school water, sanitation and hygiene: myths proved and disproved
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School Water, Sanitation and Hygiene: Myths Proved and Disproved. 9 August 2011, CARE USA Headquarters. Presenters: Malaika Wright, Shadi Saboori & Brooks Keene. School Water, Sanitation and Hygiene: Myths Proved and Disproved. SWASH+: Basic Facts. - PowerPoint PPT PresentationTRANSCRIPT
School Water, Sanitation and Hygiene: Myths Proved and Disproved
Presenters:
Malaika Wright, Shadi Saboori & Brooks Keene
9 August 2011, CARE USA Headquarters
School Water, Sanitation and Hygiene:Myths Proved and Disproved
SWASH+: Basic Facts• What: SWASH+ is a five-year applied research project started in 2006
• Goal: To identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya
• Partners: CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, the Kenya Water for Health Organisation (KWAHO), and Water.org (formerly Water Partners International)
• Where: Research and implementation conducted in Nyanza Province, Kenya
School Water, Sanitation and Hygiene:Myths Proved and Disproved
Why School WASH?
• At baseline, approximately 49% of schools provided drinking water to pupils
• Only 11% provided water for handwashing.
• In schools selected, there were 79.5 pupils per latrine on average (GoK ratios are 25:1 for girls, 30:1 for boys)
School Water, Sanitation and Hygiene:Myths Proved and Disproved
The Three Components Of SWASH+• 1) Direct implementation 2)
Research 3) Advocacy/ collaborative learning
• Direct implementation and research were started first
• Advocacy and collaborative learning were incorporated later
Research
Advocacy/Collaborative Learning
Direct implementation
School Water, Sanitation and Hygiene:Myths Proved and Disproved
• Widely acknowledged need for school WASH investments
• Yet scant evidence base for impact• Evidence necessary to justify
allocation of scarce resources• Myth vs. fact
The Research Context
• Cluster randomized trial: 2007-2009
• Base package (45 schools): – Hygiene promotion + Water Treatment
• Base package + Sanitation (45 schools):– HP+ WT + Sanitation
• Water package (25 schools):– HP+ WT + Sanitation+ Water
• Control (70 schools) – to receive improvements in third year of project
Background and Methods
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
1. Does school water, sanitation and hygiene (WASH) interventions make a difference in educational achievement?
2. Which kids benefit more from school WASH?
3. Can school WASH do more harm than good?
4. What types of investments in school WASH yield the most returns?
School Water, Sanitation and Hygiene:Myths Proved and Disproved
1. Does school water, sanitation and hygiene (WASH) interventions make a difference in educational achievement?
2. Which kids benefit more from school WASH?
3. Can school WASH do more harm than good?
4. What types of investments in school WASH yield the most returns?
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
•Significant reduction for HW+WT (OR=0.43) and HW, WT+San (OR=0.47)•Six days less absence per year for girls•No effect for boys
1. Does school water, sanitation and hygiene (WASH) interventions make a difference in educational achievement?
2. Which kids benefit more from school WASH?
3. Can school WASH do more harm than good?
4. What types of investments in school WASH yield the most returns?
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
• Followed re-infection rates for Ascaris, Trichuris and Hookworm
• Ascaris– 45% reduction in odds overall;
even greater among girls
• Trichuris– No effects
• Hookworm– Significant reduction in intensity
of infection for boys
Effect of WASH Helminth Re-infection
1. Does school water, sanitation and hygiene (WASH) interventions make a difference in educational achievement?
2. Which kids benefit more from school WASH?
3. Can school WASH do more harm than good?
4. What types of investments in school WASH yield the most returns?
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
What if key WASH components are missing? Hand Contamination
•Hand Rinse: sampled pupils’ hands for fecal contamination
•Measured for E. coli
•Compared intervention and control schools
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
What happened?
1. Does school water, sanitation and hygiene (WASH) interventions make a difference in educational achievement?
2. Which kids benefit more from school WASH?
3. Can school WASH do more harm than good?
4. What types of investments in school WASH yield the most returns?
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
•Water Package schools showed a 66% reduction in diarrheal disease and days of illness.
•This result was not gender specific.
•There was no effect seen for the Base and Base + Sanitation schools.
Reduction in Diarrheal Disease
School Water, Sanitation and Hygiene:Myths Proved and Disproved
•Significant reduction in girls’ absenteeism in schools where hand washing and treated drinking water were present (irrespective of sanitation improvement)
•Software components must not be overlooked
•Vital recurrent costs (i.e. soap, water treatment products) must be regularly budgeted and provided in order to ensure sustainability of WASH services
Reduction in Girls’ Absenteeism
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
School Water, Sanitation and Hygiene:Myths Proved and Disproved
•2008 provision of soap = over 30% of schools•2010 provision of soap = under 8%
School Water, Sanitation and Hygiene:Myths Proved and Disproved
Sustainability Successes
WASH components not requiring expenditures by schools are still sustained in a majority of intervention schools (nearly 3 yrs after implementation)
Sustainability Challenges
WASH components requiring expenditure by schools decreased dramatically (nearly 3 yrs after implementation)
Using the Evidence and Learning: Advocacy
The policy environment
• Current and planned investments in school WASH
• Interested development partners• Many policies• Low capacity for implementing them• Corruption in the Ministry of Education
Specific Policy Goals
1. Increase O&M Funding $3.30/pupil/year
2. Improve M&E Downward, decentralized and supportive
3. Knowledge and behavior New curriculum (co-developed with CDC)
An inside player
Inside learning partner
MOE investments in school WASH
Collaborative learning and capacity building
MOE investments in school WASH
Outside Expert
Independent research
Advocacy Activities
• Learning presentations• Sign-on letters with other civil society• Media work• Submitted policy briefs• Sustainability charter• Day to day badgering• International level: publishing in academic
journals, issuing briefing notes and presenting at relevant fora
Measuring Our Progress: Outcome Mapping
Boundary Partners Primary actors
Results to Date
• $3.4 million allocated for sanitary pads for school girls this year• Piloting and openness to new M&E systems, including
agreement on need for unified monitoring tool between ministries
• Doubling of funds for school WASH ($840,000/year) with potentially more to come
• Adoption of WASH curriculum and materials for in-service teacher training
• Agreement to develop a school WASH sustainability charter• International level – Uncertain impact
Thoughts on the Process
• Evidence-based advocacy works• Getting to scale through learning + advocacy
(not direct service delivery)• Trying to do implementation, rigorous learning
and advocacy simultaneously is hard (not necessary?)
• Can’t be internally-focused• In-country policy staff are essential