Hygiene Education Toolkit Evaluation

Ministry of Education, Lao PDR

WASH Section

UNICEF

Robert McLaughlin

December 2010

iii

Acknowledgements

The Consultant would like to thank the following:

UNICEF officials who made the evaluation possible, providing moral as well as

technical support throughout the entire process, from design through analysis and

reporting;

Officials on the School Health Taskforce of the Ministry of Education and the

Ministry of Health, who provided valuable input into the evaluation design and

facilitated the selection of sampled schools;

The staff and consultants at Indochina Research Laos, who organized and conducted

the fieldwork, data entry and processing;

David McClay and Michele Willsher for their assistance with developing the

classroom observation protocols;

Provincial and district education officials who facilitated the field work, in particular

the three District Education Bureaus who provided administrative and logistical

support; and most of all

The school directors and teachers who participated in the telephone interviews, as

well as the school staff and students who allowed the team to disrupt their schedules

in order for the data collection to take place.

Bob McLaughlin

Consultant

iv

Acronyms

AHI Avian and Human Influenza

CPAP Country Program Action Plan

CPI Committee for Planning and Investment

DEB District Education Bureau

DPPE Department of Primary and Pre-primary Education

DTT Department of Teacher Training

ECDM Division of Design and Construction Management

EMIS Education Management Information System

ESDF Education Sector Development Framework

ESITC Educational Statistics and Information Technology Center

ESQAC Educational Standards and Quality Assurance Center

FGD Focus Group Discussion

FTI Fast Track Initiative

GDP Gross Domestic Product

GFS Gravity-fed system

IEC Information, education and communication

IRL Indochina Research (Laos)

KAP Knowledge, Attitudes and Practice

MDG Millennium Development Goal

MNCH Maternal, Neo-natal and Child Health

MOE Ministry of Education

MOH Ministry of Health

CNS National Center for Environmental Health and Water Supply

NSEDP National Socio-economic Development Plan

NSHP National School Health Policy

PDR Peoples‟ Democratic Republic

PHO Provincial Health Office

POE Provincial Office of Education

RIES Research Institute for Educational Science

SOQ Schools of Quality

UNDP United Nations Development Program

UNICEF United Nations Children‟s Fund

VEDC Village Education Development Committee

WASH Water, Sanitation and Hygiene

WAU World Around Us

WHO World Health Organization

v

Table of Contents

Acknowledgements iii

Acronyms iv Introduction vi The evaluation vii Methodology viii Findings viii Recommendations x

Background to the evaluation 1 Sector overview 1 UNICEF’s response 1 WASH in schools 2

The evaluation 3 Rationale 3 Objectives of the evaluation 3 Methodology 4 Instrumentation 4 Formation and training of evaluation team 6 Sampling 7 Profile of sampled teachers 8 Profile of classroom observations 9 Profile of sampled students 9 Profile of sampled schools for telephone interview 11 Data collection 11 Data entry 12 Data analysis 12 Limitations of the evaluation 12

Findings 13 Teacher related 13 Teaching/use of materials related 17 Student related 21 Supporting conditions and environment related 24 Curriculum related 26 Teacher training related 30 Policy related 30

Achievements and challenges 31

Conclusions and recommendations 32 Teaching and learning materials 32 Training and follow-up support 33 School-community linkages 33 Water supply and sanitation construction and maintenance 34 Supplies and equipment 34 Demand creation and advocacy 34 Institutional arrangements 35

References 37

Annexes 39

vi

Executive summary

Introduction The population of Lao PDR suffers from low levels of access to improved water

supply and sanitation. Data from 2008 indicates a national access rate of 57% and

53% respectively (UNDP 2010), well below the targets set by the Government of Lao

PDR (GOL) of 70% of rural communities with access to improved water supply by

2010 (CPI 2006) and the Millennium Development Goals (MDGs). However,

progress has been made since the adoption of the National Socio-economic

Development Plan (NSEDP) 2006-2010, which places a strong emphasis on the

provision of water and sanitation – especially in rural and remote areas.

The lack of water and sanitation infrastructure coincides with a high prevalence of

poor hygiene practices, such as open defecation, minimal hand washing with soap,

and open waste disposal. A recent study shows the negative impact of unimproved

household sanitation on the country‟s economy (World Bank 2009). It estimated that

in 2006, Lao PDR lost an estimated USD 293 million, or 5.6% of gross domestic

product (GDP), with much of this attributed to the negative impact on health.

Overall levels of access to improved water and sanitation are reflected in the countries

schools. Only 39% of the nation‟s 8,871 primary schools have access to water supply1

and 41% have access to a latrine. Less than one third (29%) have access to both water

supply and latrines; rates are as low as 13% to 15% in several provinces (UNICEF

2009). The MOE, in collaboration with the Ministry of Health (MOH) has developed

a National School Health Policy (NSHP) since 2005, and further revised in 2010,

which aims to promote the health of both students and teachers through school-based

interventions to improve water and sanitation provision in schools and promote the

development of positive hygiene behaviors and related life skills.

The development partner response in support of MOE‟s efforts to improve the

provision of improved water supply and sanitation is led by UNICEF, though its

Water, Sanitation and Hygiene (WASH) program. UNICEF has been active in supporting water, sanitation and hygiene interventions in

schools for well over a decade. The main strategies have included: policy

development – as manifested in the National School Health Policy; provision of

improved water supply and latrines; and the development of participatory

methodologies and learning materials for primary schools to promote positive

behavioral change focused on hand washing with soap, water and latrine use, personal

hygiene related to the prevention of disease and environmental sanitation. The school

is seen as a key entry point for spreading hygiene and sanitation messages to families

and communities through children.

The methodologies and learning materials are presented in the form of the “Learning

with Joy Kit”, which is popularly known as the “Blue Box”. The Blue Box contains a

variety of learning materials, including posters, story books, games and songs. A

teacher‟s manual is included with instructions as to how to organize activities and use

1Access to water includes unimproved water supply services.

vii

the materials. It also suggests core curriculum lessons to which the activities can be

linked. In addition, a reference book for teachers is included, with more in-depth

information on hygiene, sanitation and disease prevention.

The first edition of the Blue Box was developed in 1996. Since then, several revisions

have been. Its current form was finalized for use in the 2004-2005 school year with

substantial inputs from the World Health Organization (WHO). It was at that point

officially recognized by the MOE as standard supplementary teaching material

toolkit. Since its inception, the over 3,000 Blue Boxes have been distributed to more

than 1,700 primary schools. This distribution has been linked to a three-day teacher

in-service training course to introduce teachers to the materials and methodologies.

The evaluation Since its introduction, the only assessment conducted was in 2001. The assessment

recommended areas for improvement of the Blue Box, which were taken into

consideration during the final revision. In addition, several human interest stories and

a case study have been developed over the years that have served as a means of

showcasing its effectiveness. However, the Blue Box has never been subject to a

dedicated evaluation.

UNICEF is currently working with GOL counterparts to develop its next Country

Program Action Plan (CPAP). The WASH program sees it as an important

opportunity to evaluate the effectiveness of the “software” component of its support

to schools in order to incorporate recommended changes into the new CPAP. The

policy environment as also changed, necessitating a shift in strategy for UNICEF. The

new National School Health Policy has a much broader focus, incorporating the

whole cycle of general education rather than just primary schools, whereas the Blue

Box targets only primary schools. The MOE has also adopted the Schools of Quality

(SOQ) approach, supported by UNICEF‟s Basic Education and Gender Equality

(BEGE) program. SOQ takes a holistic approach to school development that

incorporates improvement of the physical environment – including hygiene and

sanitation – with a comprehensive in-service teacher training program to promote

participatory, activity-based teaching and learning and a strong focus on developing

school management capacity and promoting a participatory approach to community

involvement. SOQ has also developed a teaching and learning supply kit for each

classroom, which brings into question whether the Blue Box – as a stand-alone toolkit

– should remain as such or be incorporated into the more comprehensive package of

learning resources provided as part of the SOQ package.

The overall objective of the evaluation is to provide information on the effectiveness

of the implementation of UNICEF-support hygiene education in primary schools

under the current CPAP, specifically related to the Blue Box and accompanying

teacher in-service training. The evaluation is expected to help create a better

understanding of the quality issues and needs related to the implementation of

hygiene education in schools and provide recommendations for future improvement

of both the Blue Box and supporting interventions in order to bring about positive

behavior change.

viii

Methodology The evaluation used a mixed-method qualitative and quantitative approach to data

collection in an attempt to gather information from a variety of perspectives and in a

variety of ways in order to address the range of evaluation objectives. Most of the

data collection methods were employed in a purposively selected sample of 15

schools, with a mix of intervention and non-intervention schools surveyed. Telephone

interviews were conducted with school directors and teachers from a separate list of

88 intervention schools.

A desk review of key water, sanitation and hygiene policies and programming was

also conducted along with informal interviews with key informants on policy-related

issues. In addition, a workshop was organized in which MOE and MOH officials

participated in a structure exercise to compare the hygiene information and teaching

methodologies presented in the Blue Box against the newly revised pre-service

textbooks and primary school teacher manuals for the World Around Us subject.

Finally, a visit to a Teacher Training College (TTC) was conducted during which

informal discussions were held with trainers and trainees, along with a brief

demonstration by the trainees on use of the Blue Box materials.

Findings In many ways, the introduction of the Blue Box has resulted in significant

achievements. Many attractive teaching and learning materials that are popular with

teachers and students have been distributed to targeted schools throughout the

country. Development partners have joined together with UNICEF and the MOE to

increase coverage to areas not targeted for UNICEF support.

Teachers reported high levels of satisfaction with the materials and use them often,

both for lessons in the textbook and as extra-curricular activities or during free time.

Competencies in using the materials are often related to overall teaching practice,

which in general remains traditional, rather than the materials themselves. Teacher

observed mostly engaged in whole class lecture and question and answer techniques.

Many also incorporated group work, but this was generally limited to having students

write down answers found in the textbooks to questions written on the board.

Students are rarely given the opportunity to handle the materials themselves. For the

most part teachers were observed calling a small number of students to the front of the

class to conduct an activity while the rest of the class observed. In some cases this is

due to limited materials. For example, the Snakes and Ladders game is not provided

in sufficient quantities to be used in group work.

Many of the Blue Box activities are suggested for extra-curricular use, which many

teachers find difficult to make time for. Also, many of the activities are not leveled,

i.e. are not designed for a specific grade level; rather, they are suggested for use in all

grades.

The most popular materials are the posters, which were seen widely used, the “Do and

Don‟t” cards, Snakes and Ladders and the various story boards and books. However,

most schools report that over the years, many of the materials have been damaged or

lost and there has been limited resupply.

ix

Though teachers report improved personal and environmental hygiene practices

among students, interviews with students and observation of their fingernails

indicated that hand washing with soap is not common. Use of sanitation facilities by

students is also rare, with most preferring to use the bushes instead. Student‟s

knowledge of hygiene-related content varies but in general is still rather limited.

A major problem is management of the school environment. Many schools have litter

and feces in the school yard. Very few have adequate fencing to keep out animals.

Toilets in general are not well-maintained. School clean-up days are often held on a

weekly basis rather than teachers promoting daily practices to keep the schoolyard

clean. Many teachers point to the lack of equipment and supplies for maintaining

personal hygiene (e.g. soap, buckets, and ladles) and environmental hygiene (waste

bins, cleaning supplies for the toilets). However, schools implementing the Schools of

Quality (SOQ) approach have much a much cleaner school environment and more

organized, daily hygiene routines.

An issue often reported by teachers is lack of demand from communities for hygiene

promotion. Though schools and communities work together on a variety of issues,

hygiene is not “on the agenda” – with the exception, again, of SOQ schools. Teachers

reported needing support from district education officials to learn how to mobilize the

community in support of school health and hygiene activities. In one school, a local

association, Nor Mai, had provided support to enhance school and community efforts

in this area. A teacher at the school said their methodologies reminded him of the

SOQ, which he had experienced in a previous school he had worked in.

Perhaps the main success is the degree to which the Blue Box has influenced the

primary curriculum. Experience shows that supplementary materials are generally

under-utilized in an environment in which teacher have limited qualifications,

resources, and time necessary to devote to activities outside the core curriculum. The

approach of introducing the Blue Box as a supplementary material, but with links to

the core curriculum, has facilitated its eventual incorporation into the core curriculum.

At the same time, the approach taken has had its limitations. These limitations are

mostly related to the overall conditions of schools and the limitations of teachers in

terms of pedagogical abilities, material resources and time available for preparing

teaching and learning materials and co- and extra-curricular activities.

The Blue Box has been introduced to teachers with a “one-off” training with little or

no follow-up support or replenishment of supplies as they are worn out or lost. It has

been a discreet activity, for the most part not integrated with a wider system of

support for classroom teaching and learning as well as whole-school – and whole-

community – management of hygiene education and systems for ensuring the school

environment supports the behavior change which the teaching and learning activities

promote.

The challenges moving forward will be the integration of hygiene education with the

school curriculum – not only in terms of what is taught in the classroom, and how it is

taught – but how schools and communities can be supported to join together in

promoting a school environment that is clean, healthy, safe and protective – and thus

conducive to the development of positive hygiene and sanitation behaviors among

students.

x

Recommendations The section is organized around specific issues arising from the findings linked with

recommendations for future UNICEF WASH in schools programming.

Teaching and learning materials

Conduct a thorough review of all Blue Box materials in terms of

appropriateness and coverage of relevant topics. Consider: level of difficulty;

presentation format; material used for printing and quantities provided.

Revise Manual and Handbook to reflect elements incorporated into pre-service

training textbooks and primary teacher manuals. Incorporate guidelines for

school management to improve the supporting conditions necessary to

improving hygiene and sanitation practices in schools.

Consider possible additions related to other subject areas into which hygiene

and sanitation messages can be integrated, such as Lao Language, first using the

supplemental material strategy but with the eventual aim of inclusion into the

next round of curriculum revision.

Consider developing additional materials for use in secondary schools in

support of the new broader focus of the NSHP.

Consider integration of the Blue Box materials into the teaching and learning

kits provided in support of SOQ.

Training and follow-up support

Integrate teacher in-service training in hygiene and sanitation with the SOQ

teacher training package.

Review current supervision guidelines for PES and DEB staff – in particular

pedagogical advisors – in support of classroom teaching and learning, school

management and community participation in support of WASH and revise as

necessary to ensure water supply and sanitation issues are monitored and issues

within the capacity of the pedagogical advisors while those technical issues

requiring MOH support are directed to the responsible district and provincial

CNS officials.

School-community linkages

Future WASH programming should take a more community-based approach

which includes the school a part of the community.

Any WASH in schools activities should be linked with UNICEF support to the

education sector and/or development partner inputs that can ensure more

intensive and long-term support to schools.

Increased partnership with a broader range of stakeholders such as non-

government organizations, local associations working with schools and the

private sector should be explored in order to provide on-going technical support

to schools in WASH-targeted communities that are not covered by the SOQ

initiative.

Water supply and sanitation construction and maintenance

Develop new designs for water supply and latrines that are appropriate to the

geographical environment in which the school is located to ensure that adequate

water supply is provided throughout the school year and that water points are

located at the point of use.

xi

Develop guidelines for maintenance of water supply and sanitation facilities at

schools and procedures for reporting problems to the DEB so follow-up support

can be provided by the district CNS.

Supplies and equipment

Consider expanding the package of materials to include basic supplies required

for maintaining a healthy school environment.

Advocate for the inclusion of expenditure line items in planned community

grants to be managed by the Village Education Development Committees

(VEDCs) for hygiene and sanitation activities including installation and

maintenance of water supply and sanitation facilities.

Demand creation and advocacy

Increase focus on IEC campaigns aimed at both schools and communities to

increase demand for improved water supply and sanitation infrastructure and

support improved hygiene and sanitation practices. Consider the use of

traditional entertainment-oriented programs to reach rural and remote

communities.

Continue advocacy efforts to ensure that the provision of improved water

supply and sanitation is explicit in MOE policies and development partner

support programs.

Institutional arrangements

Ministry of Education: The current School Health Taskforce is based with the

DPPE, and includes officials from Department of Teacher Training (DTT) and

the National Research Institute for Educational Science (NRIES). This is a

result of the predominantly classroom-based approach of current interventions

to promote behavior change through interventions in primary schools. The

new NSHP includes pre-schools and secondary schools in the policy

framework. Key departments and centers with roles related to both the

implementation and monitoring of WASH in schools – from pre-schools

through secondary schools – are currently not a member of the Taskforce,

such as the Department of Secondary Education (DSE), the Department of

Planning and Coordination, the ECDM, the Educational Statistics and

Information Technology Center and the Educational Standards Quality

Assurance Center. These should be considered for inclusion in the Taskforce.

Ministry of Health: The Information Education Communication and

Monitoring Evaluation Section of the Administrative Division should be

responsible for devising and supporting approaches for IEC and community

participation in WASH in schools. As such, the section should take a lead

technical role in the development of IEC materials for use in communities and

schools, in consultation with the MOE, in particular with RIES with regards to

materials related to the school curriculum, and the DPPE, DSE and DTT for

pedagogical issues, i.e. their use in the teaching and learning process. The

section should also take the lead in monitoring and evaluating WASH in

schools, in coordination with the relevant MOE departments. This includes

providing input into standards for data collection on hygiene and sanitation for

the Education Management Information Service (EMIS). The Rural Water

Supply Division should take the lead in setting technical standards for water

supply systems for schools in coordination with the MOH, specifically, the

xii

ECDM, and development partners. The Environmental Health Division should

take the lead in developing appropriate school sanitation systems and ensuring

water quality and waste water management standards are maintained.

Mass organizations: It is also recommended that relevant mass organizations

such as the Lao Women‟s Union and the Lao Youth Union be considered for

inclusion in composition of the revised School Health Taskforce due to their

key roles in community mobilization.

Taskforce profile: The wider range participation of participation within would

result in a review of who the Taskforce reports to: possibly a department or

center with a broader mandate than the DPPE, or a vice-minister. This would

entail the two ministries entering into a Memorandum of Understanding

(MOU) to clarify institutional arrangements and elaborate on respective roles

and responsibilities outlined in the NSHP. The MOU should include

mechanisms at the central, provincial and district levels to ensure coordination

between the two ministries and set out procedures for, among others: targeting

of schools; review of school construction and renovation plans to ensure water

supply and sanitation is adequately addressed; monitoring and feedback

mechanisms to ensure schools receive adequate technical support for both

“software” and “hardware” components, particularly related to the

establishment and implementation of systems for the maintenance of water

supply and sanitation facilities.

Raising the profile of the Taskforce may result in increased coordination between the

MOE and MOH as well as providing a platform for mobilizing increased support

from development partners.

1

Background to the evaluation

Sector overview The population of Lao PDR suffers from low levels of access to improved water

supply and sanitation. Data from 2008 indicates a national access rate of 57% and

53% respectively (UNDP 2010), well below the targets set by the Government of Lao

PDR (GOL) of 70% of rural communities with access to improved water supply by

2010 (CPI 2006) and the Millennium Development Goals (MDGs). However,

progress has been made since the adoption of the National Socio-economic

Development Plan (NSEDP) 2006-2010, which places a strong emphasis on the

provision of water and sanitation – especially in rural and remote areas – and set the

above mentioned rural coverage target. In 2006, only 52.5% of households had access

to improved water and 44.8% to improved sanitation (DOS 2006). Rates for rural

areas were much lower (35% and 15% respectively) and undoubtedly remain so.

The lack of water and sanitation infrastructure coincides with a high prevalence of

poor hygiene practices, such as open defecation, minimal hand washing with soap,

and open waste disposal. A recent study shows the negative impact of unimproved

household sanitation on the country‟s economy (World Bank 2009). It estimated that

in 2006, Lao PDR lost an estimated USD 293 million, or 5.6% of gross domestic

product (GDP), with much of this attributed to the negative impact on health. Yet

funding for the sector remains limited, and it is often overlooked in policy documents

and project designs.

Overall levels of access to improved water and sanitation are reflected in the countries

schools. Only 39% of the nation‟s 8,871 primary schools have access to water supply2

and 41% have access to a latrine. Less than one third (29%) have access to both water

supply and latrines; rates are as low as 13% to 15% in several provinces (UNICEF

2009). Unlike the NSEDP, the Ministry of Education (MOE) sector-wide

development framework, as articulated in the Education Development Sector

Framework 2009-2015, makes no mention of, and sets no targets for water supply and

sanitation in schools. However, the MOE, in collaboration with the Ministry of Health

(MOH) has developed a National School Health Policy (NSHP) since 2005, and

further revised in 2010, which aims to promote the health of both students and

teachers through school-based interventions to improve water and sanitation provision

in schools and promote the development of positive hygiene behaviors and related life

skills.

UNICEF’s response The development partner response in support of GOLs efforts to improve the

provision of improved water supply and sanitation is led by UNICEF, though its

Water, Sanitation and Hygiene (WASH) program. Lao PDR is one of the 60 countries

identified in by UNICEF (UNICEF 2006) with high child mortality and low WASH

coverage. As such, it is targeted to receive the comprehensive package of WASH

support that UNICEF‟s global strategy comprises: (i) support to water supply and

sanitation services; (ii) support to WASH in schools; and (iii) the basic package that is

2Access to water includes unimproved water supply services.

2

part of every country program. The Lao PDR WASH program aims to support the

goals set out in the National Strategy for Rural Water Supply and Environmental

Health and the NSEDP in contribution to the achievement of MDG Goal 7, Target 10:

to halve, by 2015, the proportion of people without sustainable access to safe drinking

water and basic sanitation. At the same time, due to the cross-cutting nature of the

sector, the WASH program is expected to contribute to progress towards all eight

MDGs. The program specifically targets the achievement of every child‟s right to

survival and development through increased equitable and sustainable access to, and

use of, safe water, basic sanitation services and improved hygiene (UNICEF 2007).

In addition to its role in leading the coordination of development partners in the

sector, UNICEF‟s WASH program consists of three projects: Planning and

Monitoring for WASH; WASH in rural communities; and WASH in schools.

UNICEF‟s main implementing partners for the projects are: the National Center for

Environmental Health and Water Supply (CNS) of the MOH; the Department of

Primary and Pre-school Education (DPPE) of the MOE; the Ministry of Information

and Culture; and the Lao Youth Union. Though these implementing partners, the

program works at both the national policy level as well as through area-focused

interventions targeting schools and communities in collaboration with UNICEF

programming in basic education and maternal, neo-natal and child health (MNCH).

WASH in schools UNICEF has been active in supporting water, sanitation and hygiene interventions in

schools for well over a decade. The main strategies have included: policy

development – as manifested in the National School Health Policy; provision of

improved water supply and latrines; and the development of participatory

methodologies and learning materials for primary schools to promote positive

behavioral change focused on hand washing with soap, water and latrine use, personal

hygiene related to the prevention of disease and environmental sanitation. The school

is seen as a key entry point for spreading hygiene and sanitation messages to families

and communities through children.

The methodologies and learning materials are presented in the form of the “Learning

with Joy Kit”, which is popularly known as the “Blue Box”. The Blue Box contains a

variety of learning materials, including posters, story books, games and songs. A

teacher‟s manual is included with instructions as to how to organize activities and use

the materials. It also suggests core curriculum lessons to which the activities can be

linked. In addition, a reference book for teachers is included, with more in-depth

information on hygiene, sanitation and disease prevention.

The first edition of the Blue Box was developed in 1996. Since then, several revisions

have been. Its current form was finalized for use in the 2004-2005 school year with

substantial inputs from the World Health Organization (WHO). It was at that point

officially recognized by the MOE as standard supplementary teaching material

toolkit. Since its inception, the over 3,000 Blue Boxes have been distributed to more

than 1,700 primary schools. This distribution has been linked to a three-day teacher

in-service training course to introduce teachers to the materials and methodologies.

3

The evaluation

Rationale Since its introduction, the only assessment conducted was in 2001. The assessment

recommended areas for improvement of the Blue Box, which were taken into

consideration during the final revision. In addition, several human interest stories and

a case study have been developed over the years that have served as a means of

showcasing its effectiveness. However, the Blue Box has never been subject to a

dedicated evaluation.

UNICEF is currently working with GOL counterparts to develop its next Country

Program Action Plan (CPAP). The WASH program sees it as an important

opportunity to evaluate the effectiveness of the „software‟ component of its support to

schools in order to incorporate recommended changes into the new CPAP. The policy

environment as also changed, necessitating a shift in strategy for UNICEF. The new

National School Health Policy has a much broader focus, incorporating the whole

cycle of general education rather than just primary schools, whereas the Blue Box

targets only primary schools. The MOE has also adopted the Schools of Quality

(SOQ) approach, supported by UNICEF‟s Basic Education and Gender Equality

(BEGE) program. SOQ takes a holistic approach to school development that

incorporates improvement of the physical environment – including hygiene and

sanitation – with a comprehensive in-service teacher training program to promote

participatory, activity-based teaching and learning and a strong focus on developing

school management capacity and promoting a participatory approach to community

involvement. SOQ has also developed a teaching and learning supply kit for each

classroom, which brings into question whether the Blue Box – as a stand-alone toolkit

– should remain as such or be incorporated into the more comprehensive package of

learning resources provided as part of the SOQ package.

Objectives of the evaluation The overall objective of the evaluation is to provide information on the effectiveness

of the implementation of UNICEF-support hygiene education in primary schools

under the current CPAP, specifically related to the Blue Box and accompanying

teacher in-service training. The evaluation is expected to help create a better

understanding of the quality issues and needs related to the implementation of

hygiene education in schools and provide recommendations for future improvement

of both the Blue Box and supporting interventions in order to bring about positive

behavior change.

The specific objectives of the evaluation were to:

1. Assess the quality of the Blue Box materials – as they are being used – against their

intended design in terms of the following parameters:

(i) Teacher related: competencies in teaching and use of the materials; level of

confidence; perceived competence by the teachers themselves; and personal

commitment to the use of the materials to support hygiene education.

(ii) Teaching/Materials related: methodologies used, quality and appropriateness

of the materials; and co-curricular or extra-curricular activities organized in

support of hygiene education.

4

(iii) Student related: learning outcomes in terms of knowledge, skills and

attitudes; and perceived quality of interaction by the students themselves.

(iv) Supporting conditions and environment related: school administration;

community and parental participation; and the school environment.

2. Identify strengths, weaknesses, gaps or needs in the implementation of effective

teaching hygiene in primary schools and propose suitable recommendations

accordingly. The evaluation will also assess whether the Blue Box materials supports

participatory learning to help children develop hygiene-related life skills.

3. Identify strengths, weaknesses, gaps or needs related to the design of the Blue Box

materials and propose suitable recommendation accordingly.

Methodology The evaluation used a mixed-method qualitative and quantitative approach to data

collection in an attempt to gather information from a variety of perspectives and in a

variety of ways in order to address the range of evaluation objectives. Most of the

data collection methods were employed in a purposively selected sample of 15

schools, with a mix of intervention and non-intervention schools surveyed. The

telephone interviews were conducted with school directors and teachers from a

separate list of intervention schools.

The following details the data collection methods used:

1. Focus group discussion (FGD) with teachers on various aspects of hygiene

education;

2. Classroom observation of hygiene-related lesson;

3. Student assessment interview on hygiene-related knowledge, skills, attitudes

and practices;

4. School environment observation on environmental hygiene and use of water

supply and latrines by students; and

5. Structured telephone interview with school director and one teacher on issues

related to the use of the Blue Box materials.

A desk review of key water, sanitation and hygiene policies and programming was

also conducted along with informal interviews with key informants on policy-related

issues. In addition, a workshop was organized in which MOE and MOH officials

participated in a structure exercise to compare the hygiene information and teaching

methodologies presented in the Blue Box against the newly revised pre-service

textbooks and primary school teacher manuals for the World Around Us subject.

Finally, a visit to a Teacher Training College (TTC) was conducted during which

informal discussions were held with trainers and trainees, along with a brief

demonstration by the trainees on use of the Blue Box materials.

Instrumentation Data collection instruments were developed in close collaboration with UNICEF and

the MOE, including staff from the MOH involved in working with the MOE on

hygiene education in schools. In some cases, items used in the instruments were

already available in Lao; in other cases, items had to be translated from English to

Lao. Translations were handled by Indochina Research (Laos) and the primary

5

consultant. Lao and English versions were compared for accuracy and the English

versions were updated to reflect the actual Lao versions used in the field. All

instruments were pre-tested during the preparation phase as part of training of the

field team. Revisions were made to the instruments subsequent to pre-testing. The

English versions of all instruments are attached as Annex 2. The Lao versions are

attached in electronic form.

The following briefly describes the basis for the development of the various data

collection instruments used:

1. FGD guide: Discussion guides were developed by the primary consultant

based on the information of interest as detailed in the evaluation objectives,

with input from UNICEF technical staff. Separate guides were developed for

intervention and non-intervention schools. Many of the topics are the same in

both guides, but differ in that teachers in intervention schools were asked to

discuss the Blue Box whereas teachers in non-intervention schools were asked

to discuss the textbooks and general issues related to hygiene education. The

discussion began with questions to elicit the thoughts of teachers as to

particular health and hygiene issues faced by the school and the local

communities. The FGD guide only exists in English as the moderator did not

require a Lao version.

2. Classroom observation protocol: The classroom observation protocol was

developed with input from colleagues of the primary consultant with expertise

in teacher education and the assessment of teaching and learning. The protocol

was divided into two sections, one for each of two observers.

The first section was based on a standard „time on task‟ protocol that requires

the observer to record observations of a set list of teacher and student

behaviors by time increments: in this case, three-minute periods. Observations

were conducted for 60 minutes, allowing for 20 observations of behaviors. The

list of behaviors was designed to capture the degree to which the lessons were

participatory, related lesson content to real life, and amount of time children

were on task. A space for comments was also included to note anything of

importance related to the behaviors observed.

This was complemented by a second section that required the observer to

record various other aspects of the lesson, including: the existence and

characteristics of group work; the existence and characteristics of activity-

based learning; teaching materials used; the degree of student participation;

methods used by the teacher to assess understanding; and perceptions of which

aspects of the lesson the students seemed to enjoy most. At the end of the

lesson, the observers met briefly with the teacher to obtain his/her perceptions

of the lesson; what students enjoyed most about the lesson; and the basis for

lesson planning, including any adaptations made to the lesson and the reasons

for making the changes.

3. Student assessment interview: The student assessment was mostly adapted

from the WASH KAP Study conducted by UNICEF in 2010, with additional

items based on expected learning outcomes in the school curriculum related to

6

health, hygiene and sanitation. Questions included the access to water and

latrines in the home, the importance of personal hygiene, hand washing

techniques and critical times, knowledge about, and prevention of, parasites,

prevention and treatment of diarrhea; and proper use of latrines. The interview

included a drawing activity in which students were given crayons and paper

and asked to draw a picture related to hygiene and sanitation. This served as

both an attempt to allow for more creative expression of the children‟s ideas,

and as a fun activity to do while waiting to be interviewed or just after being

interviewed and before returning to class.

4. School environment observation: The school observation protocol was mostly

based on one developed for use in a survey conducted by the World Bank and

the MOE in 2006 that investigated teaching and learning in Lao primary

schools. It was adapted to focus environmental hygiene, the existence,

condition and use of water supply and latrines, and the use of hygiene and

sanitation posters.

5. Structured telephone interview with school director and one teacher: The

director and teacher interview questionnaires were developed by the MOE

with input from UNICEF technical staff. Originally one questionnaire, it was

divided into two parts for the evaluation, with questions at the school level

included in the director interview and questions concerning the use of the Blue

Box included in the teacher interview.

Formation and training of evaluation team The evaluation team consisted of one international consultant working with a team of

researchers under the management of Indochina Research Laos (IRL) and with the

assistance of two international education experts for the development of the classroom

observation protocol. The national research team consisted of one centrally-based

field supervisor, one team leader and two research assistants. The team leader was

responsible for handling all logistical arrangements and liaison with education

officials to facilitate field work. The team leaders also served as FGD moderator,

completed section one of the classroom observation protocol and assisted with student

assessments. One field assistant served as FGD recorder, conducted the school

observations and assisted with student assessments. The other research assistant

completed section two of the classroom observation protocol and assisted with student

assessments. Back-up logistical support provided by IRL. The primary consultant

worked with the field supervisor to ensure quality control. He also conducted the

document review; led in the development of data collection instruments and training;

and conducted data analysis and reporting.

The School Health Taskforce from the MOE and MOH, along with technical staff

from UNICEF, provided advisory services in the design of the evaluation and data

collection instruments, selected the districts to be sampled, arranged for all necessary

authorizations, provided school lists and telephone numbers of school directors for the

telephone interviews, led the curriculum review exercise and monitored field work.

Training consisted of sampling procedures, a review of all data collection instruments,

interviewing skills required when working with children, and several sessions of field

7

practice in intervention and non-intervention schools in VTE Municipality during

which instruments were pre-tested. Training was led by the primary consultant.

Sampling The study used a purposive sampling of a total of 15 complete primary schools in

three districts across three provinces. Of the total number of schools, nine were

selected as intervention schools, i.e. had received UNICEF-supported WASH inputs,

and six schools were selected as non-intervention schools, i.e. had not received

UNICEF-supported WASH inputs.

The three provinces were selected to represent the northern, central and southern

regions of the country, namely Luang Namtha, Vientiane Province and

Khammouane3. One district per province was selected based on having an adequate

number of intervention schools to select from, namely Sing, Meun and

Xaybouathong, respectively. In each district, five schools were selected: three

interventions schools and two non-intervention schools. School selection was done in

collaboration with both central and district education authorities. One school that was

selected as a non-intervention school (LNT 5) turned out to be an intervention school,

resulting in 10 intervention and five non-intervention schools. Table 1 below

summarizes the planned and executed sample of schools by location and intervention

status. Note that each school has been given a code instead of using its name for

purposes of confidentiality.

Table 1: Planned and executed sample of schools

District, Province School Code Intervention Status

(Planned) Intervention Status

(Executed)

Meun, VTE VTE 1 Intervention Intervention

VTE 2 Non-intervention Non-intervention

VTE 3 Non-intervention Non-intervention

VTE 4 Intervention Intervention

VTE 5 Intervention Intervention

Sing, LNT LNT 1 Intervention Intervention

LNT 2 Intervention Intervention

LNT 3 Non-intervention Non-intervention

LNT 4 Intervention Intervention

LNT 5 Non-intervention Intervention

Xaybouathong, KHM KHM 1 Intervention Intervention

KHM 2 Intervention Intervention

KHM 3 Non-intervention Non-intervention

KHM 4 Intervention Intervention

KHM 5 Non-intervention Non-intervention

3 The province selected to represent the southern region is officially in the central

region but borders on the southern region and shares many of its characteristics.

8

Profile of sampled teachers At total of 75 teachers were planned to participate in the FGDs based on an average of

one teacher per each of five grades. A total of 96 school teachers participated in across

the 15 sampled schools. The planned versus executed sample is shown in Table 3

below. Of the total, 43 were men and 53 were women. In the ten intervention schools,

61 school teachers participated, with 28 men and 33 women. In the six non-

intervention schools, 35 school teachers participated, with 18 men and 17 women. A

detailed list of teachers is included in Annex 4.

Table 3: Planned and executed sample of teachers

District, Province School Code Intervention

Status (Planned) Intervention

Status (Executed) Teachers (Planned)

Teachers (Executed)

Meun, VTE VTE 1 Intervention Intervention 5 8

VTE 2 Non-intervention Non-intervention 5 8

VTE 3 Non-intervention Non-intervention 5 6

VTE 4 Intervention Intervention 5 4

VTE 5 Intervention Intervention 5 5

Sing, LNT LNT 1 Intervention Intervention 5 6

LNT 2 Intervention Intervention 5 6

LNT 3 Non-intervention Non-intervention 5 7

LNT 4 Intervention Intervention 5 4

LNT 5 Non-intervention Intervention 5 13

Xaybouathong, KHM KHM 1 Intervention Intervention 5 5

KHM 2 Intervention Intervention 5 4

KHM 3 Non-intervention Non-intervention 5 8

KHM 4 Intervention Intervention 5 6

KHM 5 Non-intervention Non-intervention 5 6

Total 75 96

Of the total teachers, 53% were upper secondary school graduates with from one to

three years of pedagogical training, 33% were lower secondary school graduates with

all but two having had three years of pedagogical training, and 14% had completed

primary school with most having had three years of pedagogical training. The overall

qualifications of teachers in the intervention schools were lower than those in the non-

intervention schools. The staffing profile of the intervention and non-intervention

schools varied as to the percentage of lower secondary (38% and 26% respectively,

and upper secondary graduates (49% and 60% respectively). The percentage of

primary school graduates was relatively the same, at 13% and 14% respectively.

With regards to teaching experience, teachers in intervention schools had on average

fewer years of teaching experience than those in non-intervention schools. The

average number of years teaching was 5.8 and 8 respectively, with the median number

9

of years teaching 4 and 8 respectively. In both intervention and non-intervention

schools, the range in terms of number of years teaching was wide: from a low of one

year‟s experience to a high of 19 and 23 years, respectively.

Of the 61 teachers interviewed in the intervention schools, 59% had been trained in

WASH, with all having been trained in 2006-20074. In addition, seven teachers in a

non-intervention school had just been trained in August, 2010, but had not yet

received the Blue Box materials.

Profile of classroom observations In each school, one classroom was observed for approximately one hour, for a total of

15 observations. Of the total observations, five were in Grade 3, three were in Grade

4, six were in Grade 5 and one was in a multi-grade class comprising Grades 4 and 5.

For all grades, only the World Around US (WAU) subject was observed, with teachers

selecting a WASH-related lesson to teach. Table 2 below summarizes the lessons

observed by grade, topic and number of lessons observed. A more detailed list of

classroom observations is included in Annex 4.

Table 2: Executed sample of lesson observations

Grade Lesson No. Topic No. of Lessons Observed

3 4 Intestinal Parasites 1

6 The Three “Cs” of Hygiene 4

4 4 Malaria 1

13 The Environment 2

5 * 7 Diarrhea, Cholera and Dysentery 5

8 Liver Fluke 2

*Includes multi-grade class as Grade 5 lesson was used.

Of the total lessons observed, 13 were taught by teachers with 11+1 qualifications and

two were taught by teachers with 8+3 qualifications. In the intervention schools,

seven of the ten teachers had received WASH training. In the non-intervention

schools, one teacher had received WASH training but had not yet had access to the

materials.

Profile of sampled students In the case of the students, the planned and executed samples match in terms of

overall numbers but did not match exactly in terms of gender parity. Table 4 shows

the characteristics of the student sample. Of the 150 students interviewed, 51.3 %

were boys. The imbalance is due to one school in Luang Namtha, which had a low

girls‟ enrolment rate. Otherwise, equal numbers of boys and girls were interviewed.

4 One reported having been trained two times.

10

Table 4: Executed sample of students

Characteristic

District Total

Sing Meun Xaybouathong

No. % No. % No. % No. %

Sex Female 23 46.0% 25 50.0% 25 50.0% 73 48.7%

Male 27 54.0% 25 50.0% 25 50.0% 77 51.3%

Age 8 2 4.0% 2 4.0% 1 2.0% 5 3.3%

9 3 6.0% 4 8.0% 8 16.0% 15 10.0%

10 10 20.0% 15 30.0% 7 14.0% 32 21.3%

11 15 30.0% 12 24.0% 13 26.0% 40 26.7%

12 8 16.0% 10 20.0% 14 28.0% 32 21.3%

13 9 18.0% 4 8.0% 3 6.0% 16 10.7%

≥14 3 6.0% 2 4.0% 4 8.0% 9 6.0%

Unknown 1 2.0% 1 0.7%

Grade Grade 4 30 60.0% 27 54.0% 24 48.0% 81 54.0%

Grade 5 20 40.0% 23 46.0% 26 52.0% 69 46.0%

Ethnicity Lao 1 2.0% 20 40.0% 23 46.0% 44 29.3%

Thai Dam 3 6.0% 3 2.0%

Phouthai 24 48.0% 24 16.0%

Thai Leu 8 16.0% 8 5.3%

Khmou 1 2.0% 2 4.0% 3 2.0%

Akha 23 46.0% 23 15.3%

Phounoi 1 2.0% 1 0.7%

Lolo 3 6.0% 3 2.0%

Hor 1 2.0% 1 0.7%

Hmong 29 58.0% 1 2.0% 30 20.0%

Yao 9 18.0% 1 2.0% 10 6.7%

Only Grade 4 and 5 students were interviewed, with an age range of 8 to over 14

years. The average age was highest in Luang Namtha and lowest in Vientiane

Province. The sample of students was ethnically diverse, particularly in Luang

Namtha, with nine ethnic groups represented, the major group being the Akha,

comprising 46% of the students interviewed. In Vientiane and Khammouane

Provinces, just under half of the students interviewed were lowland Lao. In Vientiane,

the majority of the students were Hmong, while in Khammouane the major group was

the Phouthai, though with almost equal numbers of lowland Lao. A detailed list of

students sampled per school is included in Annex 4.

11

Profile of sampled schools for telephone interview A total of 88 intervention schools were contacted by telephone for a brief interview

with the school director and one classroom teacher. The schools were located across

17 districts in five provinces located in the northern, central and southern regions of

the country.

In three cases, the director and teacher was the same person, either because they were

the only staff at the school (2 cases) or because they served as a classroom teacher and

no other teachers were available for interview. Of the directors interviewed, 65 were

male and 23 were female, whereas for teachers there were equal numbers of males

and females interviewed. All schools had at least one Blue Box and all had at least

one teacher who had received training. Of the teachers interviewed, 72 had received

training, with all but 10 having been trained since the 2004-05 school year, while 16

had not been trained. Teachers from all five primary grades were interviewed, with 24

teaching a multi-grade class. Class size of the interviewed teachers ranged from 10 or

fewer to more than 50 students, while most (58) had between 21 and 50 students.

The schools varied widely in terms of size, ethnicity and girls‟ participation. The

smallest school had only 40 students while the largest had 939 students, with an

average of 161 students. Almost half of the schools (40) were predominantly of Lao-

Tai ethnicity, but of which 32 had over five students from a different ethnic group in

the class of the teacher interviewed. The student body of another 35 schools was

predominantly Mon-Khmer, eight Hmong-Mien and five Sino-Tibetan (Akha). The

average girls‟ participation rate was 47%, but the range reported was dramatic: from a

low of 20% in two small schools in Savannakhet to over 70% in three schools in

Luang Namtha and Khammouane. Of the 31 schools reporting a girls‟ participation

rate of 50% or above, most are located in Luang Namtha and Oudomxay provinces.

A complete list of the 88 schools is included in Annex 4.

Data collection Data collection for the qualitative work was conducted over a period of three weeks,

from 18 October through 5 November, 2010, with one week spent in each district.

This allowed for one full day at each school, though sometimes the schedule varied

according to local circumstances, with data collection in some schools taking place

over the course of two days. Upon arrival in the district, the field team contacted the

District Education Bureau (DEB) to explain the objectives of the research and

logistical support required and to finalize school selection. In each district, one DEB

official was designated to work with the team to facilitate data collection. All schools

were informed in advance of the visit in order to allow for teachers to prepare lesson

plans for a lesson in hygiene education. As most of the hygiene lessons are at taught at

the beginning of the year, in many cases the lesson observed was a review of

previously taught content.

Phone interviews were conducted from the IRL office in VTE over a period of several

days in November, 2010. There were some delays in data collection due to lack of

phone coverage in some cases and incorrect phone numbers in other cases.

12

Data entry Following the primary data collection, the taped recordings of all focus group

discussions were transcribed in Lao. Data from telephone interviews was entered into

PAW Interviewer 5.6 and data from student assessments was entered in SPSS. Data

from the classroom and school observations and student assessments was entered into

Excel.

Data analysis After transcribing all tape recordings, the categories in the question guides were used

as key themes. Following this, the moderator analyzed the transcripts for statements

relating to the key themes. For each them quotes were documented as a means of

illustrating some of these themes. The analyses resulted in a summary of key themes

and supporting quotes along with a more detailed summary of the transcripts.

Data from student assessments and telephone interviews were analyzed in terms of

intervention and non-intervention schools in order to determine any differences

resulting from the WASH in schools inputs. Data from the student assessments and

school observations were analyzed in a similar manner.

Limitations of the evaluation The study employed mainly qualitative methods and most data collection activities

were conducted in a small sample of purposively selected schools. The data,

therefore, is only representative of the 15 schools in the sample and great care has to

be taken in extrapolating findings to cover the range of schools in the country,

including both intervention and non-intervention schools. The student assessments

were conducted with a randomly selected sample of 150 students from Grades 4 and

5, and may be considered representative of the total population of Grades 4 and 5

students in the 15 sampled schools. The school director and teacher telephone

interviews were conducted in 88 intervention schools. The selection was not

statistically representative of the entire population of assisted schools but rather was

based on accessibility by telephone.

As with any form of interview, whether it is a FGD or structured interview, one

cannot assume that reported information reflects reality. With the FGDs, efforts were

made to ensure privacy, i.e. in most cases they were conducted without the presence

of the school director or other authorities. One FDG did include a local Party

representative. However, internal social structures within the different groups of

teachers is unknown, leaving open the possibility that discussions were influenced by

factors not under the control of the moderator.

For the student assessments, language was often a challenge as many of the children

were not native Lao speakers. Even though they were selected from only the higher

primary grades, many still struggled with language. The nature of an individual

interview must also be taken into account, with many students likely to feel pressured

to respond in the way they think they were expected to respond rather than reporting

actual practice.

13

Findings This section is organized according to the specific objectives of the evaluation,

followed by additional issues that arose during the course of the research. The data for

these additional issues – mostly concerned with pre-service teacher training curricular

integration – are taken from interviews at the Teacher Training College visited and

the analytical work conducted with the Blue Box Manual and the curriculum. Much

of the data is taken from the FGDs with teachers, as the discussions capture the reality

that teachers face in their attempts to educate their students, often in challenging

circumstances. This is complemented with quantitative data from the school and

classroom observations, student interviews and telephone interviews. Due to the

wealth of data collected, only key aspects related to the objectives of the evaluation

are presented. It is important to note that for the most part, the findings reflect issues

of which UNICEF is already aware and has already taken – or plans to take – actions

to address.

Teacher related The main data sources for teacher related findings are the telephone interviews,

classroom observations and FGDs with teachers.

Of the 88 teachers interviewed by phone, all but one reported using the materials,

even those who had not received training. Overall reported utilization rates were high:

the average number of times teachers reported having used the materials during the

previous school year was 41. Of the 85 teachers for which data is available, equal

numbers report low and very high use (24 and 25 respectively) while 36 teachers

report moderately high use. Table 5 shows the reported usage rates of the teachers by

grade. Among Grade 1 teachers, roughly equal percentages of those interviewed

reported low, moderately high and very high usage rates. For Grade 2, the percentage

of those reporting very high use raises dramatically. It falls again for Grade 3, with

roughly equal percentages reporting low and very high use. For Grades 4 and 5, over

50% of teachers report a moderately high level of use.

Table 5: Reported Blue Box utilization rates among teachers interviewed

14

A total of 51 teachers reported integrating the materials with the curriculum, while 34

reported using it between lessons to fill time, as an extra-curricular activity or during

free time. Ten teachers reported only using the materials as for extra-curricular

activities or during free time. Of the 51 teachers who reported integrating the

materials into textbook lessons, most reported using the materials outside of the

curriculum as well.

The high utilization rates are also reflected in data from the FGDs with teachers in the

10 sampled intervention schools. Though rates vary, most teachers reported using the

materials at least once a week and often even more frequently. In additional to using

them during classroom lessons, teachers reported using the story cards and games in

the afternoons, when the curriculum allows for more flexible use of time. As one

teacher states:

“I use it quite often, mainly for relevant topics in The World Around Us

and Lao Language. My students like to listen to stories from the story

boards and all love to play the games.”

Another teacher states:

“I use storytelling very often because my students like to listen and enjoy

looking at the pictures. I always use it during afternoon sessions, about

one to two times a week”

From the perspective of teachers, the Blue Box has obviously provided them with a

rich source of teaching and learning materials that are applicable to specific lesson

content as well as enjoyable for students during periods of free time.

Competencies in teaching and use of the materials

Most of the data concerning teaching competencies are taken from the classroom

observations. After each lesson observation, the teacher was asked to reflect on the

lesson. Overall, teachers were able to articulate their thoughts regarding ways in

which they had adapted their lesson plans, the reasons they had made the changes and

the activities the students enjoyed most. One of the questions asked was the level of

student engagement during the lesson on a five-point scale, from none to all.

Independently, the observer recorded his/her own perception. In 9 lessons observed,

the teacher and the observer were in agreement. In another 5 lessons, there was only

one degree of difference on the scale. In only one case did the teacher and observer

have a very different response.

In lessons observed that included use of the Blue Box materials, varying degrees of

competence in their use was demonstrated. Use of the materials mostly consisted of

posters and “Do and Don‟t” phrase cards, with only two instances of the use of story

books.

In general terms, competencies observed in using the materials are related to overall

knowledge of participatory teaching and learning techniques. As described later in the

report, most teachers still engage to a large degree in traditional rote learning

15

techniques, with a substantial amount of time devoted to writing the text of the lesson

on the black board and having students copy it into their notebooks. Limited time is

devoted to group work activities. When they are used, they are often not well

structured and consist of students writing answers – often to be found in the textbook

– on a piece of paper. When conducting games and other participatory activities, as a

rule only a few students are invited to participate in front of the class, with the rest of

the class watching, or in many cases not paying attention.

In many schools, teachers are faced with large classroom sizes, making it difficult to

organize participatory activities. In two of the lessons observed in intervention school,

classes had over 50 students in very cramped classrooms. One lesson was observed in

a multi-grade class of Grades 4 and 5. The teacher demonstrated a lack of ability in

managing the class, focusing on the Grade 5 textbook and not adapting the lesson

contents to meet the needs of the Grade 4 students.

Many teachers expressed difficulty in determining the relevance of the materials and

how to use them. As this Grade 5 teacher states:

“I used [the Blue Box] only once this year. I used the picture story. This

is because in Grade 5, there are not so many lessons related to the

materials in the Blue Box and I don’t have the skills to use the materials.

I am already old. I don’t have such a talent for teaching…like the new

generation of teachers.”

As will be discussed in the section on curriculum related findings, though the Blue

Box was mainly targeted at the higher primary grades, this teacher‟s response appears

quite reasonable: despite the efforts to directly relate the materials to specific lessons

in the core curriculum, there have been many limitations as to the extent this has been

accomplished.

The Blue Box manual guides teachers to use many of the same materials across

different lessons and grades. One teacher noted that students were beginning to get

bored of the materials after a while:

“I found recently students are not very interested in the Blue Box

materials; at the beginning of the year they were very excited to see

them; after we used them two or three times they get used to them and

find it boring.”

Although most teachers try to relate lesson content to the lives of their students, many

teachers often fail to take opportunity to relate messages to real life. For instance, in

one lesson the teacher used the “Do and Don‟t” cards. When he came to the one about

littering, he failed to point out that the schoolyard was full of litter, not using the

opportunity to talk to students about how they can apply the message in real life.

Many teachers identify the need for continued supervision and support in order to be

able to improve their capacity to use the materials. A repeated theme was the lack of

follow-up provided after the original training, which in most cases took place three to

four years ago:

16

“There is no-one from the DEB and PES to supervise us after we

received the training in 2006. I always wanted to ask to receive more

material and training for new teachers but I do not know who I should

ask.”

The desire for more support from the District Education Bureau (DEB) and Provincial

Office of Education (POE) was a common theme at all schools visited, though

schools in Luang Namtha using the SOQ approach report more frequent visits from

the DEB than other schools.

Level of confidence

The vast majority of teachers interviewed likes the Blue Box and finds the materials

easy to use. Eighty-six percent of teachers interviewed by telephone reported liking

the materials a lot, and 90% reported they found them easy to use. This is reflected in

the high utilization rates reported above.

At the same time, many teachers expressed a lack of confidence in use of the

materials. This appears to have less to do with the materials themselves than with how

to organize participatory learning activities.

Many teachers expressed the need both for all teachers to be trained and for refresher

training to be provided, especially for those teachers who do not yet feel confident in

the use of the materials. Some expressed frustration that they do not receive the

support they need:

“We definitely need this course. Since we attended three years ago, we

have never received any refresher course or evaluation by the Blue Box

trainers. This year when the DEB sent a letter to our school to select only

new teachers to attend training, I requested to send previous participants

who are not very confident but they would not allow it.”

Personal commitment

There were many instances of teachers making an effort to train – not only teach –

their students positive hygiene and sanitation practices through organizing clean-up

days and in some instances making sure that soap is available for hand washing. But

for most it appears to be an uphill battle: they expressed the need support to be able to

create an appropriate school environment that promotes positive practice. The need

for support was phrased not only in terms of materials (e.g., soap, cleaning equipment

for the latrines, buckets, waste baskets, etc.) but institutional support from district

education and health services to work with schools to devise ways to work together

with communities to promote hygiene and sanitation not only in the school but in the

community as a whole. In the words of one teacher:

“I want external people or a project to come to this school to help

teachers advocate to improve hygiene and sanitation and to lead students

and the community to practice good behaviors”

17

There is a clear commitment to improve hygiene and sanitation standards at both the

school and the community, but teachers feel there is low demand from the community

and that they need support in order to mobilize communities to work together with

teachers to improve these standards.

Teaching/use of materials related The main data sources for teaching and use of materials related findings are the

classroom observations, discussion with TTC trainers and FGDs with teachers.

Methodologies used

Overall, teachers in both intervention and non-intervention schools – whether trained

in the use of the Blue Box or not – predominantly demonstrated traditional teaching

practices with minimal use of participatory activities. In many lessons, the majority of

classroom time was spent with the teacher in front of the class using a combination of

lecturing and question-answer technique eliciting either choral or individual answers

(8 observed lessons). This was more prevalent in non-intervention than intervention

schools.

The degree to which students were considered to engaged, however, varied widely,

with only five instances of a high level of engagement, with two out of the five in

non-intervention schools. It should be noted, however, that in one of the two non-

intervention schools, the teacher had access to the Blue Box materials and it was the

first time they had been used in the school, leading to a high level of student

engagement. Overall, student engagement was rated as low, with one lesson rated as

having no engagement, six as having low engagement and three as having moderate

engagement – with no discernable difference, overall, between intervention and non-

intervention schools.

A high degree of student engagement coincided with: the use of group work; minimal

time spent with the teacher writing on, and students copying from, the black board;

and high time-on-task. Of the five lessons rated as having a high rate of student

engagement, three included group work activities. The lower the rate of engagement,

the less likely group work is used. Students copying lesson content from the

blackboard was minimal in lessons rated with high engagement, with approximately

2.5 observations per lesson versus 5.8 for those lessons with lower a lower

engagement rate. For those lessons rated as having a high level of student

engagement, an average of 2 observations of students „waiting passively‟ were

recorded, whereas for the lessons rated as having moderate to no engagement, an

average of 6.1 such observations were recorded.

When participatory activities were used, they normally took the form of (i) small

group work (7 observed lessons) during which students were generally tasked with

answering a set of questions from the textbook; and (ii) games or other activities

conducted in front of the blackboard (4 observed lessons) during which only a small

number of students participated while the rest of the class observed.

Group work included the use of the Blue Box materials in only two lessons observed.

One additional lesson included use of the Avian and Human Influenza (AHI) jigsaw

puzzle (not part of the Blue Box). All three of these lessons were observed in

intervention schools in Luang Namtha, where the Schools of Quality (SOQ) approach

18

has been supported by UNICEF. In two instances, students actually handled the

materials. In one instance, students replicated the diarrhea disease cycle, using the

Blue Box poster as a model. Two of these schools implement the SOQ approach.

The students were generally engaged during small group work activities, though

teachers did not set time limits and generally did not have tasks for the groups who

finished early, resulting in many students having to wait unproductively while other

groups finished the task. In general, teachers reported back the results of the groups,

rather than having the students do so themselves. Student engagement levels were

generally high as the teacher reported on the results of the group work and assessed

the results of each group.

Rather than using group work as a time for students to have hands-on experience with

materials, teachers generally invited only individual or small groups of students to use

the materials. This was more pronounced in non-intervention schools, accounting for

three of the four observed instances. In the three lessons in which the “Do and Don‟t”

cards were used, only one teacher allowed the students themselves to handle the

cards.

Quality and appropriateness of the materials

The findings indicate wide usage of the materials but also point to a number of issues

related to the quality of the materials, their appropriateness, the quantities supplied

and shelf-life and storage issues that lead to underutilization of the Blue Box.

The most popular materials among teachers are the posters, “Do and Don‟t” phrase

cards and storybooks, especially “The Close Adventure”. All were observed in use

during the classroom observations. The story boards were also popular among

teachers of the lower grades. The “Snakes and Ladders” game was noted as being

popular as well, but with only one or two games per school teachers reported they

find it difficult to incorporate into lessons: more sets would be required to allow the

game to be played during group work. In one lesson, the teacher used the AHI jigsaw

puzzle as a group work activity as well as one of the story books. In another lesson –

in a non-intervention school that happened to have the Blue Box – the teacher to be

observed was encouraged to try out the materials. She used several posters, along with

the cards from the “Parasites” board game – rather than the game itself – which she

adapted for use as a contest to see who could be the first to find cards with a specified

message.

Many teachers requested that more Blue Boxes be provided per school, with emphasis

placed on specific materials that are frequently used or have a short shelf-life, such as

the posters – which are easily torn – and the “Snakes and Ladders” game, as

previously mentioned. In one teacher‟s words:

“We use all of them, every few weeks; therefore we have to borrow two

Blue Boxes from the DEB this year. Most of the materials in the boxes we

received in 2007 are already broken and lost.”

19

Of the schools interviewed by telephone, 46% reported the materials being in poor

condition, with another 20% reporting them to be in very poor condition. Only one-

third reported the Blue Box to be in good condition.

There were also suggestions for revising the contents of the Blue Box, in terms of

what is included, quantities provided, and the format. Below are some of the

suggestions made by teacher trainers who have been using the Blue Box as part of the

pre-service program for several years:

Posters should be printed on more durable material such as cloth in order to

increase their life-span;

Multiple copies of each poster should be provided;

Additional posters should be developed on other topics;

Multiple copies of the Snakes and Ladders game (5-6 sets) are required in

order to allow them to be used in small group work;

The story books should be made larger (A3) to make them easier for students

to see, especially considering large class sizes in many schools;

The story boards should be produced as flip charts in order to make it easier

for the teacher to keep them in order; and

The “Parasite” game should be revised to make it simpler and less time-

consuming – or delete it from the Blue Box. Reported use of the game is

minimal due to time constraints and complexity of the rules.

Table 6 summarizes the degree to which various material in the Blue Box are used

along with recommendations for what may be done to improve them and make them

more appropriate.

Storage of the Blue Box is also an issue for teachers working in schools with no office

and classroom buildings that are in poor condition and not secured against theft. One

school reported that their Blue Box had been stolen – for the box itself – not the

contents. Therefore many teachers report storing the Blue Box at their own or the

director‟s home. This decreases utilization. Another Grade 5 teacher states:

“I only use it once a year because I find it too difficult to carry the box

between here and home. We do not have an office her, so every time we

have to bring from home. When someone needs to use it, they will go to

my house and take it.”

However, the most commonly reported place for storing the Blue Box was the school

office, followed by the classroom. Only a small percentage is kept outside of the

school due to lack of infrastructure.

20

Table 6: Summary of Blue Box materials usage rate and recommendations No. Item Medium Usage Recommendations

1 Health and Hygiene Handbook

Book Rarely Revision required taking into account the new curriculum and aspects integrated into the teacher manuals.

2

Teacher’s Guide Book Sometimes

Needs to be linked explicitly with in-service teacher training; needs to be revised for pre-service to take into account aspects already integrated into the textbooks.

3 Hookworms

Poster

Very Often Printing medium needs to be reviewed to increase shelf life, or system for re-supply established. More copies provided to schools so teachers may post in the classroom and possibly inside latrines.

4 Roundworms

Very Often

5 Three Food Groups

Often

6 Hygiene Promotion

Often

7 Hand Washing

Often

8

Snakes and Ladders

Game

Often

Printing medium needs to be reviewed to increase shelf life. Enough copies need to be provided to allow for game to be played as small group work activity in the classroom.

9

Parasites Board Game Never

Consider discontinuing due to difficulty and time involved to play. Consider as lower secondary level resource due to level of difficulty. Consider provision of question cards to primary schools along with development of ideas for how to use.

10 Word Cards Game Very Often

Continue to supply, possibly with more sets per school.

11 Malaria

Story Book

Sometimes Consider including in SoQ story book set.

12 Meena Deworming

Sometimes

13 Meena Three Wishes

Sometimes

14 Meena Reaching for Help Sometimes

15 Monkey with Tooth Decay

Story Board

Often Consider reformatting as flip chart to make it easier to present. (NOTE: One story may need to remain in current format due to a particular design feature related to the use of the material.)

16 Waiting for Mother

Often

17 Wild Spirit and Dirty Water

Often

18 When the River Becomes Dirty

Often

19 Near Adventure

Very Often

20 Sanitation Songs

CD/ Tape

Rarely Provide CD and lyric book only. Consider providing larger format for lyrics to facilitate use in the classroom.

Co-curricular or extra-curricular activities

As reported above, Blue Box materials are often used for co- and extra-curricular

activities. Many schools also reported organizing weekly schoolyard cleaning

sessions in which students pick up litter. In some schools, particularly those using the

SOQ approach, a wide range of hygiene and sanitation activities are conducted. In

some schools, teachers inspect students‟ hands at the beginning of the day. In a very-

21

well resourced school in Luang Namtha, each student has a toothbrush and toothpaste

in the classroom. This school also has water buckets, ladles and soap outside the

classroom for the children to wash their hands. Some teachers report having held hand

washing days but have discontinued due to lack of supplies. One teacher reported

having organized the students to participating in cleaning up the roadside as part of a

community activity.

Student related The main data sources for student related findings are the student interviews,

telephone interviews and FGDs with teachers.

Learning outcomes in terms of knowledge, skills and attitudes

Most teachers interview by telephone reported improvements in students‟ health

(85%). Almost half (47%) reported they think students are happier as well. Almost all

teachers participating in the FGDs reported positive behavior change on the part of

the students, in both intervention and non-intervention schools. The changes most

noted were: cleaner clothes; keeping hair short (boys) and clean; cutting fingernails;

washing hands; and brushing their teeth.

The findings from the student interviews indicated some difference in knowledge and

practice between intervention and non-intervention schools, sometimes in favor of

intervention schools but just as often in favor of non-intervention schools. Location,

rather than intervention status may explain some of the results. Another factor may be

the language issues encountered in Luang Namtha, which represented four of the 10

intervention schools. Interviewers generally faced more difficulty communicating

with students in these schools than in other provinces.

Almost all students reported brushing their teeth with a toothbrush and toothpaste,

95% and 94% in intervention and non-intervention schools respectively. One quarter

of the students reported doing so three times a day. Slightly more students in

intervention schools reported doing so twice a day (63%) than in non-intervention

schools (56%).

Though few students reported eating raw meat or fish, responses to the possible

effects were similar in intervention and non-intervention schools, with bacterial

infection, stomach ache and intestinal parasites the top three answers. Bacterial

infection was a slightly more common response in the non-intervention schools (62%

versus 57%). The only students responding liver fluke were those in Khammouane

province; this is likely due to the fact that it is more prevalent in the South than in

other areas of the country.

Students were also asked to name the causes of diarrhea. Responses were similar

across intervention and non-intervention schools. In non-intervention schools the

main causes listed, in order, were: dirty food or water (56%); raw food (54%); not

washing hands (20%); and sour food (18%). For intervention schools, the main causes

listed were: raw food (42%); dirty food or water (39%); not washing hands (23%);

and sour food (20%). Putting dirty hands in the mouth was mentioned by 9% and 6%

in intervention and non-intervention schools respectively. As confirmed below,

awareness of the importance of hand washing is still low among children across all

schools.

22

When asked how to prevent diarrhea, only 23% and 32% of students listed regular

washing of hands with soap, in intervention and non-intervention schools

respectively. Boiling water was mentioned by 16% and 20% respectively. The highest

response rates were related to eating clean and well-cooked food. In order to keep

food clean, 58% of students mentioned covering the food, with the highest response

rate (over 80%) in Khammouane province. Approximately half the students

mentioned putting food in the cooking pot, cupboard or refrigerator, with differences

related to location rather than intervention status.

Knowledge of how parasites enter the body varies across location, regardless of

intervention status. Table 7 shows that students in Khammouane are more aware of

the transmission of parasites orally than students in other provinces. Fewer students

are aware that parasites can enter the body through the skin.

Table 7: How parasites enter the body

Intervention

Luang Namtha Vientiane Khammouane

Cases % Cases % Cases %

Through the skin 19 47.50% 9 30.00% 19 63.30%

Through the mouth 20 50.00% 19 63.30% 27 90.00%

Don't know/refuse 10 25.00% 7 23.30% 0 0.00%

Non-intervention

Through the skin 8 80.00% 5 25.00% 12 60.00%

Through the mouth 5 50.00% 11 55.00% 18 90.00%

Don't know/refuse 0 0.00% 8 40.00% 0 0.00%

Table 8 shows responses to a question on the proper use of a toilet for defecation, for

which multiple answers were accepted. Students in non-intervention schools had a

higher rate of correct responses than those in intervention schools. The main

difference was between girls and boys, with more significantly more girls mentioning

washing hands with soap after use. The difference is more pronounced in non-

intervention schools. However, the rate was still low, with only 60% and 50% of girls

responding so in non-intervention versus intervention schools respectively. This

apparent lack of awareness of the importance of washing hands with soap after

defecating is also reflected in responses to a question that asked students to explain

and demonstrate how and when to wash one‟s hands. Only one quarter of students

mentioned washing hands after using the toilet. However, washing one‟s hands before

eating was mentioned by almost all children, regardless of location or intervention

status.

23

Table 8: Student responses to proper use of the toilet for defecation

Intervention

Student Gender Total

Female Male No. %

No. % No. %

Pour water before use 9 18.8% 6 11.5% 15 15.0%

Pour water after use 43 89.6% 36 69.2% 79 79.0%

Wash hands with soap and water 24 50.0% 22 42.3% 46 46.0%

Non-intervention

Pour water before use 2 8.0% 5 20.0% 7 14.0%

Pour water after use 21 84.0% 21 84.0% 42 84.0%

Wash hands with soap and water 15 60.0% 11 44.0% 26 52.0%

Students were asked where they go to defecate when at school. Table 9 shows that a

much higher percentage of children use the school toilet in intervention schools and

that in these schools, boys and girls use the toilet at the same rate. Whereas in non-

intervention schools, rates are substantially lower, with less boys using the toilet than

girls. More girls report going in the bushes than boys, who report going home instead.

This is most likely related to the availability of school sanitation facilities. In non-

intervention schools, 16% of students went to schools that had no toilet.

Table 9: Use of school toilet for defecation

Student Gender

Female Male

Intervention Count Col % Count Col %

School toilet 40 83.3% 43 82.7%

In the bushes 2 4.2% 5 9.6%

Home 5 10.4% 4 7.7%

Other 1 2.1% 0 0.0%

Total 48 100.0% 52 100.0%

Non-intervention

School toilet 14 56.0% 12 48.0%

In the bushes 10 40.0% 8 32.0%

Home 0 0.0% 4 16.0%

Other 1 4.0% 1 4.0%

Total 25 100.0% 25 100.0%

Interviewers also observed students‟ fingernails to determine hand washing practice,

checking whether they were long or short; and clean or dirty. Table 10 presents a

matrix showing students by number and percentage by each category: nails short and

clean; nails short and dirty; nails long and clean; and nails long and dirty. Intervention

and non-intervention schools are compared. Of the children with long nails, over 90%

were also dirty; of the children with short nails, between approximately half to two-

thirds were dirty, with the situation worse in intervention schools.

24

Table 10: Student fingernails by length and cleanliness

Nails long Nails short

Intervention No. % No. %

Nails clean 1 3.7% 22 30.6%

Nails dirty 26 96.3% 50 69.4%

Non-intervention

Nails clean 1 8.3% 16 43.2%

Nails dirty 11 91.7% 21 56.8%

Awareness of protection against mosquito-borne diseases was very high, especially in

Khammouane province, where all children in intervention schools and 95% in non-

intervention schools mentioned sleeping under a mosquito net. In Vientiane Province,

only 70% of students mentioned mosquito nets, but many more mentioned using a

mosquito coil (30% and 20% in intervention and non-intervention schools

respectively). For Luang Namtha, 85% and 90% mentioned mosquito nets in

intervention and non-intervention schools respectively.

Perceived quality of interaction by the students themselves

The evaluation was not able to directly gather information on student perspectives on

the quality of classroom interaction. Students are not likely to make negative

statements about their teacher or classroom when they are at school. The information

gathered was limited, and restricted to classroom observations. The analysis presented

above regarding student levels of engagement and time on task in the classroom can

be used as a proxy indicator for student perceptions: higher levels of engagement

imply a more positive perception of the quality of the teaching and learning process.

A community-based research approach is suggested if one wants to learn more about

child perspectives on their learning experiences in school

Supporting conditions and environment related The main data sources for supporting conditions related findings are the school

observations, telephone interviews and FGDs with teachers.

School administration and community participation

The role of the school director in creating the routines that are necessary to develop

positive hygiene and sanitation behavior change is critical. The director is responsible

for ensuring collaboration with the surrounding communities. It was found that more

engaged and active school directors led to a better organized school and an improved

school environment.

Whereas the Blue Box focuses on classroom teaching and learning, schools receive no

support in how to organize activities to promote personal and environmental hygiene.

The SOQ approach has been largely successful in addressing these issues, pointing to

the need for a more holistic and comprehensive approach to hygiene education in

schools.

Overall, teachers were very engaged during the FDGs, were obviously concerned with

hygiene and sanitation issues and saw it as a joint responsibility of the school and the

community. They felt strongly that the school should be a model for the community,

25

but expressed frustration that hygiene and sanitation was not “on the agenda”, i.e. is

not an issue that the school and community discuss. This again implies low demand

on the part of the community.

A high level of community participation in promoting environmental hygiene was

reported in schools implementing the SOQ approach, as this teacher states:

“Our school is under the SOQ project. We always apply participatory

approaches when we plan any school activities and we always invite

communities to participate. Communities are taking care of building the

fence and hygiene practices in the school yard.”

But in non-SOQ schools – even those reporting good school-community relations –

hygiene and sanitation are not discussed. One teacher in a dilapidated school with a

poor drainage system thinks the DEB should take the initiative:

“If possible, I would like to invite the DEB to organize a meeting with

community leaders in this area as soon as possible; then we can raise the

issues of school renovation, maintenance of the fence and solving the

problems we have with our schoolyard.”

This feeling was echoed by many teachers: that they need assistance in finding ways

to mobilize communities in support of improved hygiene and sanitation at the school.

The school environment

Many schools are faced with inadequate infrastructure that makes it a challenge to

create a school environment conducive to the promotion of positive hygiene and

sanitation practices. The 88 schools interviewed reported a wide range of water

supply sources, with half using a gravity fed system (GFS) and one quarter using a

borehole well. Most of the schools with a GFS system are located in the North, while

most schools in the central and southern regions have a borehole well. Ten percent of

the total schools – all located in the North – have piped water at the school. However,

almost half (45%) of all schools report that water system that do not function

adequately. Another 11% report it did not function at all. The main reason stated in

schools in the North was lack of water in the dry season. In the central and southern

regions, the main reasons stated were related to poor design and age of the system.

All interviewed directors reported having toilets at the school, though over 20% noted

that some of the toilets were not functioning. The main reason stated was lack of

spare parts for repairs (68%). Other reasons were lack of water (16%) and the age of

the toilets (11%). As a result, four of the schools had no functioning toilet at the time

of the survey. An additional 11 schools do not have enough toilets to meet student

numbers, i.e. less than one toilet per 75 pupils, the maximum standard as set by the

MOE (MOE 2009). Twenty-five schools have one toilet per 45 to 75 students while

the rest have student to toilet ratio of less than 1:45.

In some cases, the placement of the water supply is a problem that reduces utilization

of the latrines. As this teacher in an intervention school states:

26

“Keeping the toilet clean is very difficult because the water point is far

away from the school. Therefore, the students don’t like to use the toilet

and they go in the bushes instead.”

During the school observations, utilization of the toilets over a 15-minue period

during break time showed that very few children use the school toilet, with boys using

it less than girls. The maximum number of children observed using the toilet in a

school was 14. In another school, 11 children were observed to use the toilet.

Utilization rates were higher in intervention schools, with the highest rates generally

observed in schools implementing the SOQ approach. In fact, students were observed

using the toilets in only one of the non-intervention schools, which receives support

from Nor Mai, a local association working with schools and communities.

The overall environment of most schools was generally poor, with only three schools

free of litter and four free of feces. A complete fence was present in only three

schools and garbage bins available in four schools. Hand washing facilities were

available in only five schools, four of which implement SOQ.

Overall, teachers reported the need for a more holistic approach to hygiene education

that involves both the school and the community. One teacher in a non-intervention

school that had achieved some success in improving the school environment reported

that it was due to the assistance of the Nor Mai Association. He said the approach

taken reminded him of the SOQ approach he had experienced in a school in which

he‟d previously worked.

Curriculum related One of the strengths of the design of the Blue Box and accompanying manual has

been its focus on establishing a clear relationship to the core curriculum, with most

activities and materials directly related to content delivered through The World

Around Us (WAU) textbook. In many cases, the approach has been successful;

however, an analysis of the Blue Box manual‟s instructions for use indicate several

issues: (i) the connections to the core curriculum are often not as explicit as intended;

(ii) there is no guidance regarding the appropriate Grade or lesson for many of the

materials; (iii) many of the suggested activities are not leveled, i.e. are either not

appropriate for the Grade or are recommended for all Grades without adaptation.

Connections to the core curriculum

For many activities in the manual, specific lessons in the textbooks are mentioned.

However, for most of the topics in part one of the manual, no specific lesson is

mentioned, leaving it up to the teacher to use the lesson as an extra-curricular activity.

Though designed to focus on the upper grades, of the 11 chapters in the part one of

the Blue Box manual, only three lessons in the Grade 5 WAU textbook are referred

to, all having to do with diarrheal diseases. The remaining six chapters related to

Grade 5 are designated for extra-curricular activities. The pattern for Grade 4 is

similar.

Guidance regarding grade level and lesson

For some of the materials, no guidance is given as to which grade level or lesson they

are appropriate. Only two of the nine story boards and story books are referred to as

materials for specific lesson plans in the part one of the manual. There is no reference

to the appropriate grade levels for the game “Snakes and Ladders” nor for the hygiene

27

songs. The personal hygiene poster is not mentioned as a material for any of the

lessons.

Leveling of lesson content and materials

To a great extent, the materials are not leveled, i.e. they are related to all grades rather

than to grade-specific content. As an example, activities one through five in part two

of the manual are recommended for all five grades, without any variation in the way

the activity is to be conducted to respond to the different learning needs of students as

they progress through school (i.e. putting the boxes in correct order; “Do-Don‟t”

hygiene principles; word card guessing game; wash your hands; and forming the

correct sentence). The popular story book „Near Adventure” is suggested for Grades

2, 3, 4 and 5. The food poster is recommended for all five grades. In some cases, the

re-use of the same material for different grade levels may be justified, but more

guidance would be in order to assist teachers relate the material to each specific grade.

The “Parasites” game is mentioned only in reference to Grade 3, while its level of

difficulty makes it more appropriate for secondary school.

Tables 11 and 12 show compare the lessons and activities presented in the Blue Box

Manual in relationship to grade level and lesson.

Table 11: Teaching guidelines for health and hygiene related to WAU textbooks

Grade WAU Lesson Lesson Content Blue Box Content

Any Not specified Malaria Chapter 5: Malaria

1

Activity hour Chapter 10: Water usage and river protection

Up to teacher Chapter 11: Toilet use and maintenance

6 Personal hygiene Chapter 7: Keeping food, drinking water and water supply clean (Food poster)

1-7 Chapter 8: Personal hygiene

2

Activity hour Chapter 10: Water usage and river protection

Up to teacher Chapter 11: Toilet use and maintenance

9 Infectious diseases Chapter 4: Parasitic diseases (Hookworm, Roundworm, Hand washing posters; Story book on intestinal diseases)

6,7 Personal hygiene Chapter 7: Keeping food, drinking water and water supply clean (Food poster)

1-5 Chapter 8: Personal hygiene

54 Household hygiene Chapter 9: Environmental sanitation (Story book “Near Adventure”)

3

Activity hour Chapter 10: Water usage and river protection

Up to teacher Chapter 11: Toilet use and maintenance

1,2,3 Personal hygiene Chapter 7: Keeping food, drinking water and water supply clean (Food poster)

13 Chapter 8: Personal hygiene

18-20 Risks of dirty environment

Chapter 9: Environmental sanitation (Story book “Near Adventure”)

None Game “Parasites in the Intestines”; Story books

4

Activity hour Chapter 10: Water usage and river protection

Up to teacher Chapter 11: Toilet use and maintenance

Activity hour Chapter 4: Parasitic diseases (Hookworm, Roundworm, Hand washing posters; Story book on intestinal diseases)

8 Opisthorchiasis Chapter 4: Parasitic diseases (Hookworm, Roundworm, Hand washing posters; Story book on intestinal diseases)

related topics Chapter 6: Dengue fever

Not specified Chapter 6: Dengue fever

Activity Hour Chapter 7: Keeping food, drinking water and water supply clean (Food poster)

28

Grade WAU Lesson Lesson Content Blue Box Content

1-5 Chapter 8: Personal hygiene

36 Chapter 9: Environmental sanitation (Story book “Near Adventure”)

5

10 Dysentery Chapter 1: Dysentery (Activity 3; Hand washing poster)

Activity hour Chapter 10: Water usage and river protection

Up to teacher Chapter 11: Toilet use and maintenance

9 Diarrhea Chapter 2: Diarrhea

11 Diarrhea Chapter 3: Cholera (Hand washing poster)

Activity hour Chapter 4: Parasitic diseases (Hookworm, Roundworm, Hand washing posters; Story book on intestinal diseases)

Activity Hour Chapter 7: Keeping food, drinking water and water supply clean (Food poster)

Activity Hour Chapter 8: Personal hygiene

Activity Hour Chapter 9: Environmental sanitation (Story book “Near Adventure”)

Table 12: Teaching guidelines for organizing activities as related to WAU

Grade WAU

Lesson Lesson Content Blue Activity

Any - Not specified Activity 6: Snakes and Ladders: “Who is Stronger?”

Any - Two specified in Part 1 Activities 8-16: Story boards and books

- - Not specified Poster: Personal Hygiene

2, 4, 5 See Part 1 Specified in Part 1 Poster: Hand Washing

1 - 5 See Part 1 Specified in Part 1 Poster: Three Food Groups

2, 4, 5 See Part 1 Specified in Part 1 Poster: Roundworm Transmission Cycle

2, 4, 5 See Part 1 Specified in Part 1 Poster: Hookworm Transmission Cycle

- - Not specified Songs

1

1 Human Body Activity 1: Putting boxes into the correct order: General Hygiene Principles

1 Human Body Activity 2: Do-Don’t: General Hygiene Principles

1 Human Body Activity 3: Word Cards Guessing Game: Personal Hygiene and Environmental Hygiene

4 Not specified Activity 4: Wash your Hands: Always Keep Your Hands Clean

1 Human Body Activity 5: Forming the Correct Sentence: General Hygiene Principles

2

1 Human Body Activity 1: Putting boxes into the correct order: General Hygiene Principles

1 Human Body Activity 2: Do-Don’t: General Hygiene Principles

1 Human Body Activity 3: Word Cards Guessing Game: Personal Hygiene and Environmental Hygiene

2,9 Not specified Activity 4: Wash your Hands: Always Keep Your Hands Clean

1 Human Body Activity 5: Forming the Correct Sentence: General Hygiene Principles

3

5 Food and Water Activity 1: Putting boxes into the correct order: General Hygiene Principles

5 Food and Water Activity 2: Do-Don’t: General Hygiene Principles

5 Food and Water Activity 3: Word Cards Guessing Game: Personal Hygiene and Environmental Hygiene

Extra-curr. Activity 4: Wash your Hands: Always Keep Your Hands Clean

5 Food and Water Activity 5: Forming the Correct Sentence: General Hygiene Principles

- Not specified Activity 7: Parasites Game

4

1,7 Human Body, Hygiene, Environment

Activity 1: Putting boxes into the correct order: General Hygiene Principles

1,7 Human Body, Environment Activity 2: Do-Don’t: General Hygiene Principles

1,7 Human Body, Environment Activity 3: Word Cards Guessing Game: Personal Hygiene and Environmental Hygiene

5, 21 Not specified Activity 4: Wash your Hands: Always Keep Your Hands Clean

29

Grade WAU

Lesson Lesson Content Blue Activity

1,7 Human Body, Environment Activity 5: Forming the Correct Sentence: General Hygiene Principles

5

1,7 Human Body, Hygiene, Environment

Activity 1: Putting boxes into the correct order: General Hygiene Principles

1,7 Human Body, Environment Activity 2: Do-Don’t: General Hygiene Principles

1,7 Human Body, Environment Activity 3: Word Cards Guessing Game: Personal Hygiene and Environmental Hygiene

9, 10, 11 Not specified Activity 4: Wash your Hands: Always Keep Your Hands Clean

1,7 Human Body, Environment Activity 5: Forming the Correct Sentence: General Hygiene Principles

Integration with the curriculum

In the period since the Blue Box and manuals were designed, the primary curriculum

has undergone a revision, with new student textbooks and teacher manuals produced

for all five grades over the past several years. New textbooks have also been produced

for the pre-service teacher training curriculum. During the field work phase of the

evaluation, it became apparent that many aspects of the Blue Box have been

incorporated into the new primary curriculum.

To explore the extent to which this has occurred a workshop was organized by the

School Health Taskforce to review the extent to which the content and activities in the

Blue Box Manual and Basic Knowledge of Hygiene and Sanitation in Primary

Schools Handbook have been incorporated into the new primary school teacher

manuals and primary school teacher pre-service curriculum textbooks. The workshop

participants formed three groups to compare: (i) the Blue Box Manual against Grades

1 to 3 teacher manuals; (ii) the Blue Box Manual against Grades 4-5 teacher manuals;

and (iii) the Basic Knowledge of Hygiene and Sanitation in Primary Schools

Handbook with the pre-service textbooks. The exercise resulted in a matrix

illustrating the degree to which curricular integration has been achieved. The results

of the exercise are attached as Annex 5.

For the primary grades the focus was on the WAU curriculum as expressed through

the teacher manuals. The results show a substantial degree of integration of the

content and methodologies from the Blue Box Manual. The integration was handled

in different ways for different lessons. For some lessons, such as those on intestinal

parasites, the exact text and illustrations from the Manual were incorporated into the

curriculum: they were literally cut and pasted into the teacher manuals. For other

lessons, many of the participatory teaching and learning techniques from the Manual

were incorporated, though with somewhat different content. In one instance, a

teaching material from the Blue Box (a story card) was included as a teaching and

learning resource in the teacher manual.

As for the pre-service curriculum, the WAU is also the main subject through which

WASH is taught. There are two textbook volumes for the subject. The curriculum is

designed to develop basic knowledge of teacher trainees as well as pedagogical skills,

so the level of knowledge covered by the pre-service textbook equals the level of the

content presented in the Handbook. Approximately half of the content from the

Handbook has been incorporated into the textbooks.

30

Teacher training related The Blue Box was introduced into teacher training institutions beginning 2005. The

materials and related activities were to be taught alongside relevant topics in the

curriculum as spelled out in the Blue Box Manual. In addition, a special 2-day course

in use of the materials is provided to teacher training students in their final year of

study, immediately preceding their practicum at the beginning of their final semester.

They are then given a Blue Box to take with them during their practicum, which they

conduct in groups of 10 or more students per primary school. They are instructed to

conduct Blue Box activities with both schools and communities during their

practicum.

A visit to one teacher training institute indicated that the Blue Box materials are

highly valued and incorporated into the curriculum throughout the course of study.

However, it is only during the 2-day intensive training that they are introduced to all

of the materials as some of the materials do not fit well with the curriculum.

A discussion with 12 students in their final year indicated they know the contents of

the Blue Box and have used some of the materials, specifically the story boards and

“Do-Don‟t” phrase cards. When asked which material they preferred, half said the

phrase cards and half the story boards.

They had prepared a demonstration of the Word Cubes for the visit, in which a

sentence is read out and the students need to find the correct words on the cubes and

line them up in the correct order. When the sentence was formed, it was read out loud,

followed by the teacher asking the students why the statement is important.

Of pedagogical interest was the fact that the demonstration mirrored a common

teaching practice in schools, i.e., that of having one small group of students stand in

front of the class and conduct the activity – without changing groups between

sentences – and in a prescriptive manner, i.e. with sentences dictated by the teacher

rather than students making up sentences themselves. The summary question and

answer activity after the formation of the sentence was also quite formulaic, with a set

choral response expected.

Policy related As noted in the introduction, though a key focus of the NSEDP, WASH is often

neglected in various ministry policy documents and development project designs.

In the education sector, WASH does not appear in the ESDF, the major policy

document guiding the MOE in its efforts to meet Education for All (EFA) and MDG

targets. In 2009, the MOE developed School Construction Guidelines, in which some

attention is given to water supply and sanitation. The Guidelines were developed by

the Division of Design and Construction Management (ECDM) under the Department

of Finance of the MOE. The Guidelines are a positive step towards ensuring quality

school construction, and lay out standards for water supply, latrines and waste

disposal for schools, including standards for student: latrine ratio, separate latrines for

boys and girls – as well as male and female teachers – and includes a monitoring

checklist that includes inspection of water supply and sanitation facilities. Yet it fails

to mention hand washing facilities, their location or quantities of water points

required related to school enrolment. With regards to design and implementation,

31

there is no reference to CNS, which is the legally mandated agency in charge of water

supply to rural areas, where most schools are located. The MOE worked with the

Ministry of Public Works in developing the Guidelines and did not include the MOH,

or specifically CNS, in the process.

The lack of attention given to WASH is further evidence by the data provided in the

MOE website on school construction, which only refers to classroom buildings. There

is no mention of latrines or water supply. The EMIS gathers detailed data on all

schools from pre-primary through secondary on an annual basis through a school

census. Included are items related to water supply and latrines. Specifically, schools

are requested to provide information on the availability of water in the school by

source (piped, well, or other) as well as the existence of latrines by whether they are

separate for teachers and students and boys and girls. There is little user demand for

WASH data from EMIS, even within the MOE, with UNICEF cited as the only

organization with interest in the data. There is no mention of school sanitation or

WASH in recent annual MOE reports.

UNICEF is driven by policy to place a high priority on water supply and sanitation as

a basic human right. It leads the sector, with a focus on rural water supply. Its

strategies focus at the policy level, advocating increased visibility and responsive

policies and programming on the part of both government and development partners.

It has a lesser, albeit important, role in the actual on-the-ground inputs for water

supply and sanitation. When engaged in such programming, however, its emphasis

should be on integration with complementary programs and developing expanded

partnerships with both the public and private sectors (UNICEF 2009). UNICEF has an

important role to play in the education sector, through support for CNS capacity-

building and implementation of WASH activities in schools. One of the mechanisms

for promoting WASH in schools is the School Health Taskforce, which is mandated

with ensuring that schools provide a healthy and safe environment for both school

staff and teachers.

Achievements and challenges In many ways, the introduction of the Blue Box has been a great success. Many

excellent teaching and learning materials that are very popular with teachers and

students have been distributed to a large number of schools throughout the country.

Development partners have joined together with UNICEF and the MOE to increase

coverage to areas not targeted for UNICEF support.

Perhaps the main success is the degree to which the Blue Box has influenced the

primary curriculum. Experience shows that supplementary materials are generally

under-utilized in an environment in which teacher have limited qualifications,

resources, and time necessary to devote to activities outside the core curriculum. The

approach of introducing the Blue Box as a supplementary material, but with links to

the core curriculum, has facilitated its eventual incorporation into the core curriculum.

At the same time, the approach taken has had its limitations. These limitations are

mostly related to the overall conditions of schools and the limitations of teachers in

terms of pedagogical abilities, material resources and time available for preparing

teaching and learning materials and co- and extra-curricular activities.

32

The Blue Box has been introduced to teachers with a “one-off” training with little or

no follow-up support or replenishment of supplies as they are worn out or lost. It has

been a discreet activity, for the most part not integrated with a wider system of

support for classroom teaching and learning as well as whole-school – and whole-

community – management of hygiene education and systems for ensuring the school

environment supports the behavior change which the teaching and learning activities

promote.

The challenges moving forward will be the integration of hygiene education with the

school curriculum – not only in terms of what is taught in the classroom, and how it is

taught – but how schools and communities can be supported to join together in

promoting a school environment that is clean, healthy, safe and protective – and thus

conducive to the development of positive hygiene and sanitation behaviors among

students.

Conclusions and recommendations The section is organized around specific issues arising from the findings linked with

recommendations for future UNICEF WASH in schools programming.

Teaching and learning materials Teaching and learning materials need to be provided in an appropriate format and in

adequate quantities for their intended use. A game such as “Snakes and Ladders” is

difficult to utilize if only one or two sets are provided to a school, as most classrooms

require several sets if the game is to be used in small group work. Story books need to

be of sufficient size to be visible in classrooms with up to 50 or more students: many

of the story books provided are in too small a format for whole classroom use. Posters

need to be made of a more durable material if they are to last more than a few years –

or be resupplied on a regular basis. Materials need to be leveled appropriately: the

“Parasite” game is too difficult for primary grades. Teachers require more detailed

guidance in how to use materials in a way that relates content to specific lessons as

well as to real life. Providing instructions such as “divide students into groups” is

insufficient: teachers need instructions as to group size, detailed instructions to guide

group work, length of time expected for the group work; the role of the teacher in

monitoring group work; additional activities for groups who finish their task before

other groups; and participatory methods in assessing group work.

Recommendations

Conduct a thorough review of all Blue Box materials in terms of

appropriateness and coverage of relevant topics. Consider: level of difficulty;

presentation format; material used for printing and quantities provided.

Revise Manual and Handbook to reflect elements incorporated into pre-service

training textbooks and primary teacher manuals. Incorporate guidelines for

school management to improve the supporting conditions necessary to

improving hygiene and sanitation practices in schools.

Consider possible additions related to other subject areas into which hygiene

and sanitation messages can be integrated, such as Lao Language, first using the

supplemental material strategy but with the eventual aim of inclusion into the

next round of curriculum revision.

Consider developing additional materials for use in secondary schools in

support of the new broader focus of the NSHP.

33

Consider integration of the Blue Box materials into the teaching and learning

kits provided in support of SOQ.

Training and follow-up support The “one-off” training and follow-up support provided to teachers through the WASH

in schools program is insufficient to have an impact on teaching practice, outside of

the use of the supplemental materials provided. Without a more comprehensive

teacher in-service training and supervision system, teachers are likely to continue

traditional teaching practices. Hygiene education based on a participatory, life skills

approach therefore needs to be integrated into a wider program of support that assists

teachers to be able to make the links between supplemental materials and lesson

content and to develop skills in organizing participatory teaching and learning

activities.

Recommendations

Integrate teacher in-service training in hygiene and sanitation with the SOQ

teacher training package.

Review current supervision guidelines for PES and DEB staff – in particular

pedagogical advisors – in support of classroom teaching and learning, school

management and community participation in support of WASH and revise as

necessary to ensure water supply and sanitation issues are monitored and issues

within the capacity of the pedagogical advisors while those technical issues

requiring MOH support are directed to the responsible district and provincial

CNS officials.

School-community linkages The school cannot be considered apart from the community in which it is located.

Rather, the school must be approached as an integral part of the community and all

efforts at school improvement – including hygiene and sanitation infrastructure and

practice – must be addressed through a joint community-school approach. The SOQ

approach does just that, as it involves the community in all aspects of school

development in a participatory manner, with environmental hygiene explicitly

articulated in the assessment and planning process. Such education sector

interventions are best supported through the BEGE section, with WASH providing

complementary support through a community-based strategy. For communities not

implementing the SOQ approach, additional on-the-ground support is necessary to

support improved school management and community involvement in the

implementation of WASH in schools.

Recommendations

Future WASH programming should take a more community-based approach

which includes the school a part of the community.

Any WASH in schools activities should be linked with UNICEF support to the

education sector and/or development partner inputs that can ensure more

intensive and long-term support to schools.

Increased partnership with a broader range of stakeholders such as non-

government organizations, local associations working with schools and the

private sector should be explored in order to provide on-going technical support

to schools in WASH-targeted communities that are not covered by the SOQ

initiative.

34

Water supply and sanitation construction and maintenance The existence of latrines and water supply is not sufficient to promote use of

sanitation facilities, as shown in the low utilization rates in the school observations.

Many factors lead to these low utilization rates, including: lack of piped water into

latrines; water points that are too far away from latrines; inadequate water supply;

poor maintenance of latrines; lack of access to latrines due to having to request a key

from the school director‟s office; and lack of household and community support.

Recommendations

Develop new designs for water supply and latrines that are appropriate to the

geographical environment in which the school is located to ensure that adequate

water supply is provided throughout the school year and that water points are

located at the point of use.

Develop guidelines for maintenance of water supply and sanitation facilities at

schools and procedures for reporting problems to the DEB so follow-up support

can be provided by the district CNS.

Supplies and equipment Effecting behavior change requires more than classroom teaching alone. In addition to

school management issues and community support, schools need to be provided with

adequate supplies and equipment to allow for positive hygiene and sanitation

practices to be incorporated into the school program. Soap, buckets and ladles for

hand washing are already included in the SOQ package of supplies.

Recommendations

Consider expanding the package of materials to include basic supplies required

for maintaining a healthy school environment.

Advocate for the inclusion of expenditure line items in planned community

grants to be managed by the Village Education Development Committees

(VEDCs) for hygiene and sanitation activities including installation and

maintenance of water supply and sanitation facilities.

Demand creation and advocacy Hygiene and sanitation practices will only change if there is a demand on the part of

schools and communities. Though many school staff value hygiene and sanitation, the

demand is not sufficient to mobilize them to put in place the systems required to

promote positive hygiene and sanitation behaviors. Traditional practices such as open

defecation need to be countered with intensive information, education and

information (IEC) campaigns directed at both schools and communities to increase

awareness of the negative impact of such practices and to create a demand for

solutions that will lead to improved hygiene and sanitation. Even when school staff is

motivated to initiate change, they do not have the skills or policy framework for

effective advocacy with communities.

Recommendations

Increase focus on IEC campaigns aimed at both schools and communities to

increase demand for improved water supply and sanitation infrastructure and

support improved hygiene and sanitation practices. Consider the use of

traditional entertainment-oriented programs to reach rural and remote

communities.

35

Continue advocacy efforts to ensure that the provision of improved water

supply and sanitation is explicit in MOE policies and development partner

support programs.

Institutional arrangements Pursuant to the NSHP, the MOE and MOH will appoint revised School Health

Taskforces at each level in the system. This will require a review of the current

composition of the School Health Taskforce and revise membership to ensure it

responses to the expanded scope of the NSHP, particularly with regards to the

inclusion of pre-school and secondary education.

The following outlines the relevant MOH and MOE departments, centers and

divisions that should be considered for representation in the School Health Taskforce

as determined by various GOL laws and regulations on rural water supply and health

as well as the roles and responsibilities of various departments, centers and divisions

within the MOE and MOH.

Recommendations

Ministry of Education: The current School Health Taskforce is based with the

DPPE, and includes officials from Department of Teacher Training (DTT) and

the National Research Institute for Educational Science (NRIES). This is a

result of the predominantly classroom-based approach of current interventions

to promote behavior change through interventions in primary schools. The

new NSHP includes pre-schools and secondary schools in the policy

framework. Key departments and centers with roles related to both the

implementation and monitoring of WASH in schools – from pre-schools

through secondary schools – are currently not a member of the Taskforce,

such as the Department of Secondary Education (DSE), the Department of

Planning and Coordination, the ECDM, the Educational Statistics and

Information Technology Center and the Educational Standards Quality

Assurance Center. These should be considered for inclusion in the Taskforce.

Ministry of Health: The Information Education Communication and

Monitoring Evaluation Section of the Administrative Division should be

responsible for devising and supporting approaches for IEC and community

participation in WASH in schools. As such, the section should take a lead

technical role in the development of IEC materials for use in communities and

schools, in consultation with the MOE, in particular with RIES with regards to

materials related to the school curriculum, and the DPPE, DSE and DTT for

pedagogical issues, i.e. their use in the teaching and learning process. The

section should also take the lead in monitoring and evaluating WASH in

schools, in coordination with the relevant MOE departments. This includes

providing input into standards for data collection on hygiene and sanitation for

the Education Management Information Service (EMIS). The Rural Water

Supply Division should take the lead in setting technical standards for water

supply systems for schools in coordination with the MOH, specifically, the

ECDM, and development partners. The Environmental Health Division should

take the lead in developing appropriate school sanitation systems and ensuring

water quality and waste water management standards are maintained.

Mass organizations: It is also recommended that relevant mass organizations

such as the Lao Women‟s Union and the Lao Youth Union be considered for

36

inclusion in composition of the revised School Health Taskforce due to their

key roles in community mobilization.

Taskforce profile: The wider range participation of participation within would

result in a review of who the Taskforce reports to: possibly a department or

center with a broader mandate than the DPPE, or a vice-minister. This would

entail the two ministries entering into a Memorandum of Understanding

(MOU) to clarify institutional arrangements and elaborate on respective roles

and responsibilities outlined in the NSHP. The MOU should include

mechanisms at the central, provincial and district levels to ensure coordination

between the two ministries and set out procedures for, among others: targeting

of schools; review of school construction and renovation plans to ensure water

supply and sanitation is adequately addressed; monitoring and feedback

mechanisms to ensure schools receive adequate technical support for both

“software” and “hardware” components, particularly related to the

establishment and implementation of systems for the maintenance of water

supply and sanitation facilities.

Raising the profile of the Taskforce may result in increased coordination between the

MOE and MOH as well as providing a platform for mobilizing increased support

from development partners.

37

References

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Sanitation and Hygiene Education pilot project supported by the Netherlands during

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Development Plan 2006-2010. Government of Lao PDR. VTE

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Lao PDR National Maternal and Child Nutrition Survey 2006, Final Report. VTE

Department of Water Supply and Sewerage & UNICEF Nepal. March 2006.

Participatory Assessment of the School Sanitation and Hygiene Education Programme

in Nepal. Kathmandu.

IRC International Water and Sanitation Center. Summary of results of the study on

the impact and sustainability of WASH in schools research: Kenya and Kerala, 2006-

2007. Delft.

Kambole, S.M. May 2006. Assessment of the School Sanitation and Hygiene

Education Programme in Katete and Petauke Districts of Eastern Province and

Monze, Sinazongwe and Mazabuka Districts of Southern Province. UNICEF. Lusaka.

Mathew, K., Zachariah, S., Shordt, K Snel, M., Cairncross, S., Biran, A., Schmidt, W.

The sustainability and impact of school sanitation, water and hygiene education in

Kerala, Southern India. IRC International Water and Sanitation Center. Delft.

Ministry of Health. November 2010. National Strategy for the Development of

Human Resources for Health through 2020. Vientiane.

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Supply and Environmental Health Sector. Vientiane.

Ministry of Education. December 2009. School Construction Guidelines. Division of

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Ministries of Education and Health, Lao PDR. May 2005. Implementation Strategy

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Ministries of Education and Health, Lao PDR. May 2010. National School Health

Policy. VTE.

Njuguna, V., Karanja, B., Thuranira, M., Shordt, K., Snel, M., Cairncross, S., Biran,

A., Schmidt, W. The sustainability and impact of school sanitation, water and hygiene

education in Kenya. IRC International Water and Sanitation Center. Delft.

Shordt, K., Snel, M. December 2006. Indicators for WASH in schools. IRC

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UNICEF Nicaragua. February 2005. Evaluation of the child friendly and healthy

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schools initiative‟s school sanitation and hygiene education component. Managua.

UNICEF. 1999. Towards better programming: A manual on hygiene promotion.

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New York.

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UNICEF. March 2009. Concept paper for Scaling Up WASH in UNICEF

Programmes. New York.

UNICEF. May 2009. UNICEF Water, Sanitation and Hygiene Annual Report 2008.

New York.

UNICEF. May 2010. UNICEF Water, Sanitation and Hygiene Annual Report 2009.

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Sanitation and Hygiene. Water, Environment and Sanitation Technical Guidelines

Series - No. 5. New York.

Winkler, Tom. 2010. WASH KAP Study: A Knowledge, Attitude and Practices Study

on Water, Sanitation and Hygiene in Rural Communities. UNICEF. VTE.

Winkler, Tom. November 2009. Preliminary Analysis of National Primary School

Data for Water and Sanitation in Schools Coverage during the 2008/2009 School

Year, Lao PDR. UNICEF. VTE.

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study conducted in Cambodia, Indonesia, Lao PDR, the Philippines, and Vietnam

under the Economics of Sanitation Initiate (ESI). Water and Sanitation Program, The

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Phommasack, B., Saklokham, K. 2009. Oxford University Press.

eapro.oxfordjournals.org

39

Annexes

1. Terms of Reference

2. Data Collection Instruments

a. Teacher Focus Group Discussion Guides

b. School Observation Form

c. Classroom Observation Forms

d. Student Assessment Questionnaire

e. School Director Telephone Interview Questionnaire

f. School Teacher Telephone Interview Questionnaire

3. Research Field Team and Field Schedule

4. Summary of Respondents

a. Teacher Focus Group Discussions

b. School Observations

c. Classroom Observations

d. Student Assessments

e. School Director and Teacher Telephone Interviews

f. Key Informants

g. Curriculum review team

5. Results of Curriculum Review

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ANNEX 1: Terms of Reference

TERMS OF REFERENCE

Consultant for Evaluation of Participatory Toolkit “Blue Box”

I. Background

The Ministry of Education aims to bring hygiene education to over 8,800 schools. This is not

easy in a multi-lingual country with 47 ethnic minorities and a predominantly rural

population. With UNICEF assistance, the “Learning with Joy” kit has been developed over

the past decade. The “Blue Box” as the kit is popularly known, is used for participatory

learning in the classroom through games and stories. The messages are focused on hand

washing, water and latrine use, personal hygiene and environmental sanitation for better

health. Activities in the box employ child-to-child and child-to-adult approaches in teaching.

Messages learnt in the classroom are spread by children into their family, then to the

community.

Between 1996 and 2002, four revised versions were made. The first „learning with joy‟ box

was based on five different types of letter card games and three sets of full color story cards.

With feedbacks and comments from teachers, more materials were gradually added,

including additional games, cartoon books, textbooks and a teacher‟s guide/activity book.

The kit is handed over to the school after the teachers have been trained in the proper

participatory learning techniques.

In 2003, a review meeting was held to examine existing IEC materials developed and used by

the various organizations working in the water and sanitation sector. As a result of the

combined efforts of the Ministry of Health, Ministry of Education, UNICEF and WHO, a

standard resource was developed to create a child-friendly and health promoting environment

in schools.

The current Blue Box includes educational materials related to diarrhea, malaria,

deworming/intestinal parasites, and personal and environmental sanitation. The tool kit is

being promoted for use among the various partners working in the education sector. The new

Blue Box was distributed to primary schools in targeted provinces from the academic year

2004-2005. In 2004 the Blue Box was approved as a standard educational toolkit for teaching

health and hygiene in Lao primary schools. Since 1997 to present, about 3,000 kits have been

distributed throughout the Lao PDR and more than 11,700 primary school teachers have been

trained to lead children through “hygiene education games”.

II. Justification

Since its introduction in 1997, the toolkit has not yet been subject to a dedicated evaluation.

However a primary school sanitation program assessment was conducted by UNICEF in

41

2001. The assessment highlighted the impact of hygiene education in schools and

recommended areas for improvement. Some of these recommendations were addressed in

latest revision of the Blue Box. A group of human interest stories and a case study have been

developed over the years that have served to date as a means of showcasing its effectiveness.

Nevertheless, the need for an evaluation is still great now that the Blue Box has been

approved as a standard educational toolkit by the Lao government under the school health

policy.

III. Purpose

The evaluation will seek to gather information that will help create a better understanding of

the quality issues, concerns and needs related to the implementation of hygiene education in

schools and assess its impact with both qualitative and quantitative evidence.

The Specific Objectives are as follows:

1 Assess the quality of implementation of the Blue Box materials in-use against its intended

design in terms of the following parameters, among others:

Teacher Related:

a. Competencies in teaching and use of the materials

b. Teacher confidence

c. Perceived competence by teachers themselves

d. Personal commitment

Teaching/Materials Related:

a. Teaching/Learning Materials

b. Teaching Methodologies

c. Co-curricular and extra-curricular activities organized

Student Related:

c. Measurement of outcomes: knowledge, attitude and skills

d. Quality of interaction as perceived by students

Supporting Conditions and Environment:

a. School administration

e. Community and parental participation

f. School environment

2. Identify strengths, weaknesses, gaps or needs in the implementation of effective teaching

for health and hygiene in primary schools and propose recommendation accordingly. The

42

evaluation will also assess whether the Blue Box materials supports participatory learning to

help children obtain life skills by addressing hygiene issues.

3. Identify strengths, weaknesses, gaps or needs related to the design of the Blue Box

materials and propose suitable recommendation accordingly.

Moreover, this assessment will also identify the needs for additional teacher support

materials. Areas of improvements in the content and the challenges faced by teachers in use

of the materials will also be identified. This information will provide a view on whether a

need exists for revision of the Blue Box materials and further action required for scaling up

hygiene promotion in schools.

IV. Term of reference and expected outputs

UNICEF is seeking an international consultant to conduct the evaluation of the participatory

toolkit for teaching health and hygiene in primary schools.

Please note that initial consultations may result in modifications of this TOR and the

workplan, as mutually agreed with the WASH section chief.

The consultant will be tasked to:

Task 1: Conduct desk review of documents and available data/information related to the

hygiene education in schools.

Output 1: Desk review conducted.

Task 2: In consultation with the MoE (Dept. of Pre-school and Primary Education and

Department of Teacher Training) and the WASH team at UNICEF including other

stakeholders (e.g. WHO) in Lao PDR; the Principal Researcher (an international

consultant) will develop assessment guidelines and tools (including preparing

documents, observation form, focus group discussion guides, etc.) and assessment

methods and timeframe.

Output 2: Assessment guidelines, tools, methods and timeframe available.

Task 3: Conduct field assessment visits (discussions with selected school administrators,

teachers and students; classroom observations for teacher-student interactions).

Output 3: Field assessment visits conducted by international consultant.

Task 4: Conduct analysis and prepare a draft assessment write-up.

Output 4: Analysis conducted and draft assessment report available.

Task 5: Present assessment findings to stakeholders as a PowerPoint presentation.

Output 5: PowerPoint presentation made to stakeholders.

43

Task 6: Based on feedback from stakeholders‟ meeting, revise and submit final report to

UNICEF.

Output 6: Final report of study submitted to UNICEF.

V. Supervisor

The consultant will work under the guidance of the WASH Section Chief in close collaboration with

the WASH national officer for hygiene promotion.

VI. Counterparts

Ministry of Education and Provincial Education Service, Central and Provincial Namsaat, and WHO.

VII. Time Frame

30 working days from September 2010.

Qualifications Summary

- Advanced University degree in Education; social science or related field.

- At least 6 years of working experience in the area of international educational development.

Experience within Laos or the region is considered an asset;

- Familiarity with behavior change and child-centered/participatory learning.

- Familiarity with education systems in development context.

- Excellent English communication, writing and analytical skills;

- Knowledge of spoken Lao/Thai language is an asset.

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ANNEX 2: Data Collection Instruments

2A. Teacher Focus Group Discussion Guides

WASH School Health Promotion Evaluation – Intervention Schools

Teacher Discussion Guide

1. Introduction/Warm up (5 minutes)

Moderator to explain purpose of the group – to discuss respondents views on the hygiene and

sanitation teaching…

Moderator to obtain names, age and occupation details from respondents.

Moderator to explain that there are no right or wrong answers it is the opinion of the

respondents that we value above all else - honesty & openness encouraged.

Moderator to explain that all answers will be kept confidential

2. Hygiene and Sanitation Issues (15 minutes)

Moderator to say: I would like you to talk about issues you face related to hygiene and sanitation education.

What are the main health problems faced by your students and the community?

- Which ones do you think are related to hygiene and sanitation?

- Do you think lack of clean water supply and sanitation facilities are a major problem?

- Do you think hygiene and sanitation practices are a problem?

- Do you find the problem greater among specific groups/communities?

In your idea, what is the role of the school – and teachers – in improving hygiene and sanitation practices?

Do you think the curriculum places enough emphasis on hygiene and sanitation education?

What are the most important things you think your students need to know?

3. Training support, confidence and use of materials (15 minutes)

Moderator to say: I would like you to talk about your experiences using the Blue Box materials.

Were you trained in the use of the Blue Box?

Do you use the Blue Box? If so, how often? Are there certain times of the year or the day when you tend to use the Blue Box? When and why?

Do you like the lesson plans and materials? What do you like most about them? Do you have any favorites? Which ones and why?

Are there any that you tend not to use or find difficult to use?

Have you made any changes or additions to the materials? If so, in what way?

Have you developed any of your own materials? If so, what?

What further support do you need to improve your use of the materials or overall teaching of hygiene and sanitation?

45

4. Integration with curriculum (15 minutes)

Moderator to say: I would like you to focus on issues you face in using the Blue Box materials with the curriculum

Are you able to integrate the activities within the curriculum?

Do the activities add to or replace lessons in the textbooks?

Do you conduct any extra-curricular activities around hygiene and sanitation?

Are you ever observed or assessed on the use of the Blue Box lesson plans and materials?

What further support do you need to help children improve their sanitation and hygiene behaviors?

5. Impact on student learning (15 minutes)

Moderator to say: I would now like to talk about student learning and what impact the Blue Box materials have.

Which topics do you think your students understand best? Which are the most difficult?

Which activities do the students seem to like most? Are there any they do not like?

Do you notice children changing their behaviors? If so, in what way? If not, why do you think they do not change their behaviors?

What are the most difficult challenges you face in trying to help children and the community to improve their sanitation and hygiene behaviors?

What further support do you need to help children improve their sanitation and hygiene behaviors?

6. School and community support (15 min)

Moderator to say: Now I would like to talk to you about the degree to which the school and

community support your efforts to teach hygiene education.

Is the school management and environment supportive of what you are teaching the children about sanitation and hygiene? In what ways does it support and/or not support?

Is the community leadership and environment supportive of what you are teaching the children about sanitation and hygiene? In what ways does it support and/or not support?

What further support do you need to help children improve their sanitation and hygiene behaviors?

46

WASH School Health Promotion Evaluation – Non-Intervention Schools

Teacher Discussion Guide

1. Introduction/Warm up (5 minutes)

Moderator to explain purpose of the group – to discuss respondents views on the hygiene and

sanitation teaching…

Moderator to obtain names, age and occupation details from respondents.

Moderator to explain that there are no right or wrong answers it is the opinion of the

respondents that we value above all else - honesty & openness encouraged.

Moderator to explain that all answers will be kept confidential

2. Hygiene and Sanitation Issues (15 minutes)

Moderator to say: I would like you to talk about issues you face related to hygiene and sanitation

education.

What are the main health problems faced by your students and the community?

- Which ones do you think are related to hygiene and sanitation?

- Do you think lack of clean water supply and sanitation facilities are a major problem?

- Do you think hygiene and sanitation practices are a problem?

- Do you find the problem greater among specific groups/communities?

In your idea, what is the role of the school – and teachers – in improving hygiene and sanitation practices?

Do you think the curriculum places enough emphasis on hygiene and sanitation education?

What are the most important things you think your students need to know?

3. Training support, confidence and use of materials (25 minutes)

Moderator to say: I would like you to talk about your experiences in teaching hygiene and sanitation education.

Have you received any specific training, materials or other support for hygiene and sanitation education? If so, what?

What are the main topics you teach, and when? Is it a major or minor part of the curriculum?

Do you like the lessons in the textbook? If so, why? If not, why?

Are there any that you tend not to use or find difficult to use?

Have you made any changes or additions to the textbook lessons? If so, in what way?

Have you developed any of your own materials? If so, what?

Do you conduct any extra-curricular activities around hygiene and sanitation?

Are you ever observed or assessed on the teaching of hygiene and sanitation?

What further support do you need to improve your teaching of hygiene and sanitation?

47

4. Impact on student learning (15 minutes)

Moderator to say: I would now like to talk about student learning.

Which topics do you think your students understand best? Which are the most difficult?

Which lessons do the students seem to like most? Are there any they do not like?

Do you notice children changing their behaviors? If so, in what way? If not, why do you think they do not change their behaviors?

What are the most difficult challenges you face in trying to help children and the community to improve their sanitation and hygiene behaviors?

What further support do you need to help children improve their sanitation and hygiene behaviors?

5. School and community support (15 min)

Moderator to say: Now I would like to talk to you about the degree to which the school and community support your efforts to teach hygiene education.

Is the school management and environment supportive of what you are teaching the children about sanitation and hygiene? In what ways does it support and/or not support?

Is the community leadership and environment supportive of what you are teaching the children about sanitation and hygiene? In what ways does it support and/or not support?

What further support do you need to help children improve their sanitation and hygiene behaviors?

48

2B. School Observation Form

WASH Evaluation School Observation Form

Number of Classes:

Number of Teachers:

Number of Students: Girls

Number of Annexes:

Instructions to enumerators:

THE SCHOOL OBSERVATION FORM WILL BE FILLED OUT THROUGHOUT THE

DAY BASED ON OBSERVATIONS MADE AT THE SCHOOL. ALTHOUGH SOME

QUESTIONS WILL REQUIRE HELP FROM SCHOOL PERSONNEL, THIS SECTION

SHOULD BE FILLED OUT BASED ON YOUR OBSERVATIONS RATHER THAN

RESPONSES FROM OTHERS.

Many of the questions can be answered immediately, but other questions related to time (e.g.

how many children used the toilet facilities during break time) will need to be filled out at

specific points throughout the day. Be aware of the time related questions so that you can be

sure to record them at the appropriate time.

1. School Maintenance and Management

Instructions: Walk around the school grounds and answer the questions listed below. Use

the digital camera to take photographs of all areas related to the questions below. If you take

a picture, check the “photo” box.

1. Is the schoolyard free of litter?

1= no litter

2= some litter

3= a lot of litter

Photo

2. Are there any feces in the schoolyard? 1= none

2= some

3= a lot

Photo

3. Are the grounds attractive and well-

maintained?

1=Yes, very

2= Yes, somewhat

3=No

Photo

4. Is there a fence around the school yard

(Good enough to keep animals out?)

1=Yes

2=No

Photo

School name: _____________________

District name:

Province name:

School ID:

49

5. Are there garbage bins in the school

grounds?

1=Yes

2=No

Photo

6. How is garbage disposed of? 1= exposed dump site on grounds

2=open pit

3= buried in pit on grounds

4= incinerated on school grounds

5= other ______________________________

Photo

7. Are there shade trees and/or flowers

planted and maintained?

1=Yes, maintained

2=Yes, not well maintained

3=No

Photo

8. Is the seller‟s area clean, free of litter

and hygienic?

1=Yes

2=No

9=not applicable

Photo

9. Are there facilities for the students to

wash their hands?

1=Yes

2=No

Photo

10. Is water available? 1=Yes

2=No

Photo

11. What is the water source?

More than one response possible.

1=Piped

2=Borehole well

3=Dug well

4=Gravity fed from spring

5=Rainwater collection

6=Surface water

7=Other

9=No water

Photo

12. How is the water stored? 1=Piped (no need for storage)

2=Open container

3=Covered container

7=Other____________________________

13. Is soap available? 1=Yes

2=No

Photo

14. Are there toilets accessible (not

locked) and being used by students?

If locked, check if key is accessible to

students.

1=Yes, they are accessible and used by

students

2=Yes, they are accessible but students

cannot use them

3=Noskip to question 18

Photo

50

15. How many toilets are there which can

be used?

Total

Reserved for girls

Reserved for teachers

16. Are the toilets clean?

(judge based on whether it is free of

waste, if it looks like it has been

cleaned in the past week)

1=very clean

2=fairly clean

3= dirty

Photo

17. Are the toilets for boys and girls

separated?

1=Yes

2=No

18. Is drinking water available for

students? Where is the source?

1=Yes, from well

2=Yes, surface water

3=Yes, Other (specify)_______________

4=No

Photo

19. Are the classrooms clean?

(No litter on the floor, etc.)

1=very clean

2=fairly clean

3= dirty

Photo

20. Do classrooms have waste baskets? 1=all

2=most

3=some

4=none

Photo

21. Does the school have a Blue Box? 1=Yes

2=Noskip to section #2

22. How many Blue Boxes?

(count or ask librarian, teacher or

director)

Number

888=don‟t know

23. What condition are the blue box(es)

in?

1=like new (never or rarely used)

2=somewhat worn (signs of use, but

maintained)

3=very worn/missing many items (not able

to be used)

Photo

24. Where is/are the Blue Box(es) kept? 1=in director‟s office

2=in teachers room

3=in classroom

4 =in library

5=in storage

6=cannot find

Photo

51

2. Observation Toilet Use and Hand Washing Behavior

Instructions: Select at least one break time between classes. Sit or stand so that you can see

the toilets but do not make it obvious you are observing. Note the number of boys and girls

who use the toilet and how many wash their hands after using the toilet. Note if any teachers

use the toilet and whether they wash their hands too. Time Tick for each Observation Total

1A Observation of children using toilets

during break time.

1B Observation of children washing

hands after using toilets.

2A Observation of children using toilets

during break time.

2B Observation of children washing

hands after using toilets.

Instructions: IF SCHOOL FEEDING PROGRAM ONLY Observe kitchen and cooks. Note cleanliness of kitchen and whether cooks wash their hands

before handling food. If food is cooked off-site, record „not observed‟. Observe children

before they eat the food. Record how many wash their hands first with soap and water.

3A Cleanliness of kitchen

3B Hand washing behavior of cooks

3C Hand washing behavior of students 1=All wash their hands

2=Most wash their hands

3=Few or none wash their hands

NOTES:

52

3. Information Dissemination on Health, Hygiene and Sanitation

Instructions: Take photographs of the notice board and/or posters and notices posted in the

school grounds and note their location. For each photo, mark the “Photo” box.

Is the following information displayed on a

notice board or somewhere else in the

school?

LOCATION

Hookworm Poster

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Roundworm Poster

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Three Food Groups Poster

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Hygiene Promotion Poster

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Washing Hands Poster

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Other ______________________

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Other ______________________

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

Other ______________________

1=Yes

2=No

1=Director/Teacher Office

2=Notice board

3=Exterior wall

4=Toilets/Hand washing area

5=Other _________________

Photo

(END OF SURVEY)

53

2C. Classroom Observation Forms

WASH EVALUATION OBSERVER 1: LESSON OBSERVATION SCHEDULE

Date: School: Lesson Source: Blue Box, Textbook , or both

Start Time:

End Time:

Grade:

Lesson Number and Title:

Teacher Qualification:

Years Teaching:

Teacher trained in Blue Box? Number of Students (Total / Girls):

FORMS FOR OBSERVER 1:

Part 1: Time on Task Observer 1

Part 5: Post-Lesson Reflection – Teacher and Observers Observer 1 (and Observer 2 and Teacher)

Part 6: Post-Lesson Reflection – Only Observers Observer 1 (and Observer 2)

INSTRUCTIONS

BEFORE THE LESSON

1. Before the lesson find out from the teacher, details of the class, what lesson will be taught etc, and fill in the form above.

2. If the lesson is going to be taught from a textbook, ask the teacher for a copy and familiarize yourself with the lesson.

3. If the lesson is going to be taught from the Blue Box, locate the lesson and familiarize yourself with the lesson.

4. Enter the room, sit at the back of the class, sort out your tape recorder and be ready to start before the teacher and the students

come into the room.

DURING THE LESSON

5. Observer 1 is responsible for entering the data into the single sheet labeled: “Part 1: Time on Task”.

6. The “Time on Task” sheet allows the observer to record 6 teacher behaviors and 8 student behaviors. Sometimes, more than one

behavior will be seen at the same time.

7. The observations take place continuously and are recorded in three-minute blocks for the duration of the 60 minute lesson.

8. If one of the behaviors is seen, the observer places a tick in the box corresponding to the time and the behaviour.

AFTER THE LESSON

9. As soon as possible after the lesson find a quite place for you and Observer 2 to sit down with the teacher and go through and

fill out the single sheet labeled: “Part 5: Post-Lesson Reflection – Teacher and Observers”. It is important that the teacher is

encouraged to give his or her opinions about the lesson and is not made to feel that he or she is being evaluated.

10. Thank the teacher, and then with just Observer 2 and yourself in the room, complete the single sheet labeled: “Part 6: Post-

Lesson Reflection – Only Observers”. Feel free to discuss other aspects of the lesson as well.

54

Time on Task

1 - 3

4 - 6

7 - 9

10-

12

13-

15

16-

18

19-

21

22-

24

25-

27

28-

30

31-

33

34-

36

37-

39

40-

42

43-

45

46-

48

49-

51

52-

54

55-

57

58-

60 Notes

TEACHER - time spent:

1 managing class (“sit up”; “get into groups”; “be quiet”)

2 teaching / instructing class about lesson content (reading, showing, explaining, demonstrating, helping)

3 questioning students (about lesson content; assessing understanding )

4 making lesson relevant (relating lesson to real life; extending lesson)

5 interacting with groups (class in small groups on activity while teacher goes around)

6 not engaged with students (not teaching; sitting at desk; standing outside; looking at papers)

STUDENTS – time spent:

7 settling down or finishing off (non-productive time; getting ready for lesson; packing up)

8 waiting passively (waiting while others are at the board; unproductive time)

9 listening to teacher instruction about lesson (listening passively as teacher shows, explains lesson content)

10 copying from book or board (“low level” tasks that does not challenge student; mundane)

11 engaged in meaningful task related to lesson content (use concrete materials; make poster; write story; do role play, answer questions )

12 works productively in small groups (class works in groups to seek answers/understandings)

13 asking questions (generating own questions for other students or for teacher)

14 one or two students only at front of class (one or two only writing on board; reading out loud; playing game)

55

WASH EVALUATION OBSERVER 2: LESSON OBSERVATION SCHEDULE

Date: School: Lesson Source: Blue Box, Textbook , or both

Start Time:

End Time:

Grade:

Lesson Number and Title:

Teacher Qualification:

Years Teaching:

Teacher trained in Blue Box? Number of Students (Total / Girls):

FORMS FOR OBSERVER 2:

Part 2: Student Activities Observer 2

Part 3: Teacher Management of Group Work Observer 2

Part 4: Use of Teaching Aids and Concrete Materials Observer 2

Part 5: Post-Lesson Reflection – Teacher and Observers Observer 2 (and Observer 1 and Teacher)

Part 6: Post-Lesson Reflection – Only Observers Observer 2 (and Observer 1)

INSTRUCTIONS

BEFORE THE LESSON

1. Before the lesson find out from the teacher, details of the class, what lesson will be taught etc and fill in the form above.

2. If the lesson is going to be taught from a textbook, ask the teacher for a copy and familiarize yourself with the lesson.

3. If the lesson is going to be taught from the Blue Box, locate the lesson and familiarize yourself with the lesson.

4. Enter the room, sit at the back of the class, sort out your tape recorder and be ready to start before the teacher and the students come into

the room.

DURING THE LESSON

5. Observer 2 is responsible for entering the data into the two sheets labeled Part 2, Part 3 and Part 4 as above.

6. The observer should record on the sheets whenever any of the listed behaviors are seen by ticking the appropriate box. So long as the

behavior is seen at least once during the lesson, the YES box should be ticked.

7. At the end of the lesson the observer should go over the forms and make sure that for each behavior there is a tick in either the YES box or in

the NO box (but not in both).

8. The observer should also take a few minutes to add any comments about the lesson in the appropriate sections in Part 2, Part 3 and Part 4.

AFTER THE LESSON

9. As soon as possible after the lesson find a quite place for you and Observer 1 to sit down with the teacher and go through and fill out the

single sheet labeled: “Part 5: Post-Lesson Reflection – Teacher and Observers”. It is important that the teacher is encouraged to give his or her

opinions about the lesson and is not made to feel that he or she is being evaluated.

10. Thank the teacher, and then with just Observer 1 and yourself in the room, complete the single sheet labeled: “Part 6: Post-Lesson

Reflection – Only Observers”. Feel free to discuss other aspects of the lesson as well.

56

Part 2: Student Activities

Student Activities

Observed? Comments

(Add any comments, positive or negative, about the student activities in the lesson)

Yes

No

1 Copying - teacher content from blackboard

2 Copying - from textbook or other resource

3 Copying - students answers from blackboard

4 Reading- - individually

from textbook / blackboard

5 Reading- - in groups

from textbook / blackboard

6 Writing answers - individually

to set questions

7 Discussion/Brainstorm - whole class

8 Discussion - small group

9 Game - whole class

10 Game - small group

11 Role play - whole class

12 Role play - small group

13 Other activity - whole class

14 Other activity - small group

57

Part 3: Teacher Management of Group Work

Group Work Management

Observed? Comments

(Add any comments, positive or negative, about group work)

Yes No

1 Group work was clearly explained by teacher

2 Students understood group work task

3 Teacher used appropriate group sizes (maximum of 6 per group)

4 Teacher interacted with students in groups

5 Most students participated when in groups

6 Teacher organized groups to report back

7 Teacher collected work sheets and reported back herself

Part 4: Use of Teaching Aids and Concrete Materials

Teaching Aids and Concrete materials

Observed? Comments

(Add any comments, positive or negative, about the use of teaching aids or concrete materials)

Yes No

1 Teacher used resources recommended in Blue Box manual or teacher’s guide

2 Teacher used other resources

3 Only the teacher handled the learning materials

4 Most students had an opportunity to handle learning materials

5 Teacher made additional resources

6 Teacher asked students to bring in materials for the lesson

58

Part 5: Post-Lesson Reflection – Teacher and Observers

1. How closely did the teacher follow the Blue Box Manual or the standard textbook? (Circle the appropriate box)

None Some about half a lot All

2. If the textbook lesson or blue box manual was not closely followed ask the teacher to give an example of what was changed.

3. If the teacher changed the lesson in some way, ask him/her to explain why it was changed.

4. What part or activity in the lesson did the students enjoy most? Describe.

5. Explain why this part of the lesson was enjoyable.

59

Part 6: Post-Lesson Reflection – Only Observers

1. How many of the students were engaged in the lesson? (Circle the appropriate box)

None Some about half a lot all

2. List the main things that helped the students to learn?

(e.g. teachers’ questions, teacher’s explanation, teaching aids, teacher’s personality etc)

3. General: (List anything of interest or of relevance to the lesson not covered elsewhere)

.

60

2D. Student Assessment Questionnaire

WASH School Health Program Evaluation 2010

STUDENT QUESTIONNAIRE

SCHOOL: INTERVIEWER:

DISTRICT: INTERVIEWEE:

PROVINCE:

DATE: TIME STARTED:

TIME ENDED:

CONSENT TO INTERVIEW

WE ARE WORKING ON A PROJECT CONCERNED WITH WATER, SANITATION AND HYGIENE. I WOULD LIKE TO ASK YOU

ABOUT THESE SUBJECTS. THE INFORMATION YOU GIVE WILL BE USED BY THE MINISTRY OF EDUCATION TO HELP THEM

BETTER UNDERSTAND THE NEEDS OF STUDENTS AND DEVELOP PROGRAMS TO HELP YOU. THE INTERVIEW WILL TAKE

ABOUT 15 MINUTES. PLEASE ANSWER HONESTLY AND TO THE BEST OF YOUR ABILITY. IF YOU DO NOT KNOW THE

ANSWER OR DO NOT WANT TO ANSWER, PLEASE SAY SO. YOU CAN REFUSE TO ANSWER A QUESTION. YOUR ANSWERS

WILL NOT BE SHARED WITH YOUR TEACHERS OR ANYONE OTHER THAN OUR PROJECT TEAM.

MAY I START NOW?

Yes, permission is given Record the time and then begin the interview.

No, permission is not given Record the decline and discuss this result with your supervisor.

PART 1: PERSONAL INFORMATION

A1. STUDENT GENDER

OBSERVE AND RECORD

Female......................................................... 1

Male ............................................................. 2

A2. HOW OLD ARE YOU?

IF STUDENT IS UNSURE, CHECK SCHOOL

RECORDS AND RECORD OFFICIAL AGE

Age

8 ................................................................. 1

9 ................................................................. 2

10 ................................................................. 3 3

11 ................................................................ 4

12 ................................................................. 5

13 ................................................................. 6

14 ................................................................. 7

>14 .............................................................. 8

Unsure, Don’t know ..................................... 9

61

A3. WHAT GRADE ARE YOU IN NOW? Grade 4........................................................ 1

Grade 5........................................................ 2

A4. WHAT IS THE LANGUAGE SPOKEN EVERY

DAY IN YOUR HOUSEHOLD? Language

PART 2: WATER, SANITATION AND HYGIENE

B1. WHERE DO YOU GET YOUR DRINKING

WATER AT HOME?

Piped ........................................................... 1

Borehole, Tube Well .................................... 2

Dug well ....................................................... 3

Gravity fed from spring ................................ 4

Rainwater collection .................................... 5

Bottled water ............................................... 6

Surface water .............................................. 7

Don’t know/refuse ........................................ 9

Other (specify) ___________________ Z

SKIP B3

B2. WHAT DO YOU (YOUR MOTHER) USUALLY

DO TO MAKE YOUR WATER SAFER TO DRINK AT

HOME?

(CIRCLE THE RESPONSES SPOKEN THAT APPLY)

CAN PROVIDE MULTIPLE RESPONSES

Nothing ........................................................ 1

Boil ............................................................... 2

Add bleach / chlorine ................................... 3

Strain it through a cloth ............................... 4

Use water filter (ceramic, sand/ other) ........ 5

Solar disinfection ......................................... 6

Let it stand and settle .................................. 7

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

B3. HOW DO YOU DISPOSE OF YOUR RUBBISH

AT HOME?

(CIRCLE THE RESPONSES SPOKEN)

CAN PROVIDE MULTIPLE RESPONSES

Burning ........................................................ 1

Dig hole and cover ...................................... 2

Throw into river/stream/pond....................... 3

Throw it someplace ..................................... 4

Take it out of village .................................... 5

Take it to one dedicated dump .................... 6

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

62

B4. WHAT KIND OF TOILET DO YOU USUALLY

USE AT HOME?

Probe is necessary to determine kind of

toilet. If “flush” or “pour flush”, probe:

Do you always have water to use for the

toilet?

Flush / Pour flush with water ...................... 1

Flush / Pour flush without water .................. 2

Pit latrine (dry) ............................................ 3

No facility, Bush, Field ................................. 4

Don’t know/refuse ........................................ 9

Other (specify) ______________________ Z

B5. AFTER DEFECATION, WHAT DO YOU USE TO

CLEAN YOURSELF? Water ........................................................... 1

Paper ........................................................... 2

Leaves/stick ................................................. 3

Don’t know/refuse ........................................ 9

Other (specify) ______________________ Z

B6. WHEN YOU USE THE TOILET, CAN YOU TELL

ME WHAT YOU DO BEFORE AND AFTER

DEFECATING?

CAN PROVIDE MULTIPLE RESPONSES

Pour water before use ................................. 1

Pour water after use .................................... 2

Wash hands with soap and water ............... 3

Don’t know/refuse ........................................ 9

Other (specify) ______________________ Z

B7. WHEN YOU HAVE TO DEFECATE OR

URINATE, WHERE DO YOU GO?

SCHOOL TOILET

IN THE BUSHES

GO HOME

OTHER (SPECIFY) ____________________

DON’T KNOW/REFUSE

Defecate Urinate

1 1

2 2

3 3

4 4

9 9

B8. IS THE TOILET AT YOUR SCHOOL USUALLY

CLEAN? Very clean and nice ..................................... 1

Somewhat clean .......................................... 2

Not very clean ............................................. 3

Very dirty ..................................................... 4

No toilet ....................................................... 5

Don’t know/refuse ........................................ 9

SKIP B10

B9. DOES THE TOILET AT YOUR SCHOOL

USUALLY HAVE WATER? Yes, all the time ........................................... 1

Yes, most of the time ................................... 2

No, or rarely ................................................. 3

Don’t know/refuse ........................................ 9

B10. DO YOU THINK ARE BENEFITS FROM

USING A TOILET? Yes .............................................................. 1

No ................................................................ 2

Don’t know/refuse ........................................ 9

SKIPB12

SKIPB12

63

B11. WHAT ARE THE BENEFITS OF HAVING A

TOILET?

(CIRCLE THE RESPONSES SPOKEN)

CAN PROVIDE MULTIPLE RESPONSES

Less disease ............................................... 1

Cleaner hands/body .................................... 2

Cleaner air/water/surrounds ........................ 3

Less animals/flies ........................................ 4

Spiritual reason ........................................... 5

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

B12. DO YOU NORMALLY WEAR SHOES

OBSERVE TO NOTE 1 OR 2

Yes (shoes observed) ................................. 1

Yes (shoes not observed) ........................... 2

No ................................................................ 3

Don’t know/refuse ........................................ 9

B13. CAN YOU TELL ME THE WAYS THAT

PARASITES CAN ENTER YOUR BODY?

(CIRCLE THE RESPONSES SPOKEN)

CAN PROVIDE MULTIPLE RESPONSES

Through the skin ......................................... 1

Through the mouth ..................................... 2

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

B14. CAN YOU TELL ME SOME OF THE

BENEFITS OF TAKING A BATH?

(CIRCLE THE RESPONSES SPOKEN)

Clean body, remove dirt/oils ........................ 1

Reduce disease ........................................... 2

Smell/look better .......................................... 3

Feel cooler ................................................... 4

Washing hair ............................................... 5

Spiritual reason ........................................... 6

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

B15. DO YOU CLEAN YOUR TEETH?

Probe: IF YES, HOW DO YOU CLEAN YOUR

TEETH?

Yes, with a brush ......................................... 1

Yes, with a brush and toothpaste ................ 2

Yes, with a brush and salt ........................... 3

Yes, with toothpick or cloth.......................... 4

No ................................................................ 5

Don’t know/refuse ........................................ 9

Yes, other (specify) __________________ Z

SKIP B18

SKIP B18

64

B16. WHEN DO YOU USUALLY CLEAN YOUR

TEETH?

Not regularly ................................................ 1

Morning only ................................................ 2

Evening only ................................................ 3

Morning and evening ................................... 4

Morning, mid-day and evening .................... 5

Don’t know/refuse ........................................ 9

B17. DID YOU CLEAN YOUR TEETH THIS

MORNING? Yes .............................................................. 1

No ................................................................ 2

Don’t know/refuse ........................................ 9

B18. DO YOU EVER EAT MEAT OR FISH? Yes .............................................................. 1

No ................................................................ 2

Don’t know/refuse ........................................ 9

B19. CAN YOU NAME ANY PROBLEMS THAT

EATING RAW MEAT OR FISH CAN CAUSE?

PLEASE NAME THE ONES YOU KNOW.

(CIRCLE THE RESPONSES SPOKEN)

Liver fluke .................................................... 1

Intestinal parasites ...................................... 2

Bacterial infection ........................................ 3

Stomachache .............................................. 4

Diarrhea ....................................................... 5

Don’t know/refuse ........................................ 9

Other _____________________________ 7

B20. CAN YOU SHOW AND EXPLAIN TO ME HOW

YOU WASH YOUR HANDS...... AND AT WHAT

TIMES?

(PAUSE BETWEEN ASKING HOW AND WHEN.

CIRCLE ALL RESPONSES OBSERVED OR

DESCRIBED)

Use water .................................................... 1

Use soap or ash .......................................... 2

Use both hands ........................................... 3

Rub three times ........................................... 4

Dry with CLEAN cloth or air dry .................. 5

Before eating ............................................... 6

After using the toilet ..................................... 7

Before cooking food .................................... 8

Don’t know/refuse ........................................ 9

Other (specify) __________________ Z

MOVE TO THE

END?

65

B21. MAY I PLEASE LOOK AT YOUR FINGER

NAILS?

OBSERVE AND RECORD FOR BOTH LENGTH AND

CLEANLINESS

Nails long .................................................. 1A

Nails short ................................................ 2A

Nails clean ................................................ 1B

Nails dirty .................................................. 2B

B22. HAVE YOU EXPERIENCED DIARRHOEA

DURING THE PAST THREE MONTHS? Yes .............................................................. 1

No ................................................................ 2

Don’t know/refuse ........................................ 9

2B24

2B24

B23. DID YOU DRINK OR TAKE ANY OF THE

FOLLOWING: ORALITE?

OTHER ORAL REHYDRATION DRINK?

GUAVA LEAF OR TEA?

MEDICINE (TABLET)?

SOMETHING ELSE?

Read the list first, then read each item,

asking whether the child took it and record

response.

Yes No Don’t Know /Remember

1 2 9

1 2 9

1 2 9

1 2 9

1 2 9

B24. CAN YOU TELL ME WHAT CAN CAUSE

DIARRHOEA?

(CIRCLE THE RESPONSES SPOKEN THAT APPLY)

CAN PROVIDE MULTIPLE RESPONSES

Dirty food/water ........................................... 1

Raw food ..................................................... 2

Sour food ..................................................... 3

Spirits (supernatural) ................................... 4

Not washing hands ...................................... 5

Putting dirty hands in mouth ........................ 6

Bacteria ....................................................... 7

Parasites...................................................... 8

Don’t know/refuse ........................................ 9

Other ___________________ Z

B25. CAN YOU TELL ME WAYS THAT PEOPLE

CAN PREVENT DIARRHOEA?

(CIRCLE THE RESPONSES SPOKEN THAT APPLY)

CAN PROVIDE MULTIPLE RESPONSES

Boiling water ................................................ 1

Eating clean food ......................................... 2

Eating well cooked food .............................. 3

Preventing insects touching food ................ 4

Using a sanitary toilet .................................. 5

Regular hand washing (with soap) .............. 6

Injections ..................................................... 7

Don’t know/refuse ........................................ 9

Other ___________________ Z

66

B26. WHEN SOMEONE HAS DIARRHOEA, HOW

MUCH SHOULD THEY DRINK FLUIDS?

Read each item aloud and then have the

child select one. Record the answer.

None ............................................................ 1

Little ............................................................. 2

Normal amount ............................................ 3

A lot ............................................................. 4

Don’t know/refuse ........................................ 9

B27. CAN YOU TELL ME WAYS IN WHICH YOU

CAN PROTECT YOUR FOOD TO KEEP IT

CLEAN?

Cover ........................................................... 1

Use clean plates and utensils ..................... 2

Don’t know ................................................... 9

Other ___________________ Z

B28. HOW CAN ONE PROTECT ONESELF FROM

GETTING MALARIA AND DENGUE?

If a response is give, probe to ask if they

know any other ways. Record the answers.

CAN PROVIDE MULTIPLE RESPONSES

Sleep under mosquito net ........................... 1

Keep yard clean .......................................... 2

Don’t leave containers of standing water .... 3

Wear long sleeves/pants to cover skin ........ 4

Use mosquito repellent/coil ......................... 5

Don’t know/refuse ........................................ 9

Other ___________________ Z

END OF SURVEY

ENUMERATOR OBSERVATIONS: USE THE SPACE TO NOTE ANY OBSERVATIONS ABOUT THE INTERVIEW, SUCH AS

STUDENT WAS VERY SHY OR UNCOMFORTABLE, HAD DIFFICULTY UNDERSTANDING THE QUESTIONS, SEEMED TO

HAVE BEEN PROMPTED, ETC. ALSO NOTE WHETHER THERE WERE ANY DISTRACTIONS OR INTERRUPTIONS DURING

THE INTERVIEW.

67

2E. School Director Telephone Interview Questionnaire

WASH School Health Program Evaluation

SCHOOL DIRECTOR INTERVIEW

VILLAGE NAME:

INTERVIEWEE’S NAME:

DISTRICT:

SCHOOL ID NUMBER (IF KNOW): DATE:

PROVINCE:

SCHOOL NAME:

THIS SURVEY IS FOR COLLECTING INFORMATION ABOUT THE BLUE BOX TOOLKIT AND ABOUT THE WATER, SANITATION

AND HYGIENE CONDITIONS OF YOUR SCHOOL. IT WILL TAKE ONLY ABOUT 10-15 MINUTES TO COMPLETE THIS

SURVEY.

THE INFORMATION COLLECTED WILL BE USED TO IMPROVE SUPPORT TO PRIMARY SCHOOLS IN LAO PDR. PLEASE

PROVIDE TRUTHFUL RESPONSES TO HELP US MAKE OUR SURVEY ACCURATE. THE INFORMATION YOU PROVIDE WILL

BE KEPT CONFIDENTIAL.

PLEASE USE A PEN TO CIRCLE YOUR RESPONSES ………………………………………..1 (EXAMPLE)

ONLY SINGLE RESPONSES ALLOWED FOR EACH QUESTION UNLESS SPECIFIED OTHERWISE.

PART 1: INTRODUCTORY

1. WHAT IS YOUR GENDER? Female......................................................... 1

Male ............................................................. 2

2. WHAT IS YOUR AGE Age

< 20.......................................................... 1

20 – 30 .................................................... 2

31 – 40 ..................................................... 3

> 40.......................................................... 4

3. HOW MANY STUDENTS ARE IN YOUR SCHOOL

THIS YEAR? Number of Students Total / Girls

4. WHAT ETHNIC GROUPS ARE YOUR

STUDENTS?

ASK FOR MAIN ETHNIC GROUPS. LIST IN ORDER

OF SIZE OF GROUP.

Ethnic Group 1:

Ethnic Group 2:

Ethnic Group 3:

1

68

5. HOW MANY YEARS HAVE YOU BEEN A

PRIMARY SCHOOL DIRECTOR?

Number of Years

< 1 ............................................................ 1

1 – 2 ........................................................ 2

3 – 5 ......................................................... 3

6 - 10 ....................................................... 4

11 - 20 ..................................................... 5

> 20.......................................................... 6

6. HOW MANY YEARS HAVE YOU BEEN

WORKING AT YOUR CURRENT SCHOOL?

Number of Years

< 1 ............................................................ 1

1 – 2 ........................................................ 2

3 – 5 ......................................................... 3

>5 ............................................................. 4

PART 2: FACILITIES AT THE PRIMARY SCHOOL

7. IS THERE A WATER SOURCE AVAILABLE AT

THE SCHOOL FOR USE BY STUDENTS? Yes .............................................................. 1

No ................................................................ 2

2GO TO 12

8. WHAT TYPE OF WATER SOURCE IS IT? Public tap / standpipe .................................. 1

Borehole, Tube Well .................................... 2

Dug well ....................................................... 3

Gravity fed from spring ................................ 4

Rainwater collection .................................... 5

Surface water (river, stream, dam, lake,

pond, canal, irrigation channel) ............... 6

Other (specify) ___________________ 7

6GO TO 11

9. WHAT IS THE CONDITION OF THIS WATER

SOURCE? Working well, ample water .......................... 1

Working fine/normally .................................. 2

Working but not very good .......................... 3

Not working / broken ................................... 4

Don’t know/not sure ................................... 98

GO TO 11

69

10. WHAT ARE THE REASONS WHY THIS WATER

SOURCE IS NOT WORKING WELL? Not maintained well ..................................... 1

No spare parts available.............................. 2

The system is not well designed ................. 3

It is too old ................................................... 4

Other (specify) ___________________ 5

Don’t know/not sure ................................... 98

11. ARE MANY STUDENTS DRINKING FROM THIS

WATER SOURCE DIRECTLY? Yes .............................................................. 1

No ................................................................ 2

Don’t know/not sure ................................... 98

12. IS IT COMMON FOR CHILDREN IN YOUR

CLASS TO BRING CONTAINERS WITH THEIR

DRINKING WATER?

Yes .............................................................. 1

No ................................................................ 2

Don’t know/not sure ................................... 98

13. IS THERE A TOILET AT THE SCHOOL? Yes .............................................................. 1

No ................................................................ 2

2GO TO 19

14. HOW MANY ROOMS DOES THE TOILET(S) AT

YOUR SCHOOL HAVE?

1 2 3 4 5 >5

15. HOW MANY ROOMS CAN’T WORK OR DON’T

USE ?

1 2 3 4 5 >5

No have ( can use all ) …………….…99

2GO TO 17

16. WHAT ARE THE REASONS WHY THIS TOILET

IS NOT WORKING WELL? Not maintained well ..................................... 1

No spare parts available.............................. 2

The system is not well designed ................. 3

It is too old ................................................... 4

Not enough water available ......................... 5

Other (specify) ___________________ 6

Don’t know/not sure ................................... 98

17. ARE THE TOILET ROOMS DIVIDED BY

GENDER OR TEACHER/STUDENT? No, anyone can use each room .................. 1

Yes, gender divided ..................................... 2

Yes, teacher/student divided ....................... 3

Yes, divisions for teacher/boys & girls ........ 4

Don’t know/not sure ................................... 98

18. WHO NORMALLY CLEANS AND MAINTAINS

THIS TOILET? Students ...................................................... 1

Teachers...................................................... 2

Teachers & Students ................................... 3

Other (specify) ___________________ 4

Don’t know/not sure ................................... 98

70

19. DO SOME CHILDREN ARE DEFECATING

AROUND THE SCHOOL (IN BUSHES)? Yes .............................................................. 1

No ................................................................ 2

Don’t know/not sure ................................... 98

20. DO STUDENTS USE A HAND WASHING

FACILITY AT THE SCHOOL? Yes, at the water source.............................. 1

Yes, in or near the toilet .............................. 2

Yes, separate hand washing facility ............ 3

No, they don’t use the facility ...................... 4

No, there is no facility / facility is broken ..... 5

Don’t know/not sure ................................... 98

PART 3: HYGIENE EDUCATION USING THE BLUE BOX

21. DOES YOUR SCHOOL HAVE A LEARNING

WITH JOY HYGIENE EDUCATION TOOLKIT

(BLUE BOX)?

Yes (1) ......................................................... 1

Yes (2) ......................................................... 2

No ................................................................ 3

3END SURVEY

22. WHAT IS THE CONDITION OF THE BLUE BOX

MATERIALS AT YOUR SCHOOL? Good ............................................................ 1

Good, but deteriorated a bit ........................ 2

Not so good, deteriorated ............................ 3

Not good, damaged ..................................... 4

Don’t know/not sure ................................... 98

23. WHERE IS THE BLUE BOX STORED AT YOUR

SCHOOL? Headmasters office/Teacher room .............. 1

The contents were distributed.....................2

Library.......................................................... 3

Store room ................................................... 4

Other (specify) ___________________ 5

Don’t know/not sure ................................... 98

24. DO YOU THINK THAT HAVING THE BLUE BOX

TAUGHT AT YOUR SCHOOL HAS IMPROVED

THE SCHOOL?

(MULTIPLE RESPONSES ALLOWED)

Yes, students are happier ........................... 1

Yes, the school is cleaner ........................... 2

Yes, the students are healthier ................... 3

It is about the same ..................................... 4

No ................................................................ 5

25. HOW MANY TEACHER DID THEY RECEIVE

TRAIN ABOUT BLUE BOX AND STILL TEACH

AT THIS SCHOOL ?

Specify _________________

THANK YOU VERY MUCH FOR PARTICIPATING IN THIS SURVEY.

71

2F. School Teacher Telephone Interview Questionnaire

WASH School Health Program Evaluation

SCHOOL TEACHER INTERVIEW

VILLAGE NAME:

INTERVIEWEE’S NAME:

DISTRICT:

SCHOOL ID NUMBER (IF KNOW): DATE:

PROVINCE:

SCHOOL NAME:

THIS SURVEY IS FOR COLLECTING INFORMATION ABOUT THE BLUE BOX TOOLKIT AND ABOUT THE WATER, SANITATION

AND HYGIENE CONDITIONS OF YOUR SCHOOL. IT WILL TAKE ONLY ABOUT 15-20 MINUTES TO COMPLETE THIS

SURVEY.

THE INFORMATION COLLECTED WILL BE USED TO IMPROVE INTERNATIONAL DEVELOPMENT SUPPORT TO PRIMARY

SCHOOLS IN LAO PDR. PLEASE PROVIDE TRUTHFUL RESPONSES TO HELP US MAKE OUR SURVEY ACCURATE.

PLEASE USE A PEN TO CIRCLE YOUR RESPONSES ………………………………………..1 (EXAMPLE)

ONLY SINGLE RESPONSES ALLOWED FOR EACH QUESTION UNLESS SPECIFIED OTHERWISE.

1. WHAT IS YOUR GENDER? Female......................................................... 1

Male ............................................................. 2

2. WHAT IS YOUR AGE Age

< 20.......................................................... 1

20 – 30 .................................................... 2

31 – 40 ..................................................... 3

> 40.......................................................... 4

3. WHICH CLASSROOM YEAR LEVEL DO YOU

TEACH?

IF MULTI-GRADE, CIRCLE ALL GRADES TAUGHT

1 2 3 4 5

1

72

4. HOW MANY STUDENTS ARE IN YOUR

CLASSROOM THIS YEAR? Number of Students

< 10.......................................................... 1

11 – 20 ................................................. 2

21 – 30 ................................................... 3

31 - 40 .................................................... 4

41 - 50 .................................................... 5

> 50 ......................................................... 6

5. DO YOU HAVE MORE THAN 5 STUDENTS IN

YOU CLASS FROM AN ETHNIC GROUP?

(LAO IS NOT SPOKEN AT HOME)

Yes .............................................................. 1

No ................................................................ 2

Don’t know/refuse ...................................... 98

6. HAVE YOU TAUGHT USING THE BLUE BOX IN

YOUR CLASSROOM BEFORE? Yes .............................................................. 1

No ................................................................ 2

2 END

SURVEY

7. HOW MANY TIMES DID YOU USE THE BLUE

BOX IN YOUR TEACHING IN 2009-2010

HAVE TEACHER ESTIMATE IF NOT SURE.

Number of times (specify) _____________

8. HOW DID YOU USE THE BLUE BOX?

(MULTIPLE RESPONSES ALLOWED)

Integrated with the lessons.......................... 1

Between lessons, to fill time ........................ 2

Extra curricula ............................................. 3

During free time ........................................... 4

Other (specify) ___________________ 9

9. DID YOU RECEIVE SPECIFIC TRAINING ON

USING THE BLUE BOX THROUGH THE

MOE?

No ................................................................ 2

Yes, teacher training college ....................... 1

Yes, a short training course......................... 3

If yes, in which year (specify) _________

10. HAS YOUR DIRECTOR EVER OBSERVED ONE

OF YOUR BLUE BOX LESSONS AND

PROVIDED FEEDBACK?

No ................................................................ 1

Once ............................................................ 2

A few times .................................................. 3

Regularly ..................................................... 4

Don’t know/refuse ...................................... 98

73

11. DO YOU ENJOY TEACHING USING THE BLUE

BOX? Yes, a lot...................................................... 1

Yes, it is alright ............................................ 2

Yes, but it could be improved ...................... 3

No, it should be improved............................ 4

No, I don’t like using it ................................. 5

Other comments:

12. DO YOU THINK IT IS EASY TO TEACH WITH

THE BLUE BOX IN A PARTICIPATORY WAY? Yes .............................................................. 1

Not so easy ................................................. 2

No, it is difficult ............................................ 3

13. DO YOU AGREE WITH THE CONTENT AND

MESSAGES OF THE BLUE BOX? Yes, agree with it all .................................... 1

Yes, but some of it is not appropriate .......... 2

No, some things I disagree with .................. 3

14. DO YOU THINK THAT HAVING THE BLUE BOX

TAUGHT AT YOUR SCHOOL HAS IMPROVED

THE SCHOOL?

(MULTIPLE RESPONSES ALLOWED)

Yes, students are happier ........................... 1

Yes, the school is cleaner ........................... 2

Yes, the students are healthier ................... 3

It is about the same ..................................... 4

No ................................................................ 5

Don’t know/refuse ...................................... 98

15. WHAT IS THE CONDITION OF THE BLUE BOX

MATERIALS AT YOUR SCHOOL? Good ............................................................ 1

Good, but deteriorated a bit ........................ 2

Not so good, deteriorated ............................ 3

Not good, damaged ..................................... 4

16. WHERE IS THE BLUE BOX STORED AT YOUR

SCHOOL? Headmasters office / Teacher room ............ 1

The contents were distributed. ...................2

Library.......................................................... 3

Store room ................................................... 4

Other (specify) ___________________ 9

74

17. HAVE YOU MADE ANY CHANGES TO THE

WAY YOU TEACH THE BLUE BOX?

(MULTIPLE RESPONSES ALLOWED)

Yes, I adjusted the way I teach it to keep it fresh/attractive ......................................... 1

No ................................................................ 2

Yes, I have modified/created new activities in the materials ........................................ 3

Other comments:

18. CAN YOU PROVIDE ONE SUGGESTION ON

HOW YOU THINK THE BLUE BOX COULD BE

IMPROVED AS A HYGIENE EDUCATION

RESOURCE?

19. ARE STUDENTS ENCOURAGED TO

TRANSMIT HYGIENE KNOWLEDGE TO THEIR

FAMILIES AND COMMUNITIES?

Yes, I tell my students to ............................. 1

No ................................................................ 2

Don’t know/refuse ...................................... 98

THANK YOU VERY MUCH FOR PARTICIPATING IN THIS SURVEY.

75

ANNEX 3: Research Team and Field Schedule

Research Team

Name Role Position

Mr. Robert McLaughlin Coordinator Consultant

Mr. Khamsook Technical Coordination and Supervision IRL

Ms. Bouasavanh Kanthaphat Team Leader Consultant, IRL

Ms. Bouakhai Research Assistant Staff, IRL

Mr. Amphone Research Assistant Consultant, IRL

Research Advisory and Monitoring Team

Name Role Position

Ms. Soutsaychai Douangsavanh Technical support and monitoring DPPE, MOE

Mr. Thongdam Philavanh Technical support and monitoring DTT, MOE

Ms. Boualien Kinnala Technical support and monitoring DPPE, MOE

Mr. Bounphong Syladeth Technical support RIES, MOE

Ms. Davanh Xayasit Technical support DPPE, MOE

Ms. Phetsamone Sibounheuang Technical support RIES, MOE

Dr. Boun Keomanivong Technical support CEHWS, MOH

Field Schedule

Location Date fieldwork started Date fieldwork completed

Meun District, VTE Province

For each of 5 schools:

5 FGDs teachers

10 students interviews

1 classroom observation

18/10/2010 22/10/2010

Sing District, LNT Province

For each of 5 schools:

5 FGDs teachers

10 students interviews

1 classroom observation

25/10/2010 29/10/2010

Xaybouathong District, KHM Province

For each of 5 schools:

5 FGDs teachers

10 students interviews

1 classroom observation

01/11/2010 05/11/2010

76

Summary of fieldwork issues

Meun District, VTE Province

Issues Strengths Constraints

Respondents’ participation

All selected FGDs respondents were very interested in the discussion and willing to share information.

All selected teachers for classroom observation in each school were willing and well prepared: lesson plan and teaching materials.

There is no language and communication barrier for the focus groups discussion both male and female teachers.

Students interviews and hygiene picture drawing activity was very interested by many students and fully participated.

The majority of students in 4 of 5 selected schools are Hmong ethnic group, therefore some of selected students for interviews could not answer the question well due to limitation of speaking Lao language.

1 of selected teacher for classroom observation did not receive blue box used training due to missed understood by survey team and district education Officer.

Logistical support and coordination

Very helpful and well cooperation by MOE, VTE Provincial Education Department and UNICEF school WASH program Officer during the field survey.

District education Officer and school Director of all selected school was very cooperative.

All selected schools have got an office and allowed the team to conduct a focus group discussion and students interview.

All selected locations were accessible by car and none of them took longer than 1hr on traveling time.

None

Sing District, LNT Province

Issues Strengths Constraints

Respondents’ participation

All selected FGDs respondents were very interested in the discussion and willing to share information.

All selected teachers for classroom observation in each school were willing and well prepared: lesson plan and teaching materials.

There is no language and communication barrier for the focus groups discussion both male and female teachers.

Students interviews and hygiene picture drawing activity was very interested by many students and fully participated.

Most of selected schools are multi ethnic students: Hmong, Yao, Lue and Tai Neua and Lao loum, therefore 4 0f 5 selected schools have to use student interpreters for student interviews due to limitation of speaking Lao language.

There are 2 selected schools were identify as none-intervention school was not meet to selection criteria due to: 1 school all 7 teachers received blue box training in August 2010 but have not got any blue box due to the delayed of blue box transferring from provincial education to district.

77

Issues Strengths Constraints

4 0f 5 selected schools are participating in school quality program and have got good school condition and better hygiene facilities such as: good condition toilets at least 3 – 7 toilets/school and have got enough water supply (tap water)

And another school is none-intervention school, but the school received 2 blue box kits and all of previous teacher who received training have been relocated to teach in other schools, none of recent teachers received blue box training.

Logistical support and coordination

District education Officer and school Director of all selected school was very cooperative: postponed school monthly meeting schedule to allow the survey team completed activity according to planned.

All selected schools have got proper office and activity room for the team to conduct a focus group discussion and students interview.

All selected locations were accessible by car and none of them took longer than 1hr on traveling time.

None.

Xaybouathong District, KHM Province

Issues Strengths Constraints

Respondents’ participation

All selected FGDs respondents were very interested in the discussion and willing to share information.

There is no language and communication barrier for the focus groups discussion both male and female teachers. Number of female teachers participated in the focus group discussion is covered about 70% of total teachers in 5 selected schools.

Students interviews and hygiene picture drawing activity was very interested by many students. Most of students able to speak Lao language.

1 selected teacher for classroom observation was not available due to family problem.

Logistical support and coordination

District education Officer and school Director of all selected school was very cooperative: postponed school monthly meeting schedule to allow the survey team completed activity according to planned.

All selected locations were accessible by car and none of them took longer than 1hr on traveling time.

4 0f 5 selected schools do not have teacher office and there is no activity room available for the team to conduct a focus group discussion and students interview. These 2 activities were conducted under the big trees; very difficult to concentrate due to it was too windy and dusty. Only one school has got small office and 1 empty classroom.

78

ANNEX 4: Summary of Respondents

4A: Focus Group Discussions

Meun District, VTE Province: 31 Teachers (19 Male/12 Female)

School # Teachers

(Male/Female) Sex Qualifications Years Teaching Received WASH Training

VTE 1

8

(4/4)

F 11+1 3 None

VTE 1 M 11+3 1 None

VTE 1 F 11+1 4 Trained in 2007

VTE 1 M 11+1 3 None

VTE 1 F 11+1 4 Trained in 2007

VTE 1 M 8+3 6 Trained in 2007

VTE 1 F 8+3 4 Trained in 2007

VTE 1 M 11+1 6 None

VTE 2

8

(4/4)

F 11+3 2 None

VTE 2 F 11+1 4 None

VTE 2 F 8+3 3 None

VTE 2 F 11+1 10 None

VTE 2 M 11+3 2 None

VTE 2 M 11+1 5 None

VTE 2 M 11+1 10 None

VTE 2 M 5+3 19 None

VTE 3

6

(4/2)

M 11+1 6 None

VTE 3 F 11+3 1 None

VTE 3 F 5+3 10 None

VTE 3 M 5+3 10 None

VTE 3 M 5+3 13 None

VTE 3 M 8+3 5 None

VTE 4

4

(2/2)

F 11+1 6 Trained in 2007

VTE 4 M 5+3 11 Trained in 2007

VTE 4 F 5+3 16 Trained in 2007

VTE 4 M 11+1 2 None

VTE 5

5

(5/0)

M 8+3 7 Trained in 2007

VTE 5 M 11+1 12 Trained in 2007

VTE 5 M 11+1 6 Trained in 2007

VTE 5 M 5+3 11 Trained in 2007

VTE 5 M 5+3 7 Trained in 2007

79

Sing District, LNT Province: 36 Teachers* (15 Males/21 Females)

School # Teachers

(Male/Female) Sex Qualifications Years Teaching Received WASH Training

LNT 1

6

(0/6)

F 8+3 9 Trained in 2007

LNT 1 F 8+3 4 Trained 2 times

LNT 1 F 8+3 8 Trained in 2007

LNT 1 F 11+1 10 Trained in 2007

LNT 1 F 8+3 16 Trained in 2007

LNT 1 F 8+3 18 Trained in 2007

LNT 2

6

(4/2)

F 8+3 4 None

LNT 2 F 8+3 1 None

LNT 2 M 8+3 9 Trained in 2007

LNT 2 M 8+3 4 None

LNT 2 M 8+3 2 None

LNT 2 M 8+3 13 Trained in 2007

LNT 3

7

(5/2)

M 11+1 4 Trained 10/8/2010

LNT 3 M 11+1 2 Trained 10/8/2010

LNT 3 M 8+3 13 Trained 10/8/2010

LNT 3 M 11+1 10 Trained 10/8/2010

LNT 3 F 11+1 3 Trained 10/8/2010

LNT 3 F 11+1 3 Trained 10/8/2010

LNT 3 M 5+4 1 Trained 10/8/2010

LNT 4

4*

(3/1)

F 11+1 2 None

LNT 4 M 11+1 2 None

LNT 4 M 8+3 7 Trained in 2007

LNT 4 M 11+1 2 None

LNT 4 M Party Secretary

None

LNT 5

13

(3/10)

F 5+3 1 Trained in 2007

LNT 5 F 11+1 1 None

LNT 5 M 11+1 4 Trained in 2007

LNT 5 M 8+3 1 Trained in 2007

LNT 5 F 11+1 1 Trained in 2007

LNT 5 F 8+3 1 Trained in 2007

LNT 5 F 8+3 4 None

LNT 5 F 5+3 4 Trained in 2007

LNT 5 F 11+1 3 None

LNT 5 F 8+3 2 Trained in 2007

LNT 5 M 8+3 2 None

LNT 5 F 11+1 2 None

LNT 5 F 11+1 3 None

* Totals do not include village party secretary at LNT 4)

80

Xaybouathong District, KHM Province: 29 Teachers (9 Male/20 Female)

School # Teachers

(Male/Female) Sex Qualifications Years Teaching Received WASH Training

KHM 1

5

(2/3)

M 5+3 13 Trained in 2007

KHM 1 F 11+1 4 Trained in 2007

KHM 1 F 11+1 4 Trained in 2007

KHM 1 F 11+1 4 Trained in 2007

KHM 1 M 8+3 19 Trained in 2007

KHM 2

4

(2/2)

M 5+3 23 Trained in 2007

KHM 2 M 11+1 14 Trained in 2007

KHM 2 F 8+3 1 None

KHM 2 F 11+2 2 None

KHM 3

8

(0/8)

F 11+1 13 None

KHM 3 F 8+3 15 None

KHM 3 F 11+1 10 None

KHM 3 F 8+3 12 None

KHM 3 F 8+3 15 None

KHM 3 F 11+1 5 None

KHM 3 F 11+1 11 None

KHM 3 F 8+1 15 None

KHM 4

6

(3/3)

F 11+1 3 None

KHM 4 F 11+1 2 None

KHM 4 M 8+3 6 Trained in 2006

KHM 4 M 11+1 4 None

KHM 4 M 11+1 4 None

KHM 4 F 11+1 3 None

KHM 5

6

(2/4)

F 8+3 15 None

KHM 5 M 11+1 2 None

KHM 5 M 8+1 15 None

KHM 5 F 11+1 4 None

KHM 5 F 11+1 7 None

KHM 5 F 11+1 7 None

81

4B: School Observations

Meun District, VTE Province

School Code Intervention Status Number of observations

VTE 1 Intervention 1

VTE 2 Non-intervention 1

VTE 3 Non-intervention 1

VTE 4 Intervention 1

VTE 5 Intervention 1

Total 5

Sing District, LNT Province

School Code Intervention Status Number of observations

LNT 1 Intervention 1

LNT 2 Intervention 1

LNT 3 Non-intervention 1

LNT 4 Intervention 1

LNT 5 Intervention 1

Total 5

Xaybouathong District, KHM Province

School Code Intervention Status Number of observations

KHM 1 Intervention 1

KHM 2 Intervention 1

KHM 3 Non-intervention 1

KHM 4 Intervention 1

KHM 5 Non-intervention 1

Total 5

82

4C: Classroom Observations

Meun District, VTE Province

School Code

Intervention Status

Date Grade Students

Total/Girls (Absent)

Lesson Observed Source Time (Min)

Teacher Qualification

Years Teaching

BB Training

Year Trained

VTE 1 Intervention 18 OCT 5 55/22 (?) WAU 8: Liver Fluke Textbook 70 11+1 4 NO -

VTE 2 Non-intervention 19 OCT 5 54/22 (6) WAU 7: Diarrhea, Cholera and Dysentery Textbook 70 11+1 19 NO -

VTE 3 Non-intervention 20 OCT 3 43/17 (1) WAU 6: The Three “Cs” of Hygiene Textbook 70 11+1 6 NO -

VTE 4 Intervention 21 OCT 3 20/08 (1) WAU 4: Intestinal Parasites Textbook 70 11+1 6 YES 2007

VTE 5 Intervention 21 OCT 4 52/30 (17) WAU 13: The Environment Textbook 70 11=1 6 YES 2007

Sing District, LNT Province

School Code

Intervention Status

Date Grade Students

Total/Girls (Absent)

Lesson Observed Source Time (Min)

Teacher Qualification

Years Teaching

BB Training

Year Trained

LNT 1 Intervention 25 OCT 5 38/11 (1) WAU 7: Diarrhea, Cholera and Dysentery (review) Textbook 70 11+1 10 YES 2007

LNT 2 Intervention 26 OCT 4 41/16 (1) WAU 13: The Environment Textbook 70 8+3 19 YES 2007

LNT 3 Non-intervention 27 OCT 5 20/06 (1) WAU 7: Diarrhea, Cholera and Dysentery (review) Textbook 70 11+1 9 YES* 2010

LNT 4 Intervention 27 OCT 5 20/12 (1) WAU 7: Diarrhea, Cholera and Dysentery (review) Textbook 70 11+1 6 YES 2007

LNT 5 Intervention 28 OCT 4+5 36/03 (03) WAU 7: Diarrhea, Cholera and Dysentery (review) Textbook 70 11+1 5 NO -

* Training had been provided in August 2010 but materials had not yet reached the school. The teacher was given a Blue Box to make use of in the observed lesson.

Xaybouathong District, KHM Province

School Code

Intervention Status

Date Grade Students

Total/Girls (Absent)

Lesson Observed Source Time (Min)

Teacher Qualification

Years Teaching

BB Training

Year Trained

KHM 1 Intervention 01 NOV 3 32/12 (3) WAU 6: The Three “Cs” of Hygiene (review) Textbook 70 11+1 8 YES 2007

KHM 2 Intervention 02 NOV 5 23/11 (2) WAU 8: Liver Fluke (continuing lesson) Textbook 70 8+3 26 YES 2007

KHM 3 Non-intervention 03 NOV 3 33/09 (6) WAU 6: The Three “Cs” of Hygiene (review) Textbook 70 11+1 10 NO -

KHM 4 Intervention 04 NOV 4 19/09 (0) WAU 4: Malaria (review) Textbook 70 11+1 4 NO -

KHM 5 Non-intervention 04 NOV 3 29/17 (4) WAU 6: The Three “Cs” of Hygiene (review) Textbook 70 11+1 10 NO -

83

4D: Student Assessments

VTE 1 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 9 4 Hmong Completed

S 02 Female 11 4 Hmong Completed

S 03 Female 12 4 Hmong Completed

S 04 Female 11 5 Hmong Completed

S 05 Female 12 5 Hmong Completed

S 06 Male 9 4 Hmong Completed

S 07 Male 10 4 Hmong Completed

S 08 Male 13 4 Hmong Completed

S 09 Male 11 5 Hmong Completed

S 10 Male 12 5 Hmong Completed

VTE 2 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 10 5 Lao Completed

S 02 Female 9 4 Hmong Completed

S 03 Female 10 4 Hmong Completed

S 04 Female 14 5 Hmong Completed

S 05 Female 12 5 Yao Completed

S 06 Male 11 4 Hmong Completed

S 07 Male 11 4 Hmong Completed

S 08 Male 8 5 Hmong Completed

S 09 Male 13 5 Hmong Completed

S 10 Male 14 5 Hmong Completed

VTE 3 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 10 4 Lao Completed

S 02 Female 10 5 Lao Completed

S 03 Female 12 5 Lao Completed

S 04 Female 11 4 Hmong Completed

S 05 Female 11 4 Hmong Completed

S 06 Male 10 4 Lao Completed

S 07 Male 12 5 Lao Completed

S 08 Male 13 5 Lao Completed

S 09 Male 10 4 Hmong Completed

S 10 Male 11 4 Hmong Completed

84

VTE 4 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 8 1 Lao Completed

S 02 Female 9 4 Lao Completed

S 03 Female 10 4 Lao Completed

S 04 Female 10 5 Lao Completed

S 05 Female 11 5 Lao Completed

S 06 Male 10 4 Lao Completed

S 07 Male 10 4 Lao Completed

S 08 Male 10 5 Lao Completed

S 09 Male 10 5 Lao Completed

S 10 Male 11 5 Lao Completed

VTE 5 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 11 4 Lao Completed

S 02 Female 12 4 Hmong Completed

S 03 Female 12 4 Hmong Completed

S 04 Female 10 5 Hmong Completed

S 05 Female 12 5 Hmong Completed

S 06 Male 10 4 Lao Completed

S 07 Male 98 4 Lao Completed

S 08 Male 11 4 Hmong Completed

S 09 Male 12 5 Hmong Completed

S 10 Male 13 5 Hmong Completed

LNT 1 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 8 1 Lao Completed

S 02 Female 10 4 Leu Completed

S 03 Female 10 5 Leu Completed

S 04 Female 11 5 Leu Completed

S 05 Female 12 4 Akha Completed

S 06 Male 10 4 Leu Completed

S 07 Male 13 4 Leu Completed

S 08 Male 10 5 Leu Completed

S 09 Male 11 5 Leu Completed

S 10 Male 11 4 Akha Completed

85

LNT 2 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 10 4 Akha Completed

S 02 Female 11 4 Akha Completed

S 03 Female 11 4 Akha Completed

S 04 Female 13 5 Akha Completed

S 05 Female 13 5 Akha Completed

S 06 Male 10 4 Akha Completed

S 07 Male 13 4 Akha Completed

S 08 Male 13 4 Akha Completed

S 09 Male 12 5 Akha Completed

S 10 Male 13 5 Akha Completed

LNT 3 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 9 4 Akha Completed

S 02 Female 9 4 Yao Completed

S 03 Female 9 4 Yao Completed

S 04 Female 11 4 Yao Completed

S 05 Female 12 5 Yao Completed

S 06 Male 11 4 Yao Completed

S 07 Male 12 4 Yao Completed

S 08 Male 12 4 Yao Completed

S 09 Male 12 4 Yao Completed

S 10 Male 11 5 Yao Completed

LNT 4 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 10 4 Thai Dam Completed

S 02 Female 10 4 Thai Dam Completed

S 03 Female 11 5 Thai Dam Completed

S 04 Female 8 1 Phounoi Completed

S 05 Female 11 5 Hor Completed

S 06 Male 12 5 Leu Completed

S 07 Male 10 4 Khmou Completed

S 08 Male 10 4 Lolo Completed

S 09 Male 11 4 Lolo Completed

S 10 Male 14 5 Lolo Completed

86

LNT 5 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 11 4 Akha Completed

S 02 Female 11 5 Akha Completed

S 03 Female 12 5 Akha Completed

S 04 Male 11 4 Akha Completed

S 05 Male 13 4 Akha Completed

S 06 Male 14 4 Akha Completed

S 07 Male 11 5 Akha Completed

S 08 Male 13 5 Akha Completed

S 09 Male 13 5 Akha Completed

S 10 Male 14 5 Akha Completed

KHM 1 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 11 5 Lao Completed

S 02 Female 9 4 Phouthai Completed

S 03 Female 9 4 Phouthai Completed

S 04 Female 12 5 Phouthai Completed

S 05 Female 14 5 Phouthai Completed

S 06 Male 10 4 Phouthai Completed

S 07 Male 12 4 Phouthai Completed

S 08 Male 12 5 Phouthai Completed

S 09 Male 12 5 Phouthai Completed

S 10 Male 11 5 Hmong Completed

KHM 2 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 12 5 Lao Completed

S 02 Female 11 4 Phouthai Completed

S 03 Female 11 4 Phouthai Completed

S 04 Female 11 4 Phouthai Completed

S 05 Female 14 5 Phouthai Completed

S 06 Male 12 4 Lao Completed

S 07 Male 11 4 Phouthai Completed

S 08 Male 11 4 Phouthai Completed

S 09 Male 12 5 Phouthai Completed

S 10 Male 14 5 Phouthai Completed

87

KHM 3 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 8 1 Lao Completed

S 02 Female 9 4 Lao Completed

S 03 Female 9 4 Lao Completed

S 04 Female 11 5 Lao Completed

S 05 Female 12 5 Phouthai Completed

S 06 Male 9 4 Lao Completed

S 07 Male 9 4 Lao Completed

S 08 Male 9 5 Lao Completed

S 09 Male 11 5 Lao Completed

S 10 Male 11 5 Phouthai Completed

KHM 4 (Intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 9 4 Lao Completed

S 02 Female 10 4 Lao Completed

S 03 Female 11 5 Phouthai Completed

S 04 Female 12 5 Phouthai Completed

S 05 Female 12 5 Khmou Completed

S 06 Male 12 4 Lao Completed

S 07 Male 14 4 Lao Completed

S 08 Male 11 5 Lao Completed

S 09 Male 13 5 Lao Completed

S 10 Male 13 5 Phouthai Completed

KHM 5 (Non-intervention)

Student Sex Age Grade Ethnicity Completion Status

S 01 Female 10 4 Lao Completed

S 02 Female 12 5 Lao Completed

S 03 Female 10 4 Phouthai Completed

S 04 Female 10 4 Phouthai Completed

S 05 Female 11 5 Phouthai Completed

S 06 Male 10 4 Lao Completed

S 07 Male 10 5 Lao Completed

S 08 Male 12 5 Lao Completed

S 09 Male 13 5 Lao Completed

S 10 Male 12 4 Khmou Completed

88

4F: School Director and Teacher Telephone Interviews

No. Province District Director Total

Students Total Girls

Total Boys

Main Ethnic Group

Total Blue

Boxes

# Teachers Trained

Teacher Grade Year

Trained

Main Water Supply

Condition of Water Supply

Students per

Toilet

Hand Washing Facility

1 LNT Namtha Male 144 68 76 Khmou 2 3 Female 1 2007 GFS Not working well 36 Separate facility

2 LNT Namtha Male 149 69 80 Khmou 1 13 Female 4 2006 None N/A 30 No facility

3 LNT Namtha Male 128 59 69 Khmou 2 2 Female 3 2007 GFS Not working well 43 No facility

4 LNT Namtha Male 216 117 99 Khmou 2 11 Female 5 2002 GFS Working OK 43 At or near toilet

5 LNT Namtha Male 59 30 29 Mien 1 2 Female 5 2008 GFS Working OK 20 At or near toilet

6 LNT Namtha Female 307 143 164 Hmong 2 16 Female 4 2006 GFS Working OK 102 At or near toilet

7 LNT Namtha Male 84 64 20 Khmou 2 2 Male 5 2004 None N/A 0 No facility

8 LNT Sing Female 235 102 133 Thaileu 2 8 Female 4 2007 Piped Working OK 47 At or near toilet

9 LNT Sing Male 116 84 32 Khmou 2 7 Female 3,4 2009 Dug well Not working well 29 No facility

10 LNT Sing Male 152 71 81 Hmong 1 2 Female 5 2008 GFS Not working well 51 Separate facility

11 LNT Sing Male 80 40 40 Thaileu 1 4 Male 5 2008 Dug well Not working well 27 Separate facility

12 LNT Sing Female 50 30 20 Akha 2 2 Female 1,2 2007 None Working very well 50 Separate facility

13 LNT Sing Male 139 87 52 Thaileu 2 2 Male 3 2005 GFS Not working well 46 Separate facility

14 LNT Sing Male 219 120 99 Tai 2 8 Male 3 2009 Piped Working very well 44 At or near toilet

15 LNT Sing Female 339 159 180 Hmong 2 7 Female 1 2005-06 Dug well Not working well 68 No facility

16 LNT Sing Male 111 36 75 Akha 2 1 Female 5 GFS Not working well 56 No facility

17 LNT Sing Male 204 91 113 Akha 2 2 Male 4 2008 GFS Working very well 41 Separate facility

18 LNT Sing Male 170 57 113 Thaileu 2 1 Female 4 Dug well Not working well 0 At or near toilet

19 LNT Sing Male 84 44 40 Tai 2 6 Female 1,2 2008 Piped Working OK 17 Separate facility

20 LNT Long Male 81 34 47 Tai 2 2 Female 5 2005 GFS Working OK 27 Separate facility

21 LNT Long Male 67 32 35 Thaileu 1 2 Male 1,2,3 2007 GFS Working very well 13 At or near toilet

22 LNT Long Male 133 59 74 Hmong 2 2 Male 5 2007-08 GFS Not working well 44 Separate facility

23 LNT Long Male 109 35 74 Akha 2 2 Male 5 2004 GFS Working OK 22 At or near toilet

24 LNT Viangphoukha Female 197 104 93 Khmou 2 1 Female 2 GFS Not working 66 Separate facility

25 LNT Viangphoukha Male 59 26 33 Thaileu 2 1 Female 4 GFS Working very well 12 At or near toilet

26 LNT Viangphoukha Female 172 85 87 Khmou 1 2 Female 1 2009 Piped Working very well 57 At or near toilet

27 LNT Viangphoukha Female 49 24 25 Thaileu 2 7 Female 2 2006-07 GFS Not working well 16 At or near toilet

28 LNT Viangphoukha Male 76 32 44 Khmou 2 2 Female 2,3 2006 Piped Not working well 25 At or near toilet

29 LNT Nale Male 98 52 46 Khmou 2 2 Male 5 2008 GFS Not working well 0 At or near toilet

30 LNT Nale Male 111 57 54 Khmou 2 1 Male 3 GFS Not working well 28 Not used

31 ODX Xay Female 95 49 46 Thaileu 2 2 Female 4,5 2007 Piped Working very well 24 Separate facility

32 ODX Xay Male 264 144 120 Khmou 2 2 Male 5 2007 GFS Not working 88 No facility

33 ODX Xay Male 208 87 121 Lao 2 2 Female 4 2007 Rainwater Working OK 52 No facility

89

No. Province District Director Total

Students Total Girls

Total Boys

Main Ethnic Group

Total Blue

Boxes

# Teachers Trained

Teacher Grade Year

Trained

Main Water Supply

Condition of Water Supply

Students per

Toilet

Hand Washing Facility

34 ODX Xay Female 209 96 113 Thaileu 2 5 Female 1,3 2007 GFS Working OK 42 At or near toilet

35 ODX Xay Male 439 207 232 Khmou 2 6 Male 5 2006 Rainwater N/A 88 No facility

36 ODX Xay Male 95 44 51 Khmou 2 5 Male 5 2006 GFS Working very well 19 Separate facility

37 ODX Xay Male 375 193 182 Khmou 2 1 Male 3,5 Piped Working very well 75 Separate facility

38 ODX Xay Male 314 151 163 Thaileu 2 4 Female 5 2007 GFS Not working well 63 Separate facility

39 ODX Xay Male 243 117 126 Khmou 2 2 Male 4 2009 Borehole Not working well 49 At or near toilet

40 ODX Xay Female 115 50 65 Khmou 2 3 Female 2,3 2008 GFS Not working well 115 Not used

41 ODX Xay Male 120 68 52 Khmou 2 2 Male 5 2008 Borehole Not working well 60 Separate facility

42 ODX La Female 65 33 32 Lao 2 3 Female 3 2008 GFS Not working 16 No facility

43 ODX La Male 66 30 36 Thaileu 1 3 Female 2,3 2006 GFS Not working well 17 At or near toilet

44 ODX La Male 77 37 40 Khmou 2 4 Female 4 2006 GFS Not working well 19 No facility

45 ODX Namo Male 132 53 79 Tai 2 5 Female 5 2009 GFS Not working 44 No facility

46 ODX Namo Male 104 57 47 Lao 2 6 Male 2 2003-04 Dug well Not working well 35 At or near toilet

47 ODX Namo Male 124 67 57 Akha 1 3 Male 3 2008-09 Piped Working very well 41 At or near toilet

48 ODX Namo Male 140 67 73 Tai 2 5 Male 5 2006-07 GFS Not working well 47 At or near toilet

49 ODX Namo Female 274 124 150 Khmou 2 1 Male 5 Dug well Not working well 55 Separate facility

50 ODX Namo Male 79 47 32 Hmong 2 5 Male 2,3 2004 GFS Working very well 26 At or near toilet

51 ODX Namo Male 178 99 79 Thaileu 2 5 Male 1 2009 GFS Working OK 59 At or near toilet

52 ODX Namo Male 189 99 90 Khmou 2 4 Male n/a 2008 GFS Not working well 63 At or near toilet

53 ODX Namo Male 72 48 24 Khmou 2 2 Male 4 2009 GFS Working OK 24 At or near toilet

54 ODX Namo Male 148 62 86 Lao 2 4 Male 5 2008 GFS Not working well 37 At or near toilet

55 ODX Namo Female 139 73 66 Khmou 2 3 Male 2,3 2008 Piped Working very well 46 At or near toilet

56 ODX Beng Male 282 149 133 Khmou 2 2 Male 5 2008 Rainwater N/A 141 Separate facility

57 ODX Beng Male 267 132 135 Khmou 2 2 Male 3 2008 GFS Not working well 53 At or near toilet

58 ODX Beng Male 66 32 34 Thaileu 2 1 Female 1 Borehole Not working 22 No facility

59 ODX Houn Female 410 186 224 Thaileu 2 2 Female 5 2005 Borehole Not working 205 At or near toilet

60 ODX Houn Female 138 80 58 Lao 2 5 Male 5 2008 GFS Working OK 28 No facility

61 ODX Houn Male 193 80 113 Hmong 2 4 Male 5 2008 GFS Not working 64 At or near toilet

62 ODX Pakbeng Male 87 45 42 Khmou 2 4 Male 2 2006 GFS Not working well 29 No facility

63 VTE Viangthong Male 344 142 202 Tai 1 3 Male 2 2006-07 Rainwater N/A 115 No facility

64 VTE Viangthong Female 106 62 44 Lao 2 1 Male 5 Dug well Working very well 35 At or near toilet

65 VTE Met Male 182 90 92 Tai 2 5 Male 5 2008 GFS Working OK 61 No facility

66 VTE Met Male 131 58 73 Tai 2 1 Female 5 Rainwater N/A 44 No facility

67 VTE Meun Male 427 187 240 Lao 2 2 Male 1,3 2009 Borehole Not working well 142 No facility

68 VTE Meun Male 939 416 523 Hmong 2 5 Female 5 2006 Borehole Not working 188 No facility

90

No. Province District Director Total

Students Total Girls

Total Boys

Main Ethnic Group

Total Blue

Boxes

# Teachers Trained

Teacher Grade Year

Trained

Main Water Supply

Condition of Water Supply

Students per

Toilet

Hand Washing Facility

69 VTE Meun Female 109 52 57 Lao 1 4 Male 4 2008 Borehole Not working well 36 No facility

70 KHM Hinheup Male 162 76 86 Tai 2 4 Female 3 200607 Borehole Not working well 54 No facility

71 KHM Hinheup Male 287 130 157 Phouthai 1 1 Female 3 Borehole Working very well 96 Separate facility

72 KHM Hinheup Male 100 46 54 Phouthai 2 1 Male 4 2007 Borehole Not working well 33 At or near toilet

73 KHM Hinheup Male 85 40 45 Phouthai 2 10 Male 4 2007 Borehole Working very well 21 No facility

74 KHM Hinheup Male 111 79 32 Phouthai 1 2 Male 3,4 2009 Borehole Working very well 37 At or near toilet

75 KHM Hinheup Male 160 58 102 Phouthai 2 2 Male 3,4 2009 Borehole Not working well 53 No facility

76 KHM Hinheup Male 118 67 51 Phouthai 2 1 Female 1,3 Rainwater N/A 59 No facility

77 SVK Xepon Female 63 21 42 Phouthai 2 5 Male 1 2005 Borehole Working very well 21 Separate facility

78 SVK Xepon Female 88 36 52 Khmou 1 1 Female 2,4,5 Borehole Working very well 22 Separate facility

79 SVK Xepon Male 104 43 61 Tri 2 2 Female 2,3 2009 Borehole Working very well 26 At or near toilet

80 SVK Xepon Male 148 48 100 Phouthai 1 1 Female 1,2,3,4 Dug well Not working well 148 No facility

81 SVK Xepon Male 132 59 73 Phouthai 2 3 Male 5 2005 GFS Not working 0 Separate facility

82 SVK Nong Male 74 25 49 Makong 1 1 Male 1,2,3,4 2007-08 Borehole Not working well 37 No facility

83 SVK Nong Female 48 15 33 Makong 1 1 Female 1,2,3,4,5 2007 Borehole Working OK 16 No facility

84 SVK Nong Female 78 26 52 Makong 2 7 Female 1 2006 Borehole Not working well 26 Not used

85 SVK Nong Male 40 8 32 Makong 1 1 Female 4,5 Borehole Working OK 13 No facility

86 SVK Nong Male 60 12 48 Makong 1 1 Male 1,2 Rainwater N/A 20 At water source

87 SVK Nong Female 181 98 83 Taoy 2 6 Female 5 2006-07 GFS Not working well 60 No facility

88 SVK Nong Female 69 22 47 Makong 1 2 Female 1,2 2007 Borehole Working very well 23 Separate facility

91

4F: Key Informant Interviews

Name Position Organization

Mr. Viengsamay Vongkhamsao Country Team Leader Water and Sanitation Program, The World Bank, Lao PDR

Mr. Mahboob A. Bajwa Head of Section WASH, UNICEF, Lao PDR

Dr. Bounphone Vannalath Chief of Division Management and Administration Division, Center for Environmental Health and Water Supply, Ministry of Health, Lao PDR

Ms. Siamphone Vongkhamsa National Project Officer BEGE Section, UNICEF, Lao PDR

4G: Curriculum Review Team

Name Position Organization

Dr. Mithong Souvanvixay Director General DTT, MOE

Mr. Thongdam Philavanh Technical Staff DTT, MOE

Mr. Soulivanh Khamphavong Technical Staff DTT, MOE

Ms. Khamphat Xayalinkham Technical Staff DTT, MOE

Mr. Khonesavanh Kounlaboud Technical Staff DPPE, MOE

Ms. Paneed Soukhoanouvong Technical Staff DPPE, MOE

Ms. Boualiene Kinnala Technical Staff DPPE, MOE

Ms. Davanh Xayasing Technical Staff DPPE, MOE

Mr. Bounphong Syladeth Technical Staff RIES, MOE

Mr. Tha Sonephet Technical Staff RIES, MOE

Mr. Viadd Kanephachanh Technical Staff RIES, MOE

Ms. Banchai Technical Staff RIES, MOE

Dr. Soudsady Oudomsack Deputy Chief of Division National Malaria Center

4H: Technical Review Committee for Blue Box Evaluation

No Name and Surname Position Organization

1 Ms. Khamkhanh SOULIGNADETH Deputy Director DPPE, MoES

2 Ms. Soutsaychay DOUANGSAVANH Deputy Chief of Division DPPE, MoES

3 Ms. Panith SOUKHANOUVONG Technical Staff DPPE, MoES

4 Ms. Boualian KINNALA Technical Staff DPPE, MoES

5 Ms. Davanh XAIYASING Technical Staff DPPE, MoES

6 Ms. Chanthamaly SOULIGNASACK Technical Staff DPPE, MoES

7 Mr. Kikham PHIMBOUNGNOR Technical Staff DPPE, MoES

8 Mr. Khamphanh KHAMAONE Technical Staff DPPE, MoES

9 Mr. Thongdam PHILAVANH Technical Staff DTT, MoES

92

10 Ms. Vathsalin CHOUNLAMANY Technical Staff DTT, MoES

11 Ms. Phetsamone SIBOUNHUANG Technical Staff RIES, MoES

12 Mr. Bounphong SILARLATH Technical Staff RIES, MoES

13 Dr. Khampoung SOUDTHISOMBATH Deputy Director of Center Center for Ophthalmology

14 Ms. Bounthanom PHIMMASONE Technical Staff CNS

93

ANNEX 5: Results of Curriculum Review

The World Around Us Blue Box - Health and Hygiene at School

Grade No. & Name of

Chapter No. & Name of

Chapter Content Activities Content Activities Remarks

Gr1 Chapter 5

Cleaning the Body

Chapter 8

Cleaning the Body

1. The importance of the various organs of the body

2. Diseases affecting the organs

3. Cleaning the body correctly in accordance with the principles of hygiene

1. Brainstorming - organs of the body, their purposes, and cleaning the body.

2. Group work– telling experiences of ear, eye, nose, mouth, and teeth cleaning

3. Hand washing demonstration

1. How to clean your face, shower, and cut your toenails and fingernails

2. Explaining the benefits of having a clean body

3. Regular cleaning of the body

1. Cleaning the various parts of the body

2.Hand-washing

3. Teacher asks questions for discussion

Gr1 Chapter 20

Looking After and Cleaning the School

Chapter 9

Cleaning the house and Surrounding Environment

1. Human waste disposal

2. Cleaning the house

3. Disposing of dirty water

1. Storytelling “An adventure near the village”

2. Group work

3.Demonstration – open defecation and

1. Looking after and cleaning the classroom and school

2. Recognizing the difference between schools

1. Picture discussion, explanation of how to look after the classroom and recognize the items of cleaning equipment involved

The main topics and content are the same but the activities and subtopics differ.

94

the building of toilets near water sources

4. Discussion (on the importance of water to our lives, how water gets contaminated, and how to look after it

5. Discussion on cleaning the school

which are clean and attractive and schools which are not

2. Recognizing the difference between clean and dirty classrooms

3. Summary by teacher and students

Gr1 Chapter 40

Water

Chapter 10

Using and Looking After Water Systems

1. Water and its importance

2. Using and looking after dug well, tap water, and rainwater and collecting rainwater

1. Brainstorming on the importance of water

2. Group discussion on the types of water and how to use and look after it

3. Storytelling “When the Stream Gets Dirty “

1. Explanation – Characteristics of water and how it benefits us

1. Discussion about water sources

2. Elicitation and discussion about the characteristics of water

3. Discussion about the benefits of water

4. Experiment about water which appears clear but isn’t pure

5. Discussion about hazardous disasters

The main topics are the same but the activities and subtopics differ.

95

caused by water

Gr2 Chapter 26

Water and Weather

Chapter 10

Using and Looking After Water Systems

1. Water and its importance

2. Using and looking after dug well, tap water, and rainwater and collecting rainwater

1. Brainstorming on the importance of water

2. Group discussion on the types of water and how to use and look after it

3. Storytelling “When the Stream Gets Dirty”

1. Characteristics of water

2. Why water is important to us

3. How water sources get contaminated

1. Experiments about water

2. Discussion about the benefits of water

Gr3 Chapters 1, 2, 3, and 5

Food Groups, Benefits of Food, Micronutrient Deficiency, and Correct Eating

Chapter 7

Food hygiene, drinking water, and water for other purposes

1. Explanation about food hygiene, drinking water, and water for other purposes

2. Storing and looking after food

1. Game – Finding the names of foods

2. Brainstorming about finding clean water

3. Student demonstration and presentation about washing fruit and vegetables

1. Naming the 3 food groups

2. Categorizing food

3. Telling the benefits of the foods of each group

4. Saying which foods should be eaten for the sake of good health

1. Brainstorming on the names of foods

2. Picture discussion about food groups (in the textbook)

3. Picture discussion (picture of person suffering from malnutrition)

4. Answering questions about the names of foods

96

4.Demonstration – water filtering

Gr3 Chapter 4

Intestinal Worms

Chapter 4

Intestinal Worms

1. Appearance and characteristics of intestinal worms

2. Characteristics and symptoms of those infected with worms

3. Causes of transmission and the life cycle of intestinal worms

4. Preventive measures

1. Brainstorming about the meaning and types of intestinal worms

2. Role-play

3. Group research about the types of intestinal worms, their characteristics, food, causes, life cycles, and modes of transmission and preventive measures

1. Appearance and characteristics of each type of intestinal worm

2. Causes and symptoms of contracting intestinal worms

3. Harmful effects of contracting intestinal worms

4. Preventive measures

1. Discussion about intestinal worms

2. Picture discussion about the various types of intestinal worms

3. Study into the life cycle and transmission modes of intestinal worms

Identical

Gr3 Chapters 26 – 28

Using Water and Looking after Water Sources

Chapter 10

Using and Looking after Water Systems

1. Water and its importance

2. Using and looking after dug well, tap water,

1. Brainstorming about the importance of water

2. Discussion

1. Explanation – The various ways in which water is important

2. Causes of

1. Study about the benefits of water

2. Discussion about how water gets contaminated

The majority of the content and activities is similar.

97

and rainwater and collecting rainwater

about the types of water and how to use and look after it

3. Storytelling “When the Stream Gets Dirty”

water contamination

3. Harmful effects and how to look after water sources

4. Clearing forests for slash and burn cultivation at upstream destroys water source

3. Water resource survey

4. Study trip to an area where land has been cleared

5. Listing of village water sources that have been destroyed

Morale Education Blue Box Teacher’s Guide – Health and Hygiene at School

Grade No. & Name of

Chapter No. & Name of

Chapter Content Activities Content Activities Remarks

Gr1 Chapter 10

Keeping the School Clean

Chapter 9

Cleaning the House and Surroundings

1. Human waste disposal

2. Cleaning the house and school

3. Disposal of dirty water

1. Storytelling “An adventure near the village”

2. Group work

3.Demonstration – open defecation and the building of toilets near water sources

Activity 2 Chapter topics and certain activities are the same.

98

4. Discussion (on the importance of water to our lives, how water gets contaminated, and how to look after it

5. Discussion on cleaning the school

Gr3 Chapter 13

Looking after Water Sources and Using Them Economically

Chapter 10

Using and Looking after Water Systems

1. Water and its importance

2. Using and looking after dug well, tap water, and rainwater and collecting rainwater

1. Brainstorming about why water is important to us

2. Group discussion about the types of water and how to use and look after it

3. Storytelling “When the Stream Gets Dirty”

1. Explanation – the significance of water

2. Practice exercise – Using water economically and looking after water sources

3. Comparing the advantages and disadvantages of using water economically

1. Song – The River

2. Picture discussion (in the textbook)

3. Group discussion about protecting water sources

The chapter topics, aims, and content are similar.

99

Grade 4 & 5

The World Around Us Blue Box - Health and Hygiene at School

No. and Name of Chapter

Content Activities Grade No. and Name of Chapter

Content Activities Remarks

Chapter 3

Dengue Fever

1. Causes of dengue fever

2. Symptoms of dengue fever

3. Explanation – The life cycle of the mosquito and transmission modes

4. The characteristics and breeding sites of the common house mosquito

5. How to prevent dengue fever

1. Relating of experiences

2. Group work

3. Class discussion

4. Role-play – Transmission routes of dengue fever

Gr4 Chapter 6

Dengue Fever

1. Characteristics and symptoms of dengue fever

2. Causes of dengue fever

3. Transmission routes and prevention

1. Relating of experiences

2. Brainstorming about causes

3. Group discussion

Chapter 4 Malaria

1. Causes of malaria

2. Symptoms of malaria

3. Prevention of Malaria

1. Class discussion

2. Survey of mosquito breeding sites

3. Picture discussion

4. Group discussion

Gr4 Chapter 5

Malaria

1. Causes of malaria

2. Symptoms and dangers of malaria

3. Preventive measures

1. Discussion in pairs or groups

2. Group discussion

Chapter 13

The Environment

1. What the environment means

2. Differentiating between natural and manmade elements of the environment

3. Duties and

1. Class discussion about what the environment means

2. Differentiating between natural and manmade elements of

Gr4 Chapter 9

Cleaning the house and surroundings

1. Cleaning the surroundings and the school thoroughly

2. Practice until students grow accustomed to cleaning and hygiene

1. Storytelling from the story card “ An adventure near the village”

2. Group work

3. Demonstration – open defecation and the building of

Chapter 13 IV no. 3 - Group discussion about the problems and impact of the environment - no. 4 - Surveying water sources and

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causes of environmental problems

4. Solutions to local environmental problems

the environment

3. Group discussion about the problems and impact of the environment

4. Surveying water sources and refuse

toilets near water sources

4. Discussion

5. Discussion - Hygiene

refuse – and Chapter 31 – Air Pollution (from the national textbook)

Chapter 31

Air Pollution

1. The meaning and causes of air pollution

2. Dangers of air pollution and how to protect against it

1. Dangers arising from air pollution

2. How to protect against air pollution

IV no. 3

Discussion about the dangers of air pollution

Chapter 1

The Human Eye

1. Eye Care 1. Eye care

2. Exercise – Measuring the students’ eyesight

Gr5 Chapter 8

Personal Hygiene

1. Importance of the various organs of the body

2. Diseases affecting the various organs of the body

3. Correct hygiene principles regarding the various organs of the body

1. Brainstorming

2. Students talk about their experiences in groups

3. Demonstration – hand washing

Chapter 1 IV no. 6 – Eye Care – no. 7 – Measuring the Students’ Eyesight – Chapter 2 – The Human Ear – in IV no. 3 – Relating of Experiences – no. 4 – Discussion about ear care – Chapter 3 – The Human Nose – Chapter 4 – The Human Tongue – Chapter 5 – The Human Skin

Chapter 2

The Human Ear

1. Ear diseases

2. Ear care

1. Real observations

2. Group research about the structure of the ear

3. Relating of experiences

4. Discussion about ear care

(hair, eyes, eyebrows and eyelashes, nose, ears, mouth, teeth, neck, breasts, armpits, arms, and hands)

Chapter 3

The Human Nose

1. Nose care to avoid colds

2. Nose diseases

1. Taking a look at the nose

2. Relating of experiences of nose diseases

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3. Discussion – Nose care

Chapter 4

The Human Tongue

1. Mouth and tongue diseases

2. Mouth and tongue care

1. Pair discussions about the tongue

2. Experiment into the tastes of foods

3. Class discussion about tongue diseases and how to avoid them

Chapter 5

The Human Skin

1. How to look after the skin and keep it clean

1. Game about skin diseases

2. Story study: Cleanliness Keeps Disease at Bay

Chapter 7

Diarrhea, Cholera, and Dysentery

1. Sources and symptoms of diarrhea, cholera, and dysentery

2. Transmission routes of the above

3. Preventive measures and treatment for the various stages of diarrhea, cholera, and dysentery

Diarrhea

1. Class discussion about the causes and symptoms of diarrhea

2. Demonstration – Loss of bodily fluids

3. Class discussion about the symptoms of dehydration

4. Demonstration of how to prepare Oralit and oral rehydration salts (ORS)

5. Broken sentences

Chapter 1

Dysentery

1. Characteristics and symptoms

2. Causes

3. Preventive measures

1. Organise group for role play

Chapter 2

Diarrhea

1. Characteristics and symptoms

2. Causes

3. Preventive measures

1. Relating of experiences

2. Brainstorming

3. Demonstration of bodily fluid loss due to diarrhea

4. Demonstration of how to prepare ORS

5. Review of how to avoid diarrhea

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about how to avoid cholera

Chapter 3

Cholera (Severe Diarrhea / Running to the Toilet and Vomiting)

1. Characteristics and symptoms

2. Causes

3. Preventive measures

1. Relating of experiences

2. Group work

3. Class discussion

4. Demonstration – hand washing

Diarrhea

1. Class discussion about the symptoms of diarrhea

2. Role-play about the symptoms of diarrhea

3. Jumbled sentences about preventive measures

Notes

In addition, in the main curriculum the following topics about health education have been inserted (Diseases Found in Birds) or are already in the curriculum but not in the Blue Box:

1. Gr4 Chapter 5 – Addictive Substances

Chapter 12 – AIDS and Preventive Measures

Chapter 22 – Diseases Found in Birds

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Teacher Training College - Primary Education Teacher Training

The World Around Us (TTC - Primary Education Teacher Training) Blue Box - Health and Hygiene at School

(average of 54% of the primary education teacher training course)

No. and Name of Chapter

Content / Topics Activities Page Book No. and Name of

Chapter Content / Topics Activities Remark

Chapter 2

How to Teach Health and Environmental Education

1.The environment and causes of environmental problems

2. Environmental problems occurring locally

3. Using and looking after water systems

1. Questions and discussion

2. Storytelling “An adventure near the village”

3. Discussion

4. Brainstorming about disposing of dirty water and how to keep water clean

5. Observing real conditions and practice for homework

19-30

2 Chapter 10

Using and Looking after Water Systems

1. The importance of toilets

2. How to use the various types of dug well

3. Advice on looking after dug well

4. Rainwater and how to collect it

5. Looking after and using water jars (large water containers)

6. Tap water

1. Brainstorming

2. Group research

3. Storytelling from the story card “When the Stream Gets Dirty”

4. Storytelling from the story card “An Adventure near the Village”

5. Storytelling from the story card “Ghost of the Forest and Dirty Water”

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6. Storytelling from the story card “Little Fish Waiting for His Mom”

Chapter 3 (continued)

How to Teach Health and Environmental Education

1. Toilet use

2. Nutrition

3. Food hygiene, drinking water, and water for other purposes

1.Finding clean water

2. Demonstration – Cleaning fruit and vegetables

37-42

2 Chapter 11

Using and looking after toilets

Chapter 7

Food hygiene, drinking water, and water for other purposes

11.1 Toilets and how to use them

11.2 Looking after toilets

7.1 Food hygiene

7.2 Cleaning drinking water and water for other purposes

1. Relating of experiences

2. Group discussion – How to look after toilets

3. Story – Meena’s Three Wishes

4. Game – Finding the names of foods you eat every day and putting them into groups

5. Brainstorming about finding

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clean water

6. Student demonstration combined with explanation about washing fruit and vegetables

7. Demonstration of water filtering

Chapter 4

Cleaning the Body

1. Cleaning the various organs of the body

2. Genitals, the reproductive process, and cleaning

1. Get the students to explain and mime cleaning the various organs of the body as they have been doing it in the past

2. Mime about showering

3. Looking after the teeth and gums

47-51

2 Chapter 8

Personal Hygiene

1. What is the body?

2. Why do we have to clean our bodies?

3. Cleaning the various organs (hair, eyes, eyebrows and eyelashes, nose, ears, mouth, teeth, neck, breasts, armpits,

1. Brainstorming

2. Get the students to relate their experiences in groups

3. Demonstration – hand washing

4. Storytelling from the storybook – “Little Monkey with

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arms, and hands) Toothache”

5. Game putting yellow cards together – General hygiene principles

6. Game – Snakes and ladders “Who is stronger”

7. Arrange the word boxes – General hygiene principles

8. Word card game Should or shouldn’t – General hygiene principles

9. Guess the yellow card game – Washing your body and surroundings

Chapter 5 1. Roundworms 1. Brainstorming about the 2 Chapter 4 1. Roundworms 1. Brainstorming

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Intestinal Worms

2. Pinworms

3. Whipworms

4. Hookworms

5. Tapeworms

6. Liver flukes

various types of intestinal worms

2. Role play about story “dirty hands and food”

3. Group work

4. Role play about always rubbing hands together until they are clean

56-65

Intestinal Worms

2. Pinworms

3. Whipworms

4. Hookworms

5. Tapeworms

6. Liver flukes

about intestinal worms

2. Role play about the story: Dirty hands and food

3. Group work

4. Role play -Always rubbing hands together until they are clean

5. Board Game on Skill building: Intestinal worms

6. Story: Meena Gets Rid of Intestinal Worms

Chapter 6

Malaria and Dengue Fever

1. Malaria

1.1 Causes and transmission

1. Questions for class discussion about malaria

2. Storytelling “Little Mosquito and Old Tiger”

71-76

2 Chapter 5

Malaria

5.1 Characteristics and symptoms of malaria

5.2 Causes and

5.1 Group discussion about malaria

5.2 Storytelling

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1.2 Symptoms and treatment

1.3 Prevention

2. Dengue fever

2.1 Symptoms

2.2 Causes of transmission and life cycle

2.3 Preventive methods and treatment

3. Relating of experiences about malaria symptoms

4. Brainstorming about transmission of dengue and protection against dengue

5. Group discussion

Chapter 6

Dengue Fever

transmission

5.3 Protective measures

5.4 Treatment

6.1 Characteristics and transmission routes

6.2 Protection

from story card “The Little Mosquito and the Old Tiger”

6.1 Relating of experiences about dengue fever

6.2 Brainstorming

6.3 Group discussion

Notes:

1. After the group review of the TTC teacher’s guide “for the teacher training curriculum and teaching methods for The World Around Us

Volume 1, there is no overlapping content with the Blue Box Teacher’s Guide – Health and Hygiene at School”. Blue Box materials were integrated in Volume 2.

2. Topic: diseases affecting birds is present in the Gr5 syllabus but not in the Blue Box materials. Materials on Avian Influenza for schools were later produced for primary schools.

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3. Teacher’s Guide – Health and Hygiene at School (The group assessed that an average of 54% of the Blue Box materials are included in the content of the primary education teacher training curriculum)