Author: Asingwire, N.; Muhangi, D.; Makerere University
Over the last 3-4 years, the Government of Uganda (GoU), with support from UNICEF, has been implementing a School Sanitation Program in 34 districts. The programme was initiated in the context of increased primary school enrollment. Enrolment has increased from 2.6 million in 1995 before UPE to almost 6.5 million pupils at present. The interventions under the Program have included support for construction of two 5-stance latrines per selected school, provision of rain water harvesting tanks, training of teachers in WATSAN and hygiene, promotion of drama on sanitation and school competitions, media campaigns, and formation of school health or science clubs.
Purpose / Objective
This study was therefore commissioned to assess the sanitation, water and hygiene situation in primary schools in the context of UPE and in light of the interventions. The study further sought to identify the factors facilitating and/or constraining the implementation and success of the programme.
The study was conducted in a sample of 16 districts, covering a total of 235 schools: 162 intervention and 73 non-intervention. A sample of 2323 pupils (52% male, 48% female) was also covered. Other study participants included school authorities, district officials, sub-county officials, and those in-charge of health units. Data was collected using a combination of formal interviews, key informant interviews, observation and review of documentary sources.
Key Findings and Conclusions
The findings indicate that all schools, except one, had some form of a latrine. Almost all schools (97.2%) had slab/sanplat latrines, although these were simultaneously used together with traditional latrines (93.8%). The number of pupils using a single stance was very high in all sampled districts: 96:1 for sanplat/slab latrines alone, and 84:1 for sanplat/slab and traditional latrines combined. Thus, the current pupil-stance ratio of 96:1 falls below the recommended ratio of 40:1. However, the current pupil-stance ratio represents an improvement from the pre-intervention time when the ratio was estimated to range from 100-700:1. The large numbers of pupils using a single stance makes cleaning and maintenance of latrines very difficult; hence, most latrines were found unhygienic, with some posing a health hazard. Also, given the fact that most schools had an enrolment of 500-1000, with a few exceeding 2000 pupils, latrines will quickly fill up. Indeed, close to 10% of all latrines were already full at the time of this study amidst lack of any replacement or sustainability plans. Part of this constraint also lies in the type of latrine technology being used (unlined latrine pit), which does not lend itself to emptying.
Maintenance and cleanliness of latrines remains a daunting challenge for a majority of schools. A large proportion of observed latrines fell short of appropriate hygienic conditions. Fouling was one of the major problems; 42.6% of the boys' latrines, 36% of the girls' latrines and 13% of the teachers' latrines were found fouled. Between 16-30% of all the latrines either lacked doors and/or did not provide adequate privacy. Only 36.6% of the pupils' latrines and 50.7% of the teachers' latrines had some form of anal cleansing materials. These largely consisted of plant leaves.
Majority of the latrines (60.6%) had hand-washing facilities. However. 61.7% of all HWFs contained water, 39.3% had soap, and only 59.8% had wet soil beneath them. This implies that even where HWFs exist, they may not be used. Up to 81.7% of the schools had urinal places, although their hygienic conditions left much to be desired. On the other hand, a few schools (16.5%) had a separate cleaning room for adolescent girls near the latrines. The difference between intervention and non-intervention schools were noticeable, with a quarter (25.8%) of the former having such rooms compared to less than a tenth (7.2%) in the latter. Majority of the schools (79.5%) had refuse disposal.
With respect to safe water facilities, majority of the schools (85.2%) depended on protected sources. About a third of the schools (33.1%) had received rainwater tanks. Majority of all rainwater tanks were complete and functional (66.3%). The tanks that were non-functional lacked certain materials such as gutters and facial boards, which were supposed to be contributed by the communities/schools. In some instances, some of the tanks had broken taps and schools could not replace them. Almost half (47.6%) of the schools drew their water from a distance of less than 100 meters. However, problems such as overcrowding at the source and drying up of water in the tanks were reported.
Regarding personal hygiene, a large number of pupils (85.1%) reported unprompted that they washed their hands after latrine use. Hand washing after latrine use could have been over-reported since only 60.6% of the schools had hand-washing facilities and, of those, only 61.7% contained water. The over-reporting, however, indicates high levels of knowledge about appropriate and social acceptability of the behavior. Assessment of personal hygiene amongst pupils indicated that female pupils tended to observe better personal hygiene standards compared to their male counterparts.
With regard to IEC campaigns, science lessons and school teachers were the major reported sources of WATSAN and hygiene-related information reported by 65.7% and 51.1% respectively, indicating the possible contribution of the training of teachers under the school sanitation program. A few pupils (4.9%) cited science or health clubs as their source to information; formation of these clubs has not been effected in a majority of the schools. Other software components of the programme such as media campaigns, school competitions and drama activities had not taken off well.
With respect to knowledge and awareness of WATSAN and hygiene-related diseases, a majority of the pupils (92.8%) reported some of the diseases caused by poor hygiene and sanitation, especially diarrhea. 26.6% of the females and 28.6% of the males reported that they had suffered from WATSAN-related diseases in the preceding 3 months to this study.
As much as the Program effects are being realized, the Program has inherent constraints and threats that can potentially impinge on sustainability. There are, for instance, critical issues regarding institutional and management aspects of the Program. Although it is appreciated that the Program has attempted to invoke all possible stakeholders, in the absence of effective co-ordination and clear demarcation/definition of roles and responsibilities, this has tended to create tension and confusion. There is evident "fight" for ownership and control of the Program between District Education Departments and District Health Directorates. In terms of implementation, in some districts, officials are dealing directly with schools by-passing Subcounties, while others have no clear systems for the selection of beneficiary schools. It was also pointed out that in some of the districts, Tender Boards tend to be under enormous political influence in awarding tenders. Another critical problem is that of raising local contributions for rainwater tanks and latrine construction. The contradictory messages from the MoES and District Education Departments regarding the role of parents and community in the context of UPE do not promote mass involvement and sustainability mechanisms.
Different technology options should be explored with a view of: a) identifying a technology suited to collapsing soils, b) identifying a technology that promises more sustainability, such as one that allows emptying. The fact that many schools pick tanks and fail to install them also requires a pre-condition that schools with allocated tanks should first have the platform and the gutters ready before they pick the tank, and beyond a certain period, their allocation is forfeited to another applicant.
There is a need to improve the implementation procedures especially the selection of schools and allocation of assistance, to make these processes more transparent and more accessible to needy schools. There is a need to improve the partnership and working relationship between the district education department and health. More importantly, there is a need to bring the education department on board, and ensure their full participation in the programme.
There is a need to think and work out sustainability mechanisms especially with respect to latrines. There is a need to involve the sub-counties more. A more bottom-up approach would make the programme more demand driven, locally owned, sustainable and more effective and rational. There is a need to rethink the accompanying strategies of health/science clubs and drama activities since they seem not to be working.
There is a need for well-planned and authentic information to parents about their roles and responsibilities in the context of UPE. This would help to overcome the apparent contradictions in policy.
Proper information management is also key to programme success. This may require report/monitoring formats that are filled from time to time. As an alternative to pinning posters on walls against the associated risk of removal, schools should be encouraged and facilitated to put wall paintings, wood carving, and clay portraits that depict hygiene and sanitation messages. These alternatives could be installed in such a manner that they are not easily removable. There is a need to target teachers with tailor-made sanitation and hygiene training while they are still in Teacher Training colleges. This will ensure that by the time they come out, they are already acquainted with sanitation and hygiene issues, strategies for their promotion, and the roles they have to play.
PDF files require Acrobat Reader.
Water and Environmental Sanitation
Government of Uganda