package to be developed and
supported.

Session IV: Objective To identify monitoring mechanisms for WASH in Schools.

MONITORING & Strengthen national situation • Developing good indicators and


INDICATORS assessments and data collection monitoring, tying in with
for advocacy. Education Information
Management Systems (EMIS).

DAY 2 Objective To share practical experiences, resources and tools relating to


water, sanitation and hygiene education leading to agreed definitions for
key concepts.

Session I: Objective To provide those involved in developing a WASH in Schools


programme with relevant information and tools for effective planning
and implementation.

Child-friendly water Child-friendly facilities • Balancing quality facilities with


and sanitation developed as a result of low-cost replicable designs and
facilities children’s participation and that easy O&M features.
promote safety, use, and
sustainability.
Evidence base for Improving baseline data. • Strengthening EMIS systems,
hygiene promotion monitoring and evaluation of
WASH in schools.

Session III: Objective To gain a regional overview of costing standards and issues
for WASH in Schools.

Mobilising greater resources and • Better costing information


influencing national (capital and O&M) for tracking
development of budgets to and advocacy (more detail, more
include investments in WASH in transparency).
schools.

Session IV Objective To better understand the stages/content involved in planning a


WASH response in emergencies and the role of WASH programmes in
relation to Avian Influenza.

Emergency WASH in Core Commitments for Children • Emergency preparedness and


schools in Emergencies response plans (EPRPs).
Avian Influenza preparedness • Positioning of supplies, human
and financial capital.
• Pre-testing of hygiene messages
among target groups and
development of IEC materials.
• Pre- and post-emergency life

x Brief on the WASH in Schools Situation in the East Asia Pacific Region
skills based hygiene education in
schools and communities to
lessen humanitarian
consequences of a disaster.

Summary of the UNICEF WASH in Schools Project Country Status survey

Life Skills Based Education


Key KNOWLEDGE challenges in addressing the priority hygiene behaviours of school age children is the
safe disposal of excreta not practiced at home (82%), and that children don’t know washing hands with
soap prevents disease (64%).

Key PRACTICE challenges in addressing the priority hygiene behaviours of school age children is the
inadequate supply of soap at school (91%), and an inadequate amount of clean water at school (64%).

HYGIENE and HEALTH are the two most common subjects for hygiene education, both (64%).

Most common RISK PRACTICES targeted are hand-washing with soap (82%), and safe disposal of
human excreta (55%).

HYGIENE AND ENVIRONMENTAL HEALTH is adequately promoted in the curriculum (55%), according
to the 11 EAP countries surveyed.

FLIP CHARTS (64%) and STORY CARDS (27%) are the most common communication channels used to
disseminate hygiene messages to children in schools.

MONITORING of hygiene practices is undertaken by teachers (64%)

The three most common MONITORING TOOLS are observation (45%), and informal discussions with
students (27%), and student-run monitoring system (27%). Though 55% said monitoring for the
PRESENCE OF SOAP in schools does not take place, and when it does take place the most common
method is SPOT CHECK OBSERVATION (36%).

Technology
WES COVERAGE ranged from %0-25 (43%) and %51-75 (29%) out of the seven countries that had
data.

The WATER SOURCE most common to schools was hand pump (82%), and tap water (55%) Water
source depends on topography, e.g. Myanmar has tons of rain each year so rainwater collection a smart
technological choice.

FLUSH TOILETS were the most common latrine in schools (67%), followed by SQUAT POT and VIP
TOILET, both (27%).

Countries reported SEPARATE LATRINES for girls and boys (82%). The GIRLS PER STALL ratio of 26-
50 girls: 1 stall (44%) and 51-75 girls: 1 stall (44%). The BOYS PER STALL ratio was reported 0-100
boys: 1 stall in (100%) of the responding countries. URINALS are used (64%) with the most common
BOYS PER URINAL ratio of 41-60 boys: 1 urinal (57%).

The MAINTENANCE OF FACILITIES was reported to be done by cleaning committees, external cleaning
personnel, and individual students (40% in each instance).

HANDWASHING facilities are not automatically installed in most cases (66.7%).

xi Brief on the WASH in Schools Situation in the East Asia Pacific Region
The most common STANDARDS FOR SANITATION FACILITIES that existed include the number of
pupils per stall (55%), and the provision of hand-washing facilities with sanitation facilities (55%).
Eighteen per cent (18%) of the countries reported that no standards existed. MONITORING for water and
sanitation facilities takes place primarily on status of water supply/systems (73%), and water quality
(18%). Actual versus planned use is barely monitored (9%) though these figures could help with
establishing cost.

Institutional Setting & Co-ordination


NATIONAL WATER AND SANITATION POLICIES exists for most countries (64%).

LOCAL WATER AND SANITATION POLICIES existed 36% of the time. Only 18% reported that no
policies existed.

Hygiene education is part of the OFFICIAL CURRICULUM (45%).

NATIONAL AND LOCAL GOVERNMENT is reported to contribute to WASH in schools (45%). Only two
countries (Thailand and Viet Nam) reported spending on both the national and local levels (18%).

LOCAL ORGANISATIONS and INTER-MINISTERIAL STEERING GROUPS represent the most


common co-ordination mechanism (45%), followed by UN AGENCIES (27%).

Countries responded that the NATIONAL WASH SITUATION had not been adequately assessed and
analysed (73%).

Financing Options
UNICEF PROJECT FUNDS (82%) are the most common method of financing capital costs for WASH in
schools. PUBLIC-PRIVATE PARTNERSHIPS are not being fully explored.

PTAS, GOVERNMENT BUDGET ALLOCATIONS, and UNICEF PROJECT FUNDS are the most
common financial sources for the O&M of school WES facilities, each (27%).

Long-term capacity building of relevant professionals supported primarily by TECHNICAL TRAINING


(64%), and NETWORKING & KNOWLEDGE MANAGEMENT (45%).

Partnerships & Stakeholder Participation


Most of the countries reported that no UN ORGANISATIONS (45%) are active in supporting
WASH in schools. The most involved UN organisation is WHO (18%).

KEY DONORS FUNDING WASH IN SCHOOL initiatives are AusAID (36%), the World Bank and
NATCOMs, both (27%).

PTAS have a role in WASH in schools (73%), mainly operations and maintenance.

Formal LINKAGES BETWEEN WASH IN SCHOOLS AND COMMUNITIES exist (82%). Common
linkages are hardware-related i.e. school connected to community water source and supplying WES for
schools and community at the same time.

UNICEF WASH in Schools Project


WASH IN SCHOOLS fall under one section - Education (9%), WES (27%), Health and Nutrition (18%);
WES and Education sections (27%); and other (11%).

xii Brief on the WASH in Schools Situation in the East Asia Pacific
Region
Most common portion of the COUNTRY PROGRAMME BUDGET spent on WASH in schools is %0-10
(27%); %11-20; and %21-20, both (18%).

NATCOMs (36%) are the most common source of funding for UNICEF’s WASH in Schools project,
followed by AusAID (18%).

Key activities are HYGIENE EDUCATION (64%), followed by CASH SUPPORT (45%). The least
implemented activity was DE-WORMING (9%), which is possibly due to WHO and/or Japan International
Cooperation Agency (JICA) initiatives in the schools.

The GOVERNMENT (55%) was most frequently cited as implementing partner; followed by NGOS (36%).

The most common KEY RESULTS from the project were improved supply of safe water in schools and
improved access to sanitary latrines in schools; and improved knowledge of children regarding sanitation
both hygiene (64%). The least commonly cited key result was reduction in childhood diarrhoea and other
water-related diseases (45%).

xiii Brief on the WASH in Schools Situation in the East Asia Pacific
Region
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Cambodia
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 13,798
h Primary school drop-out rates are persistently high
(only 61% of students reached Grade 5 in Under-five mortality rate (per 1000) 141
2000/2004).
h Rural/urban coverage disparities are very high, Total adult literacy rate (%) 74
and at only 8 %, rural sanitation coverage is the
lowest in the region and the second lowest outside
of Africa. Where rural community sanitation is low, WASH in Schools
school sanitation tends to also be low. National school water/sanitation coverage
h Diarrhoea and pneumonia are two illnesses that No data
can be linked to inadequate access to safe water,
sanitation facilities and hygiene education. In Hygiene education in schools
Cambodia, deaths among children under five Social Sciences class
years of age due to diarrhoeal diseases are
reported at 16.6% (2000); deaths among children Water source common to schools
under five years of age due to pneumonia, 20.6% Hand pump
(2000).*
h Arsenic contamination of aquifers is a significant Sanitation facilities common to schools
problem, especially in the lowland areas near the Flush toilet
Mekong River and its major tributaries.

Main Components

h The Education, and Seth Koma (Community Action for Child Rights) sections support WASH in Schools.
h UNICEF-supported WASH in Schools activities include:
• Safe drinking water in rural communities and schools.
• Improved sanitation for families and schools in rural areas.
• Water quality monitoring including arsenic testing and mitigation.
h All WASH activities include support to capacity building at central, provincial and local government levels.

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Cambodia
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
WASH in Schools Activities

Enabling • Development of new approaches to stimulate demand for sanitation.


Environments • Support for improving the competitive bidding and contracting process at the local
government level.
• Institutional support to government to strengthen capacity for the implement the new
national policy.

Water and Sanitation • Provision of safe water for over 41,000 school children through construction of wells in
Services 131 schools (54 completed, 77 on-going).
• Water use and hygiene education and operations and maintenance training for school
directors and teachers.
• Improved sanitation has been provided to over 21,000 children through construction of
latrine blocks in 137 primary schools (54 completed and 83 on-going); and 304
community preschools (83 completed and 221 ongoing).

Hygiene • Hygiene education and operations and maintenance training for school directors and
Education/Behaviour teachers.
• The new curriculum is not yet rolled out but a two-hour per week allotment for health
Change education has been approved by the government, and is expected to be implemented
Communication next year.
• UNICEF is attempting to get teachers to work hygiene practices into their every day
routines, for example, taking children to wash their hands.
• Teachers will learn child-centred teaching methodologies that can be applied to all
subjects, particularly health and hygiene education through teacher training at the
Teacher Creativity Center (TCC).

Policies to support • The new National Policy on Water Supply and Sanitation issued in 2003
WASH in Schools promotes greater community participation, more active hygiene and sanitation
promotion and increased involvement of the private sector in implementation.
• Two hours of health education per week approved by Government for school children.

Key Partners
h Ministry of Rural Development at the central, provincial and district levels.
h Local Governments (Commune Councils).
h WHO, NGOs and external agencies including ECHO, AUSAID and UNICEF National Committees.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Cambodia
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

China
Rationale for WASH in Schools
Basic Indicators
Total population (1000s) 1,307,989
h Through a recent UNICEF survey the WASH
situation of about 15,000 rural schools in 8 Under-five mortality rate (per 1000) 31
counties has been established. The results
showed that less than 10% of rural schools in the Total adult literacy rate (%) 91
surveyed counties had access to safe water,
latrines and hand washing facilities.
h About 190 million children are infected with round WASH in Schools
worm; and another 70 million with whip worm; and National school water/sanitation coverage
over 40 million have hook worm. In 2005, sample survey in 80 counties of 10
h Diarrhoea and pneumonia are two illnesses that provinces, only 8% of schools with sanitation
can be linked to inadequate access to safe water, facilities
sanitation facilities and hygiene education. In
China, deaths among children under five years of Hygiene education in schools
age due to diarrhoeal diseases are reported at Health and Hygiene classes
11.8% (2000); deaths among children under five
years of age due to pneumonia, 13.4% (2000).* Water source common to schools
h Diarrhoeal diseases and hepatitis are common Hand pump, Open well
among the 400 million school-attending children.
h Large portions of China's water supply are Sanitation facilities common to schools
contaminated by arsenic, a toxic substance VIP toilets, Urinals
distributed widely throughout the earth's crust.

Main Components

WASH in Schools is one project under China’s 2006-2010 Water, Sanitation and Hygiene Programme. China
plans to implement the following activities:

h Develop, adopt, and pilot revised national technical standards (designs) and guidelines on WASH in
Schools in five counties for adoption by rural communities and school authorities, particularly boarding
schools, and nationally as part of the requirements for assessing schools qualification for nine-year
compulsory education.
h Establish a multi-level co-ordination mechanism for implementation of WASH in Schools. Develop and
implement national, policy, standards and guidelines for public-private investment in WASH in schools;
h Communication strategy for effective hygiene practices in child-friendly schools is developed and tested.
h Policy guidelines and standards for de-worming children in kindergarten and primary schools.
|

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: China
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
WASH in Schools Activities

Enabling • Carry out research, including a thorough national assessment of the risk of
Environments fluoride and arsenic contamination of water.
• Support water quality monitoring units at provincial, district and community
levels.
• Support capacity building of local government in the treatment of water and
improvement of sanitation facilities based on ecological sanitation concepts.

Hygiene • Develop teaching materials on sanitation and hygiene.


Education/Behaviour • Train teachers in use of hygiene education materials, construction of water
Change facilities, latrines, urinals and hand-washing facilities.
Communication • Carry out health assessments and de-worming of school-aged children.
• Encourage child participation in keeping school environments clean and in
monitoring families in the improvement of sanitation, water supply and
personal hygiene behaviours.

Policies to support • Under ‘Safe Water Supply for Rural Areas’, the strategy to promote provincial
WASH in Schools and county level plans for increased investment in the provision of safe water
for rural areas was advanced through advocacy campaigns targeting policy
makers, training and awareness raising through the design and printing of an
album on the progress/achievement of rural water supply in China. This
resulted in the central government investing in over US$ 248 million on rural
water supply throughout the country of which about US$ 88 million was
allocated in seven project provinces. The Government has also started
allocating funds for sanitation (around US$ 12 million), for the first time in
2005.

Key Partners
h Government: Ministry of Water Resources, National Patriotic Health Campaign Committee Office, Ministry of
Health, Ministry of Education, Provincial and County Governments, Department of Disease Control and
Bureau of Water Resources
h Bi-laterals: SIDA, UK/DFID, AusAID; Institutes: Chinese Academy for Science and Technology,
Environmental Health Monitoring Institute
h NGOs: All China’s Women Federation, Central Youth League and Civilization Establishment Offices

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: China
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

DPRK
Rationale for WASH in Schools
Basic Indicators
Total population (1000s) 22,384
h Primary school drop-out rates and enrolment rates
are not reported though UNICEF is working with Under-five mortality rate (per 1000) 55
the government to strengthen Education
Management and Information Systems (EMIS). Total adult literacy rate (%) -
h Diarrhoea and pneumonia are two illnesses that
can be linked to inadequate access to safe water,
sanitation facilities and hygiene education. In the WASH in Schools
DPRK, deaths among children under five years of National school water/sanitation coverage
age due to diarrhoeal diseases are reported at No data
18.9% (2000); deaths among children under five
years of age due to pneumonia 15.2 %, (2000).* Hygiene education in schools
h Rural/urban coverage disparities are reported as Social Sciences, Hygiene, Health, Life Skills,
minimal at only 58%, urban and 60%rural. Science

Water source common to schools


Tap water

Sanitation facilities common to schools


Flush toilet, Simple pit latrine, Urinals

Main Components
h The Water, Sanitation and Hygiene section supports the WASH in Schools initiative that is UNICEF
Pyongyang is initiating.
h UNICEF-supported WASH in Schools activities include:
• Upgrading/constructing water supply systems and sanitation facilities for households and key child
care institutions within the targeted communities of Hyesan and Hoeryong cities.
• Ensuring that families, teachers, and caregivers have the necessary knowledge on key hygiene
practices in Kosan, Kowon and Jongpyong counties.

WASH in Schools Activities

Water and Sanitation • Due to child care institutions needs vis-à-vis the national programme, 70 hand
Services pumps have been installed outside of focus counties.
• In Yonsan, Rinsan and Unryul counties, 12 childcare institutions have
improved WES facilities.
• Two Pyongyang schools have improved WES facilities.
• Environment-friendly waste disposal facilities (construction activities ongoing
as of December 05), constructed at 33 child care institutions.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: DPRK
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
Hygiene ƒ UNICEF assisted the MoE with a workshop introducing the concept of Life-skills
Education/Behaviour Education and Early Childhood Development (ECD). MoE officials undertook study
visits to Singapore and Thailand in connection with ECD, Child Friendly Schools (CFS)
Change and Learner Assessment (LA).
Communication

Key Partners
h Ministry of City Management (MoCM), Ministry of Education (MoE)
h External agencies including AUSAID

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: DPRK
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Indonesia
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 220,077
h Although 89% of primary school students reached
Grade 5 (2000/2004), disparities exist amongst Under-five mortality rate (per 1000) 38
rural and urban children. More children from urban
areas (71.9%) go to junior high compared to those Total adult literacy rate (%) 88
from rural areas (54.1%).1
h Diarrhoea and pneumonia are two illnesses that
can be linked to inadequate access to safe water, WASH in Schools
sanitation facilities and hygiene education. In National school water/sanitation coverage
Indonesia, deaths among children under five years No data
of age due to diarrhoeal diseases are reported at
18.3 % (2000); deaths among children under five Hygiene education in schools
years of age due to pneumonia, 14.4% (2000).* Hygiene class
h The December 2005 Tsunami and March 2006
Nias earthquake necessitated the construction of Water source common to schools
300 permanent schools and the rehabilitation of Hand pump, Open well
200 schools, outfitted with child-friendly water and
sanitation facilities. Ongoing hygiene promotion, Sanitation facilities common to schools
operations and maintenance of facilities is needed Flush toilet, Urinals
to sustain gains in school water and sanitation
coverage.

Main Components

h The Water and Sanitation section supports WASH in Schools.


h UNICEF-supported WASH in Schools activities include:
• School Hygiene Promotion, Water and Sanitation in Maluku and North Maluku provinces and
in Ambon city.
• Construction of school latrine units with hand-washing facilities and proper waste disposal.
• Hygiene education, including training of trainers and training of teachers and reprinting and
distribution of existing hygiene education materials to schools.
• Programme support costs, including one national officer for technical support, project
coordination and field monitoring.

1
United Nations Children’s Fund, ‘Fact Sheet: Girls education in Indonesia’
*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Indonesia
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
Aceh/Nias Main Components

h UNICEF entered Aceh and Nias after the Tsunami and Nias earthquake. The WASH in Schools
programme is supported by the Education, and Water and Sanitation sections.
h WASH in Schools activities include:
• Water supply, hand-washing facilities and hygiene education in existing schools, temporary
schools and new, permanent schools.
• The provision of separate toilets for boys and girls.
• Hygiene education.

WASH in Schools Activities

Enabling • UNICEF (Aceh and Nias) co-ordinated with the entire international relief
Environments community to discuss water, sanitation and hygiene with the local, Health and
Education departments.
• Both WES and Education project staff briefed the Ministry of Health on the
UNICEF-assisted WASH in schools strategy.

Water and Sanitation • WASH programme in 40 Ambon schools.


Services • Sanitation and hand-washing facilities have been upgraded in 50 existing
schools and 200 temporary schools.
• As part of the Aceh tsunami recovery programme, provided separate toilets
for boys and girls, water supply, hand-washing facilities and hygiene
education in 450 existing schools, 200 temporary schools and 300 permanent
new schools.

Hygiene • Information, education and communication (IEC) materials (some based on


Education/Behaviour competencies) developed for WASH in schools. More discussion will take
Change place with government partners before the materials are used in the
Communication classroom.
• Hygiene education and teacher training package to be developed and
implemented starting in 2006.
• Teacher guidelines developed on school level planning and monitoring.

Key Partners
h Provincial and district-level authorities from the Ministry of Resettlement and Regional Infrastructure
(responsible for water and sanitation facilities in communities and schools), and Ministry of National
Education (responsible for hygiene education)
h Community-based organizations; CARDI – international NGO
h United Nations Environment Programme (UNEP), World Food Programme (WFP)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Indonesia
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Lao PDR
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 5,792
h Arsenic and fluoride contamination in groundwater
is an emerging problem in Lao. Under-five mortality rate (per 1000) 83
h The sanitation gap is particularly wide, with 80% of
people living in rural areas without access, Total adult literacy rate (%) 69
compared to the 33% of those living in urban
areas. School sanitation coverage tends to mirror
that of community sanitation coverage. WASH in Schools
h Diarrhoea and pneumonia are two illnesses that National school water/sanitation coverage
can be linked to inadequate access to safe water, No data
sanitation facilities and hygiene education. In Lao,
deaths among children under five years of age Hygiene education in schools
due to diarrhoeal diseases, 15.6% (2000);deaths Life Skills, Health, and Hygiene classes
among children under five years of age due to
pneumonia, 19.1% (2000) ∗ Water source common to schools
Hand pump, Tap water

Sanitation facilities common to schools


Flush toilet, Urinals

Main Components
h The Education, and Water and Sanitation sections support WASH in Schools.
h UNICEF-supported WASH in Schools activities include the following:
• Primary school sanitation.
• Participatory hygiene education.
• De-worming of school children.

WASH in Schools Activities

Enabling • Developed and expand appropriate sanitation technologies.


Environments • Established water quality control and surveillance system.
• Integrate health and hygiene issues into primary school curricula.
• Developed and disseminated Information, Education and Communication
(IEC) materials to increase community participation in WASH, and facilitate


These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Lao PDR
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
linkages between school and community WASH.

Water and Sanitation • Improved access to clean water, segregated latrines in 69 primary schools.
Services • De-worming of school children in 23 schools in Hin Hurb (Vientiane) and 10
primary schools in Sepone (Savannakhet province).
• Modification of the school-latrine design.

Hygiene • Training took place for 1,700 teachers from 12 provinces, after which they
Education/Behaviour started to use the ‘Blue Box’ for participatory learning in the classroom.
Change
Communication

Key Partners
h Government: Nam Saat (Ministry of Health), Ministry of Education
h Bilaterals/multilaterals: SIDA, WSP-EAP, World Bank
h Other local institutions and NGOs: ADRA, SCF-UK, Lao Women’s Union, Lao Youth Union
h New Zealand UNICEF National Committee, World Health Organization (WHO)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Lao PDR
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Mongolia
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 2,614
h In the rural areas of Mongolia schools and
communities use the same water source – thus Under-five mortality rate (per 1000) 52
school children have limited access to safe water
and sanitation as 54% of the rural population is Total adult literacy rate (%) 98
has access to safe drinking water, and 34% has
sanitary latrines.
h A survey to determine arsenic content in drinking
WASH in Schools
water (2004) showed that the country average of National school water/sanitation coverage
arsenic content in well water is 0.014mg/l and No data
10% of all samples are arsenic positive.
h Limited access to water compounded with poor Hygiene education in schools
water quality affects the teaching and learning Health class
environment.
h Diarrhoea and pneumonia are two illnesses that Water source common to schools
can be linked to inadequate access to safe water, Hand pump, Rainwater collection, Open well,
sanitation facilities and hygiene education. For Unprotected sources
Mongolia, deaths among children under five years
of age due to diarrhoeal diseases are reported at
Sanitation facilities common to schools
14.5% (2000); Deaths among children under five VIP toilet, Urinals
years of age due to pneumonia, 17.1% (2000).*

Main Components

h The UNICEF Mongolia WASH in Schools project is in the initial stages. There are plans to mobilise
resources in the coming year.
h Mongolia has adopted Master Plan of Operations and WASH is one of the priority areas in the next period.

Key Partners
h Government of Mongolia, World Bank

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Mongolia
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Myanmar
Rationale for WASH in Schools
Basic Indicators
Total population (1000s) 50,004
h Many drinking water sources in rural areas are not
safe and the collection of water often requires Under-five mortality rate (per 1000) 106
walking more than 200 metres. The task of water
collection often falls to girls and competes with Total adult literacy rate (%) 90
enrolment, attendance and academic
achievement.
h At any point in time approximately 30% of all water WASH in Schools
systems are not functioning. Insufficient water National school water/sanitation coverage
supply is a factor in girls of menstruation age No data
dropping out of school.
h Primary school drop-out rates are persistently high Hygiene education in schools
(only 65% of students reached Grade 5 in Life Skills, Health, Hygiene, and Science classes
2000/2004).
h Diarrhoea and pneumonia are two illnesses that Water source common to schools
can be linked to inadequate access to safe water, Hand pump, Rainwater collection, Open well,
sanitation facilities and hygiene education. In Unprotected sources
Myanmar, deaths among children under five years
of age due to diarrhoeal diseases are reported at Sanitation facilities common to schools
21.1% (2000); deaths among children under five Flush toilet
years of age due to pneumonia, 19.3% (2000).∗
h Arsenic and fluoride contamination is a threat to
water quality in many schools located in rural
townships.

Main Components

h The Education, and Water and Sanitation sections support WASH in Schools activities.
h WASH in Schools activities include the following:
• Behaviour change communication and hygiene promotion activities in schools.
• Provision of water and sanitation facilities to schools and rural health centres.
• Water quality control and surveillance to ensure conformity to established norms and
standards.


These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Myanmar
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
WASH in Schools Activities

Enabling • Develop strategies and guidelines to facilitate decentralisation, integrated


Environments water, sanitation and hygiene, involvement of NGOs and private sector.
• Document experiences and lessons learned; conduct research and studies;
exchange information; programme support.

Water and Sanitation • Constructed 72 tube-wells, 82 rainwater collection tanks, 143 gravity-flow
Services water systems and 35 dug-wells in 313 schools and 43 communities.

Hygiene • Life-skills are in the core curriculum for secondary school and the curriculum
Education/Behaviour is competency-based and uses active learning.
Change • UNICEF and its counterparts have implemented a unit approach and built on
Communication the higher grades from information learned in the lower grades. Personalised
questions have been added to link what children have already learned.
• Life-skills based education (LSBE) training has been incorporated into teacher
training at teachers’ colleges and follow-up training. Both a teacher’s guide
and a student’s guide have also been developed to promote hygiene in LSBE.
• Encouraged school children and basic health staff to act as agents of change
in communities and households.

Key Partners
h Department of Development Affairs, the Ministry of Health, the Ministry of Education and other concerned
government departments at state/division and township level
h Members of Donor Working Group on Water Sector; Parent Teacher Associations (PTAs), communities;
private sector; NGOs
h Department for International Development (DFID-UK), UNICEF Swiss and German National Committees

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Myanmar
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Philippines
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 81,617
h In the Philippines drinking water coverage
declined in urban areas from 95% to 87%, partially Under-five mortality rate (per 1000) 34
due to a two-thirds increase in population. Access
to safe drinking water is a factor in children Total adult literacy rate (%) 93
becoming infected with worms, which affects their
physical well-being and ability to learn in school.
h Diarrhoea and pneumonia are two additional
WASH in Schools
illnesses that can be linked to inadequate access National school water/sanitation coverage
to safe water, sanitation facilities and hygiene No data
education. In the Philippines, deaths among
children under five years of age due to diarrhoeal Hygiene education in schools
diseases are reported at 12 % (2000); deaths Planned for 2007-2009
among children under five years of age due to
pneumonia, 13.4% (2000).∗ Water source common to schools
Hand pump

Sanitation facilities common to schools


Squat pot, Pour flush, Urinals

Main Components

h The UNICEF Philippines WASH in Schools project is in the initial stages.


• In 2006 more than 50 schools were targeted for improved access to water and sanitation
facilities, and hygiene activities.
h UNICEF-supported WASH in Schools activities for 2007-2009 will include:
• Provision of safe water.
• Basic school sanitation.
• Hygiene education.
• Teacher training.

WASH in Schools Activities

Water and Sanitation • Three hundred (300) priority schools in CPC areas of the country will have
Services increased access to an adequate amount of safe water, basic school
sanitation and hygiene education (2007-2009).


These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Philippines
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
• School and community WASH linkages will be strengthened through the
provision of basic sanitation facilities for 45,000 people (including women and
children) from 7,500 households of impoverished barangays. (2007-2009).

Hygiene • This year a series of flip charts entitled ‘Pointers to Good Health’ was
Education/Behaviour completed and disseminated in selected schools and communities to promote
Change positive hygiene practices.
Communication • Hygiene promotion planned for 45,000 community people (including women
and children) through a sanitation-awareness campaign.
• UNICEF in co-operation with the Government has developed Early Childhood
Development (ECD) curriculum standards, i.e. what children ages 0- to 6-
years old should learn, to ensure basic competencies in health and hygiene.
• The WASH team is attempting to introduce a more localised teacher training,
providing teachers with “how-to materials” to take back into the classrooms.

Key Partners
h Local Government Units (LGUs)
h Swedish International Development Cooperation Agency (SIDA), the Government of Norway
h Procter & Gamble, Parent Teacher Associations (PTAs),

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Philippines
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Thailand
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 63,694
h Thailand has benefited from a booming private
sector and impressive development but the Under-five mortality rate (per 1000) 21
schools that are located in conflict areas and are
mostly attended by the poor, migrant and ethnic Total adult literacy rate (%) 93
minority children commonly provide a lower level
of access to safe water, sanitation facilities and
hygiene education. A Multiple Indicator Cluster WASH in Schools
Survey (MICS) has recently been conducted and National school water/sanitation coverage
the subsequent analysis can be used to assess No data
the WASH in Schools situation of children living in
the 26 most vulnerable provinces (including the six Hygiene education in schools
tsunami-affected areas). Health class
h Diarrhoea and pneumonia are two illnesses that
can be linked to inadequate access to safe water, Water source common to schools
sanitation facilities and hygiene education. In Hand pump, Rainwater collection, Tap water
Thailand, deaths among children under five years
of age due to diarrhoeal diseases are reported at Sanitation facilities common to schools
21.9% (2000); deaths among children under five Squat pot, Urinals
years of age due to pneumonia, 19.6%.*

Main Components

h There had not been any WES/Health and Nutrition programme in Thailand for more than 10 years prior to
the tsunami.
h Post-tsunami UNICEF-supported WASH in Schools activities include:
• Water supply schools, child-care centres.
• Hygiene education.
• Emergency preparedness and response.

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Thailand
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
WASH in Schools Activities

Water and Sanitation ƒ UNICEF assisted 12 temporary schools and 2,000 families in temporary
Services shelters with upgraded water and sanitation facilities, including purification
equipment, latrines and drainage.
ƒ UNICEF initiated a two-year programme to reach 500 schools in six of the
tsunami-affected provinces.

Hygiene • UNICEF conducted a sanitation and hygiene information campaign designed


Education/Behaviour to reach 300,000 schoolchildren and 500,000 members of the general
Change community. As part of this campaign, UNICEF provided education materials
Communication and costs for teacher training.
• The ‘School-based Approach to Avian Influenza Prevention and Pandemic
Influenza Preparedness and Response in Thailand’ project resulted in the
development of five manuals covering Avian/Pandemic Influenza along with
other high-risk diseases such as diarrhoea.
o Five (5) schools are developing Emergency Preparedness and
Response plans for emergency situations including severe
diarrhoea.
o Thirty nine (39) schools are implementing a life skills-based health
education curriculum unit on avian and pandemic influenza, which
includes behaviour practices that prevent diarrhoea such as
handwashing with soap.

Key Partners
h Ministry of Education, Ministry of Public Health, Government of Japan, Kenan Institute Asia

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Thailand
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Timor-Leste
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 887
h Incidences and eruptions of violence have Under-five mortality rate (per 1000) 80
exacerbated access to water and sanitation
amongst schools and communities in Timor-Leste. Total adult literacy rate (%) -
Contaminated drinking water, inadequate
sanitation and poor nutrition aggravate the health
risks.
WASH in Schools
h Infant and under-five mortality rates are relatively National school water/sanitation coverage
high, with malaria, diarrhoea and respiratory No data
infections taking a heavy toll.
h Diarrhoea and pneumonia are two illnesses that Hygiene education in schools
can be linked to inadequate access to safe water, Hygiene class
sanitation facilities and hygiene education. In
Timor-Leste, deaths among children under five Water source common to schools
years of age due to diarrhoeal diseases are Hand pump, Tap water, Unprotected sources
reported at 21.9%, (2000); deaths among children
under five years of age due to pneumonia, 19.6% Sanitation facilities common to schools
(2000). * VIP toilet, Squat pot, Flush toilet

Main Components

h The UNICEF Timor-Leste WASH in Schools project is in the initial stages.


h UNICEF-supported WASH in Schools activities include:
• De-worming of school children.
• Provision of water and sanitation systems to primary schools.

WASH in Schools Activities

Water and Sanitation • More than 1,200 children received de-worming treatment in a pilot project at
Services seven (7) schools.
• The initiative proved successful and will be replicated in at least 50 schools in
2006, with the objective of taking it to scale on a national level as part of the
regular school health programme.
• Twenty-four primary schools received new water and sanitation systems.

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Timor-Leste
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
Hygiene • De-worming activities were followed up with a series of education and
Education/Behaviour communication activities at the community level, involving staff from the
Change ministries of education, health and water.
Communication

Key Partners
h AusAID, Parent Teacher Associations (PTAs)
h United Nations Department of Economic and Social Affairs (UNDESA), the World Bank, UNICEF National
Committees (NATCOMs)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Timor-Leste
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
COUNTRY PROFILE
Water, Sanitation and Hygiene (WASH) in Schools

Viet Nam
Rationale for WASH in Schools Basic Indicators
Total population (1000s) 83,123
h Although Viet Nam has experienced increased
access to water and sanitation, water quality is a Under-five mortality rate (per 1000) 23
concern in communities and schools as Arsenic
and fluoride contamination in groundwater is an Total adult literacy rate (%) 90
emerging problem.
h Primary school enrolment is over 90%, but one
third of Viet Nam’s children do not complete Grade WASH in Schools
5, and 70% of school dropouts are girls. National school water/sanitation coverage
h Diarrhoea and pneumonia are two illnesses that Water, 65% - Sanitation, 42% (2003)
can be linked to inadequate access to safe water,
sanitation facilities and hygiene education. In Viet Hygiene education in schools
Nam, deaths among children under five years of Health, and Hygiene classes
age due to diarrhoeal diseases are reported at
10.4% (2000); deaths among children under five Water source common to schools
years of age due to pneumonia, 11.5% (2000)* Hand pump

Sanitation facilities common to schools


Flush toilet, Urinals (boys/girls)

Main Components

h The Education, and Water and Sanitation sections support WASH in Schools activities.
h WASH in Schools activities include the following:
• Creating an enabling environment by establishing sustainable management structures and
processes, including training of counterparts, reaching poorest households and maintaining
water quality standards.
• Supporting community WASH through the construction of community water systems; water
and sanitation facilities in schools and day care centres; and establishing local operation and
maintenance systems.
• Increased focus on hygiene and sanitation, as well as inter-sectoral and community-focused
approaches.

WASH in Schools Activities

Enabling • Developed and expand appropriate sanitation technology options.

*
These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World
Health Report, 2006 Edition'.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Viet Nam
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
Environments • Developed, disseminated and monitored IEC material, increasing community
participation in relation to WES to facilitate community and school WASH
linkages.
• Supported and trained for Management Information Systems (MIS) database.
• Supported policy development on Environmental Protection and People’s
Health, including a focus on child-friendly interventions.
• Supported the systematic documentation of field experiences for in-country
and regional exchanges.

Water and Sanitation • Participated in the School Sanitation and Hygiene Education (SSHE) Global
Services Pilot Project (2000-2004) that targeted 100 primary schools reaching 25,000
children.
• Supported gender sensitive and child-friendly WES designs in kindergartens
and primary schools through the Institute of School Design Studies under the
Ministry of Education and Training.
• UNICEF also supported a participatory assessment of the School Sanitation
and Hygiene Education (SSHE) pilot project through the Centre for
Environmental and Health Studies.

Hygiene • Implemented teacher training in Life Skills and Hygiene Education, and
Education/Behaviour developed a teacher’s guide book.
Change • Undertook desk review of all existing materials relating to Hygiene Education,
Communication and is planning to develop a guidebook, first for teachers and second for the
students. The students’ book will include mainly pictures and illustrations.

Policies to support ƒ National Target Programme II has a clear target of 100% WES coverage in
WASH in Schools schools by 2010.
ƒ The approved child-friendly latrine design will stimulate a high level of
interest/commitment for:
o Incorporating WES facilities in the Ministry of Education and
Technology (MoET) standard for new schools.
o Improving quality of WES facilities at other existing locations.
o Guidance on monitoring quality of construction by schools/local
authorities.

Key Partners
h Government: Centre for Rural Water Supply and Sanitation (CERWASS), the Department for Preventive
Medicine; Thai Binh Medical College, National Institute of Occupational Health
h Department for International Development (DFID-UK), the Danish International Development Agency
(DANIDA), AusAID, World Bank, Asian Development Bank (ADB), World Health Organization (WHO),
United Nations Development Programme (UNDP) and local and international NGOs

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Viet Nam
Data years: WES (2002), mortality/population (2004), literacy (2000/2004)
WATER, SANITATION AND HYGIENE IN SCHOOLS REGIONAL WORKSHOP
18-20 OCTOBER 2006
AMARI WATERGATE HOTEL
BANGKOK, THAILAND

1
ACRONYMS 4

INTRODUCTION 6

REVIEW CURRENT FRAMEWORKS RELATING TO WASH IN SCHOOL 8

OUTCOMES FROM THE SCHOOL SANITATION AND HYGIENE EDUCATION EVALUATION 12

A GLOBAL UPDATE ON WASH IN SCHOOLS 15

ASSESSING IMPACT AND EFFECTIVENESS 17

CHILD FRIENDLY WATER AND SANITATION FACILITIES IN VIET NAM 19

HYGIENE PROMOTION IN SCHOOLS: CURRICULA AND EXTRA-CURRICULA 23

THE EVIDENCE BASE FOR HYGIENE PROMOTION 26

FINANCING WASH IN SCHOOLS: WHAT DOES IT COST? 29

WASH IN EMERGENCY PREPAREDNESS AND RESPONSE, AVIAN INFLUENZA 32

WASH IN EMERGENCY PREPAREDNESS AND RESPONSE, CHILD FRIENDLY SPACES 34

TAKING WASH FORWARD IN THE REGION 36

PARTNERSHIPS FOR SUSTAINABILITY OF WASH IN SCHOOLS 38

GOVERNMENT/INTER-MINISTERIAL PARTNERSHIPS (INCLUDING SWAPS) 40

THE GLOBAL HANDWASHING INITIATIVE 42

CHILDREN AS CHANGE AGENTS 47

CHILDREN’S PARTICIPATION IN HEALTH AND HYGIENE ACTIVITIES 49

CHILDREN AS CHANGE AGENTS II 53

THE RELATIONSHIP BETWEEN WASH IN SCHOOL AND WASH IN COMMUNITIES 56

GENERAL PLENARY DISCUSSION 58

ANNEX I: WHO GUIDELINES ON MINIMUM STANDARDS FOR WASH IN SCHOOLS 59

ANNEX II: CHILDREN’S WATER MANIFESTO 90

2
ANNEX III: INTERNATIONAL COMMITMENTS TO WASH IN SCHOOLS 92

ANNEX IV: WATER, SANITATION, AND HYGIENE IN SCHOOLS WORKSHOP AGENDA 93

ANNEX V: PARTICIPANT LIST 96

3
Acronyms

ADB Asian Development Bank


AI Avian Influenza
AIDS Acquired Immune Deficiency Syndrome
ARI Acute Respiratory Infection
BCC Behaviour Change Communication
CDC Centers for Disease Control and Prevention
CFS Child Friendly School
CFSp Child Friendly Space
CHW Child Health Week
CRC Convention on the Rights of the Child
CTC Child-to-Child
DFID Department for International Development
EFA Education for All
EPRP Emergency Preparedness and Response Plan
EU European Union
FTI Fast Track Initiative
FQ Fun Quotient
FRESH Focusing Resources on Effective School Health
GIS Global Information Sharing project
HIV Human Immunodeficiency Virus
HPS Health Promoting School
HWI Handwashing Initiative
IEC Information, Education, and Communication
INGO International Non-governmental Organisation
IRC International Water and Sanitation Centre
JICA Japan International Cooperation Agency
JOICEP Japanese Organization for International Co-operation in Family Planning
LSBE Life Skills Based Education
LSHTM London School of Hygiene and Tropical Medicine
LoA Letter of Agreement
MDGs Millennium Development Goals
MNE Multinational Enterprise
MoE Ministry of Education
MoET Ministry of Education and Technology
MoH Ministry of Health
MoPH Ministry of Public Health
MoU Memorandum of Understanding
MTSP Medium-term Strategic Plan
NGO Non-governmental Organisation
PBA Programme Based Approach
PPP Public-Private Partnership
PSI Population Services International
PTA Parent Teacher Association
SSHE School Sanitation and Hygiene Education
SWAp Sector Wide Approach
UNICEF United Nations Children's Fund
UNESCO United Nations Education, Scientific, and Cultural Organization
UNGEI United Nations Girls’ Education Initiative

4
VIPP Visualisation in Participatory Programmes
WASH Water, Sanitation, and Hygiene
WES Water and Sanitation
WFFC World Fit for Children
WFP World Food Programme
WHO World Health Organization

5
Introduction
We all know and can recite the mandates and rationale for water, sanitation and hygiene in schools:
The Millennium Development Goals, Education for All, the Convention on the Rights of the Child, A
World Fit for Children, and Vision 21 are just some of the commitments that UN agencies and
concerned organisations recognise as the prelude to water, sanitation and hygiene (WASH) in
schools. We all agree that now is the time to bridge the gap between policy and implementation of
water, sanitation and hygiene and education, in support of child survival, children’s rights to quality
education, and to ensure the attainment of core learning outcomes. The UNICEF East Asia and Pacific
Region Water, Sanitation and Hygiene in Schools Regional Workshop took place from 18 to 20
October 2006 in Bangkok, Thailand, and gathered internal and external water and sanitation,
education, and communication professionals to share challenges and opportunities for scaling up
Wash in schools across the region.
The workshop took a unique approach in that the first two days were internal UNICEF sessions
designed to align the priorities of the Water and Sanitation (WES) and Education sectors for WASH in
schools. The third day included government partners from the Thailand ministries of Public Health and
Education, the World Bank in Viet Nam, UNESCO Bangkok, the Southeast Asian Ministers of
Education Organization (SEAMO), Education International, Plan Asia Regional Office, Plan Viet Nam,
the Child-to-Child Trust, Education International Asia Pacific Region, the American Red Cross IFRC,
and external consultants. The objective was to share experiences and debate issues in support of
stronger partnerships in the provision of water and sanitation facilities in schools for all children.
The UNICEF Education Strategy for 2006-2015 clearly highlights life-skills based water, sanitation
and hygiene education as a global priority in recognition of the impact of school-based WES
interventions on educational quality, access, attendance, learning environment and process.
Furthermore, the provision of appropriate hygiene facilities and supplies in schools is identified within
the strategy as an important contribution to achieving a holistic Child Friendly School model.

Accordingly, the UNICEF Water, Sanitation and Hygiene Strategies for 2006-2015 asserts that the
overall objective of UNICEF in WASH is to contribute to the realisation of children’s rights to survival
and development through global and national promotion of sector investment and support to
programmes that increase equitable and sustainable access to, and use of, safe water and basic
sanitation services, to and promote improved hygiene. UNICEF aims to work in close partnership with
sister UN agencies in support of nationally identified priorities in support of accelerated achievement of
the Millennium Development Goals (MDGs).

Workshop participants affirmed that WASH is an important prerequisite for ensuring the right to basic
education. Children commonly miss school because they are too busy hauling water or are at home
sick with a waterborne disease. Girls, particularly those who have reached the age of menstruation,
often drop out of school when toilet and washing facilities are neither private nor safe, or simply non-
existent. Even when children attend school, they fail to reach their full learning potential because of
worm infections and diarrhoea.

Representatives from 10 East Asia Pacific UNICEF country offices shared how their water and
sanitation programmes have allocated resources to improve the health of children through increased
access to safe water, latrines and handwashing facilities in schools. The workshop sought to identify
and build on best practices across the region by which UNICEF will co-operate with partners to ensure
that all schools receive a basic package of water, sanitation and hygiene education by 2015.

Specific objectives of the UNICEF internal sessions were to:


• Strengthen commitment and joint understanding between Education and WES country teams from
the region on WASH in Schools.
• Better understand the variety of experience available across the region and identify potential
resources for improved programming. To further identify regional areas of strength and common
challenges.
• Identify monitoring mechanisms for WASH in Schools.
• Provide those involved in developing a WASH in Schools programme with relevant information
and tools for effective planning and implementation.
• To gain a regional overview of costing standards and issues for WASH in Schools.
• Better understand the stages and/or content involved in planning a WASH response in
emergencies and the role of WASH programmes in relation to Avian Influenza (AI).

6
• Highlight how WASH in Schools will be taken forward jointly within WES and Education sections.

Providing children with safe, clean and reliable school WASH facilities helps create a learning
environment that is pleasant and healthy. Providing children with child-centred hygiene education
provides the foundation for a healthy and productive life; and creates an informed demand for safe
water and hygienic sanitation facilities. Where properly integrated with community programmes,
WASH in schools can transform children into change agents for the whole community.

7
Review Current Frameworks Relating to WASH in School
Cliff Meyers, Regional Education Advisor, UNICEF EAPRO

It is important to be well versed in water, sanitation, and hygiene and some of its frameworks. The
WASH overall objective is to contribute to the realisation of child rights to survival and development
through support to programmes that increase equitable and sustainable access to, and use of, safe
water and basic sanitation services, and promote improved hygiene. The revised WASH strategies
have been developed in tandem with the formulation of the UNICEF medium-term strategic plan
(MTSP) 2006-2009 and are designed to directly contribute to the MTSP targets in the focus areas of
young child survival and development and basic education and gender equality.

• Target 1: Halve, by 2015, the proportion of people without sustainable access to safe drinking
water and basic sanitation (Millennium Development Goal Target 10).

• Target 2: Ensure that all schools have adequate child-friendly water and sanitation facilities and
hygiene education programmes (now widely recognised as a sector priority — endorsed at the
World Summit for Sustainable Development and by the Commission for Sustainable
Development).

WASH globally: Three packages of support

1. In 60 countries with high child mortality and low WASH coverage:


a) Support to water supply and sanitation services.
b) Support to WASH in schools.
c) The basic package.

2. In emergency countries: UNICEF Core Commitments for Children in Emergencies (CCCs) include
WASH.

3. In all other countries where UNICEF supports programmes:


a) Hygiene improvements
b) Drinking water safety
c) Monitoring global indicators
d) Emergency preparedness

UNICEF supports seven strategies in 54 priority


countries. These strategies include:

1. Promoting a balanced national WASH programming


framework (3 pillars).
2. Supporting inter-sectoral approaches.
3. Providing catalytic and continuous support for scaling
up sustainable WASH programmes.
4. Supporting community management through effective
decentralisation processes.
5. Promoting safe and sustainable water supplies through
improved water resources management.
6. Focusing on sanitation, water quality and hygiene at
the household level.
7. Addressing a child’s right to health and education
through the provision of WASH in schools.

These strategies are global and are applicable to both WASH in schools and WASH in communities.
One of the things we recognised in relation to education is that we won’t have much success in
schools if WASH in communities is not being addressed alongside.

WASH in relation to the MDGs and the Dakar Framework for Action
So how does WASH in Schools link to the overall MDGS? With WASH in schools you have your own
piece of the MDG puzzle. MGD 2 and MGD 3: These are not going to be achieved without having solid
WASH in Schools programmes. So even in Dakar, we were already saying our targets have to be

8
backed with strategies, and our strategies have to include water and sanitation to allow children to
have quality education.

The ‘Dakar Framework for Action’, for example, has a target and strategy regarding quality:

• Target 6: Improving all aspects of the quality of education for all, so that recognised and
measurable learning outcomes are achieved by all, especially in literacy, numeracy, and
essential life skills.

• Strategy 8: Create safe, healthy, inclusive, and equitably resourced educational environments
with clearly defined levels of achievement for all.

Basic education and gender equality


In the UNICEF medium-term strategic plan WASH cuts across four key result areas:

1) Early childhood education


2) Access
3) Quality
4) Education in emergencies

WASH is placed more in quality than in access. It’s not just for access that you include water and
sanitation, now we are saying that a school is not a quality school unless you have water and
sanitation, and hygiene.

Draft Education Strategy


In the ‘Draft Education Strategy’ there are two references to WASH. The first is in relation to quality, to
establish child friendly schools and essential life skills as standard policy and practice:

1. Prioritise Child Friendly Schools (CFS) as a “one-stop” model for quality education processes and
standards. CFS is the main model that UNICEF uses and advocates for a holistic approach to
quality education.

Providing essentials like nutrition, safety from violence and/or accidents, hygiene facilities and
supplies and an environment that is generally conducive to good practices and learning
achievement. Promoting Child Friendly Schools as a holistic model for inclusive and equitable
quality education.

2. Boost Life Skills Based Education (LSBE) in 54 HIV priority countries and 56 WASH priority
countries.

UNICEF will work with UNESCO and other partners to consolidate and revitalise work on life skills
as an emerging discipline that requires greater clarity. Revitalised life skills will not only deal with
HIV/AIDS prevention in schools and for out-of-school children and youth, but will also renew
support for nutrition and hygiene packages such as WASH and FRESH.

The ‘Draft Education Strategy’ is still in the process of finalisation. The Education priority countries
have also used the WASH priority countries as criteria for their selection. Also the Regional
Adolescent Education strategy prominently includes WASH.

Out of 54 global priority countries, there are four Education priority countries, and eight WASH priority
countries in the East Asia Pacific region:

Priority countries Cambodia, China, Myanmar, Papua New Guinea


Not on list (FTI/ Pacific
UNGEI) Viet Nam
Education Mongolia
Timor Leste
Lao PDR

9
Priority countries Cambodia
China
Indonesia
Lao PDR
Myanmar
Papua New Guinea
WASH
Philippines
Viet Nam
Not on list Democratic People’s Republic of Korea
Timor Leste
Mongolia
Thailand

There is a concern whether countries that are not on the list will receive funding. So far the countries
not on the priority list have not received financial support for water and sanitation.

Focusing Resources on Effective School Health (FRESH)


The FRESH framework takes you beyond the ‘education world’ and is broad reaching. A brief
background: The FRESH initiative was launched at the World Education Forum by four key players:
UNESCO, UNICEF, World Bank, and the World Health Organization and is experiencing a revival of
sorts. Plan International is one of the strongest supporters in the region; and Education International,
which represents 280 teachers' unions and professional organisations worldwide, and the Partnership
for Child Development are core members of the global committee. The FRESH framework consists of
four core components:

• Health-related school policies which FRESH Core Components


do not exclude pregnant girls, that
encourage healthy tobacco-free
lifestyles, and that help maintain the
education system in the face of
HIV/AIDS.

• Provision of safe water and


sanitation to provide a healthy
learning environment that reinforces
hygienic behaviours and provides
privacy to promote participation of
adolescent girls in education.

• Skills-based approach to health, hygiene, and nutrition education that focuses upon the
development of knowledge, attitudes, values, and life skills needed to establish lifelong healthy
practices and to reduce the vulnerability of youth and teachers to HIV/AIDS.

• School-based health and nutrition services that are simple, safe and familiar, and address
problems that are prevalent and recognised as important within the community, including the
provision of counselling to cope with the HIV/AIDS epidemic.

There has been a debate concerning the most accurate term to use for water, sanitation, and hygiene
in schools. Some call it FRESH, others refer to it as WASH, and many recognise it as SSHE (School
Sanitation and Hygiene Education). UNICEF is encouraging the term ‘WASH in Schools’ and a move
away from SSHE, with the understanding that WASH is one contribution to the FRESH initiative.

Health Promoting Schools (HPS)


While the World Health Organization originally focussed on de-worming, as a focal point of the Health
Promoting School strategy, but this has expanded. WHO also states that Health Promoting Schools
can be easily captured under the Child Friendly School umbrella. The Health Promoting School
strategy includes:

1. Research to improve school heath programmes.

10
2. Building capacity to advocate for improved school health.
3. Strengthening of national capacities.
4. Creating networks and alliances for the development of heath promoting schools.

WASH and Child Friendly Schools (CFS)


The Child Friendly School model is central to UNICEF’s Education Strategy. Child-friendly schools are
those that are: inclusive; effective; protective, safe and healthy; gender equitable; and promote the
participation of the student, parent(s) and community. These five core dimensions of child-friendly
schools are closely related to, and inter-dependent on WASH in schools. The WASH elements need to
be featured in all dimensions of CFS so that all children can attend school. We are now seeing
countries where children are involved in school self assessments, and their participation makes a
difference in the dynamic of the school. When children report that the toilets are the worst part of their
school it really has a strong impact. In this region the gender dimension of CFS has been a struggle
because some say gender is not a problem because we see an equal number of girls and boys
enrolled. But we are losing sight of what happens inside the classroom, are focussing too much on
enrolment figures, and not looking enough at inclusion processes.

Now we must look at integrating WASH with the child-friendly school concept. This integration starts
first with the external capacity building of WES. We don’t see the WES unit getting as much capacity
building as the others. One thing that we do see with WASH in schools is the involvement of the
Ministry of Education in the implementation of the Child Friendly School model, yet the school
construction person is not always a part of the WES team. We don’t explore public-private
partnerships as much as we could. For example, this can be done by getting companies to adopt
schools. We see this a lot in Latin America but less so in East Asia. We need to look at how to get
education donors to invest in water supply. Without water – toilets and hygiene education lessons are
often fruitless. The million dollar question is how do we get education donors to invest in water supply
when the cost will be different from school-to-school? Last, we need to form stronger WASH in schools
and community linkages. When you are supplying WASH in communities, you should already be
taking in consideration the amount of water needed for the school. We need to support those linkages
better from the beginning.

11
Outcomes from the School Sanitation and Hygiene Education (SSHE) Evaluation
Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO

Obviously in the UNICEF world there are more than six countries that have been doing WASH in
schools. We have been tracking activities in the various annual reports, and the last count indicated
that almost 90 countries (2005) have been engaging in WASH in schools activities. It’s a phenomenon
that has been growing every year but in 2000 there was a structured attempt to try out certain
protocols and support life skills. Now we have a report and the documented findings of what went on in
six countries.

Six Pilot Countries


Burkina Faso, Colombia, Nepal, Nicaragua, Viet Nam, Zambia

Expected results 2000-2004


• Develop country-specific, child-centred teaching programme utilising life skills approach.
• Support initiatives by different stakeholders at community level.
• Document and disseminate experiences.
• Increase global, regional and national awareness of, and commitment to SSHE.

Design of pilot interventions


• Mobilisation in and around schools in rural settings.
• Collecting baseline date of various types.
• Contribution of local govt or parents.
• Construction/rehabilitation of water, sanitation and handwashing facilities.
• Participation of children, including clubs.
• Life skills education and material development.
• Training/orientation of teachers, sometimes others.

Assessment sought answers


1. What are main results of each pilot project?
2. What were major lessons learned (both positive and negative)?
3. What experiences, strategies, plans, resources or materials useful in other contexts?
4. Implications for scaling up?

Judging the findings


• Country teams determined the criteria for successful practice.
• Achievement was set at 4/5 schools or 80 per cent children (teachers/of the community).
• Comparison of project schools with control schools (Some control schools had interventions from
other agencies).

Outcomes: Water
• Facilities functioning: In each country still working in 80 per cent or more of project schools, within
200 m or within compound.
• Some system for maintenance and repair in place
• Storage: In 4/5 countries 80 per cent of schools stored drinking water in adequate fashion (but no
water quality testing)

Outcomes: Handwashing
• Handwashing with soap or ash: In none of the six countries were 80 per cent of children washing
their hands.
• Less than 1/3 used soap – absent or difficult to access.
o But some improvement over pre-project practices where no handwashing was practiced.

Outcomes: Toilets/Urinals
• In 4/5 countries, numbers followed national norms of ratio of children per facility. (In some
countries the MoE has developed norms of their own).
• Variation of norm: 25/toilet -> 100/toilet.
• Designs: 3/5 reported CF features.

12
o In one country, 1/10 latrines collapsed.
• Use and cleanliness: Five countries, in 80 per cent or more of project schools, toilets used and
kept clean.
o By children or by janitors.
• Project schools performed better than controls (in both use and cleanliness).

Outcomes: For children


• Knowledge: 80 per cent or more knew health reasons for washing hands (better than control).
• Participation: Many groups/clubs, 4/5 studies showed in 80 per cent or more of schools these are
activities:
o Designing facilities.
o Monitoring handwashing.
o Surveying community sanitation/hygiene needs.
o Cleaning tasks.

Outcomes: Home and community


• Home: In 4/5 countries, school-initiated activities reached to families:
o Behaviour change possibly due to other interventions because there were behaviour
change activities going on at the time; therefore, it is difficult to contribute positive
behaviour changes directly to WES projects.
• Community: In 4/5 countries, schools used as entry point to initiating community mobilization

Outcomes: Institutional setting and co-ordination


1. Except for Colombia, there were three or more government institutions involved in addition to
NGOs and donor agencies
2. Different approaches to co-ordination
3. Scaling up in Viet Nam:
o Finalising child-friendly designs
o Scaling child-friendly designs as standard for all schools
o Training more than just teachers
o Advocacy

Main conclusions
1. Greater emphasis needed on handwashing with soap:
• We need more work on handwashing as we didn’t attain the success rate we had hoped for.
• We have to explore the means to ensure the availability of soap:
o How do we ensure there is soap, and how do we ensure that the soap does not
disappear?
2. Baseline data missing
• Had to use control schools.
• Reinforces the importance of investing in monitoring. If our role is to advocate, we need to invest
in monitoring.
3. Need to have better costing information.
• Finance as part of advocacy.
• Resource mobilisation.
• We want to be honest with donors. You have to be clear on what it is included and have to be
clear on what it is you are getting out of it.

Question and Answer


Q: Was there tracking of de-worming?

A: This wasn’t part of the programming although it’s being done. We have some studies and evidence
on the importance of de-worming and we will be looking at some of the evidence for hygiene
promotion later on. For this pilot in the assessment we do have some data on the impact of de-
worming.

Q: How about the tracking of the impact of better environment in schools on children’s learning? This
would be good advocacy material later.

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A: The answer is no at this point. To that degree it’s quite difficult. The pilot study was a conservative
effort. There are some facts and figures but a lot of it is very qualitative. Some countries only looked at
eight schools while others had up to 40 schools (Viet Nam).

Q: You mentioned the availability of soap and water. Has this programme made an effort to connect
soap making to adult education programmes?

A: I don’t know specifically of this but maybe if we looked at country reports we would see some
instances. It sounds like an interesting idea to contribute to achieving sustainability.

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A Global Update on WASH in Schools: Developments from a global perspective
Therese Dooley, Senior Advisor for Sanitation & Hygiene, UNICEF New York

There is a growing recognition that schools and learning centres need to be safe, healthy and
protective (Quality Learning Environments); and that water, sanitation and hygiene are crucial factors
for school attendance and completion, particularly for girls. There has been an evolution of global
recognition that can be captured in the following timeline:

• 1993: The first studies and workshops by IRC and WHO showing SSHE experiences but
mainly at small scale.
• 1998: The IRC-UNICEF SSHE manual building on country experiences.
• 1999-2003: The pilot SSHE programme in six countries and other interested countries.
• 1999 – 2004: Increase in programme support for SSHE/WES in schools and advocacy and
international call for action
• 2005: Symposium SSHE: the Way Forward, Oxford roundtable.
• 2006: UNICEF/IRC Global Information Sharing (GIS) project; and
• 2006-07: Impact and Sustainability Study

Since Cliff and Mark have already expounded on the aforementioned topics I will focus on the final two
points:

UNICEF/IRC Global Information Sharing (GIS) project


Some counties are building facilities and others are working on developing materials. It doesn’t mean
that if you aren’t building latrines you aren’t doing WASH, countries are at different levels of
implementation.

The GIS project has seven main components:


1. Update and maintain WASH in schools Web site. The purpose is to have a Web site that everyone
can access and people can share and build information and to get this network kick started.
2. Create new content for the Web site.
3. WASH in schools network rejuvenated.
4. Publish two additional issues of the SSHE newsletter. The SSHE newsletter is published two to
three times per year and the latest one came out in October.
5. Produce and disseminate case studies and human interest stories (12 in total); they should be out
by November.
6. Translation (2006) of the World Bank/UNICEF toolkit (developed by WES team of the World Bank)
into French and Spanish.
7. Finalise the revision of the UNICEF school sanitation manual (the most downloaded manual on
the UNICEF WES Web site) that was published in 1998, but we have come a long way and
learned a lot more.

2006-07: Impact and Sustainability Study


People are asking, why is WASH in schools important? To answer that question UNICEF is embarking
on an 18-month study. The following counterparts are involved:
• Scientific study looking primarily at the evidence base for WASH in schools.
o LSHTM – health and hygiene behaviours
o University of Utrecht – education focus
o Research methodologies, planning and analysis – UNICEF M&E/WES units
o Literature review, detailed research methodology, design workshop
• Two country studies (India and Kenya where WASH in schools have longest history).
• National workshops, research process and immediate outcomes.
• Reports with ideas for dissemination, and a document of field research with programming
implications.
• Final document.
• International Forum – December 2007.
• Capacity Building on WASH in schools and knowledge management.

Public-private partnerships
I would also like to talk a little bit about public-private partnerships because a lot is going on at the
global level. It’s easy to count toilets and the number of children who stay in school, but it is hard to

15
measure handwashing because it requires observations, which can be costly. UNICEF has formed a
small-scale partnership with Procter and Gamble which focuses on water quality in schools. A larger,
well-known public-private partnership in the region is with Unilever and its Lifebuoy Soap. It is basically
targeting the handwashing practices of school-aged children. It’s not about a donation of soap – that is
the mistake we make when we think about partnerships – we automatically think of someone donating
something. Public-private partnerships can also allow us to work on behaviour and social change
where there are marketing initiatives that trigger positive behaviour practices.

A third public-private partnership is the Global Water Challenge, a number of private companies, some
big corporations that come together under the auspices of corporate social responsibility and
contribute money for schools. We want to make sure that money is not just used to build schools but
also for the software side of WASH in schools which includes hygiene education and promotion. Part
of our challenge is finding ways to influence what they these corporations are doing, and making sure
that WASH in schools is included.

Finally, a new innovation called “play pumps” is being introduced. Children play on these water pumps
and in the process water is released for use in the school. India has been working on two additional
pumps. There is a little controversy as to whether it’s forced play or child-initiated play. This will have
to be worked out via consultations with children at the schools.

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Assessing Impact and Effectiveness: Reviewing potential indicators/standards
George Attig, UNICEF Consultant, Mahidol University

There are very few documents that contain information about indicators for WASH. So let’s start from
the beginning with this question: What is an indicator? An indicator is a piece of information that
indicates a state or level. An indicator can be a measurement, a number, a fact, an opinion or a
perception of a specific condition or situation. They thus can be quantitative or qualitative. When we
talk about percentages, portions or numbers that’s quantitative. When we talk about participatory
aspects, that’s qualitative. An indicator can be written as a sentence, a question, or in any form as long
as people understand its meaning.

Indicators measure and monitor the achievement of expected results of activities (progress in
achieving outputs; process indicators) and the degree to which these have achieved a desired state
(outcome, impact) and thus the success of a programme. They answer questions such as, have the
activities done had an affect or change for the better? Indicators are important to WASH in Schools,
for all programmes for that matter, because they prove the success or effectiveness of a process
through positive outcomes. Indicators are needed to open people’s (policy makers) eyes, create
informed demand, gain additional resources (partners/funds), and start the scaling-up process.

A key WASH issue that I have heard you all say is that there is no baseline data: Today we can talk
about what indicators we need; indicators that can be monitored from the baseline to the end of a
project’s donor life?

Indicators need to be specific, understandable and directly measurable. They have to be easily
acceptable and recognisable. There should be no assumptions or lingering questions such as “what
do you mean by this”? Everyone has to see it and understand it. Indicators need to be objective and
timely (one result, measures only one thing at a time; comparable data can be collected, especially at
different assessment levels), and remains stable over time so that change can be measured. It’s
difficult when an indicator has two pieces; therefore, it is better to look at one aspect at a time.
Indicators have to be valid, i.e. they must measure the element they are supposed to measure. You
must be vigilant on this, is the number of latrines a valid measure of use? I don’t know how many
times I’ve seen the number of latrines for WASH in schools programmes as an indicator. And lastly,
indicators must be practical. That means they are realistically achievable and data can be easily
collected.

Steps in developing and/or identifying indicators


When we start to identify indicators we can break it down to manageable steps starting at:
• Levels: You have child/family/school/system (wider government). What do you want to see
children, teachers, families and communities, doing with WASH?
• What needs to be measured: Do you want to look at knowledge, use, polices, partnerships, etc.?
• After developing trial measures/indicators you have to assess each trial indicator
1. Does the indicator measure what it is supposed to measure?
2. Is it useful?
3. Can data be easily collected?
4. Can it be monitored over time?
5. Select the best indicators for a specific project or programme?

Group Work: School WASH Indicators


We will now divide ourselves into 4 groups (assessment levels), leaving the last set of indicators to
cover as a group:

Group 1 child-specific WASH indicators:


1. Children have access to safe drinking water from an improved water source.
2. Access to water and soap (or another acceptable alternative).
3. Consistent organised maintenance:
• Toilets.
• Drinking water.
• Hand washing facilities.
4. School children effectively use latrines.
5. Children take pride in their own and school’s hygiene (sustainability).

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6. Children help each other in using facilities and helping each other in maintaining facilities.
7. Students pass hygiene messages, practices to families.
8. Children help and participate in the making and monitoring of school’s plan of action in WASH
in schools.

Group 2 school indicators:


1. Facilities
• Latrine and handwashing facilities exist.
• Latrine to student ratio.
• Separate latrines for boys and girls.
• Sanitation facilities are safe.
• Handwashing facilities are close to the latrines.

2. Behaviour change
• Is soap available?
• Are paths overgrown, doors locked, etc. (access and use of facilities)
• Clean school environment.
• Tools exist in school to assist teachers in measuring behaviour change.

3. Enabling environment
• Financial, operation, and maintenance plans in place.
• Children receive hygiene messages in school.

Group 3 family & community indicators (agency perspective):


1. Percentage of household that have safe water systems (access).
2. Percentage of household using sanitary latrines.
3. Incidence of population with diarrhoea disease incidence within last two weeks.
4. Handwashing with soap and clean water.
5. Percentage of families/children encouraging children/families to adopt safe practices learned
in the school WASH programme.

Group 4 system indicators:


1. Government commitment.
2. Policies plans and programmes/adequate national and lower level policy/legislation exists on
water and sanitation standards.
3. Adequate regulations and guidelines exist on WASH in schools for private and faith-based
educational institutions.
4. Co-ordination body exists at different levels.
5. Knowledge and information systems (EMIS) include key WASH indicators.
6. Ministries of health/education sharing same goals; have a coordinated strategy, vision,
resources.
7. Where education and heath sector plans exists, WASH in schools is a feature, component.
8. Whether the new schools being constructed include water and sanitation.

Due to time limitations we won’t get a chance to go over the last set of indicators: outcome/impact
indicators. When you return to your country offices, you could think about specific school (or even
national) WASH indicators that could be included as a statistical table for UNICEF’s ‘State of the
World’s Children’ publication.

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Thursday, 19 October 2006 – Day 2

Child Friendly Water and Sanitation Facilities in Viet Nam


Chander Badloe, Chief of Water, Environment and Sanitation, Section, UNICEF Viet Nam

Viet Nam is one of the East Asia Pacific countries that has shown large increases in access to
improved sanitation facilities from 1990 to 2004, though arsenic contamination in groundwater is an
emerging problem. In Viet Nam there are 15,000 schools (kindergartens, primary schools, secondary
schools). The nation has about 32 million children (about 40 per cent of total population), with a net
primary enrolment of 97 per cent (2004-05). The national school WES coverage remains at 65 per
cent for water, and 42 per cent for sanitation (2003).

Viet Nam was one of the six pilot countries that participated in the SSHE Global Pilot Project (2000-
2004) which sought to develop country-specific, child-centred teaching programme utilising life skills;
support initiatives by different stakeholders at community level; document and disseminate
experiences; and to increase national awareness of, and commitment to SSHE.

The lessons that the Viet Nam country team learned from the SSHE Global Pilot Project include:
• The norms on urinals/cubicles vary considerably. There were also difficulties in ensuring
adherence to technical specifications for design and construction quality.
• Water facilities were in working order in less than 80 per cent of the schools.
• Water quality was not all tested.
• Toilets and urinals are cleaned either by hired janitors or caretakers, or by children depending on
financial means of the school.
• Availability of soap is a major problem.
• Difficult to attribute changes in the community and at the household level to the school
programmes alone.
• SSHE is the responsibility of a wide range of institutions and agencies, requiring a good level of
co-ordination.
• Gender issues were addressed, with separate latrines for boys and girls, cleaning responsibilities
disaggregated by sex. The increased enrolment of girls has been mentioned as a positive effect
of SSHE.

The Child-friendly WES design is important in Viet Nam because the child-friendly approach is not yet
widely applied in school water, sanitation, and hygiene. It is becoming much more common, and in
Viet Nam there is a movement toward child-safe approaches. Currently there are standard uniform
latrine designs though many different designs are used across the country. It is therefore difficult to
control the quality of WES construction because many people are doing different things. There are
even new schools being built with no water and environment sanitation at all, but the Ministry of
Education and Technology (MoET) is in the process of establishing a standard of design for use in all
new schools. There are also many schools with insufficient/non-functioning WES systems. But WES in
schools (and health centres) is in the National Target Programme II: 100 per cent by 2010. This is a
major breakthrough because now the government is not only prioritising rural water and sanitation but
for the very first time there is a very clear target for WES in schools.

Child-Friendly WES design


• (Jointly) developed key criteria (linked to child safe
environment/child safe community)
• Linked to wider concept of child-safe environment,
facilities, etc. There was a distinction in the type of
school, and took into consideration the age-group of
children. Consultations – national and local levels,
including with children.
• Came up with criteria via wide consultations.
• Once completed, the MoET set target. By the end of
this year (2006) it will have revised the standard of
designs. The MoET has strongly indicated that the
CFS designs will be issued as a standard.
• Adaptation of designs and testing; approval

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Child-Friendly WES design process: Timeline
This was quite a lengthy, intensive process to ensure that all stakeholders at the various levels were
involved. Here you can see that it started in 2002 and will not be finalised until 2007.

After the review of available water and latrine designs, we embarked on consultations with children.
From the children’s perspective, child-friendly latrines should be:

• Safe to access.
• Well lighted and ventilated.
• Nice and safe to use.
• At the right place.
• Clean and well-maintained.

We also did consultations with teachers and technical staff on the design. In the very early stages of
the discussion there were only technical drawings, which are not very clear and don’t say much to
people who are not engineers. So we learned to make sure that our presentations are clear, so that it
becomes visual to all involved.

Our experience was that after if we do construct what we know to be the preference of
children/community as a result of consultations, the cost is slightly higher. But the other side of the
costing debate is that following recommendations received from consultations results in a better
quality, more used facility. Below is a rough estimate of the costs in Viet Nam which is slightly higher
than the norm.

• Septic tank latrine + urinals + hand washing: $4,000-$5,600


• Dry latrine (double vault + urinals + hand washing): $2,000
• Maintenance: About $20 per school per month

Key lessons learned with Child Friendly WES design:


• Child-friendly design fits into the wider concept of CFS environment and/or child safe
community and healthy living. It’s a perfect fit with the various ministries and headed in the
right direction.
• It is critical to have all key partners on board (MoET and the Research Institute of School
Designs). It also important to have the Involvement of other key institutions, particularly at the
local or provincial levels.
• It is essential to incorporate children’s voices in all phases. As one of the children indicated, if
we ask their opinion we have to try to respect that.
• The local viewpoint is important, particularly on operation and maintenance issues,
construction quality, etc. The first reactions and views of teachers and headmasters vis-à-vis
operations and maintenance were more practical because educators are at the schools and
have valuable insight that outsiders would not otherwise be privy to.
• Testing is needed to improve the design. It takes time, it requires patience but it is essential.

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Opportunities and next steps within the Vietnamese context
The National Target Programme II has a clear target of 100 per cent water and sanitation in schools
by 2010. It is a big programme and significant amount of resources are being allocated. There is also
an increased focus on child friendly environments and child friendly communities. The approved child-
friendly design will stimulate high level of interest and commitment for incorporating WES facilities in
the MoET’s standard for new schools; and improving quality of WES facilities at other existing
locations. Now there needs to be more guidance on monitoring the quality of construction by schools
and/or local authorities.

Question and Answer


Q: In your design you have separated urinals from places to defecate. Is there problem with usage
(i.e. children defecating in urinals)?

A: No. We haven’t had such problems. The truth is children tend to urinate in school more than
defecate. The distinction is clear as to the places for urination and the places for defecation. There is
also a regulation on the use of the toilets which is posted on the latrine. The partitions we have used in
Viet Nam are an outcome of consultations with children who said they prefer privacy. This resulted in
higher costs and in the adult’s mind cost comes into play but we have to remember the child’s
preference. It’s not entirely OK if we are doing something that is not right/or preferred by the child. It
may result in a slightly higher cost of the latrine but if we do consult children we need to, where
possible, respect the suggestions coming up.

Q: You have now reached a point where there are standard designs that will be routinely implemented
so the children will no longer be consulted. How will you deal with that?

A: The involvement of children will not cease after consultation. The facility is only child friendly if it is
used extensively by children, and that is a continual process that takes place in the school with the
normal health and hygiene education. The child-friendly latrine design is in the overall context of child-
friendly facilities. Viet Nam, with support of the Swedish government and CIDA, declared that they
have five safe communes that have met the criteria, which includes facilities.

Q: Is there any standard on the ratio of children per stall?

A: There are some guides, for example, one unit for 50 children. But the guides are translated into
national context. Sphere has guidelines, and if there are shifts in schools then the number of stalls
needed could be less. There is an IRC publication that helps project officers come up with ratios. Keep
it practical: some schools only allow children to go out during a break which means you will have peak
times and you might need different ratios although you have the same number of students as other
schools. You should also look at the space within the school and sometimes there has to be
compromises.

Q: Did you consult with the user about the separation? It appears that the separation makes cleaning
and maintenance more difficult.

A: That brings back to mind the point that operation and maintenance doesn’t start after the
construction but from the beginning. You have a valid point.

Q: What about the cost-sharing mechanism. Did UNICEF provide 100 per cent of the cost?

A: With the models we supported full cost. But the other way to finance WES in schools is cost-
sharing where UNICEF pays half and the central government pays half – not the community. We tried
cost-sharing with the community in the past and found that the community could not always support
the cost, which of course affected quality.

Q: Is operation and maintenance easier for different size/location of blocks?

A: That is a very interesting perspective and my impression is that when looking at school facilities we
are looking at one unit in one particular spot in an area. In terms of separating the facilities by age
group so that age-appropriateness becomes a dimension, that also makes sense.

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Q: Have you done any advocacy?

A: Advocacy is one of the keys required to propel the initiative into the broader plan. Otherwise it
remains in pilot stage. We saw an opportunity through the National Target Programme II, and we did a
lot of pushing for the government to include WES targets for all schools by 2010. I feel it is a bit
ambitious but it also translates into the acceptance of the idea and the national commitment to WES in
schools. The other key partner is the MoET itself. We worked side-by-side with them because at the
end of the day, once it’s clear, they will issue CFS latrine designs as a MoET standard, which means it
has to be used by anyone building schools in this area.

Q: How is waste-water cleaned?

A: The main systems are septic so the liquid and solid waste comes together after treatment.
Handwashing water is often drained out to the sides of the school. Urine is drained into soak pits.

Q: Is there a separate provision for drinking water and handwashing water?

A: Water sources are different from province-to-province and from school-to-school. The bigger
schools often have individual drilled underground water with pumping and distribution. But the smaller
rural schools with two or three classrooms have simple water sources, often a dug-well. Water quality
is not regularly tested in schools, or in rural settings. Now I think we have progressed from just looking
at water quantity to include quality.

Q: How can water quality be tested?

A: You can put H2S test strips into the water to test quality. The kits cost less than USD$.10, and can
be used by children. Banda Aceh has been using it for a long time and they have field monitors
regularly checking on the water quality. It has also been used to monitor the water quality of housing
providers. The downside is that the test strips can give false positives so you will need to double
check. It also doesn’t tell the level of contamination only that the water is contaminated. We (Viet Nam)
are developing a test kit that is locally made so the price is very reasonable.

You can also consider water treatment where a safe water source doesn’t exist. Sometimes it’s about
testing and other times it’s about treatment. If you lack funding you might have to do small-scale
treatments. UNICEF has a global MoU with Population Services International (PSI); at the country
level you can easily step in with that MoU as PSI is present in many countries. In addition, in most
countries chlorine costs about USD$.15 and can treat about 1,000 litres of water so it is cost effective.

Q: What is the process for using H2S strips?

A: The process is:


• The person keeps the water sample against his/her body for 24 hours.
• If the water is black that means you can get diarrhoea (from faecal pollution).
• You can have students test it, then boil and test it again. It’s a good way to get them involved.

Pros and Cons


• Gives an indication but doesn’t tell the level of contamination.
• Sometimes may give false results.
• Important thing to generate interest in children (community) in water testing.
• Can invite two people from Thailand University and they can convey the technology to local
technicians and they can start producing in their own countries.
• Less than $.10, so it’s cost effective.

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Hygiene Promotion in Schools: Curricula and extra-curricula
Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust

Hygiene is not the same as geography and math. The whole thing is different and this worries people
because they are used to working in their own boxes. It’s hard to break into government curriculum
because it’s already written already and hygiene is left around the edges. I decided to go back to
school in the past four or five years and looked at curriculum in health education and how you deliver
it. I examined the planned content of health education (often centred on hygiene) in primary schools
generally and with special emphasis on three countries I know well, India (Federal and Maharashtra
State), Uganda and Zambia.

I expected to find that health education and hygiene education was a ‘Cinderella’ subject with little
commitment and low priorities; little content in the syllabus; and little enthusiasm to raise the status of
the subject and/or use new approaches.

I found instead that health education is enormously important. There were high priorities accorded at
all levels (in Zambia a survey mounted by the Centers for Disease Control and Prevention (CDC) saw
health hygiene as parents’ highest priority over literacy and numeracy). The curriculum was awash
with health topics all over the place but chiefly in science social studies (civics), and physical
education. So the actual content in terms of volume was there. There was also a considerable concern
that schools and children should be doing more to raise hygiene standards, tackle pollution and
prevent disease and ‘deadly habits’. People were worried that the schools were not delivering.

And this concern was justified. Generally there existed:


• Lack of co-ordination and overlap. Between different subjects, if you learned about
handwashing you learned in about five different places.
• Little appreciation of the needs, interests and capabilities of children at different levels
particularly at lower primary level. Most of the stuff wasn’t geared toward the needs of young
children. There were very little which raised the ability of children to think and act.
• A very sketchy appreciation of what active learning meant and why it was needed. Practically
none of the active learning was closely linked with something called ‘life skills’, which every
one was ‘for’ but few really understood or defined in the same way.
• Very few people understood about transferring active learning concepts into action. Everyone
believed in life skills and non one knew what it was. When they talked about it they used large
words: socioeconomic, interpersonal and empathy that no one understood very well but didn’t
understand very well.
• Still largely time and space bound. Linked with lessons in schools. ‘Children for Health’
activities seen as a nice but optional and working generally from the school rather than in the
school.

The schools realise that what they are doing at the moment doesn’t work. Here are some ideal
changes in approach which would do much to set us on the right track.

Think content and competencies, not curriculum and syllabus


Let’s cut out all the talk about curriculum. People think curriculum is Bloom’s taxonomy. In actual fact
we are choosing planned content in schools. We are not thinking planned content. We need to
choose:

• Aims and goals (knowledge to master; skills to develop; attitudes to foster and experiences to live
and learn from);
• A plan (how much and in what order);
• The right methods and approaches (because these get our knowledge known and our skills
developed).
• The materials and experiences our children are going to be given.
• What we assess and how.

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We need to take a new look at planning (as units) instead of individual lessons.
• Select a term on a subject.
• Almost certainly units can be revisited in different ways over the three levels.
• There are probably no more than a few topics on hygiene promotion. So you constantly
develop it over time.
• Probably related to broad bands rather than individual classes perhaps e.g. in the
primary/basic cycle as early middle and upper primary e.g. sixth through seventh, eighth
through 10th, and 11th through 12th.
• The plan then needs to list at least three headings
o Knowledge and Skills
o Action in class to support and develop these
o Action round school and in families
o With possibly a fourth (reinforcement in other subjects)

A new look at methodology as doing rather than ‘dancing’.


• A methodology which changes between what we do in school and what we do in the
community. Obviously that will take place over several lessons and backed up by other
subjects.
• Doing involves both “I can” and “we can”.
• Projects using the Child-to-Child approach often see this as a step-by-step approach.
• Involving children moving between school and community

A new look at our materials a focusing out rather than in.


• Textbooks aren’t good for hygiene education. If we use textbooks (aren’t workbooks better?)
should they not let them focus out rather than in?
• The richest materials are in our own local environment and it is here that our study should
focus.
• Are these changes do-able? They don’t involve any extra time or expense. Children would
welcome them. They make learning much more fun.

But in reality these changes are quite threatening and fundamental because in almost every case they
let the light into the safe self-contained world that the school has been used to for so long. We need to
open the door to that world gradually so that the light does not blind those who take shelter within.
These approaches let the community into the school and the school likes to be self-contained, and
teach the lessons. So it won’t be all that easy but there are some things we can look at which might
help us.

Opening the Door


Looking at what we mean and the implications of what we mean is not time wasted. In India there is a
subject called Socially Useful and Productive Work, and in other countries there are Citizenship
classes that can be used to teach hygiene education.

Unpack the rhetoric


Think through goals and definitions and their implications (if possible at ministry and project
management level). What are these ideas and competencies we seek and what are the implications of
changing attitudes in the light of real conditions and real cultural values?

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Link with high status subjects
As we all know some school subjects in school are ‘more equal than others’. The most ‘equal’ are
undoubtedly language and maths in that order followed closely by science. In many countries health
and hygiene is linked with Physical Education (a very unequal subject), in some with Citizenship (even
worse). Many would have Health and Hygiene as a separate subject, but how high would its status
be? If there was a chance to link with these subjects we would have better opportunities to teach
hygiene. In Uganda, thanks to UNICEF, health is located within the Science curriculum, ring-fenced in
separate units with their own time allocations, and examined. It is taken seriously. Close links with
Language are desirable and productive. We miss an enormous trick when we miss language. Children
want to read, write, and produce plays. It doesn’t matter what they are writing about. Why not let them
read and write about hygiene content? The same can be done with mathematics: Children can do
activities such as measure the distance to the well, do statistics with the instances of diarrhoea, which
can be brought in and everyone can accept.

Demystify life skills


Life skills are not only developed in class, but out of class. We want children to ‘notice things’ ‘solve
problems’ ‘stand up for themselves’ ‘get inside other people’. Let us use these words rather than high
language such as ‘psycho-social’ ‘cultural awareness or ‘empathy’. And remember, life skills have to
be lived, in the play ground, at home, talking with older or younger children … not just taught in
lessons.

Work with the whole school (that involves a redefinition of school). Every one needs to know and be
involved:
• Every teacher a teacher of health and hygiene
• Every parent concerned with hygiene
• Every worker an example for hygiene
• Every passer-by able to assess the schools through how it looks and how its children behave.

Involve teacher educators


Surely this should be part of hygiene and sanitation. This, however, is the weakest part in any system.
Just as schools need to live water and sanitation every college needs also to develop in a way that
includes hygiene education instruction. Their curriculum needs to parallel that of schools.

Blow trumpets
If we want schools to lead the way we must reward those who do. We should involve media; stage
competitions and open days; wave flags: In Uganda there was the idea of a school flag. The school
raised the flag when it met certain criteria and lowered the flag when it didn’t meet the criteria.

In closing, we mustn’t just think of life skills as a series of lessons. We need to think instead of schools
which try to meet competencies, which work with units, which exploit other subjects, which develop life
skills in and outside the classroom and I think you would be surprised if you taught through
programmes in this manner. For instance, if you yourself developed a programme based on
competencies and took it to the director of education he/she might say “very well”, “how can we
change and do things as you suggest”?

25
The Evidence Base for Hygiene Promotion
Emmanuelle Abrioux, Project Officer, Life Skills Education, UNICEF EAPRO

Many may ask the question why WASH in Schools is needed. Evidence shows time-and-time again
that inadequate access to safe water, hygienic latrines and handwashing facilities, combined with the
lack of hygiene knowledge is the leading cause of disease and death among children younger than
five-years old.

Causes of deaths among children under five, 2000-


2003
• More than 3.5 million children younger than 5 die
from diarrhoea and acute lower respiratory tract
infection annually.
• The leading cause of younger than five deaths is
pneumonia - accounting for more than 2 million
under five deaths per year. Together, diarrhoeal
diseases and pneumonia account for 36 per cent
of all younger than five deaths globally.
• The major cause of diarrhoeal diseases is human
excreta.
• Children in developing countries average from
four to five bouts of diarrhoea each year,
accounting for an estimated 4 billion cases
annually.

Key evidence linking WASH services to disease, education and development


As the numbers indicate, the lack of WASH is inexorably linked to the morbidity and mortality of
children. Water, sanitation, and hygiene are important factors in the access to, and the quality of
education as it is affects enrolment, attendance and drop-out. Numerous studies have documented the
affect of WASH on girls’ education in particular. Girls tend to be water haulers and either miss school
because they have to fetch water at home, or are sent out of class to fetch water at school. Girls who
reach the age of menstruation miss class during their period, or drop out of school altogether if
adequate amount of water and private and clean sanitation facilities are not available. Both girl and
boy children are susceptible to helminth (intestinal parasitic worms) infections, which cause a number
of health problems that affect physical and mental development, and attendance and performance at
school. There is a dearth of anecdotal evidence on how WASH is linked to education and health, but
there are two particular studies that quantified the linkages.

A 1985 study conducted by Steven Esrey looked


water quality at the source and found that water
quality impacts the incidence of diarrhoea. A
2004 meta-analysis conducted by Lorna Fewtrell
and John Colford looked at water quality, water
quantity, sanitation, and hygiene as it relates to
incidence of diarrhoea. Through a
comprehensive literature search and
bibliographic review, 2,120 titles published prior
to 26 June 2003 were screened, 336 papers
were secured for a more thorough examination,
and 64 of these papers (representing 60 distinct
studies) water quality, sanitation, hygiene or multi-factorial interventions and examined diarrhoea
morbidity as a health outcome in non-outbreak conditions.

In developing countries, interventions aimed to increase water quality, particularly point-of-use


treatment, decreased levels of diarrhoeal illness. Water supply activities decreased diarrhoea, but this
outcome was more common with the provision of household connections and water use without
household storage. Hygiene activities, specifically those promoting handwashing were proven very
effective. There was limited data on sanitation interventions, but those available implied success in
reducing incidences of diarrhoea.

26
The effect of handwashing on children’s health
While water quality and quantity has a major effect on child health, hygiene practices such as
handwashing with soap has also been proven to reduce incidences of diarrhoea, which contributes to
absenteeism. A study on a one-year programme implemented in Pakistan studied the impact of
handwashing with soap

The study was a randomised controlled trial from 11 to 25 neighbourhoods in Karachi to assess the
effect of handwashing promotion with soap on incidence of acute respiratory infection, impetigo and
diarrhoea. The intervention took place in large squatter communities where 41 per cent of the deaths
of children aged younger than 5-years old were due to diarrhoea, and 15 per cent due to respiratory
tract infections. It included multi-modal interventions: fieldworkers visited weekly to distribute soap and
conduct health education sessions to encourage handwashing. The key findings were that a large
reduction in diarrhoea could be attributed to the use of water with soap. As far as the differentiation
between plain soap and microbial soap, the researchers found that there was no statistical difference.

Duration and frequency of intervention effectiveness was only noted only after eight weeks. In
addition, the duration of behaviour change was not measured. The impact of participatory
methodologies was an issue because success/failure of interventions was based on anecdotal
evidence. Gender and age emerged as an issue because anyone in the household over 30 months
was included and it involved both men and women. The programme would have been more effective if
household members younger than 30 months were included and mothers were targeted for
handwashing the hands of their infants as well. It is important to note that the availability of water and
sanitation services essential.

Impact of WASH on girls’ enrolment


In the Alwar District in the state of Rajastan, India, girl’s enrolment increased over the years as school
water and sanitation improved.

Impact of de-worming on cognitive performance and absenteeism in Jamaica


Helminth infections affect not only a child’s physical health but also mental development and cognitive
performance. A 1992 study conducted by Catherine Nokes et al. shows us very strongly the impact of
de-worming on cognitive performance. Infected children who were treated showed a marked
improvement in cognitive performance.

Improvement in cognitive performance with de-worming of school children in Jamaica

27
In 1993 Nokes et al. conducted a study on the impact of de-worming on school absenteeism. As you
can see, those with highest rate of worm infections have the highest absenteeism. Thus, the Nokes’
study is one of many evidences that link the lack of water, sanitation, and hygiene to poor cognitive
performance and attendance.

School absenteeism and helminth infection in school children in Jamaica

28
Financing WASH in Schools: What does it cost?
Murat Sahin, Project Officer, Water, Sanitation and Hygiene, UNICEF DPRK

We decided to do a costing exercise to generate an approximate estimate of the overall costs and
resources required for WASH in Schools; to discuss explicitly the inputs required to achieve WASH in
schools; and to provoke substantive discussion about practicalities of achieving WASH in Schools
goals

When we talk about costs we have to classify them into two categories: First there are capital costs,
which are investments in fixed WASH assets and infrastructure. This includes regular capital
investments for upgrading depreciating capital and establishing new training programmes). Second,
there are recurrent costs, which are the regular costs of operating, maintaining and administering
WASH programmes.

Systems costs vary and include:


• Relative costs of systems, technologies
• Hydro-geological and climatic conditions
• Ground water based systems
• Population densities
• Community/partners cost sharing (includes hardware and software)

Different countries are using different technologies depending on the region, cultural appropriateness,
cost, and other factors. What the costing exercise found in regards to rural water and sanitation is as
follows:

Rural sanitation
• VIP latrines: $200 per unit
• Simple latrines: $100 per unit

Rural water
• Hand pump on dug well: $2,700 per unit
• Hand pump on bore well: $1,000 per unit

29
There are 17 countries promoting hand pumps.

WASH per capita


As anticipated, the WASH per capita for UNICEF-supported systems varied by region.

30
Financial allocation for hardware versus software
Hardware can be described as sanitation facilities that include latrines and handwashing facilities; and
technology and tools that deal with water supply and quality. Software deals more with hygiene
education and promotion such as community management, training, institutional capacity building and
such. UNICEF allocated 55 per cent of the WES budget for hardware, and 45 per cent for software.

In 2004 UNICEF allocated $32 million from regular resources for water, sanitation and hygiene
programming; and $160 million from other resources. (This large variation can possibly be attributed to
the 2004 Indian Ocean tsunami and the 2005 Pakistan earthquake).

MDG costing exercise in Tajikistan


The Ministry of Education through a reform process began reviewing its budget vis-à-vis Education for
All (EFA) and the MDG commitment. The target is increasing the gross domestic product share from
3.2 per cent to 5.3 per cent by 2009, where 1.5 per cent of the education budget is allocated for
sanitation and hygiene promotion projects.

ALL PILLARS NEED INVESTMENT

31
WASH in Emergency Preparedness and Response, Avian Influenza
Katrin Imhoff, Education Officer, UNICEF Thailand

The UNICEF Thailand office in co-operation with the Government of Thailand embarked on a school
emergency preparedness and response planning (EPRP) project called School-based Approach to
Avian Influenza Prevention and Pandemic Influenza Preparedness and Response in Thailand. It was
conducted by the Kenan Institute Asia with funding support by UNICEF. The objectives were to
strengthen the capacity of Thailand’s school system to develop healthy behaviours; and to develop
plans for emergency preparedness and response, with a preliminary focus on Avian Influenza and
Human Influenza Pandemic at school levels. At the same time we are working in emergency
preparedness and response on the provincial level on up.

Basically the process was as follows:

Activity Participants Outcomes

1. Workshop on Five public school • Prototype EPRP planning process including risk
developing a school principals from Tak, analysis form and template for school EPRP on
EPRP process (8-12 and Mae Hong Son pandemic influenza.
May 2006) Provinces
• EPRP plans for five schools covering: pandemic
influenza, fire, forest fire, landslides, fighting in
border area, flooding, vehicle accident, severe
diarrhoea.
2. Workshop on School teachers, • Draft life skills-based health education curriculum
developing a life education unit and lessons plans (grades K-12) on avian and
skills-based health supervisors, public pandemic influenza.
education curriculum health officials from
unit (grades K-12) on Tak, Mae Hong
avian and pandemic Son, and Nakhon
influenza (8-12 May Sawan Provinces
2006)
3. EPRP 39 public school • 39 schools are formulating EPRPs for pandemic
orientation/training principals from 17 influenza and at least one other high risk
workshops (24-25 provinces* in the emergency situation (to be completed by Sept.
June and 1-2 July north, northeast, 2006).
2006) central, and south of
Thailand
4. Avian and pandemic 22 education • 39 schools are implementing a life skills-based
influenza life skills supervisors, 39 health education curriculum unit on avian and
education public school pandemic influenza.
orientation/training principals, 115
workshops (24-25 teachers from 39
June and 1-2 July public schools in 17
2006) provinces in the
north, northeast,
central, and south of
Thailand

The workshop was developed with experienced participants, and there were five manuals developed
from this workshop. The aim was to include avian influenza and to include other high-risk diseases
such as diarrhoea. In the beginning there was pre-testing, then teachers taught it, then there was more
feedback during activities and workshops carried out in October. It is fully aligned with the Thai health
care system curriculum. At the same time behaviour change can be monitored and child-to-child
activities implemented. We had a launch on 10 October 2006 and we will provide the materials to all
learning institutions in Thailand (vocational schools, private schools, etc).

32
Question and Answer
Q: Each country got money for hygiene kits, how was this linked?

A: We have only provided soap; we haven’t given any hygiene kits to those schools. Thailand is quite
well-equipped in soap but it is still missing toilets. We had developed the hygiene kits but the Ministry
of Public Health found that those items are there. What we working on are “Learning Kits”, in an
emergency situations when children have to miss school; they can stay home and continue to learn.

Q: Avian Influenza in relation to all of the other issues there is a potential for information overload.
How did you handle that?

A: That’s why we integrated it into the health curriculum. It touches on all the standards on the
curriculum so it can be used in health education curriculum. We use Avian Influenza as an entry point.
We took the same approach in the south of Thailand where there is violence, we have the learning kits
for emergencies and they use it all of the time.

A: Lao used posters and materials from Thailand. We [Lao Country Office] supplemented the “Blue
Box” and spoke with the MoE and got them to allocate one hour per week for Avian Influenza
prevention education. We divided the curriculum into two areas, Grades 1-2 (handwashing, and don’t
touch dead/sick birds); and Grades 3-5 (handwashing, and don’t touch dead/sick birds, eat cooked
poultry].

Q: Why do we have to do Avian Influenza? Health education is more practical.

A: As an implementer we need to see both sides of the coins. We have to take the opportunity to re-
instate whole health and hygiene education – Avian Influenza-related activities are too short to really
have impact on behaviour change. In Thailand we don’t have Health/WES/Health Education officer,
but since Avian Influenza became an issue, it helped us to open the door to the two core ministries
(Ministry of Public Health and Ministry of Education). Before Avian Influenza became a priority each
ministry was working on its own, for example, the MoPH has been doing work in Thailand a long time
but alone. We have to think positively about this project and take it as important step to re-establishing
health education on a broader scale.

33
WASH in Emergency Preparedness and Response, Child Friendly Spaces
Gary Ovington, Education in Emergencies Officer, UNICEF EAPRO

If you think WASH is important in stable times it’s much more so in times of emergency. The first thing
you will have to in an emergency response is an assessment. One useful assessment tool that was
used in the Education sector for the very first time in Aceh was The Rapid Assessment of Learning
Spaces (RALS). This assessment looks at factors such as pupil and teacher numbers, conditions at
the schools both environmental and structural, the availability of water and sanitation infrastructure
and other key information.

WASH in Schools in the initial relief and subsequent recovery stages can be partially addressed
through temporary learning spaces or Child Friendly Spaces (CFSp). The UNICEF Core Commitments
for Children (CCCs) advocates that the building of safe environments for children and women is
primarily defined as a protection issue, but at the same time, linked with the education sector. Centres
set up as part of the CFSp approach, provide a protective space for children where they can engage in
structured recreational and educational activities, as well as have access to basic primary health and
nutrition services. The centres provide targeted programmes for pre-school children, primary school-
aged children, youth and parents, and provide water points and latrines.

Diagram of a Child Friendly Space (CFSp)

SPHERE standards
SPHERE standards also address water, sanitation, and hygiene education/promotion in emergencies.
In regards to health and hygiene education, SPERE standards call for health services that are based
on relevant primary health care principles. The key indicators are that all people – including children –
have access to health information that allows them to protect and promote their own health and well-
being. This includes hygiene education in camps, shelters, public places, and/or schools or temporary
learning spaces to include handwashing with soap, the safe disposal of excreta, handling safe water
and food. SPHERE also addresses access to water quantity, and water quality; queuing time and the
distance of water points from dwellings, which historically affects girls’ attendance in school. The
access to and number of toilets; the design, construction and use of toilets; and vector control are also
critical components.

INEE Minimum Standards for Education in Emergencies


The Inter-Agency Network for Education in Emergencies (INEE) is a global network of over 100
organisational and 800 individual members who are working together to ensure the right to education
in emergencies and post-crisis reconstruction. The INEE has put together some standards that
address water and sanitation in schools/learning spaces in both manmade and natural disasters. The
standard in particular that includes water, sanitation, and hygiene is: Access and learning

34
environment standard 3: facilities ⇒ Education facilities are conducive to the physical well-being of
learners.

Key indicators (and guidance notes for this standard) include:


1. Basic health and hygiene are promoted in the learning environment.
2. Adequate sanitation facilities are provided, taking account of age, gender and special
education needs and considerations, including access for persons with disabilities.
Sanitation facilities should include solid waste disposal (containers, waste pits), drainage
(soak pits, drainage channels) and adequate water for personal hygiene and to clean
latrines/toilets. Learning environments should have separate toilets for males and females
and adequate privacy. Sanitary materials should be available for girls and women of
menstruation age.
3. Adequate quantities of safe drinking water and water for personal hygiene are available at
the learning site. Water should be available within or in close proximity to the learning
environment as per local/international standards.

These standards are highly optimistic and can even be difficult to meet under stable conditions;
however, they are a good set of guides and have linkages to the SPHERE standards.

35
Taking WASH Forward in the Region
Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO
One reason we organised this workshop is because we thought there was room for improvement.
Another thing we hoped to get out of this was to increased information sharing on issues related to
WASH in schools. Now that we have heard to a certain extent what our colleagues have going on in
their respective countries, what other mechanisms do we have that are doable? What about those
indicators? Is there a need to take that further? What about ideas on improving financial resources?
Let’s look hear what ideas are out there on the areas of interest:

Topic What Who


WASH in Schools Corrections/additions to mailing list Countries
network Designation of country focal point(s) Countries
Regional synthesis Prepare regional write-up including country summary pages EAPRO
Corrections/additions to write-up Countries
Cost information Return cost questionnaires to Murat with suggestions on Countries
framework for presentation (capital and recurrent)
Preparation and distribution of cost summary for region Murat Sahin,
DPRK
Baselines, Indicators – Sort through available survey tools and Chander
assessments and questionnaires and prepare a set of useful and regionally Badloe, Viet
monitoring relevant indicators Nam

Promote core indicators for use with partners building on mid- Countries
decade assessment (MDA) indicators, and inclusion into EMIS
for routine reporting
Expressions of Prepare TOR for designing CF facilities and developing WASH in Mongolia
interest in technical Schools strategies
assistance from Prepare TOR for programme design, development and Indonesia
regional or global monitoring
sources Community, school and health facilities strategies Timor Leste
Review TORs and help identify suitable sources of technical EAPRO,
assistance WES-NY
Information, Share KAPs and country situation analyses Countries
documentation and Prepare comparative summaries of water quality in schools (H2S EAPRO
experience sharing: strips, testing kits, treatment options, etc)
Locations of special Existing manuals with CF designs and bills of quantities (BOQs) Lao PDR, Viet
resources Nam
ROSA publication on designs and BOQs under preparation WASH
regional
advisor, ROSA
Sharing of documented experience on demand creation for Waldemar
sanitation in Myanmar Pickardt,
Myanmar
Blue Box of Lao PDR – presentation available on workshop CD Lao PDR
WASH resource library on CD finalised and distributed to country Waldemar
offices Pickardt,
Myanmar
Occasional updates - WASH in Schools info sharing project and Therese
sustainability/impact study Dooley,
New York
Viet Nam website – repository of hygiene promotion materials Nguyen To
http://www.cerwass.org.vn/wesieclib/uni/home/index.php Tran, Viet
Nam
Updates on handwashing partnership with Unilever Therese
Dooley, NY
FRESH networking Upcoming preparations and participation in 2007 Mekong sub- EAPRO, Lao
regional workshop on FRESH and HIV PDR, VN,
Myanmar,

36
Cambodia
EASan 2007 Upcoming preparations and participation in regional sanitation EAPRO,
conference in June 2007 in Xi’an, China. Countries where countries
UNICEF is to lead country preparations are: China, DPRK,
Myanmar, Mongolia, and Timor Leste. WSP to lead country
preparations in Viet Nam, Cambodia, Lao PDR, Philippines,
Indonesia.
Funding SIDA interest in funding Ecosan in schools and communities Therese
opportunities Dooley, NY

37
Friday, 20 October 2006 – Day 3

Partnerships for Sustainability of WASH in Schools


Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO

We wanted to take the opportunity to have a third day to invite our counterparts – government, bi- and
multi-lateral partners – engaged in WASH in Schools. The first session is an overview of partnerships
for WASH in Schools, the second session is an overview on child participation, and the third session
focuses on balancing school and community water and sanitation. Co-ordination among partners has
been a common theme: donor co-ordination and integration at all levels is a challenge. At a global
level UNICEF is involved in FRESH and the School Health Project. We also need to work with our
partners to find a way to go to scale and ensure the quality and sustainability of services.
Governments have many groups presenting priorities so the question becomes how do we ensure that
governments can take it on themselves?

How to secure funding for WASH in Schools is an area of concern for sustainable initiatives. Many
times projects tend to be “donor driven” and funding is received in small packages. As a result,
interventions get stuck in pilot mode and have difficulties going to scale. From the initial stages we
should be working in partnership with the government to ensure integration, and link with facility
design use into budget programme. While UNICEF may not be funding WASH in School in all
countries, it’s still the role of the agency to influence policy, build capacity and create enabling
environments. So the question arises, how do you create an enabling environment? That depends on
the country: In some countries the funding is there but maybe the knowledge is not in the ministries
that hold the funding. Sometimes we have to look at facilitating that enabling environment in countries.
Building capacities both within UNICEF and with counterparts all feeds into sustainability. While
funding can be a limitation, planning and the lack of financial and human resources, and lack of
common language between sectors all hinders the success and sustainability of WASH in Schools
programmes.

A pillar of WASH in Schools, behaviour change communication often attempted through life-skills
based education (LSBE), is an area in which we have to work more closely with the relevant ministries
to improve upon. What we are finding is that it’s difficult to maintain students’ interest in LSBE. One of
the underlying reasons is that we expect a lot out of life skills-based hygiene education (in terms of
behaviour change). In addition we assume it has to be taught the way other subjects are taught; but
whenever students are cooperating around schools, whenever parents come to schools we are
ensuring the development of life skills. We also must remember that life skills are the way the schools
are run, life skills have to be captured in the school environment. Sometimes we have to develop the
skills of the teachers. There has to be a careful of provision of materials to make sure that they
understand how to use it.

If we want to improve impact and boost sustainability we have to look at baseline data and work with
our government counterparts on information systems. The reality of the situation is that information
and assessment is broader than baseline and there is a role for UNICEF to support national
assessments which can then be discussed by the national steering committee, or the designated
agency. Lastly how do we link WASH in School with WASH in communities. Ownership and needs are
often defined by donors and not by community itself. We can address this through participatory
planning, designing and mobilising community behind WASH.

Keeping in mind the key issues we have discussed over the past two days, we wanted to bring our
counterparts together to work on the way forward to addressing these important prerequisites to
sustainability of WASH in Schools programmes.

The objectives for the external session are:


• To share key discussion points and introduce focus on WASH partnerships.
• To better understand the potential of institutionalising children’s participation in WASH
initiatives, and to identify and examine best practices and lessons learned in this area.
• To explore the balance between WASH in Schools and WASH in communities.

38
Words of Welcome
Anupama Rao Singh, Regional Director, UNICEF EAPRO

I would like to extend a warm and special welcome to our partners from our sister agencies and
representatives of government with which we work, the World Bank and civil society partners. I
apologise for not being here through the entire workshop but we have a lot going on in Bangkok at the
moment. WASH from a UNICEF perspective is so important. In East Asia and the Pacific region about
944 million people still live without basic sanitation; and 402 million lack access to clean water. There
has been progress but anyone who compares water and sanitation with progress within MDG
indicators know that water and sanitation is far behind compared with poverty reduction, school
enrolment and child mortality. As we all know that girls, when they have their period, water and
sanitation can be the deciding factor as to whether they continue school.

If you adjust statistically for China, the prevalence of malnutrition younger than 5-years old is as bad
as sub-Saharan Africa. It’s just because some parts of China, the numbers have improved but frankly
we are no better than sub Saharan Africa in the area of child survival. Amongst all the different
agencies working on these issues I am delighted that this meeting is taking place and I am able to
attend. It would be good to bring other initiatives of the agencies in the region together as this is the
strategy our board has approved. We need to look at the commonalties and differences between
FRESH and WASH and see how we can work together.

It is especially important for key agencies such as the World Food Programme, which has invested
resources in school feeding, on how we can maximise results with regards to improved school
attendance, achievement, and the overall health and nutrition status of children. With international
financing institutions one of the issues that we see is how do we take the outcomes to bi-lateral
partners with funding and donors of area, and to commitments that were made in Paris as far as
harmonising aid and making it more effective. Today we have a unique opportunity to bridge our
partners for a discussion on water, sanitation and hygiene and schools.

I have been travelling a lot recently and as I was reflecting on today’s meeting there were two issues
that I wanted to bring to you what is going to happen in the context of the larger development debate
and lessons learned: Today is the last day in Manila on the Asia Pacific Forum. The Asian
Development Bank, World Bank, DFID (Department for International Development), and the
Government of Japan were hosts. As a run up to this were case studies evaluating aid effectiveness
and the indicators of the Paris Declaration from the perspective of partner countries. What emerged as
most useful were programme-based approaches (PB As), which consist of the coming together of
government and partners around sectors. That seems to move forward the fastest and is not
contingent on pooled resources or budget support.

All of the partners in Lao supporting education without project appraisal visits, pooled unspent financial
resources and generated enough money to provide basic textbooks for every child in Lao for the 2006
academic year. Everyone came around specific result aimed for achievement rather than process. If
we can come up with real results in today’s meeting, we can find ways to form pragmatic partnerships
because none of us can do it alone, but real opportunities and possibilities exists if we all work
together. Today you will be looking at what works, please also spend time on debating what is needed
to take successful initiatives to scale. That is critical if we are to meet the goals that we have set.
Taking things to scale demands different support rather than just project support. Finally, I am
delighted that this meeting is taking place and that we have our partners here to help further this
important initiative.

39
Government/Inter-Ministerial Partnerships (including SWAps)
Cliff Meyers, Regional Advisor for Education, UNICEF, EAPRO

Sector Wide Approaches (SWAps) and Programme Based Approaches (PBAs)


There are gold-standard SWAps – and there are PBAs which are looser confederations of donors
supporting sub-sector plans. The example given on textbooks in Lao was a good illustration of a PBA.

Some of the key characteristics are:

• Single Planning Process


• Joint reviews and missions
• Single reporting process

You don’t need ‘basket funding’ and abolition of all ‘projects’ to qualify as a SWAp. The key element is
government leadership. Transactional costs rarely decline, and government capacity to lead takes
time to build. In Cambodia it took four or five years for the government to get strong enough to take
leadership.

SWAps/PBAs and WASH


There is real potential when we sit at the table. Through dialogue with SWAp partners, we can
advocate WASH issues at the highest levels. Pilot projects can be shared – impact and processes
demonstrated – for mainstreaming and taking to national scale. This is also a potential to leverage
resources if targets are in the sector plan. We can focus on EMIS (Education Information
Managements Systems) and monitoring of SWAp success to include WASH indicators in EMIS.

Issues with SWAps/PBAs and WASH


Education sector may not prioritise WASH. This is not always true but it’s sometimes the case.
Historically, water and sanitation may not be managed by Education sections, but by Physical
Facilities Ministries or other Departments not covered by the SWAp. Procurement can be an issue:
whose procurement procedures become the SWAp standard? In SWAp, standard procurement
procedures, that’s where NGO partners and UN partners can be more proficient. The European Union
(EU) and the World Bank procedures are so cumbersome that it can kill all initiative so we have to also
look at that. The lack of fixed costs for water facilities scares of some donors. So the question is how
do you arrive at fixed costs for water because water is not a fixed cost, it depends on how long the
pipe, how deep well, and so on. Decentralisation is not always SWAp friendly; in this case you can
push for greater public-private partnerships.

What are the experiences with WASH and SWAps?


Cambodia is a good example of an education SWAp, but WASH is not an issue. The SWAp is run by
mini-or rural-development and the Ministry of Health is not so much involved as the Ministry of
Education. We have a good SWAp but no WASH. In Myanmar there are similar interests and the
MDGs give clear common goals and procedures. The issues with SWAp are that competition is still
quite strong for government resources. A second problem is that SWAp is related to good governance
so in countries without good governance a SWAp can run into problems. The last concern is
accountability, how can we be more specific with funds if pooling resources?

The first step is getting an enabling environment in place and getting all to agree. This can be done,
for example, by getting the respective ministries to sign a MoU. In Lao, under the PBA, the books got
out. In Tanzania, the Education SWAps are connected with poverty reduction strategies. So if we try
to connect with the overall country agenda, it will be more successful.

Joint programming
Joint programming can be formalised with a Memorandum of Understanding or can be more informal
with Letters of Agreement. The WFP and UNICEF have a partnership related to nutrition and feeding.
JICA, JOICEP, and the WHO maintain one related to de-worming and sanitation and hygiene
education. Water Aid and UNICEF participate in cost-sharing on water sanitation community
development projects

40
What are the key issues and lessons learned on joint programming in the region?
Key issues with Plan Viet Nam are that we are one of 50 INGOs in water and sanitation. We should
not forget that people are doing things for themselves funded by overseas remittances. That sum of
money well overshadows official sources and we should do advocacy to ensure that it’s spent wisely.
We have looked to other NGOs and UN agencies and recently teamed up with UNICEF because of
our joint interest. When you find another partner who is equally enthusiastic and interested in what you
are doing, and you put one and one together it really does make eleven.

There are two lessons learned from UNICEF Viet Nam: Whatever is discussed in the context of
partnership or joint programming the key is to have a set of principles, clear and agreed upon because
that is something that cuts across the promotion of national ownership and commitment. It is also
important to have flexibility in partnerships and SWAps, and to have options available.

Public-private partnerships
Public-private partnerships often look for visible projects to support so WASH can leverage from these
partnerships. Working with Unilever and others as funding and advocacy partners; and the use of local
procurement to build capacity and local market strength are some examples of PPPs. Smaller-scale
private sector ‘adopt-a-school’ efforts (examples from Colombia) are ways to exploit PPPs. The
‘Global Compact’ for corporate responsibility is one way of making sure that WES is taken care of in
the community.

Positive experiences with public-private partnerships


Traditionally there is this tension surrounding the privatisation of water. But with water, the private
sector helps out a lot in the Philippines. With a recent typhoon public officials looked at three
industries: water, telephone, and electro-power. The water and power sectors agreed to do an audit in
the schools in the area and the results worked in their favour.

We have to look at each country on case-by-case basis. The tendency is to go to the big boys with a
bowl in hand. Looking at the core expertise of these local and national multinational enterprises, and
seeing how we can tap into them is the way forward on this issue.

41
The Global Handwashing Initiative
Nga Nguyen, Handwashing Initiative, The World Bank in Viet Nam

Why handwashing with soap? About a year and half ago we had WES guru who pushed handwashing
with soap and people in the government they laughed. They said handwashing is for kids we don’t
need to wash our hands with sop. But now a year and a half later people are taking it serious in Viet
Nam

Reviews suggest that handwashing with soap can reduce the risk of:
• diarrhoeal infections by 47 per cent
• respiratory tract infections from 19 per cent to 45 per cent
• intestinal infections by 48 per cent

It is estimated globally that handwashing can save more than a million lives. It is feasible and cost
effective; is often called the “do-it-yourself” vaccine; and is especially important in this region because
handwashing with soap can prevent SARS and Avian Flu.

The Problem
• Each year, an estimated 14,000 children die from diarrhoea
• Diarrhoea is the second leading cause of illness among children under five, accounting for
almost 18 per cent of morbidity and mortality cases in hospitals
• Acute respiratory infections (ARIs) caused over 30 per cent of child hospital deaths (1998)
• Diarrhoea affects nutrition and in Viet Nam we still have 34 per cent of children under five
suffer from malnutrition (1998)
• Estimated rate of handwashing with soap is only 3 per cent (when we interviewed women in
Viet Nam said they wash hands only when they could see dirt)

When addressing handwashing in Viet Nam we need to look how we can we catalyse behaviour
change? In Viet Nam, we need a modern, consumer-based approach built upon what the consumer
does, and wants. We took this approach in the Viet Nam National Handwashing Initiative (HWI) with
the objective of:

• Reducing morbidity and mortality among children younger than five through an integrated
communications campaign promoting handwashing with soap to prevent diarrhoeal diseases.

And we do that through Public-Private-Partnerships (PPPs) to effectively promote handwashing with


soap.

How is the HWI special?


• It treats people as consumers, not as victims
• Is large-scale, replicable and likely to be cost-effective
• PPP is a model for other sectors

42
Approach I: TV and Radio

• Advantage: Audience reach


o TV – 70 per cent
o Radio – 50 per cent

• Disadvantage
o Mass Media is effective in raising awareness but cannot alone change behaviour.

Approach II: Health Education

• Disadvantage
o Messages were not reaching mothers.

Approach III: Private sector community marketing events


We hired private marketing firms. At Supermarket when a new soap comes out, we had one-on-one
personal communication. When someone is in areas that are more media-dark then we would hire
private marketing firms to come and do events where mothers are likely to be.

What’s new to this approach?


• 1 message
• 1 audience per phase

43
Benefit to public health
• Efforts toward achieving the Millennium Development Goals
• Reduced infections
• Increased resources
• Expertise

Benefit to industry
• Increase in soap volume: Most activities do not include a provision of soap. Our approach is soap
is cheap; it’s getting people into the habit of using it.
• Expanded markets: If they are focusing more on the poor it’s a much larger profit margin.
• Influence: now we have access to the various ministries.
• Motivation
• Good citizenship

Steps for Viet Nam Handwashing Initiative


Step I: Consumer Research: messages will be used to devise creative strategy
Step 2: Pre-test
Step 3: Launch

Where are now on step one in Viet Nam:


• 8 provinces
• 16 focus group discussions

44
• 54 behavioural trials: With the behavioural trials we would say, for example, use soap for 14 days
only for handwashing, and then they return to tell us what happened. We would note all of the
positive aspects of using the soap.
• 54 in-depth interviews
• 500 structured observations: From 6 a.m. to 9 a.m. we sit in people’s homes and observe when
mothers are using soap, washing hands, etc.

Partners in the HWI

In Ghana we did research with mothers and kids at same time because we were targeting our
messages for mothers. In Senegal we did research with mothers first, then with school-age children.

In Senegal:
• Numerous school hygiene programmes exist and hygiene and sanitation messages are often
included in the curriculum; however,
• Educating children about hygiene is important, but not enough for behaviour change; what we
need to is,
• Understand children’s motivations!
o Children do not always model their behaviour after adults (and we need to understand
that).
o Children need to “fit in” and peer social norms shapes a big component of their social
lives.

Research in Dakar, Senegal


Objective I was to find out, what are the risky practices?

Method(s)
1. Structured observations at juncture points (after use of toilet and before eating). We also did that in
schools for months, seeing the practices, the ratio of latrines to children in schools, etc.
2. Children drawing activities conducted by children in bathrooms.

Objective II was to understand the motivations for hygiene

Method(s)
• Handwashing stands for each classroom with prominent bar of soap and classroom ownership of
soap.
• Clean toilets with water buckets and incense to keep toilets smelling nice.
• Large campaign with slogan, “Handwashing Is In” and teachers’ involvement in explaining activities.
Group debriefing done by children who developed and acted out a drama to provide feedback. We
wanted to do things that were cool, allowed them to fit in, and we wanted to work with teachers.

Objective III was to find out how do children communicate?

Method(s)
• Diaries of their busy schedules, so that we would understand when hygiene messages would best fit
into their lives.

45
• A fake 10 pound note and asked them, “What would you spend it on?” so that we would understand
children’s priorities.

Results coming soon! Let’s Collaborate for Cleaner Hands

Question and Answer


Q: When taking on a PPP how are partners chosen keeping in mind the distinction between local
versus multinational enterprises (MNEs)?

A: The local soap company Lix Detergent Co. about a $2000 in advertising budget so a PPP is not
feasible. Small local companies can participate in training given by large MNEs as long rivals aren’t
invited.

Q: How do you balance between competitors?

A: It’s a really delicate balance; you have to play a game with the MNEs. I sent letters out to all of the
companies; local companies may not participate because they don’t have time or money for
advertisements.

A: UNICEF doesn’t allow branded campaigns but after funds run out the private sector can take it on
and brand it. It can improve sustainability after the public funds out.

46
Children as Change Agents
Joachim Theis, Project Officer, Youth and Partnership, UNICEF EAPRO

Different countries use varying ages to define childhood, adolescence and adulthood. For the
purposes of today’s discussion we will use the UN definition which defines a child as a person who is
from 0-to 17-years old; an adolescent, a person who is 10- to 19-years old, a young person, someone
who is 10- to 24-years old, and a youth, as a person who is 15- to 24-years old.

Children, WASH and health


Children are especially vulnerable to water and sanitation-related diseases:
• 4,000 children die every day from diarrhoeal diseases alone.
• Millions of other children are made sick, weakened or are disabled by diarrhoea and other
water-and sanitation-related diseases.
• WASH and HIV/AIDS: People with compromised immune systems are especially susceptible
to faecal-oral transmission of diarrhoea-causing germs. Many adolescents (primarily girls) are
caring for sick relatives. They need knowledge and skills related to WASH.

Children, WASH and education


Water, sanitation and hygiene impact a child’s right to education. About 400 million school children
have reduced learning abilities due to intestinal worm infections. The overall quality of education is
affected by the lack of water and sanitation. Girls drop out of school because of household chores
(e.g. fetching water), and due to the lack of adequate sanitation facilities in schools. Separate
sanitation facilities in schools improve girls’ enrolment and retention. UNICEF promotes private toilets
for girls that are located in secure areas away from boys’ toilets and equipped with facilities for
menstrual hygiene.

Children, WASH and natural disasters


Children are often the first victims of environmental degradation and natural disasters. They are also a
force for environmental protection, reconstruction and relief efforts.

Many lives can be saved when people are aware of risks and are prepared. Each year, 17,000
children die in Bangladesh due to floods. UNICEF is supporting an NGO programme teaching children
to swim as way to prep for natural disasters.

“We as children and young people pledge to be involved in designing implementing and
evaluating child managed water and sanitation projects and other initiatives.” (Children’s Water
Manifesto Kyoto Japan March 2003)

Some may ask why children should participate in WASH.

1. Convention on the Rights of the Child states in Article 24 “To ensure that all segments of
society, in particular parents and children, are informed, have access to education and are
supported in the use of basic knowledge of child health and nutrition, the advantages of
breastfeeding, hygiene, environmental sanitation and the prevention of accidents.” Article 24, 2 (e)

2. In addition to this/Children and young people:


• Learn quickly and adapt readily.
• Can acquire useful knowledge from participating in environmental activities.

47
• “Are a source of creativity, energy and initiative, of dynamism and social renewal” (’We the
Peoples’: The Role of the United Nations in the 21st Century, 2000).
• Can contribute meaningfully to environmental restoration and protection in their
communities.
• Are forceful advocates who carry healthy lifestyle messages home and to their community.

Now Hugh will discuss ways in which children can have meaningful participation in health and hygiene
activities.

48
Children’s Participation in Health and Hygiene Activities
Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust

There are many styles and example of child participation in more than 70 countries. Nearly all involve
hygiene and sanitation programmes. Very few are called child-to-child programmes. Most involve a
children-for-health approach. In the first place the idea as children as a messenger is a small part of it.

There are many things that children can do in health and hygiene activities. One child for instance can
help the baby by washing hands after the baby; two or three children can conduct a survey; a group of
children can do a puppet show, can help in activities.

Pass(es) knowledge younger


to child/children at
One child
home or in school

Teach(es) skills to same age


Two or three child/children at
Children home or in school

Demonstrate(s) by their family/families


example
to
A group of children
Work(s) the community
together with

Visualisation in Participatory Programmes (VIPP) card exercise


We will now split into groups and discuss ways that children can meaningfully participate in health and
hygiene activities:

Group 1: Handwashing for seven-year olds


Group 2: Diarrhoea for nine-year olds
Group 3: Rubbish and flies for 11-year olds
Group 4: Water supply for 13-year olds

Group task for each topic:


• What can one child do?
• What can a group of two to three children do?
• What can a larger group of children do?

Criteria for the activities:


• Important for health
• Appropriate for the age of the child thus not too difficult and sufficiently challenging
• Interesting and engaging

Because of time we will only focus on the following: What can individual children, and what can a
group of children do to help better water and sanitation practices in families?

GROUP 1: Handwashing for seven-year olds


• Monitor for behaviour
• Monitor peers at school
• Be role models to smaller ones

What can a group of children do?


• Role plays and puppet shows

49
• Singing
• Pressure for handwashing
• Create social norms

GROUP 2: Diarrhoea for nine-year olds


• Can take care of him/her self to prevent diarrhoea
• Communicate to elders in house
• Role model to younger children
• Make oral re-hydration solution and demonstrate to other child

What can a group of children do?


• Puppet shows, plays on prevention

GROUP 3: Rubbish and flies for 11-year olds


• Clean house, stop littering (and help others to stop)
• Take action to cover food, particularly to rid flies
• Use tools to kill flies
• Relay messages to other children
• Help take out garbage at home

What can a group of children do?


• Pick garbage up
• Can mobilise community

GROUP 4: Water supply for 13-year olds.


• Investigate messages about water supply, distribute information and talk to their peers

What can a group of children do?


• Provide mutual support to each other. If a child is going on a survey in the community, looking
at water resources, or practices at home, it’s a bit daunting for a single child; but two or three
can help
• They can design posters, leaflets
• They have a preference about involvement in WASH
• They can be consulted/lobby

The largest criticism of the child-to-child approach has been in relation to cultural issues … many of it
by persons who fail to realise how carefully most people who use the approach weigh and consider it
before finding the most effective and sensitive channels. However there are some occasions in which
the school and its children need to stand out against manifestly unhealthy or unjust practices and in
this case the children must have the full hearted support of adults. Issue such as teenage pregnancy,
female genital cutting, or children eating late in the evening – we can say this is wrong.

In regards to the acceptability of children telling adults, it’s about the way it is done It also will depend
upon the age of the children, the issue being approached, and cultural considerations in relation the
message; age, and attitudes. It may not be culturally acceptable to talk about the message but it may
be OK to put on a play about it. There are some issues that the school has got to raise the flag, I
haven’t heard of any health and hygiene issues, but I wonder if there are any: girls only hauling water;
open defaecation and so forth.

50
Less Appropriate More appropriate
Your way is wrong. ⇒ Can we try this as well?
Here is a new thing you should do. ⇒ Can I tell you what we learned at school?
Wash your hands after cleaning the baby. ⇒ May I wash my hands now I have cleaned the baby?
We have learned that this custom is not … ⇒ We have learned that this custom is …
People shouldn’t act like that. ⇒ May we put on the play we prepared with the teacher?
We haven’t done this yet. ⇒ Can I help you?

Lessons from experience


• Child participation is sustainable:
o Where children are given responsibility and support at the same time.
o Where children can see that the activity enhances their image and promotes their rights.
o Where children are able to learn and develop at the same time as contributing.
o Where children are stimulated and have fun.

Please remember that children are children. In the early days of child-to-child we had our own jargon,
the fun quotient (FQ). So please try to think in terms of high FQs rather than low FQs.

Ethical practices to consider


• Using children as loud speakers.
• Having them chant slogans about things they don’t understand.
• Using them to do things that adults don’t want to do.
• Choosing some children and putting them ‘over’ other children. The “Little Doctors”
programme in Indonesia where you had to be chosen and put on that white coat is probably
not a good idea. Have to involve even the poorest and most deprived children have to be
involved.
• Children ‘with more’, helping (and condescending) children ‘with less’. In India the “Blue Bell
Schools”, the “better” schools going to the slums to help out. This is not a good idea.

Question and Answer


Q: What is meaningful participation?

A: Meaningful participation begins where children understand what they are doing. It needs to be
meaningful to the community. It has to be an effective way that children contribute as citizens. We
have to look at ethical standards, how we can avoid tokenism and manipulation. We have to make
sure that children know what they are getting into, and that the process is democratic and fair. If we
have to select children we must ensure that the selection criteria is transparent, that the environment
is child friendly, and that there is some follow up.

Q: How can we prevent favouring one child over another?

A: We can set up health clubs, HIV/AIDS club and/or sanitation clubs. The problem with sanitation
clubs is that many children say school sanitation club is not a good one because their job is to clean
latrines. Also when we visit various schools and met heads of some clubs, then go back the following
week, we find that the same children are the heads of other clubs.

We have to look at the degree of control children have over their decisions. Quite often we have to
start from zero because people have a lot of misunderstandings about child participation. It’s ok to
start small and support something that doesn’t meet all of the requirements and is not fully
sustainable, but it has to be heading in the right direction. The whole business of designing puppet
shows, writing books is an example of things that can be done that are not practical, such as cleaning
up.

Q: Many children aren’t interested in WASH because they are focussing on their entrance exams.
How do we handle that?

51
A: It is true that academically-oriented students may not want to be involved. But for those who are
dropping out of school, WASH may be very real and relevant to them.

A: One thing we are trying to do is integrate hygiene into the traditional lessons. The challenge is
translating knowledge into action; however, the complaint across the region is that the curriculum is
crowded enough.

A: In Bangladesh we involved adolescent girls from slums for participatory monitoring in hygiene. One
adolescent girl was responsible for monitoring from eight to 10 households. In the end more than
5,600 children were involved in 14 municipalities. Now we have expanded the issue to early marriage
and other social campaigns such as immunisation, and the initiative is now under supervision of
mayor.

52
Children as Change Agents II
Joachim Theis, Project Officer, Youth and Partnership, UNICEF EAPRO

Some of the challenges we face when dealing with young people’s participation in WASH is that it is
so multi-faceted and we do it for different reasons. I think we start from a range of objectives, we
achieve on those and then we carry on with others.

It is important to know the reasons for young people’s participation in WASH:

1. Children’s access to health information


Children who have access to information about health, water and sanitation are better able to survive
and to protect themselves. Information is essential for children to realise their right to survival. Where
children are denied access to information about health matters, their survival is put at risk
(AI/HIV/AIDS/diarrhoea, etc). When speaking of access we have to look at the range of actors in
society: It is the responsibility of governments, teachers the education system, parents, community
and religious leaders, the media and private sector to ensure that children and young people have
access to this vital information.

2. Develop children’s capacities


Children who are able to express themselves and are being listened to at home and in school learn
and develop better. They develop an interest in their own health and will take better care of
themselves and others. If adults listen to children, give them time to articulate their concerns, provide
them with appropriate information, children will acquire the confidence and ability to contribute to their
own health care. It encourages children to take more responsibility for their own health

Ex: Lao PDR


Young people were trained to learn media skills in radio production to communicate health/WES. This
was done in addition to training in technical and interview techniques.

3. Consulting children
Research and assessment results are better if they are based on information from children and
adolescents. Consulting children leads to better understanding of children’s own health care needs
and concerns; people who are involved are often shocked by children’s opinion and helps shape new
perspectives.

Ex: Viet Nam


Children are consulted for inputs before new WASH facilities are ready for use (to see if they like
them…). This increases the chance that latrines and handwashing facilities will be used.

4. Young people’s control over decisions


Water and sanitation services are better if children and young people have control over their design,
operation and maintenance.

53
Ex: Viet Nam
Children actively participate in monitoring for correct use, maintenance and advocacy.

5. Children’s contributions
Water, sanitation and health services are more effective if they include the contributions of children;
this is probably the area where we start but we need to recognise that child participation is much
broader, although this is an important area and attractive to adults

Ex: Indonesia
Child health clubs have been established in 200 school WASH programmes where students monitor
the hygiene behaviours of their community. Every sixth grader is responsible for monitoring a dozen
neighbouring households. Students developed indicators of hygiene practices through school-level
hygiene assessment and planning.

Children and young people are consulted, contribute and decide

54
Benchmarking tool for children’s participation
It is a long arduous process of moving up. Keep in mind that participation is a process, and it doesn’t
happen overnight. This bench marking tool is worth studying, you can see how it can be adopted to
the WASH situation for planning, monitoring and review. It gets around some of the things we are
studying and in most situations we will be able to agree where we are.

Dimensions, standards and indicators


• Impact of child and youth participation and degree of children’s control over decisions
• Sustainability and institutionalisation of children’s participation

• Quality of children’s participation


• Costs of children’s participation

If no awareness ⇒ Resistance by adults


If no youth mobilisation ⇒ Stagnation, loss of interest
If no capacities ⇒ Ineffectiveness
If no standards ⇒ Manipulation and abuse of children
If no structures ⇒ Diffusion of efforts
If no resources ⇒ Frustration of everyone

55
The Relationship between WASH in School and WASH in Communities
Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust

Before we get started I want to get from the participants the definition of “school”.

• A community of learners
• Child-friendly environment where children can learn and grow
• Place here children grow academically and socially
• A place where people can get their formal education
• A place where people of learning where people can acquire knowledge in a positive way
• A place which makes duty bearers feel that education takes place only inside the building
• A place where children can learn the world The most common centre for violence against
children
• An institution for transmitting scientific culture and norms for your children
• A place that serves community’s learning needs

Those are interesting definitions but no one included parents, or siblings; it might be worthwhile to
include parents, family, and community. It is amazing how we have closed the gates around the
school.

FRESH: Start local think national


We all know what our national WASH priorities are but we don’t know how they play out at local level.
We need is to involve local people in helping to decide what schools can do to help us. This involves
breaking down the isolation of the schools. When we went to Pakistan we used the FRESH categories
to look at schools and it was quite helpful. Let us try to do this using the FRESH framework.

FRESH Student Community Health and


components Participation Partnerships Education
School Health -Children help Parent Teacher Child health weeks
Policies make the policy Associations (CHWs),
-Girls participate (PTAs) that discussions with
in facility ratio actively students, Civic
participate in Ethics and Codes
decision- of Conduct
making
processes
Water Sanitation -Conduct simple Linking school Standards and
and the survey drawing to community standardisation at
Environment what happens water systems national and local
-Participate in – PTA and level
sanitation & water
hygiene committee
committees
-Self-cleaning of
school
environments
-Promote
hygiene through
songs, drama,
games, stories
-Children’s
participation in
assessing child-
friendliness of
their school
-School clubs
-Peer educators
on WASH

56
Skills-based Participate in Skills transfer; Integrated
health education needs local curriculum,
assessments knowledge appropriate
teaching
techniques
School Health M&E of services Healthy Referral to
and Nutrition lifestyles at community-based
Services home and in youth friendly
schools services

We need to broaden the concept of what we mean by skills. As far as school health, some see it as
school nurse or feeding. If you look at it, there is a whole bunch that the school can do for itself. If you
look at mental health, children force other people to notice a child who is unhappy or sleeping in class.

Examples of where hygiene education in schools can be linked to communities:


• In the Philippines computers underused, so after class used by community
• Development of teaching aids
• IT for hygiene promotion
• Teaching aid, materials shared with PTA members
• Through assistance for homework
• Mobile and public libraries
• WASH methods part of the curriculum
• Children take home workbooks and parents and siblings help and are exposed to messages
• Transfer health stories into audio-visual format, animation
• Children translate reading into drawings
• Reading rooms for children, getting parents to read stories to their children in the evening

57
General Plenary Discussion
Therese Dooley, Senior Advisor for Sanitation & Hygiene, UNICEF New York

How can school and community WATSAN initiatives integrate closer at local level toward maximising
the strengths of each? Not just education component, the facilities and the enabling environment.

We need to consider is:

– What might this involve?


– How can the process start?
– How can it be helped to gain momentum?

• School is seen as an integrated part of the community.


• Balanced approach to technology between community and schools.
• At community level not as big of a problem, it can be a problem because we as development
agencies compartmentalise.
• Need to approach WASH in schools holistically.
• Community action planning process, looking at resources before school starts and go to water
sources and look at what’s available, etc.
• Need to advocate for a policy change.
• Community as a classroom, where children are encouraged to go into their environment to
learn about WES.
• Before build WES facilities have community dialogue.
• Children as advocators, child can bring good experiences good and bad to community.
• Creating demand, having appropriate technologies in community.

School WASH and community WASH is often seen as two separate areas of programming. The issue
of separation can be partly due to the fact that initiatives are project-based and there is an artificial
separation created by funding and projects, but if begin to look at all WASH as community-based, we
might already have the funds. We should use the community as a place of learning and draw from the
community, remembering that the school is a community itself and the community involves parents.

While WASH is handled by different ministries in the government we have to take every opportunity to
facilitate and co-ordinate between the ministries. This afternoon we looked at how we can bridge this
gap between communities and schools; now we can look at how we can tie it up.

58
Annex I: WHO Guidelines on minimum standards for WASH in schools
Draft for review, 31January 2006

I. Introduction 1
1.1 Purpose and scope of these guidelines 1
1.2 Policy rationale 1
1.3 Audience 2
1.4 Stakeholders, roles and responsibilities 2
1.5 Schools settings 3
1.6 Required inter-sectoral linkages 4
1.7 Relation to national standards and codes 4

II. Importance of APPLYING standards for water supply, sanitation and hygiene 5
2.1 Disease prevention 5
2.2 Learning 5
2.3 Gender 5
2.4 Change in the wider community 5
2.5 Life-long skills 5

III. Management of Standards at Local Level 6


3.1 Positive policy environment 6
3.2 Steps in managing standards 6
3.3 Local body for managing standards 6
3.4 Using the guidelines to create minimum standards for specific school settings 7
3.5 Assessment and planning 7
3.6 Phased improvements 8
3.7 Technology choice, operation and maintenance 8
3.8 Ongoing monitoring, review and correction 9
3.9 Staff requirements and training 9
3.10 Hygiene behaviour 9

IV. Guidelines 11
1. Water Quality, 13
2. Water Quantity, 15
3. Water facilities and access to water, 16
4. Hygiene promotion 17
5. Toilets,, 18
6. Control of vector-borne disease,, 20
7. Cleaning and waste disposal 21
8. Food storage and preparation, 22

V. Summary of Guidelines 24

VI. Further Reading 25

VII. Glossary 26

VIII. Reference 27

IX: Assessment Checklists for Water Supply, Sanitation, and Hygiene in Schools 29

59
I. INTRODUCTION

1.1 Purpose and scope of these guidelines


These guidelines recommend a basis for creating the minimum conditions required for providing
schooling in a healthy environment for schoolchildren1, teachers and other staff. They can be used to
do the following:

1. Develop specific national standards in the area of water supply, sanitation, hygiene and waste
management for various types of school in different contexts.
2. Assess the situation regarding water supply, sanitation, hygiene and waste management in
existing schools to evaluate the extent to which they may fall short of the defined standards.
3. Plan, and carry out, improvements so that the standards are met.
4. Ensure that the construction of new schools meets minimum standards.
5. Prepare and implement comprehensive and realistic action plans so that acceptable standards
are maintained.

The guidelines deal specifically with water supply (water quality, quantity and access), hygiene
promotion, sanitation, control of vector-borne disease, cleaning and waste disposal and food
storage and preparation. They are designed for use in low-cost settings where simple and
affordable measures used when improving existing schools or building new ones can make a
significant improvement to hygiene and health. The word ‘school’ is used in this document to
include primary and secondary schools, boarding and day schools and kindergartens or pre-school
settings.

1.2 Policy rationale


High standards of water supply, sanitation, hygiene and waste management in schools have a number
of positive effects. The disease burden among children, staff and their families is reduced; healthy
children in healthy environments learn more effectively; there can be greater gender equity in access
to education and meeting hygiene-related needs; educational opportunities are created to promote
safe environments at home and in the community; and schoolchildren can learn and practice life-long
positive hygiene behaviours.2

However, despite these important benefits, acceptable standards of water supply, sanitation and
hygiene are not met in many schools world-wide. Efforts to increase school enrolment have been
successful, but the number of children in schools with inadequate water supply, sanitation and hygiene
has also grown. It has been estimated that approximately half of primary schools in the developing
world lack water supply and three quarters lack adequate sanitation3.

The international policy environment increasingly reflects these issues. Providing adequate standards
of water supply, sanitation and hygiene in schools is of direct relevance to the Millennium
Development Goals on achieving universal primary education, promoting gender equality and reducing
child mortality. It is also supportive of other goals, especially those on major diseases and infant
mortality. At the same time the Millennium Project and the UN Secretary-General have highlighted the
importance of rapidly addressing 'quick wins' - identifying specifically provision of services to schools
and health care facilities. Targets promoted by Vision 21 include 80 per cent of primary schoolchildren
educated about hygiene and all schools equipped with facilities for sanitation and handwashing by
2015. Strategy 8 of the ‘Dakar Framework for Action’ produced at the World Education Forum in 2000
is to create safe, healthy, inclusive and equitably resourced educational environments.

1
The word ‘schoolchildren’ is used in this document to include children of all ages in various school or pre-school settings, and
includes children who may also be referred to as ‘pupils’ or ‘students’
2
Snel et al., eds. 2004
3
UNICEF 2005, personal communication.

60
Putting policy into practice in this area demands stronger linkages between professional sectors such
as education, health, water supply and sanitation, planning and construction.

1.3 Audience
These guidelines are written for use by education managers and planners, architects, urban planners,
water and sanitation technicians, teaching staff, school boards, village education committees and
similar bodies. They are encouraged to work together to create minimum standards that are relevant,
achievable and sustainable.

1.4 Stakeholders, roles and responsibilities


The following table presents the major stakeholders and their roles and responsibilities in
implementing these guidelines, to promote health and learning in schools.

Stakeholder group How they are affected by How they can contribute to
inadequate water, sanitation and improved water, sanitation and
hygiene in schools hygiene in schools
Schoolchildren -High exposure to water, sanitation -Comply with procedures for use and
and hygiene-related disease risk care of water and sanitation facilities,
-Absenteeism because of illness or and observe appropriate hygiene
unacceptable water and sanitation measures
conditions -Participate in the design and
-Poor learning because of disease construction process, and play an
active role in maintenance of facilities
-Monitor state and use of facilities
School children’s -Intermediate exposure to water, -Encourage children to comply with
families sanitation and hygiene-associated procedures for use and care of water
disease risk, indirectly from disease and sanitation facilities, and observe
transmitted to their children at school appropriate hygiene measures at
-Personal and material burden of school and at home
additional disease in the family
Teachers -Low or intermediate exposure to -Monitor state and use of water and
water, sanitation and hygiene- sanitation facilities
associated disease risk -Organise care and maintenance of
facilities
De-motivating working conditions due -Encourage schoolchildren to adopt
to: appropriate behaviours at school and
- schoolchildren’s absenteeism and at home through hygiene education
learning difficulties; -Participate actively in achieving and
- poor water and sanitation facilities maintaining standards

School directors or -Low or intermediate exposure to -Plan and implement programmes to


head teachers water, sanitation and hygiene- define, achieve and maintain
associated disease risk standards
-Professional and personal difficulties -Create conditions in which staff are
created by disease risk, absenteeism motivated to achieve and maintain
and learning difficulties faced by standards
schoolchildren -Develop and enforce rules for
correct use and care of facilities
Local education -Impaired reputation as a result of -Provide resources and direction for
authorities inadequate environmental health setting, achieving and maintaining
conditions in schools standards
-Difficulty in achieving and -Advocate as appropriate at district or
maintaining schoolchildren’s national level for adequate resources
attendance and performance -Co-ordinate with local environmental
-Difficulty in recruiting and retaining health services
staff

61
Stakeholder group How they are affected by How they can contribute to
inadequate water, sanitation and improved water, sanitation and
hygiene in schools hygiene in schools
Environmental-health No direct impact -Collaborate closely with local
authorities education authorities to provide
specialist advice for identifying
problems and recommending
solutions for water supply, sanitation
and hygiene
Parent teachers Challenges created by disease risk, -Discuss options for improvements
associations (PTAs), absenteeism and learning difficulties with school directors and teachers
school governors, -Advocate locally for improvements in
school committees water supply, sanitation and hygiene
and similar bodies in schools
Politicians -No direct impact for most -Provide /mobilise political and
-Direct concern for ministers of financial support for improvements
education in terms of budget and
performance of ministry
Construction industry No direct impact -Design, build or upgrade school
(public and private) facilities with suitable water and
sanitation facilities
National and No direct impact -Provide funding for appropriate new
international funding school facilities, upgrading or
bodies renovation of existing facilities and
ongoing maintenance of standards

1.5 Schools settings


These guidelines are intended for use in resource-scarce situations where simple, robust and
affordable solutions are required for providing healthy school environments. They apply to a range of
school settings. Three broad types of setting illustrate the issues involved in designing and applying
standards for water supply, sanitation and hygiene, as follows:

1. Kindergartens / pre-school facilities providing day care and early learning for children from
2-to 5-years old. Children in this age group are particularly susceptible to infectious disease
because of undeveloped immunity, and behaviours such as frequently putting their hands and
objects into their mouths. They are also at an age where they are susceptible to physical injury,
so require a safe physical environment and require a high level of care and attention. They are
also at a stage during which essential hygiene behaviours are developed, so they need an
environment in which positive behaviours are facilitated. This type of facility may be a formal
structure with recognition and support from local authorities, but may often be run as an
informal private or community-based service in a location that is not specifically designed for
such purposes, by staff with little or no specific training. In many countries this is a loosely
regulated area of activity.

2. Day schools, from 6-to 16-years old provide academic and, in many cases, recreational
activities for children who return home every day, but who may often eat at or near the school.
Problems faced by schoolchildren and teachers in this kind of school often include lack of basic
water supplies and sanitation facilities, inadequate or hazardous outdoor space and
overcrowded classrooms where noise, poor lighting, poor seating, excessive heat or cold,
damp and poor indoor-air quality. Funding for improved conditions in schools may be lacking,
but there may also be a strong desire and capacity for change among staff, schoolchildren and
parents.
3. Boarding schools cater for children who for various reasons are unable to return home each
day. In boarding schools, all meals, sleeping accommodation and washing facilities are
provided. It is therefore of critical importance that water and sanitation facilities, and hygiene

62
measures, conform to recognised standards. On the one hand, risks of transmission of
communicable disease are raised because of the communal eating, sleeping, sanitation and
hygiene arrangements in boarding schools, but on the other it is possible to provide adequate
water, sanitation and hygiene standards for all children.
Within each of these broad types of school setting there is a great variation in access to
financial and human resources and in the existing level of water supply, sanitation and hygiene.
The guidelines in this document are aimed to help achieve acceptable standards in all schools,
whatever the existing situation and current level of resources. Simple and low-cost measures
exist for improving even the worst situations, and providing the first step towards acceptable
long-term standards.

1.6 Required inter-sectoral linkages


Technical support may be required from the water-supply and sanitation and public works sectors for
ensuring the correct design and construction of buildings and sanitary infrastructure. The health sector
should provide guidance on the environmental health aspects of school design, construction and
maintenance. The health sector can also provide support by monitoring environmental health
conditions, monitoring child health, providing selected health services (such as micronutrient
supplements, treatments for helminth infections, vaccination campaigns or health inspections) and
providing training and advice for teachers, schoolchildren and parents on water, sanitation and
hygiene.

1.7 Relation to national standards and codes


These guidelines are intended to support and complement existing national standards and codes, and
do not modify or substitute for them. Readers should try to find relevant national standards through
their ministries of health, education, environment, planning, or natural resources, or from professional
bodies and training organisations.

63
II. IMPORTANCE OF APPLYING STANDARDS FOR WASH

2.1 Disease prevention


Water-, sanitation- and hygiene-related diseases are a huge burden in developing countries. It is
estimated that 88 per cent of diarrhoeal disease is caused by unsafe water supply, and inadequate
sanitation and hygiene4. Many schools serve communities that have a high prevalence of diseases
related to inadequate water supply, sanitation and hygiene, and where child malnutrition and other
underlying health problems are common.
It is not uncommon for schools to lack drinking-water and sanitation facilities completely, particularly in
rural areas, or for such facilities as do exist to be inadequate both in quality and quantity. Schools with
poor water, sanitation and hygiene conditions, and intense levels of person-to-person contact, are
high-risk environments for children and staff, and exacerbate children's particular susceptibility to
environmental health hazards.
These guidelines are designed to help strengthen water supply, sanitation and hygiene measures in
particular, while recognising the importance of, and links with, other areas of environmental health,
such as air quality and physical safety.

2.2 Learning
Children’s ability to learn may be affected in several ways. Firstly, helminth infections, affecting
hundreds of millions of school-age children, can impair children’s physical development and learning
ability through pain and discomfort, competition for nutrients, and damage to tissues and organs.
Long-term exposure to chemical contaminants in water (e.g. lead) may impair learning ability.
Diarrhoeal diseases, malaria and helminth infections force many schoolchildren to be absent from
school. Poor environmental conditions in the classroom can also make both teaching and learning
very difficult. Lastly, teachers’ impaired performance and absence due to disease has a direct impact
on learning.

2.3 Gender
Girls and boys are likely to be affected in different ways by inadequate water, sanitation and hygiene
conditions in schools, and this may contribute to unequal learning opportunities. For example, lack of
adequate, separate and secure toilets and washing facilities may discourage parents from sending
girls to school, and can contribute to girls missing days at school or dropping out altogether at puberty.

2.4 Change in the wider community


Children who have adequate water, sanitation and hygiene conditions at school are more able to
integrate hygiene education into their daily lives, and can be effective agents for change in their
families and the wider community.

2.5 Life-long skills


The hygiene behaviours that children learn at school, made possible through a combination of hygiene
education and suitable water and sanitation facilities, are skills that children are likely to maintain as
adults and pass on to their own children.

4
World Health Organization 2004b

64
III. MANAGEMENT OF STANDARDS AT LOCAL LEVEL

3.1 Positive policy environment


Positive policies are required at national, district and school levels to encourage and facilitate the
achievement of appropriate standards of water, sanitation and hygiene in schools. A supportive policy
environment should allow stakeholders at district and school level to establish effective governance
and management arrangements to, plan, fund, implement and coordinate improvements.

3.2 Steps in managing standards


The essential steps in managing standards at national and local levels are as follows:

National level Local level


1. Develop a national policy framework that is 1. Mobilise support from teachers,
supportive of improved conditions in schools. schoolchildren, families and other local
stakeholders to achieve and sustain a
healthy school environment.
2. Ensure appropriate institutional 2. Create an appropriate local body to oversee
arrangements for setting and monitoring the setting and implementation of standards.
standards.
3. Create a regulatory framework that 3. Define a set of standards, policies and
encourages and supports the setting, procedures appropriate to the school or type
application and monitoring of standards. of school concerned.
4. Provide expertise and resources for 4. Assess existing conditions and plan
assessment and planning. improvements and new developments5.
5. Provide locally appropriate plans and 5. Plan improvements or new developments
specialist input for new structures and required, with specialist technical input if
improvements to existing structures. necessary.
6. Provide and/or facilitate funding for planned 6. Seek funding for planned improvements and
improvements and new developments. new developments.
7. Ensure local oversight of improvements and 7. Oversee implementation of planned
new developments to encourage the improvements and new developments.
application of appropriate standards.

8. Operate a responsive national-level 8. Monitor ongoing conditions and ensure


monitoring programme. remedial action where required.

3.3 Local body for managing standards


Managing the various and interdependent aspects of water, sanitation and hygiene at the level of the
school requires the involvement of all staff, as well as schoolchildren and parents (see Section 1.4).
The most appropriate body to provide coordination at school level will depend on the type of school
and the degree of involvement of the education authorities and local authorities, but this body should
include parents, teachers and, where appropriate, schoolchildren. Options include existing structures
such as a parent-teachers association or community education committee, or a specific structure such
as a school health committee. Where there are deficiencies in present water supply and sanitation
arrangements, it will be helpful for this body to create strong links with the local Department of
Environmental Health, and to invite Departmental officials to its meetings on a regular basis.
Whatever the specific management arrangements put in place, there should be a clearly identified
body with authority to carry out steps 3 to 8 in Section 3.2 above.

5
In the case of new schools or extensive renovation/extension of existing schools, it is essential that plans for water
supply, sanitation and hygiene facilities are integrated with plans for buildings and outdoor spaces.

65
3.4 Using the guidelines to create minimum standards for specific school settings
The guidelines in Section 4 reflect general principles in support of creating healthy school
environments. They can be used, as follows, for creating specific standards appropriate for individual
schools or types of school.
Review the eight guidelines, which are narrative statements describing the situation to be aimed for.
Identify major areas that require attention in relation to specific guidelines. Consider local conditions
that might affect the way that the guidelines are interpreted in practice. Note that local constraints,
such as lack of funding or lack of a suitable water source, should not be taken into consideration at
this stage. The aim is first to define appropriate standards required for providing a healthy school
environment in a particular setting, then to seek ways to meet those standards, rather than defining
limited standards that are insufficient.
Use national standards and/or the indicators under each guideline to define specific standards,
such as the number of users per toilet or the quantity of water per person per day required. See the
guidance notes for advice on taking account of local conditions when setting specific standards and
on intermediate steps to achieving standards.

3.5 Assessment and planning


Once specific standards have been defined for a particular school or type of school, they can be used
as a checklist to determine how and to what extent the existing situation falls short of them. This will
identify specific problems that need addressing. See the assessment checklist at the end of this
document.
It is important to analyse the reasons for shortfalls in as inclusive a way as possible, because solutions
will mostly require the participation of all parties concerned: schoolchildren, teachers, head
teachers/school directors, maintenance staff and education managers. A useful tool for this analysis is
the problem tree (see the box below). Objectives should be understandable and motivating to all those
concerned by their achievement, and progress towards achieving them should be possible to measure
and describe easily and clearly.

66
The problem tree/solution tree is a simple method to identify problems, their causes and effects,
and then define objectives for improvement that are achievable and appropriate to the specific
conditions of each school. It is performed as a group activity through the following steps.

1. Discuss any major aspects of the current situation where water supply, sanitation and hygiene
standards defined for the school are not met. Write each one in large letters on a piece of paper
(e.g. A6 size) or a postcard.

2. For each major problem, discuss its causes by asking the question “why?”. For each of the
contributing problems identified, ask the question “why?” again, and so on until root causes for
each problem have been revealed and agreed. Write all the contributing problems in large letters
on a piece of paper or postcard and stick them on a wall, arranged in a way that reflects their
relation to each other and to the major problem.

3. For each of the contributing problems noted, discuss possible solutions. Check that these
solutions contribute to solving the major problems identified by asking the question "what" to
identify the effects of the action. Some solutions proposed will probably have to be abandoned
because they are not realistic, given current conditions, or because they do not have sufficient
impact on the major problems.

4. Once a number of feasible solutions have been agreed, they should be phrased as objectives.
For each objective, the group can then discuss and agree strategy (how the objectives can be
reached), responsibilities (who will do what), timing and resources.

3.6 Phased improvements


Many schools are currently very far from achieving minimum standards for water, sanitation and
hygiene, and may have no suitable facilities at all, because of lack of resources, skills or adequate
institutional support. It is recognised that achieving the standards will often not be possible in the
short term. Therefore, steps should be taken both to prioritise necessary improvements and to
work in a phased way so that the most urgent problems can be identified and targeted
immediately, and other benefits subsequently achieved. See specific guidelines in Section 4 for
advice on intermediate measures for situations where minimum standards cannot be reached in
the short term.

3.7 Technology choice, operation and maintenance


It is most important that maintenance, repair and eventual replacement of water and sanitation
facilities are taken into account during the design and construction phases. As far as possible,
facilities should be hardwearing, durable and possible to maintain without specialist skills.
Technology should be chosen taking account of local capacities for maintenance and repair. It
may be necessary in some cases to choose a lower level of service in order to avoid essential
equipment that cannot be repaired when it breaks down. For example, it may be better to keep an
open well, rather than equip it with a cover slab and pump, until there is a reliable system in place
for maintenance and repair of the pump.
Responsibilities for operation and maintenance should be clearly defined, and appropriate skills
provided. See Section 3.9.

Maintenance, repair and replacement of facilities should be planned and budgeted for from the
beginning of a programme to improve facilities or build new ones. Some form of local income-
generating system may be required if institutional funding is not certain.

3.8 Ongoing monitoring, review and correction


Maintaining acceptable standards requires ongoing efforts at all levels. The role of the school
health committee or equivalent body in ensuring regular monitoring of water, sanitation and
hygiene conditions is critical. The local department of environmental health should be a major
partner, providing expert monitoring and advice. For example, schools should be included in
regular water-quality surveillance and control programmes.

67
A monitoring system should use a limited set of indicators that are easily and regularly measured
to identify problems and correct them in a timely way. For example, water shortages at
handwashing points may be monitored by teachers or schoolchildren according to an organised
schedule, and signalled immediately to caretakers or maintenance staff, where these exist, for
action. If the school is connected to the local water distribution system, the frequency and
duration of water shortages may also be recorded so that water-supply reliability can be measured
over time.
Recording forms may be developed at school level or district or national level for standardised
monitoring reports, to enable collation and comparison of data from all schools.

3.9 Staff requirements and training


Many activities that are important for creating healthy school environments are performed routinely
by staff and schoolchildren as they use and care for classrooms, outdoor space, toilets etc. One
important decision that has to be made regarding the maintenance of facilities is whether or not
schoolchildren should be responsible for cleaning toilets and other sanitary facilities. The benefits
of involving schoolchildren include cost saving, encouraging schoolchildren to take care not to dirty
the facilities and to clean up after themselves and the opportunities this provides for teaching
important hygiene skills. However, great care must be taken to ensure that such an arrangement
works effectively in practice, without exposing schoolchildren to disease risk, and without placing
an unfair burden on one group of children in particular.
Water supply, sanitation and hygiene should be given a central place in the training and
supervision of all teachers, as they provide role models for schoolchildren and are largely
responsible for encouraging the participation of schoolchildren in maintaining a healthy school
environment. In addition, the subject should be taught as a curriculum component for those who
teach related subjects such as biology.
Head teachers/school directors have a very important role to play, through their work with teachers
and other staff, schoolchildren, parents and local authorities. They should be made aware of the
importance of water, sanitation and hygiene in schools, and provided with guidance and support
so that they can promote the development and maintenance of a healthy school environment.
In some schools there may be other staff, such as cleaners and kitchen staff, who are specifically
responsible for maintaining healthy conditions. In their training and management, they should be
given a strong awareness of the importance of their role and should be able to apply basic
principles of hygiene to their daily work.

3.10 Hygiene behaviour


Many children learn some of their most important hygiene skills in school or pre-school settings,
and for many this is where they are introduced to hygiene practices that are not promoted or may
not be possible in the home. Teachers can be very effective hygiene promoters, building valuable
life skills through hygiene education and by acting as role models for schoolchildren.
However, good hygiene behaviour and the effectiveness of hygiene promotion in schools are
severely limited where water supply and sanitation facilities are inadequate or inexistent. Teachers
cannot credibly convey the importance of handwashing if there is no water in the school, or
promote the use of latrines if they themselves avoid using their use because they are dirty or
unsafe.
It is therefore important to achieve the right balance between hygiene education and ensuring
acceptable environmental health conditions. One cannot be effective in promoting health without
the other.
More broadly, health should be promoted in all aspects of the school environment and activities.
Adequate water supply, sanitation and hygiene are crucial foundations of this goal.

IV. GUIDELINES
This document is intended to be used as a basis for setting standards at national level. The
guidelines, indicators and guidance notes in this section are intended to be used, together with
existing national standards and guidelines, for creating standards, policies and procedures to be used
in each school.

68
• The guidelines are in the form of a statement that describes the situation to be aimed for and
maintained.
• Each guideline is specified by a set of indicators that can be used as benchmark values for the
following activities:
- assessing existing situations;
- planning new facilities or improvements to existing ones;
- monitoring progress;
- monitoring ongoing maintenance of standards.

The indicators provide benchmarks that reflect current understanding of appropriate levels of
service required to create and maintain healthy school environments. They are adapted from a
number of documents that guide practice in schools and other relevant settings, and the main
documents from which they are drawn are shown as footnotes and presented in the reference list.
Specialist technical terms are explained in the Glossary in Section 7. The indicators need to be
adapted in the light of national standards, local conditions and current practices. They mostly
concern results, e.g. the quantity of water available or the ratio of schoolchildren to toilets.
However, the process indicators are also very important. These concern the means by which
outputs are to be achieved and maintained. They are presented in the guidelines and relate
closely to the management issues in Section 3.
• The guidance notes provide advice on applying the guidelines and indicators in practice and
highlight the most important aspects that need to be considered when setting priorities for action.
They are numbered according to the indicators to which they refer.
Additional information on assessment, implementation and monitoring can be found in the
reference list and Section 6 (Further reading).
The guidelines and indicators are designed to help set standards for creating healthy school
environments for the long term. For schools that are a long way from meeting standards, a basic
minimum level of facilities essential for preserving health should be provided as a temporary
measure until adequate long-term facilities are provided.

69
Essential short-term measures required to protect health in schools

1. Fence the school grounds so that a clean environment can be maintained.


2. Provide basic sanitation facilities that enable schoolchildren and staff to go to the toilet without
contaminating the school grounds or resources such as water supplies. This may entail
measures as basic as digging temporary pit latrines or defining defecation areas outside the
school and rotating those areas to avoid a rapid build-up of contamination.
Note that the risk of transmission of soil-based helminths is increased with the use of
defecation fields. The use of shoes or sandals provides protection from hookworm infections.
3. Provide water for handwashing after going to the toilet and before handling food. This may be
done using simple and economical equipment, such as a pitcher of water, a basin and soap or
wood ash.
4. Provide safe drinking water from a protected groundwater source (spring, well or borehole), or
from a treated supply, and keep it safe until it is drunk. Untreated water from unprotected
sources can be made safer by simple means such as boiling or filtering it. Schoolchildren and
staff may have to bring water from home if the school does not have a safe water source
nearby.

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1. Water Quality6,7

Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose
intended

Indicators
1. Microbiological quality of drinking-water
E. coli or thermotolerant coliform bacteria are not detectable in any 100-ml sample.
2. Treatment of drinking-water
Drinking-water from unprotected sources is treated to ensure microbiological safety.
3. Chemical and radiological quality of drinking-water
Water meets WHO Guidelines for Drinking-Water Quality or national standards concerning
chemical and radiological parameters.
4. Acceptability of drinking-water
There are no tastes, odours or colours that would discourage consumption of the water.
5. Water for other purposes
Water that is not of drinking-water quality is used only for cleaning, laundry and sanitation.

Guidance notes
1. Microbiological quality is of overriding importance. It is essential that the water supplied is free of
pathogens and that it is protected from contamination inside the school itself. Drinking-water
supplied to schools should meet national standards and follow WHO drinking-water quality
guidelines. In practice, this means that the water supply should be from a protected groundwater
source, such as a dug well, a borehole or a spring, or should be disinfected if it is from a surface
water source. See indicator 2. Rainwater may be acceptable without disinfection if the rainwater
catchment surface, guttering and storage tank are correctly operated, maintained and cleaned.
The local department of environmental health should be involved in monitoring the microbiological
quality of the water in the school, as part of a routine surveillance and control programme.
2. Disinfection with chlorine is the most appropriate way of ensuring microbiological safety in most
low-cost settings. Bleaching powder, liquid bleach, chlorine tablets and other sources of chlorine
may be used, depending on local availability. At least 30 minutes’ contact time should be allowed
between the moment when the chlorine is added to the water and the moment it is drunk, to
ensure adequate disinfection. The free chlorine residual after the contact time should be between
0.5 and 1.0 mg/l.
Free chlorine residual (the free form of chlorine remaining in the water after the contact time) can
be measured with simple equipment.
Chlorinated water should not be stored for more than 2 days, to avoid losing its residual
disinfection capacity.
If the turbidity of the water is significantly greater than 1 NTU, it should be treated to remove
suspended matter before disinfection, by sedimentation (with or without coagulation and
flocculation) and/or filtration. It may be preferable in many situations to disinfect water up to 5 NTU
without such prior treatment, as the disadvantages of adding a treatment process, in terms of
increased cost, complexity and risk of error, may outweigh the benefits. As simple equipment
(turbidity tube) is available for measuring turbidity as low as 5 NTU, this level may be used as an
interim and local monitoring target.
Filtration, chlorination, solar disinfection or other small-scale technologies may be appropriate for
treatment of water in schools that are not connected to piped supplies, as well as those that are
connected to piped supplies whose quality is not consistently satisfactory8.

6
WHO 2004a
7
EEA/WHO 2002
8
WHO 2002

71
3. Chemical constituents such as arsenic, fluoride and nitrates may be present in excess of guideline
levels in groundwater supplies, and it may not be possible, in the short term, to remove them or to
find an alternative source of water. In circumstances where WHO drinking-water quality guidelines
or national standards for chemical and radiological parameters cannot be met immediately, an
assessment should be made of the risks caused to schoolchildren and staff, given the levels of
contamination, the length of exposure and the degree of susceptibility of individuals. Children of all
ages, particularly younger ones, are more susceptible than adults to the harmful effects of
chemical contaminants.
4. It is important that the taste and odour of drinking-water are acceptable to schoolchildren and staff,
or they may not drink enough, or may drink water from other, unprotected sources, which would be
harmful to their health.
5. Water used for sanitation, laundry and cleaning floors and other surfaces need not be of such high
quality as drinking-water. However, water for handwashing and bathing and dishwashing should
be of drinking-water quality, particularly if there are no specific drinking-water points. All water
used for food preparation and washing utensils should be of drinking-water quality.
If water below drinking-water quality is used for certain purposes, it should be in separate, clearly
marked containers or distribution systems, and necessary measures should be taken to ensure
that the drinking-water supply cannot be contaminated by the lower-quality supply.

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2. Water Quantity9,10

Sufficient water is available at all times for drinking, personal hygiene, food preparation,
cleaning and laundry

Indicators
1. Basic quantities required
Day schools -5 litres per person per day for all
schoolchildren and staff
Boarding schools -20 litres per person per day for all residential
schoolchildren and staff
-5 litres per person per day for all non-
residential schoolchildren and staff
2. Additional quantities required
The following should be added to the basic quantities as necessary. Figures given are for day
schools. They should be doubled for boarding schools.

Flushing toilets -10 - 20 litres per person per day for conventional flushing toilets
-1.5 - 3 litres per person per day for pour-flush toilets

Anal washing -1- 2 litres per person per day

Guidance notes
1. These guideline figures include water used for drinking, hand hygiene, cleaning and, where
appropriate, food preparation, and laundry. The figures should be used for planning and design of
water-supply systems. The actual quantities of water required will depend on a number of factors,
such as climate, availability and type of water-use facilities, and local water-use practices.
It is important that drinking water is available throughout the school day, and that children are
encouraged to drink, as even minor dehydration reduces children’s ability to concentrate, and may
damage their health in the long term. Many children walk long distances to school, often after
having carried out household chores, and may arrive at school thirsty.
In schools without a safe drinking-water supply, children and staff may have to carry their drinking
water with them to school.
2. The additional water quantities required for sanitation need to be adjusted for local conditions,
including the exact type of toilets used (including the use of urinals), prevalent practices and the
time that children and staff actually spend in school.

3. Water facilities and access to water11,12

Sufficient water-collection points and water-use facilities are available in the school to allow
convenient access to, and use of, water for drinking, personal hygiene, food preparation,
cleaning and laundry.

Indicators
1. A reliable water point, with soap or a suitable alternative, is available at all the critical points within
the school, particularly toilets and kitchens.
2. A reliable drinking-water point is accessible for staff and schoolchildren at all times.

9
WFP/UNESCO/WHO 1999
10
Sphere Project 2004
11
WFP/UNESCO/WHO 1999
12
Zomerplaag & Mooijman 2005

73
3. One (1) shower is available for 20 users in boarding schools (users include schoolchildren and
residential staff). Separate showers, or separate showering times, are provided for staff and
schoolchildren, and separate showers or times are provided for boys and girls.
4. Laundry facilities, with soap/detergent and hot water and/or chlorine solution, are provided in
boarding schools

Guidance notes
1. Basic hygiene measures by staff and schoolchildren, handwashing in particular, should not be
compromised by lack of water or lack of access to handwashing basins or suitable alternatives. If
soap is not available then schoolchildren should be encouraged to wash their hands with water
and a small amount of sand soil or wood-ash. This should be avoided if it is likely to block the
drainage system.
Water points should be sufficiently close to users to encourage them to use water as often as
required. Staff toilets and schoolchildren’s toilets should have handwashing points, with adequate
drainage, next to them. Children should also be encouraged to wash their faces to prevent eye
diseases. A water point close to the classrooms may be useful for this.
Simple and low-cost handwashing points can be made in various ways, including the following: a
pitcher of water and a basin (one person can pour the water for the other who washed their hands;
the wastewater falls into the basin); a small tank (e.g. an oil drum) fitted with a tap, set on a stand
and filled with a bucket, with a small soakaway or a basin under the tap to catch the wastewater; a
‘tippee-tap’ made from a hollow gourd or plastic bottle that is hung on a rope and that pours a
small stream of water when it is tipped.
2. If possible, drinking water should be provided separately from water provided for handwashing and
other purposes, even if it is from the same supply. Drinking water may be provided from a piped
water system or via a covered container with a tap where there is no piped supply. Drinking-water
points should be clearly marked.
3. If the age-range of schoolchildren is more than 3 or 4 years, separate showers or showering times
may need to be provided for younger and older children.
Showers may be simple cubicles made from local materials, with stone or brick on the floor to
provide a clean and draining surface. Users bring water to the cubicle in a bucket and pour it over
themselves (or over the small child they are washing) with a large cup.

4. Hygiene promotion13

Correct use and maintenance of water and sanitation facilities is ensured through sustained
hygiene promotion. Water and sanitation facilities are used as resources for hygiene
education.

Indicators
1. Hygiene education is provided for schoolchildren as part of the school curriculum.
2. Positive hygiene behaviours, including mandatory correct use and maintenance of facilities, are
systematically promoted among staff and schoolchildren
3. Facilities and resources enable staff and schoolchildren to practice behaviours that control disease
transmission in an easy and timely way.

Guidance notes
1. Hygiene education should be a core part of teacher training, and refresher trainings should be
carried out regularly to sustain knowledge and awareness.
Hygiene education, using a variety of participatory and other learning methods, should enable
schoolchildren to develop the knowledge, attitudes and life skills they need for adopting and
maintaining healthy lifestyles, particularly with respect to water, sanitation and hygiene.

13
WHO 2003a

74
2. A healthy school environment and appropriate use of water supply, sanitation and hygiene
facilities should be systematically promoted through the application of clear regulations and the
participation of staff, schoolchildren and parents in planning and managing facilities and the school
environment.
One particularly important aspect is the cleaning and maintenance of facilities. Schoolchildren may
be required to carry out activities such as cleaning toilets, carrying water to the school or within the
school and collecting solid waste. These activities should be organised fairly and transparently,
within the limits of schoolchildren’s age and ability, and should not be used as a punishment.
Schoolchildren are heavily influenced by the example set by school staff, their teachers in
particular, who should provide positive role models by consistently demonstrating appropriate
hygiene behaviours.
3. Staff and schoolchildren should not be expected to adopt behaviours that are inconvenient,
uncomfortable or impractical. For example, staff cannot be expected to set a good example to
schoolchildren if they cannot wash their hands after using the toilet because there is no water.
Where improvements to facilities are required at the school, their planning and construction can be
used as an effective tool for hygiene education.

75
5. Toilets14,15,16

Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for
schoolchildren and staff.

Indicators
1. There are sufficient toilets available - 1 per 25 girls / female staff, and 1 toilet plus 1 urinal (or 50
cm of urinal wall) per 50 boys / male staff17.
2. Toilets are easily accessible – no more than 30 m from all users
3. Toilets provide privacy and security
4. Toilets are appropriate to local cultural and social conditions
5. Toilets are hygienic to use and easy to clean
6. Toilets have convenient handwashing facilities close by
7. There is a cleaning and maintenance routine in operation that ensures that clean and functioning
toilets are available at all times

Guidance notes
1. The number of toilets and urinals required for each school depends on the numbers of children
and staff, but also on when the schoolchildren and staff have access to the toilets. If access is
restricted to break times, then peak demand could be high, particularly if all the classes have
breaks at the same time.
Urinals for girls and women, as well as for boys and men, have been used with success in some
countries. They are quicker and cheaper to build than toilets, they reduce the smells in latrines and
they are easy for young children to use.
Separate toilet blocks, or toilet areas separated by solid walls and with separate entrances, should
be provided, rather than separating boys and girls facilities by lightweight partitions. Doors should
reach down to floor level.
For children up to the age of about nine, separate toilets for boys and girls may not be necessary.
It may be appropriate to provide separate toilets for staff and schoolchildren, particularly where
special toilets are provided for young children.
If the school has no formal kind of toilet (e.g. latrines), it is probably best to improve the existing
system (e.g. defecation fields) and continue using it until a sufficient number of toilets are available
to provide accessible and hygienic facilities for everyone. If just one or two latrines are provided for
a whole school, the area around them is likely to become rapidly contaminated and the latrine pits
will fill in a short time. Defecation areas can be improved by providing correct drainage to avoid
contaminating the nearby environment, setting up a rotation system and using shallow trench
latrines rather than open defecation.
2. In principle, toilets should be as close as possible to classrooms and playing areas, to ensure they
can be used conveniently and safely. Entrances should be positioned to provide maximum
discretion in entering and leaving a toilet block. In pre-school facilities, toilets may need to be
adjacent to the child-care space, as young children frequently need supervision when going to the
toilet.
The location of toilets should also take into account the need to minimise odours (taking account
of prevailing winds) and avoid contamination of water supplies and food. Particular care should be

14
Franceys et al. 1992
15
Zomerplaag & Mooijman 2005
16
WHO 1997
17
WFP/UNESCO/WHO 1999

76
taken when siting latrines and septic tanks with soakaway pits or infiltration trenches. All latrines
and infiltration systems should be located at least 30 m from any groundwater source, and at least
1.5 m above the groundwater table.
3. In order to minimise the risk of violence, including sexual violence, toilets should be carefully
located, should be lockable (to protect people while using them), and they and their access routes
should be lit at night.
4. The cultural and social conditions prevalent in the community to which the schoolchildren belong
should be taken into account in the design and siting of toilets. The segregation of boys and girls
toilets is one of the most common requirements of parents.
Younger children may require toilets of different dimensions than those of older children and
adults, and specific features need to be taken into account to make the toilets easy and
comfortable to use. For example, the squatting hole in a pit latrine may need to be smaller and
footrests may need to be closer together.
Children with physical disabilities may require additional modifications to standard toilet designs, to
enable them to use the toilets with as much autonomy as possible.
5. Toilets should be designed and built so that they are hygienic to use and do not become centres
for disease transmission. Surfaces that may be soiled should be of smooth, waterproof and
hardwearing material that can be cleaned with water and that is resistant to cleaning products.
The most important part of a latrine, in terms of cleaning, is the slab, which should be made of
concrete or some other hardwearing and smooth material. Other parts of the latrine, such the
superstructure, can be made with cheaper local materials.
The design of the toilet should include measures to minimise odours and control fly and mosquito
breeding.
6. A toilet is not complete without a handwashing point with soap and adequate drainage. All toilets
designs should include convenient handwashing facilities so that handwashing after using the
toilet can become a single routine activity for schoolchildren and teachers. Effective handwashing
facilities may be built at little cost, with locally available materials (see Guideline 3).
7. Toilets should be cleaned whenever they are dirty, and at least once per day, with a disinfectant
used on all exposed surfaces. Strong disinfectants should not be used in large quantities, as this
is unnecessary, expensive, potentially dangerous, and may damage the sanitation system.
If no disinfectant is available, plain cold water should be used with a brush to remove visible
soiling.

6. Control of vector-borne disease18,19,20


Schoolchildren, staff and visitors are protected from disease vectors.

Indicators
1. The density of vectors in the school is minimised
2. Schoolchildren and staff are protected from potentially disease-transmitting vectors
3. Vectors are prevented from contact with schoolchildren and staff or substances infected with
related vector-borne diseases

Guidance notes
1. Appropriate and effective methods for reducing vector numbers depend on the type of vector, the
location and number/size of breeding sites, vector habits, including places and times of resting,
feeding and biting, and chemical resistance of specific vector populations.

18
WHO 1997
19
WHO 2003b
20
Rozendaal 1997

77
Basic environmental control methods, such as proper excreta disposal, food hygiene and drainage
should be the basis of any strategy. The location of new schools should be chosen, if possible, to
avoid local disease-vector risks.
Mosquitoes and flies can effectively be excluded from buildings by covering opening windows with
fly-screen and fitting self-closing doors to the outside. Resting sites for mosquitoes inside buildings
should be minimised by the use of smooth finishes where possible.
The use of chemical controls, such as residual insecticide spraying, in and around the school
requires specialist advice, which should be available from the local Department of Environmental
Health.
2. Schoolchildren and staff may be protected from certain vectors through the use of barriers (e.g.
covered food storage to prevent contamination by rats and flies, or insecticide-treated bednets
against mosquitoes in boarding schools) or repellents.
3. Schoolchildren and staff with vector-borne diseases such as malaria, lassa fever and typhus
should be identified and treated rapidly. They should not attend school during the infectious period
so that the related vectors do not transmit the disease from them to other people in the school. In
addition, regular inspections should be carried out to detect and treat body lice and fleas.
The school premises and, to the extent possible, the immediate surroundings of the school, should
be kept free of faecal material to prevent flies and other mechanical vectors from carrying
pathogens.

78
7. Cleaning and waste disposal21

The school environment is kept clean and safe.

Indicators
1. Classrooms and other teaching areas are regularly cleaned, to minimise dust and moulds.
2. Outside and inside areas are maintained free of sharp objects and other physical hazards.
3. Solid waste is collected from classrooms and offices daily and is disposed of safely.
4. Wastewater is disposed of quickly and safely.

Guidance notes
1. Dust and moulds contribute to infectious respiratory disease, asthma and allergies.
For cleaning of floors and walls, wet mopping with hot water and detergent, if available, is
recommended, rather than sweeping. Floors and other washed surfaces should be made of a
suitable non-porous material that is resistant to repeated washing with hot water and detergents. If
this is not possible then daily sweeping should be carried out.
2. Schoolchildren and staff should not be exposed to unnecessary risk of injury during the time they
spend in the school. This can be avoided by promoting proper disposal of solid waste in the
school, regular cleaning of all inside and outside areas of the school and monitoring and reporting
on broken furniture, window glass etc. so that temporary or permanent repairs can be made
rapidly.
3. Most solid waste produced in schools is non-hazardous and can be collected, stored if needed
and then disposed of in the municipal waste-collection system or burned or buried in a suitable
location on-site. If waste is burned in or near the school grounds, this should be done when the
schoolchildren are absent.
Waste produced in school laboratories should be managed by a qualified laboratory technician or
teacher according to national or international guidelines. It should not be mixed with waste from
offices and classrooms.
4. Schools may produce wastewater from one or more of the following: handwashing points, flushing
toilets, showers, kitchens, laundries and laboratories.
If the school is connected to a properly built and functioning sewer system, this is the most
appropriate wastewater disposal option.
In other situations, soakaway pits or infiltration trenches should be used. These should be
equipped with grease traps, which should be checked weekly, and cleaned, if needed, to ensure
the systems operate correctly. All systems that infiltrate wastewater into the ground must be sited
so as to avoid contaminating groundwater. There must be at least 1.5 m between the bottom of
the infiltration system and the groundwater table, and the system should be at least 30 m from any
groundwater source.
All wastewater drainage systems should be covered, to avoid the risks of disease-vector breeding
and direct contamination.

8. Food storage and preparation22


Food for schoolchildren and staff is stored and prepared so as to minimise the risk of disease
transmission.

Indicators
1. Food handling and preparation is done with utmost cleanliness
2. Contact between raw foodstuffs and cooked food is avoided
3. Food is cooked thoroughly

21
WHO 2003b
22
WHO 2001

79
4. Food is kept at safe temperatures
5. Safe water and raw ingredients are used

Guidance notes
1. Food handlers must wash their hands after using the toilet and whenever they start work, change
tasks, or return after an interruption. Soap and water should be available at all times during food
preparation and handling, to ensure that handwashing can be done conveniently.
Kitchen staff and carers with colds, influenza, diarrhoea, vomiting and throat and skin infections)
should not handle food, and all infections should be reported.
Eating utensils should be washed immediately after each use with hot water and detergent, and air
dried. The sooner utensils are cleaned; the easier they are to wash. Drying cloths should not be
used, as they can spread contamination.
Food-preparation premises should be kept meticulously clean. Surfaces used for food preparation
should be washed with detergent and safe water and then rinsed, or wiped with a clean cloth that
is frequently washed. Scraps of food should be disposed of rapidly, as they are potential reservoirs
for bacteria and can attract insects and rodents. Refuse should be kept in a covered place and
disposed of quickly and safely. See Guideline 7.
Food should be protected from insects, rodents and other animals, which frequently carry
pathogenic organisms and are a potential source of contamination of food. See Guideline 6.

2. Separate equipment and utensils such as knives and cut ting boards should be used for handling
raw foods. Food should be stored in containers to avoid contact between raw and prepared foods
It is particularly important to separate raw meat, poultry and seafood from other foods.

3. All parts of foods cooked must reach 70 °C to kill dangerous microorganisms. To ensure this,
soups and stews should be brought to boiling, and meat should be heated until juices are clear,
not pink. Cooked food must be reheated thoroughly.

4. Cooked food should not be left at room temperature for more than 2 hours.
All cooked and perishable food to be stored should be refrigerated promptly (preferably below
5°C). Food should not be kept for too long in a refrigerator.
Cooked food to be served should be kept hot (more than 60°C) prior to serving.

5. Only safe water should be used for food preparation. For specification of safe water, see Guideline
number 1.
Fruit and vegetables should be washed with safe water. If there is any doubt about the cleanliness
of raw fruit and vegetables, they should be peeled or cooked just before serving.
Non-perishable foods should be stored safely in a closed, dry, well-ventilated store and protected
from rodents and insects. They should not be stored in the same room as pesticides, disinfectants
or any other toxic chemicals. Containers that have previously held toxic chemicals should not be
used for storing foodstuffs.
Food should not be used beyond its expiry date.

6. In many situations, schoolchildren buy food from street vendors outside the school, or bring food
to school with them. In these cases, the school hygiene committee or equivalent should seek ways
with the vendors or the families of the school children to ensure that food is prepared hygienically.
If schoolchildren carry meals with them to school, they should avoid foods that carry a high risk if
stored at ambient temperature.

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V. SUMMARY OF GUIDELINES

1. Water Quality
Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose intended

2. Water Quantity
Sufficient water is available at all times for drinking, personal hygiene, food preparation, cleaning and
laundry

3. Water facilities and access to water


Sufficient water-collection points and water-use facilities are available in the school to allow convenient
access to, and use of, water for drinking, personal hygiene, food preparation, cleaning and laundry.

4. Hygiene promotion
Correct use and maintenance of water, sanitation and hygiene facilities is encouraged by hygiene
promotion. Water, sanitation and hygiene facilities are used as resources for hygiene education.

5. Toilets
Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for
schoolchildren and staff.

6. Control of vector-borne disease


Schoolchildren, staff and visitors are protected from disease vectors.

7. Cleaning and waste disposal


The school environment is kept clean and safe.

8. Food storage and preparation


Food for schoolchildren and staff is stored and prepared to minimise the risk of disease transmission.

81
VI. FURTHER READING
Assessment, planning and monitoring
WFP/UNESCO/WHO (1999) Annex 8
World Health Organization (1997) Appendix C
Zomerplaag & Mooijman 2005 pp 41-45
United Nations Children’s Fund (1998)

Operation and maintenance


Brikké F, Bredero M (2003)

Community participation
United Nations Children’s Fund (1998) Chapter 6

Hygiene promotion
World Health Organization (2003a)
United Nations Children’s Fund (1998)

Water quality, control and treatment


World Health Organization (2004a)
World Health Organization (2002)
World Health Organization, Fact sheets 2.8 to 2.28

Water supplies and water-use facilities


World Health Organization (1997) Appendix B
WFP/UNESCO/WHO (1999) Annex 8

School toilets
World Health Organization (1997) Appendix B
Franceys R et al. (1992)
Zomerplaag J, Mooijman A (2005)

Vector control
Rozendaal JA (1997)

82
VII. GLOSSARY

Coagulation-flocculation: coagulation is the lumping of particles that results in the settling of


impurities. It may be induced by coagulants (e.g. lime alum and iron salts). Flocculation in water and
wastewater treatment is the agglomeration or clustering of colloidal and finely-divided suspended
matter after coagulation by gentle stirring by either mechanical or hydraulic means, such that they can
be separated from water or sewage.

Colour comparator (or colour-match comparator): equipment used to measure a chemical


parameter (e.g. chlorine in water) by adding a specific reagent (e.g. DPD) to the sample and
comparing the colour obtained with a colour scale.

Disinfection: a process of removing/de-activating microorganisms without complete sterilization.

DPD: reagent used for determining chlorine in water by colour comparison (abbreviation of N,N-
diethyl-p-phenylenediamine)

Infiltration trench: a shallow trench, containing gravel and a porous pipe that enables water to
percolate into the soil over a larger area, and therefore with a greater infiltration capacity, than a
soakaway pit.

Sedimentation: the act or process of depositing sediment from suspension in water. The term also
refers to the process whereby solids settle out of wastewater by gravity during treatment.

Soakaway pit or soakpit: a simple excavation in the ground, either lined or filled with stones, that
allows water to percolate into the surrounding soil.

Thermotolerant coliform bacteria or faecal coliforms: in relation to water-quality indicators,


bacteria in the coliform group able to form colonies at 44 °C. Typically, most thermotolerant bacteria
are of the species Escherichia coli, which is always derived from faeces.

Turbidity: cloudiness in water caused by particles in suspension, which makes chemical disinfection
of the water less effective. Turbidity is commonly measured in NTU (Nephelometric Turbidity Units)
and can be determined visually using simple equipment.

83
VIII. REFERENCES

Brikké F, Bredero M (2003). Linking technology choice with operation and maintenance in the context
of community water supply and sanitation: a reference document for planners and project staff.
Geneva, World Health Organization / Delft, IRC Water and Sanitation Centre. Available at
www.who.int/water_sanitation_health/hygiene/om/

European Environment Agency, World Health Organization (2002). Children’s health and environment:
a review of evidence. Luxembourg. Office for Official Publications of the European Communities.
Available at www.who.int/phe/health_topics/children/en/index.html

Franceys R et al. (1992). A guide to the development of on-site sanitation. Geneva, World Health
Organization.

Rozendaal JA (1997). Vector control: methods for use by individuals and communities. Geneva, World
Health Organization.

Snel M et al., eds. (2004). School sanitation and hygiene education. Symposium proceedings and
framework for action. Delft, IRC International Water and Sanitation Centre.

Sphere Project (2004). Humanitarian Charter and minimum standards in disaster response. Geneva,
The Sphere Project. Available at www.sphereproject.org

United Nations Children’s Fund (1998). A manual on school sanitation and hygiene. Water,
Environment and Sanitation Technical Guidelines Series No. 5. New York, NY. Available at ww.irc.nl/

WFP/UNESCO/WHO (1999). School feeding handbook. Rome, World Food Programme.

World health Organization (1997). Primary school physical environment and health. Information Series
on School Health: Document 2. Geneva.

World Health Organization (2001). Five keys to safer food. Poster WHO/SDE/PHE/FOS/01. Geneva.
Available at www.who.int/foodsafety/consumer/en

World Health Organization (2002). Managing water in the home: accelerated health gains from
improved water supply. WHO/SDE/WSH/02.07. Geneva. Available at
www.who.int/entity/water_sanitation_health/dwq/wsh0207/en and
www.who.int/entity/household_water/

World Health Organization (2003a). Skills for health, skills-based health education including life skills:
an important component of a child-friendly/health-promoting school. Information series on school
health: document 9. Geneva. Available at www.who.int/school_youth_health/resources/en/

World Health Organization (2003b). The physical school environment: an essential component of a
health-promoting school. Information series on school health: document 2. Geneva. Available at
www.who.int/school_youth_health/resources/en/

World Health Organization (2004a). Guidelines for drinking-water quality, 3rd ed. Vol.1,
Recommendations. Geneva. Available at www.who.int/water_sanitation_health/dwq/

World Health Organization (2004b). Water, sanitation and hygiene links to health. Facts and figures.
Geneva. Available at www.who.int/water_sanitation_health/publications/facts2004/en/index.html

84
Zomerplaag J, Mooijman A (2005). Child-friendly hygiene and sanitation facilities in schools:
indispensable to effective hygiene education. Delft, IRC International Water and Sanitation Centre.
Available at www.irc.nl/

85
IX. ASSESSMENT CHECKLIST FOR WASH IN SCHOOLS

Each set of questions in the following checklist relates to the indicators presented under the relevant
guideline in Section 4. The questions in the checklist are designed to help assess whether or not a
school meets the guidelines in this document. Questions may be answered with a ‘yes’, a ‘no’ or a ‘not
applicable’. A ‘no’ answer to any question should alert the assessor to remedial action required, either
in the design and construction of facilities or their operation and maintenance. Guidance on action to
take can be found in the guidance notes under each guideline in Section 4 and in the documents listed
in the further reading list in Section 6.

1. Water Quality

Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose
intended

Design and construction Operation and maintenance

1. Is water from a safe source (free of faecal Is the safety of the water source
contamination)? monitored regularly?
Is water protected from contamination in Is the quality of the water supplied to the
the school? school monitored regularly?
Are water storage and use facilities at the
school adequately maintained to avoid
contaminating the water?
2. If necessary, can water be treated at the If water is treated at the school, is the
school? treatment process operated effectively?
Are there sufficient supplies and
adequately trained staff to carry out
treatment? Is the quality of the treated
water monitored regularly?
3. Does the water supply meet WHO If necessary, are measures in place to
guidelines or national standards avoid over-exposure of susceptible
regarding chemical or radiological children to chemical contaminants?
parameters?
4. Is water acceptable (smell, taste, If the water is not acceptable to some or
appearance)? all of the schoolchildren and staff, do they
use a safe alternative supply of drinking-
water?
5. Is the school water supply designed and Are procedures for protecting drinking-
built so that low-quality water cannot water in the school followed consistently?
enter the drinking-water supply and
cannot be drunk?

100
2. Water Quantity

Sufficient water is available at all times for drinking, personal hygiene, food preparation,
cleaning and laundry

Design and construction Operation and maintenance

1. Does the water supply have the capacity Is sufficient water available at all times for
required? all needs?
Is there a suitable alternative supply in Is the water supply operated and
case of need? maintained to prevent wastage?

3. Water facilities and access to water

Sufficient water-collection points and water-use facilities are available in the school to allow
convenient access to, and use of, water for drinking, personal hygiene, food preparation,
cleaning and laundry

Design and construction Operation and maintenance

1. Are there sufficient water points in the Is water accessible where needed at all
right places for all needs? times?
Is there always soap or a suitable
alternative at handwashing points?
2. Are there sufficient, clearly identified Are drinking-water points properly used
drinking-water points? and adequately maintained?
3. In boarding schools, are there sufficient Are showers properly used and
showers? adequately maintained?
4. In boarding schools, are there sufficient Are laundry facilities properly used and
laundry facilities? adequately maintained?

4. Hygiene promotion

Correct use and maintenance of water, sanitation and hygiene facilities is encouraged by
hygiene promotion. Water, sanitation and hygiene facilities are used as resources for hygiene
education.

Design and construction Operation and maintenance

1. Is hygiene education part of the school Is hygiene education actually provided?


curriculum? Are hygiene-education methods used
Is staff trained in providing hygiene effectively?
education?
2. Is hygiene promoted systematically?
Do schoolchildren participate actively in
maintaining hygiene?
Does staff provide positive role models
for hygiene behaviours?
3. Are school facilities designed to be easy Are school facilities maintained so as to
to use and maintain hygienically? be easy to use hygienically?

100
5. Toilets

Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for
schoolchildren and staff.

Design and construction Operation and maintenance

1. Are there sufficient toilets at the school? Are there sufficient toilets actually in use?
2. Are the toilets situated in the right place?
3. Do the toilets provide privacy and Are there working locks on the toilet
security? doors?
4. Are the toilets appropriate to local culture Are the toilets being used according to
and social conditions? their design?
5. Are the toilets hygienic to use and easy Are the toilets clean and without too
to clean? much smell?
6. Are there handwashing facilities close Is there water and soap available?
by?
7. Is there are cleaning and maintenance Is there an effective cleaning and
plan? maintenance routine in operation?

6. Control of vector-borne disease

Schoolchildren, staff and visitors are protected from disease vectors.

Design and construction Operation and maintenance

1. Is the site for the school protected from Are local vector-breeding sites avoided or
disease vectors? controlled?
Are school buildings designed and built to Are inbuilt protective measures effectively
exclude disease vectors? used and maintained?
2. Are barriers and/or repellents used to
reduce exposure to vectors?
3. Are schoolchildren and staff with vector-
borne diseases kept at home and treated
rapidly?
Are there regular inspections to detect
and treat body lice and fleas?
Are the school grounds kept free of
faeces?

100
7. Cleaning and waste disposal

The school environment is kept clean and safe.

Design and construction Operation and maintenance

1. Are floors smooth and easy to clean? Are teaching areas regularly cleaned?
Are buildings designed and built to avoid Are teaching areas clean?
damp and moulds?
2. Are the school premises free of sharp
objects and other physical hazards?
3. Are there adequate bins and other Is solid waste collected daily and safely
equipment for managing solid waste? disposed of?
Is hazardous waste managed
appropriately?
4. Is the wastewater drainage system Is the wastewater drainage system
correctly designed and built? correctly used and maintained?

8. Food storage and preparation

Food for schoolchildren and staff is stored and prepared so as to minimise the risk of disease
transmission.

Design and construction Operation and maintenance

1. Are food storage and preparation areas Do food handlers wash their hands when
designed and built so as to be easy to necessary?
keep clean? Are food storage and preparation areas
kept clean?
Are food storage and preparation areas
protected from insects and rodents?
2. Are there facilities and equipment Is contact between raw foodstuffs and
provided for preventing contact between cooked food prevented?
cooked and raw foodstuffs?
3. Are cooking facilities adequate for Is food cooked thoroughly?
heating food sufficiently?
4. If cooked food is stored, is there a fridge Is food kept at safe temperatures?
at the school for this?
5. If dry foods are stored at the school, is Are only safe water and ingredients
the store appropriate? used?

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Annex II: Children’s Water Manifesto
Drafted at the Children’s World Water Forum, 21 March, 2003, Shiga, Japan

In the name of love, peace and harmony – we, the 109 children and young people of the world
representing 32 countries – pledge to seek the support of decision-makers in planning, designing,
implementing and evaluating programmes related to children, water, sanitation and hygiene. We want
the decision-makers to guarantee the participation of children and young people, according to the
Convention on the Rights of the Child (CRC), to ensure the participation, protection, survival and
development of children and young people through promoting a safe environment for their healthy
development and wellbeing.

We assert the following:

Governments are obliged to:


• Ensure that children and young people are involved in the decision-making and policymaking
processes beginning from the planning stages through the implementation and evaluation of
household water-related programmes/issues, including access, safety, conservation and use
of water.
• Improve water and sanitation facilities, particularly for girls so that they can stay in schools,
and therefore allocate sufficient budget for water and sanitation programmes in schools.
Reallocate investments on armaments as budgets to support school programmes and child-
friendly facilities.
• Strengthen partnerships and cooperate with children and young people with NGOs,
governments, municipalities, private companies and media to strengthen school programmes
and establish child-friendly facilities.
• Encourage free exchange and sharing of information, technology and experiences across
industrialised and developing nations, specific to household water security.
• Take preparatory measures towards strengthening the infrastructure and basic services during
emergencies and train children and young people to exchange ideas and support during
emergencies.
• Respect children and young people’s opinions and different cultures in relation to water use
and sanitation, as well as provide safe water areas for children and young people’s play.
• Promote strong environmental, child-friendly education on issues related to diversified water
use for boys, girls, teachers, parents and community leaders.
• Support children and young people’s projects and activities relating to water and the
environment that affect the access to potable water and sanitation.

We as children and young people pledge to:


• Establish action groups, clubs, organizations and networks of children and young people for
activities on water, sanitation and hygiene – locally, nationally and internationally.
• Be responsible for peer-to-peer education as young facilitators and child-to-adult education on
conservation of water, sanitation and hygiene.
• Develop and use child-friendly resource materials and use child peer-education methods,
such as drama, poetry, drawing and websites to create more awareness on environment,
water and sanitation issues.
• Work with decision-makers to promote better water and sanitation facilities at schools in rural
and urban areas and in the community so that girls do not drop out of schools or face abuse.
• Be involved in designing, implementing and evaluating child-managed water and sanitation
projects and other initiatives.
• Form a Global Children and Young People’s Alliance on water, sanitation and hygiene.

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Statement of the Working Group on Water and Sanitation in Schools
We believe that poverty is the most critical cause for lack of safe water, sanitation facilities and
hygiene in schools around the world. We need to make water sanitation and hygiene in schools a
greater priority for governments and decision makers. Building on the CRC, we assert our rights to be
informed and to participate in matters that affect our lives. We assert the following:

Governments are obliged to:


• Improve water and sanitation facilities, particularly for girls so that they can stay in schools and
therefore allocate sufficient budget for water and sanitation programmes in schools.
• Reallocate investments on armaments as budgets to support school programmes and child-
friendly facilities.
• Strengthen partnerships and cooperate with children and young people, involving NGOs,
governments, municipalities, private companies and media to strengthen school programmes
and establish child-friendly facilities.
• Provide stronger written commitments, with established targets, timed goals and accountability
for the improvement of sanitation conditions in schools.

We children and young people resolve to:


• Form children and young people’s committees, groups, clubs or organizations in schools to
influence local, national and international decision-making processes related to sanitation and
child-friendly sanitation facilities.
• Form a global children and young people’s alliance on water sanitation and hygiene.
• Develop and use child-friendly resource materials and use child peer-education methods such
as drama, poetry, drawing and websites to create more awareness on environment, water and
sanitation issues.
• Work with decision-makers to promote better water and sanitation facilities at schools in rural
and urban areas and in the community so that girls do not drop out of schools or face abuse.

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Annex III: International Commitments to WASH in Schools
23

The eight interlinked United Nations Millennium Development Goals (MDGs) propose to eradicate
poverty using integrated approaches to ensure that social, economic and political dimensions are
addressed. The Goals and targets focus on capacity-building and empowerment of the poor as actors
in their own development. They call for halving the proportion of people living without sustainable
access to safe drinking water by 2015 and to “halve by the year 2015, the proportion of people who do
not have access to basic sanitation.” There is a call for action at all levels, including for the
improvement of sanitation in public institutions, especially schools; the promotion of safe hygiene
practices and the promotion and outreach to children as agents of behaviour change.

The Education for All, Dakar Framework for Action (2000) stressed the importance of “the creation
of safe, healthy, inclusive and equitably resourced educational environments conducive to excellence
in learning.”

The Second World Water Forum’s Vision 21, part of the action plan of the international water
community, set specific goals so that by 2015, 80 per cent of primary schoolchildren are provided
hygiene education and all schools are equipped with sanitation and handwashing facilities.

These ambitions are echoed in the World Fit for Children (WFFC) outcome document of the UN
2002 Special Session on Children. Investments in school water, sanitation and hygiene education
endorse the fundamentals of child protection as articulated in the Convention on the Rights of the
Child (CRC), with a direct bearing on the right of all children everywhere to a quality education. Article
24 of the CRC recognizes the rights of the child to the enjoyment of the highest attainable standard of
health, and to facilities for the treatment of illness and rehabilitation of health. The Convention also
outlines commitments to:

• Reduce the number of primary-school-age children who are out of school by 50 per
cent, and increase net enrolment or participation in alternative, good-quality primary education
programmes to at least 90 per cent by 2010.
• Eliminate gender disparities in primary and secondary education by 2005; and achieve
gender equality in education by 2015, with a focus on ensuring girls’ full and equal access to
and achievement in basic education of good quality.

Education, a tool for empowerment and sustainable development, serves as a door to the overarching
goal of poverty reduction, with girls’ education a key to unlocking its full transformative potential. This
is recognized in the MDGs targets for education and gender, in turn taking up the World Education
Forum’s Education for All (EFA) goals of eliminating gender disparity in primary and secondary
education by 2005, and in all levels of education no later than 2015. As well, they intend to ensure that
by 2015 all children everywhere, boys and girls alike, will be able to complete a full course of primary
schooling.

The United Nations Girls’ Education Initiative (UNGEI), led by UNICEF, is spearheading
partnerships and programme approaches to accelerate progress towards the 2005 Gender Parity
target in education. As a first goal to come due, it serves as the first test of credibility of the
commitments of the international community. It is widely recognised that without significant progress in
education, achievement of the other goals will be hindered.

23
UNICEF, IRC, Oxford Roundtable Final Report, Oxford, 2005, p. 62.

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Annex IV: Water, Sanitation, and Hygiene in Schools Workshop Agenda

Day 1: WASH- KEY CONCEPTS

Key Objective: To strengthen commitment and joint understanding between Education and WES
country teams from the region on ‘WASH in Schools’.

Wednesday, October 18th

Session 1 Objective: To view the intersections between various Facilitator/ Resource


education/WES frameworks and their potential in guiding WASH in Person
Schools.
08:30-09:30 • Welcome and introduction to the regional workshop
• Administrative and personal arrangements
• Introductions
09:30-10:30 • Review Current Frameworks relating to WASH in Schools Mr Cliff Meyers
• Outcomes from SSHE Evaluation
• A Global Update on WASH in Schools Mr Mark Henderson
Ms Therese Dooley
10:30-11:00 Tea Break
Session 2 Objective: To better understand the variety of experience
available across the region and identify potential/relevant
resources for improved programming. Further, to identify
regional areas of strength and common challenges.
11:00-13:00 Presentations of country “WASH in Schools” posters.
13:00-14:00 Lunch Break
Session 3 Objective: To identify the factors which hinder effective joint WES +
Education programming and provide recommendations on how to
overcome.
14:00-15:30 • Problem analysis/tree on WASH (main issues in Ms Therese Dooley
programmes and responding with potential resources and
tools relating to water, sanitation and hygiene education).
• Cross Sectoral Programming: Overcoming Challenges for
WES + Education Partnerships.
Ms Emmanuelle Abrioux
15:30-16:00 Tea Break
Session 4 Objective: To identify monitoring mechanisms for WASH in
Schools.

16:00-17:30 ƒ Assessing Impact and Effectiveness: Reviewing potential Mr George Attig


indicators/ standards.

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Day 2: WASH IN PRACTICE- BALANCING SOFT & HARDWARE ISSUES

Key Objective: To share practical experiences, resources and tools relating to water, sanitation and
hygiene education leading to agreed definitions for key concepts.

Thursday, October 19th

Session 1 Objective: To provide those involved in developing a WASH in Schools programme with
relevant information and tools for effective planning and implementation.
08:30-09:30 • Child Friendly Facilities (Technology, design, use Mr Waldemar Pickardt
and maintenance). Mr Chander Badloe
9:30-10:00 • The evidence base for hygiene promotion in schools Ms Emmanuelle Abrioux
10:00-10:15 Tea Break
Session 2 Objective: To provide those involved in developing a WASH in Schools programme
with relevant information and tools for effective planning and implementation.
10:15-12:00 • Hygiene promotion in schools: Curricula and Extra- Ms Therese Dooley
curricula. Mr Hugh Hawes
Session 3 Objective: To gain a regional overview of costing standards and issues for WASH in
Schools.
12:00-13:00 • Financing WASH in Schools: What Does it Cost? Mr Murat Sahin
13:00-14:00 Lunch Break
Session 4 Objective: To better understand the stages/content involved in planning a WASH
response in emergencies and the role of WASH programmes in relation to Avian
Influenza.
14:00-15:00 • WASH in Emergency Preparedness and Response Ms Katrin Imhoff
(Avian Influenza)
• WASH in Emergency Preparedness and Response Mr Gary Ovington
(Child Friendly Spaces).
15:00-15:30 Tea Break
Session 5 Objective: To highlight how WASH in Schools will be taken forward jointly within WES
and Education Sections (Annual Work Plans, Regional Planning)
15:30-17:00 • Country Group Work: Annual Work Plan elaboration Mr Mark Henderson

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Day 3: PARTNERSHIPS FOR SUSTAINABILITY OF WASH IN SCHOOLS

Key Objective: To identify and examine best practices and lessons learned from WASH in Schools
programmes in the region, with a particular focus on school/community linkages and children and
young people’s participation.

Friday, October 20th

Session 1 Objective: To share key discussion points and introduce focus on WASH partnerships.
08:30-08:45 • Words of Welcome: Ms Anupama Rao Singh, Regional Director, UNICEF East
Asia and Pacific Office
8:45-09:15 • An Overview of Key Discussion Points
09:15-10:15 • Government/Inter-Ministerial partnerships (including SWAps) Mr Cliff Meyers,
UNICEF EAPRO
• The Global Handwashing Initiative, Ms Nguyen, National Handwashing
Initiative, The World Bank in Viet Nam
10:15 – 10:45 Tea Break
Session 2 Objective: To better understand the potential of institutionalising children’s
participation in WASH initiatives, and to identify and examine best practices and
lessons learned in this area.
10:45-13:00 • Children as Change Agents Mr Joachim Theis, UNICEF EAPRO; and Mr Hubert
“Hugh” Hawes, Child-to-Child Trust
13:00-14:00 Lunch Break
Session 3 Objective: To explore the balance between school and community water, sanitation
and hygiene improvement initiatives.
14:00-15:30 • The relationship between WASH in schools WASH in communities.
15:30-15:45 Workshop Closure
Session 4 (Internal UNICEF session)
16:00-17:00 • Overview of recommendations relating to partnerships for WASH in schools.
• Defining further steps for strengthening WASH.

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Annex V: Participant List

Cambodia Ms Julia Rees


Project Officer
Community Action for Child Rights Programme
UNICEF/Phnom Penh
jrees@unicef.org

Ms Kerstin Karlstrom
Project Officer
Education
UNICEF/Phnom Penh
kkarlstrom@unicef.org

DPR Korea Mr Murat Sahin


Project Officer
Water, Sanitation and Hygiene
UNICEF/Pyongyang
msahin@unicef.org

Indonesia Ms Afroza Ahmed


Project Officer
Water, Environment and Sanitation
UNICEF/Jakarta
afahmed@unicef.org

Mr Yang Zhenbo
Project Officer
Water, Environment and Sanitation
UNICEF/Banda Aceh
zyan@unicef.org

Ms Ewinur C Machdar
Assistant Project Officer
Water, Environment and Sanitation
UNICEF/Nias
emachdar@unicef.org

Ms Ari Rahayu Hadinoto


Assistant Project Officer
Water, Environment and Sanitation
UNICEF/Banda Aceh
arhadinoto@unicef.org

Lao PDR Ms Southalak Sisaleumsak


Assistant Project Officer
Water, Environment and Sanitation
UNICEF/Vientiane
ssisaleumsak@unicef.org

Mr Bandith Leuanvilay
Assistant Project Officer
Water, Environment and Sanitation
UNICEF/Vientiane
bleuanvilay@unicef.org

Mongolia Ms Budragchaa Uranchimeg


Project Officer
Education

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UNICEF/ Ulaanbaatar
ubudragchaa@unicef.org

Ms Gochoo Soyolgerel
Project Officer
Health/Nutrition
UNICEF/ Ulaanbaatar
sgochoo@unicef.org

Myanmar Mr Waldemar Pickardt


Chief WASH
UNICEF/Yangon
wpickardt@unicef.org

Ms Aye Aye Yee


Assistant Project Officer
Life Skills Education
UNICEF/Yangon
aayee@unicef.org

Philippines Ms Ma. Lourdes de Vera-Meteo


Chief and Programme Officer
Education Section
UNICEF/Manila
mldevera@unicef.org

Mr Bishnu P Timilsina
Water, Environment and Sanitation (Engineer) UNV
UNICEF/Manila
btimilsina@unicef.org

Thailand Ms Katrin Imhof


Project Officer
Education
UNICEF/Bangkok
kimhof@unicef.org

Mr Gulam Rasul
Project Officer
Health & Nutrition (Tsunami)
UNICEF/Bangkok
grasul@unicef.org

Ms Reawadee Eiamsuntonhwit
Assistant Project Officer
Water, Environment and Sanitation
UNICEF/Bangkok
reiamsuntornwit@unicef.org

Ms Pornthida Padthong
Assistant Communication Officer
UNICEF/Bangkok
ppadthong@unicef.org

Ms Achara Jantarasaengaram
Asst Programme Communication Officer (AI)
UNICEF/Bangkok
ajantarasaengaram@unicef.org

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Timor Leste Mr Bishnu Pokhrel
Project Officer
Water, Sanitation, and Hygiene
UNICEF/Dili
bpokhrel@unicef.org

Viet Nam Mr Chander Badloe


Section Chief
Water, Environment and Sanitation
UNICEF/Hanoi
cbadloe@unicef.org

Ms Le Anh Lan
Assistant Project Officer
Child Friendly
Primary Education Project
UNICEF/Hanoi
lalan@unicef.org

Ms Tran Thi Thu An


Assistant Project Officer
Hygiene
UNICEF/Hanoi
tttan@unicef.org

UNICEF/NYHQ Ms Therese Dooley


Senior Advisor, Sanitation & Hygiene
UNICEF/NY
tdooley@unicef.org

UNICEF/EAPRO Ms Anupama Rao Singh


Regional Director
UNICEF/EAPRO
asingh@unicef.org

Mr Cliff Meyers
Regional Advisor
Education
UNICEF/EAPRO
cmyers@unicef.org

Mr Mark Henderson
Regional Advisor
Water, Environment and Sanitation
UNICEF/EAPRO
mhenderson@unicef.org

Ms Emmanuelle Abrioux
Project Officer
Life Skills Education
UNICEF/EAPRO
eabrioux@unicef.org

Ms Anna Dammert
Assistant Programme Officer
Education
UNICEF/EAPRO
adammert@unicef.org

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Ms Aya Aoki
Project Officer
Girls’ Education
UNICEF/EAPRO
aaoki@unicef.org

Resource Person Mr Hubert “Hugh” William Hawes


Co-founder Child-to-Child Trust, UK
hhawes1@aol.com

Mr George Attig
Consultant
Mahidol University
Nakhon Pathom, Thailand
frgat@mahidol.ac.th

Mr Gary Ovington
Project Officer
Education (Emergencies)
UNICEF/EAPRO
govington@unicef.org

Rapporteur Ms Lisa Nicol Woods


Communications Consultant
UNICEF/EAPRO
jetset_lisa@yahoo.com

Secretariat Ms Srisamorn Silawatanawongse


Programme Assistant
Education
UNICEF/EAPRO
srisamorn@unicef.org

Ms Nataya Tanyasiri
Messenger
UNICEF/EAPRO
ntanyasiri@unicef.org

Government & Ms Teechat Boonyakarnkul


UN Agencies Director, Sanitation and Health Impact Assessment Division
Department of Health
Ministry of Public Health
Bangkok

Ms Srisamorn Boonkitchinda
External Relation Officer
Bureau of Policy and Planning
Bangkok

Ms Pensri Kramomtong
Chief of Schoolage and Youth Health Group
Department of Health
Ministry of Public Health
Bangkok

Mr Satavat Kumut
Architect, General Administration bureau
Department of General Administration Bureau
Ministry of Education
Bangkok

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Ms Chantra Tantipong
Educator, Academic Affairs and Educational
Standards Bureau
Ministry of Education
Bangkok

Ms Roseanne Wong
HIV/AIDS Prevention Education and School Health Officer
HIV/AIDS Coordination & School Health Unit UNESCO/Bangkok

Mr Glen Kurokawa
Consultant
Regional Unit for Social & Human Sciences in Asia and the Pacific
UNESCO/Bangkok

Mr Edilberto C de Jesus
Director
SEAMEO
Bangkok

Mr Benet Benoza
Program Officer
Development
SEAMEO
Bangkok

NGO & Other Partners Mr Aloysius Mathews


Chief Coordinator
Education International Asia Pacific Region
Malaysia

Ms Hoa-Phuong Tran
Regional Learning & Education Advisor
Plan Asia Regional Office
Bangkok

Mr John Collette
Water and Sanitation Advisor
Plan Vietnam

Mr John McGown
Water and Sanitation Delegate for American Red Cross International
Federation of Red Cross and Red Crescent Societies
Bangkok

100