School Water, Sanitation and Hygiene: Myths Proved and Disproved

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

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

School Water, Sanitation and Hygiene: Myths Proved and Disproved Why School WASH? • At baseline, approximately 49% of schools provided drinking water to pupils • Only 11% provided water for handwashing. • In schools selected, there were 79.5 pupils per latrine on average (GoK ratios are 25:1 for girls, 30:1 for boys)

School Water, Sanitation and Hygiene: Myths Proved and Disproved The Three Components Of SWASH+ • 1) Direct implementation 2) Research 3) Advocacy/ collaborative learning • Direct implementation and research were started first • Advocacy and collaborative learning were incorporated later

School Water, Sanitation and Hygiene: Myths Proved and Disproved The Research Context • Widely acknowledged need for school WASH investments • Yet scant evidence base for impact • Evidence necessary to justify allocation of scarce resources • Myth vs. fact

School Water, Sanitation and Hygiene: Myths Proved and Disproved Background and Methods • Cluster randomized trial: 2007-2009 • Base package (45 schools): • Hygiene promotion + Water Treatment • Base package + Sanitation (45 schools): • HP+ WT + Sanitation • Water package (25 schools): • HP+ WT + Sanitation+ Water • Control (70 schools) – to receive improvements in third year of project

School Water, Sanitation and Hygiene: Myths Proved and Disproved

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

School Water, Sanitation and Hygiene: Myths Proved and Disproved • Significant reduction for HW+WT (OR=0.43) and HW, WT+San (OR=0.47) • Six days less absence per year for girls • No effect for boys

School Water, Sanitation and Hygiene: Myths Proved and Disproved Effect of WASH Helminth Re-infection • Followed re-infection rates for Ascaris, Trichuris and Hookworm • Ascaris • 45% reduction in odds overall; even greater among girls • Trichuris • No effects • Hookworm • Significant reduction in intensity of infection for boys

School Water, Sanitation and Hygiene: Myths Proved and Disproved What if key WASH components are missing? Hand Contamination • Hand Rinse: sampled pupils’ hands for fecal contamination • Measured for E. coli • Compared intervention and control schools

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

School Water, Sanitation and Hygiene: Myths Proved and Disproved Reduction in Diarrheal Disease • Water Package schools showed a 66% reduction in diarrheal disease and days of illness. • This result was not gender specific. • There was no effect seen for the Base and Base + Sanitation schools.

School Water, Sanitation and Hygiene: Myths Proved and Disproved Reduction in Girls’ Absenteeism • Significant reduction in girls’ absenteeism in schools where hand washing and treated drinking water were present (irrespective of sanitation improvement) • Software components must not be overlooked • Vital recurrent costs (i.e. soap, water treatment products) must be regularly budgeted and provided in order to ensure sustainability of WASH services

School Water, Sanitation and Hygiene: Myths Proved and Disproved • 2008 provision of soap = over 30% of schools • 2010 provision of soap = under 8%

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

Using the Evidence and Learning: Advocacy

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

Specific Policy Goals • Increase O&M Funding $3.30/pupil/year • Improve M&E Downward, decentralized and supportive • Knowledge and behavior New curriculum (co-developed with CDC)

Independent research MOE investments in school WASH Outside Expert MOE investments in school WASH Inside learning partner Collaborative learning and capacity building An inside player

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

Measuring Our Progress: Outcome Mapping School administrations NGO and Development Partners Boundary Partners Primary actors Health and educational outcomes SWASH+ Students National officials (education, health)

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

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

For more information, visit our website at www.swashplus.org.

School Water, Sanitation and Hygiene: Myths Proved and Disproved