2004 MLW: Evaluation of Strategic Sanitation and Hygiene Promotion in School Pilot Projects in Nkhata Bay and Kasungu
Author: DeGabriele, J.; Keast, G.; Msukwa, C.
In the promotion of hygiene and sanitation, there has been a programmatic shift of focus to schools and children, as it is recognized that schools offer an important point of entry for raising the profile of hygiene and sanitation, as well as improving the environmental health conditions in schools and communities. Children can be effective change agents for behavioural practices such as washing hands, using latrines and maintaining hygienic environments. Moreover, children who adopt good hygiene practices at a young age not only work as peer advocates but are likely to grow up to be equally conscious adults, and further transfer these knowledge, skills and practices to their families.
The Government of Malawi/UNICEF are currently implementing a pilot project in 100 schools in two districts of Nkhata Bay and Kasungu districts known as the Strategic School Sanitation and Hygiene Promotion project. The purpose of the project is to develop and adopt programmatic guidelines and standards for the implementation of school sanitation and hygiene promotion with three components:
- Provision of the gender and child-friendly facilities
- Life skills Hygiene Education with a focus on skills and not content-based education
- Outreach activities to communities for sanitation improvements in the household.
- To establish and develop capacity at national, district and sub-district levels to support the development and implementation guidelines to deliver effective sanitation, hygiene and water to schools and surrounding communities.
- To develop a range of options for sanitation facilities suited to various geological, socio-economic conditions and gender considerations.
- To develop gender-sensitive school sanitation and hygiene promotion systems and materials.
- To develop health-promoting schools with hygiene, sanitation and water facilities.
- To extend sanitation and hygiene promotion to families.
- Review of relevant documentation used and developed by project.
- Visit sample 10 schools and surrounding communities in Nkhata Bay and Kasungu.
- Review activities: Facilitation of meetings with school management committees, teachers, pupils, communities. Also to meet with project management teams and district staff, including extension workers.
- Instruments developed to evaluate construction, child and girl friendliness of use of facilities: latrines, urinals, hand washing
- Visit the school sanitation and hygiene promotion project in Dowa District.
Findings and Conclusions
1. To establish and develop capacity at national, district and sub-district levels to support the development and implementation guidelines to deliver effective sanitation, hygiene and water to schools and surrounding communities.
While the National Steering Committee has not formally met for over a year, members have taken part in the Study tours, evaluation meetings for sanitation technology and HEP. The evaluation team endorses a previous recommendation that a national forum for school sanitation should be revived for Phase 2 as a working and learning body, to participate in SSHP pilots by applying and developing policies, guidelines and strategies; and this may be done under the COWASAC initiative.
The District Assemblies were involved in setting up the PMTs and the school selection criteria, but ways must be explored on how they can better internalise SSHP. This can be done by involving them more in the planning and monitoring of activities in Phase II. In Nkhata Bay, the District Assembly requested quarterly feedback from the PMT and the DEC, and the PMT was accountable to it.
The policies and guidelines of the various line ministries are well understood by the Project Management Teams. However, the District Executive Committees and the PMTs need to realign their activities to include more training on policy, coordination, supervision and enforcement. It is recommended that the project should consider initiating a participatory review of the implementation processes.
Similarly, extension staff, although having taken a role in the implementation of SSHP, still need to integrate themselves into its activities; this is especially so for the Health Surveillance Assistants. Nkhata Bay has recommended that extension workers conduct joint supervision and present joint reports to the PMT; this can be seen as a very positive development. It is recommended that the project also explore ways of facilitating a forum, whereby the School Management Committees request the services of various extension workers.
2. To develop gender-sensitive school sanitation and hygiene promotion systems and materials.
The project was designed so that communities should be involved in every stage of the project cycle, and that their participation should go beyond the provision of materials. To a large extent, this has been achieved. The evaluation team noticed that the various school committees had grown in their roles through their involvement. It is recommended that in order to further develop the communities' level of participation, during the Phase II of the project, the extension workers should review the participatory processes with the communities so that they can assume a greater role. In the long term, future project designs should incorporate the strategies described in the National Strategy for Community Participation in Schools, as well as the lessons learnt in the Malawi Education Support Activity.
The process of developing the school selection criteria should be reflected on, as the criteria tend to favour a needs-based approach, rather than supporting a rights-based approach where the duty bearers have already taken some initiatives. One such criterion is the existence of low cost hygiene and sanitation activities.
The use of the Participatory Hygiene and Sanitation Transformation (PHAST) has been used effectively as a Hygiene and Sanitation Promotion tool. The project should conduct a review of the way PHAST has been implemented so that its transformational capacity can be effective.
Community-based Management of water points is effective, and communities have funds and are purchasing parts. Spares are readily available to support Village Level Operation and Maintenance activities. The CBM training content should be reviewed to take into account the particular issues faced by water point committees managing the users of school water point. This should reflect the co-management of a water point by teachers' families and the communities. Capacity for advanced repairs of hand pumps does not yet exist, and the required materials are unavailable locally.
Most of the sanitation clubs were not very active on hygiene as sanitation promotion. They often limited their roles to organising rotas for latrine cleaning, and some acted as a type of sanitation police force. One school had a very energetic club with a wide range of activities and was led by an enthusiastic sanitation teacher; this school had exceptionally clean facilities! Nkhata Bay is in the process of developing terms of reference for the clubs; this is a positive development as it appears that clubs are inactive because of a lack of imagination in devising the scope of activities.
Group discussions with children showed a high level of knowledge on hygiene and sanitation issues, in particular the faecal-oral route. Sources of knowledge were varied, but school assembly appears to be the main focus of behaviour change. Children claimed that they influenced behaviour change at home: more frequent hand washing, and more frequent cleaning of latrines. However, their involvement in the selection of latrine technology was limited.
3. To develop a range of options for sanitation facilities suited to various geological, socio-economic conditions and gender considerations.
A costing exercise shows that a full complement of two four by four latrines, two urinals and two hand washing facilities costs $10,700 per school. Assuming a reasonable life span of 20 years, and the costs appear as $0.50 per child, per year. The latrines are child friendly, and some schools have provisions for older girls. For ease of cleaning, it is recommended that the sanplats be installed flush with the floor. The promotion of empty-able latrines is not recommended.
The school sanitation options catalogue needs reviewing so that it helps communities make better informed choices. This will also assist the PMTs and extension staff in their supervision. The catalogue can be complemented by sani centres, models, posters and decision trees. Contractors also found the catalogues difficult to use. The revised catalogue should also include detailed drawings of hand-washing facilities and urinals.
4. To develop health promoting schools with hygiene, sanitation and water facilities.
The evaluation team is convinced that hand washing tanks should continue to be promoted. At one school, all children were observed to wash their hands on leaving the latrine - if it can work in one school, it can work in others. Observations showed that tanks were not used because they were poorly designed or poorly constructed. An optimum size appears to be 200 litres.
In the 10 schools visited, the pupil to latrine ratio is 69 pupils per drop hole. This appears to be sufficient, especially in view of the urinals. The allocation of one class per latrine needs to be reviewed, as the junior classes are much larger than the senior classes and go to the latrine more often. Although the catalogue latrines are fully VIP, none of the latrines inspected were fully VIP. The construction quality indicates that the latrines are durable, and that the pit sizes are adequate for this. One concern is the generally poor quality of the drainage. Urinals are a big success, especially girls' urinals. There is no doubt about their use and advantages. The latrines in all the schools visited were well-maintained, especially in those schools with urinals.
5. To extend sanitation and hygiene promotion to families.
Both districts have higher traditional latrine coverage than the national average; this is a good starting point for sanitation promotion. Access to water is significantly lower than the national average. Hand washing remains a challenge; communities are becoming aware of the critical times, but the method, especially before eating, is still poor. Schools should still continue developing small tanks for demonstrating their use at home.
The project has yet to tackle on a large scale the extension of hygiene and sanitation promotion to the communities; this has been proposed as part of phase 2.
Evaluation of the Primary Community Schools Project concludes that expensive latrines may have limited demonstration value because of their inappropriateness to the community. Consultations with the community strongly suggest that communities do not aim to replicate school latrines at home, mainly because of cost. Communities expressed a willingness to pay at least part of the cost of a SanPlat or a dome slab; this needs to be investigated further. Payment will also reduce the number of uninstalled platforms. The project now has to rise to the challenge of facilitating the meeting of the demand. It is recommended that a household level sanitation catalogue be devised, and a strategy for making sanitation platforms available to buy or to make.
In addition to the recommendations found throughout the report, the team recommends the following action:
- To conduct a participatory review by the stakeholders
- To revitalise a national body that can form and develop policy and coordinate at a national level
- To involve the District Assemblies more in the planning and supervision of activities
- To conduct a review of the way PHAST has been implemented
- To review the CBM training to include a stronger co-management component
- To encourage extension workers to conduct joint supervision, monitoring, and report writing
- To facilitate the SMCs to set a forum where they request the support of the extension workers
- To design a participatory monitoring form and encourage regular monitoring
- To improve the catalogue to assist communities and contractors
- To include detailed drawings of hand washing tanks
- To review the process by which communities are informed about the various latrine options and how the choices are made
- To facilitate and support Afridev advanced repairs
- To facilitate and support the availability of full cost or subsidised sanplats and dome slabs
Full report in PDF
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