Afghanistan Bangladesh China Ghana Global WASH in Schools - UNICEF · WASH in Schools Distance-Learning Course Learnings from the Field 2014 Afghanistan Bangladesh China Ghana Global

WASH in Schools Distance-Learning CourseLearnings from the Field 2014

BangladeshBangladeshAfghanistanAfghanistan China GlobalGhana

NepalNepal Sri LankaLao PDRKyrgyzstanKyrgyzstan MongoliaMongolia

Acknowledgements

UNICEF and Emory University thank the following participants in the WASH in Schools Distance Learning Course for their

contribution to this publication: Rania Elessawi, Cormac Rooney, Abdel Haseeb Aftab, Abdus Saboor, Storay Faizy (Aghanistan),

Saiful Islam, Ruhul Amin, Siddique Abu Baker, Fiona Ward (Bangladesh national), Walidul Islam, Ranajit Das, Marcel Ratan

Guda, Furqan Ahmed, Nahid Mahmud, Mohammad Monirul Alam (Bangladesh rural), Hao Zhiming, Jiang Chaocheng,

Jiang Linghui, Ngawang Tenzin (China), George Dorgbetor (Ghana), Louise Maule, Yodit Sheido, Elynn Walter (Global), Esen

Turusbekov, Rima Imarova, Marguba Eshbaeva, Farhad Imambakiyev (Kyrgyzstan), Mahboob Ahmed Bajwa, Southalak

Sisaleumsak, Kaykhoun Khounvisith, Vongtavanh Mueangchanh (Lao PDR), Batnasan N., Enkhbat N., Myagmar J., Batbold O.,

Ariunaa P., Basandorj (Mongolia), Anu Paudyal Gautam, Nuria Leftcourt, Bishow Raj Bhatt, Samira Shakya, Shanta Karki, Ishor

Ghimire (Nepal), Dilrukshi Coomarasamy, Kanagasundaram Vasanthakumar, Saravanamuththu Sivanesasingam, Suranga De

Silva (Sri Lanka).

The course was organized by Matthew Freeman and Murat Sahin. It was facilitated by a team from the Center for Global Safe

Water at Emory University (Matthew Freeman, Shadi Saboori, Bethany Caruso and Leslie Greene), CARE (Brooks Keene), and

UNICEF (Murat Sahin, Therese Dooley, Peter van Maanen and Carlos Vasquez).

Design and layout: Sarratou Mariko | sarra2mariko.com

Editor: Jeff Sinden

For more information, please contact Murat Sahin at [email protected].

December 2014

UNICEF

Programme Division / WASH

3 United Nations Plaza

New York, NY 10017 USA

www.unicef.org/wash/schools

Commentaries represent the personal views of the authors and do not necessarily reflect the positions of the United Nations

Children’s Fund (UNICEF).

The designations employed in this publication and the presentation of the material do not imply on the part of UNICEF

the expression of any opinion whatsoever concerning the legal status of any country or territory, or of its authorities or the

delimitations of its frontiers.

This publication presents the work of students who successfully completed the WASH in Schools Distance-Learning Course.

The material is included with their permission and has been edited for length, clarity and consistency. The scientific quality is

not verified, but reflects that the authors met the course requirements and understand the basic principles of WASH in Schools

programmes.

Cover photo credits (from top left):

© UNICEF Afghanistan/2013/Pavone; © UNICEF/BANA2013-00329/Haque/Drik; © UNICEF China/2011/Hao Zhiming;

© UNICEF Ghana/2013/Ofori; © UNICEF/SLRA2013-0498/Asselin; © UNICEF/NYHQ1997-0537/Murray-Lee;

© UNICEF/2009; © UNICEF Mongolia/Batnasan N; © UNICEF/NYHQ2012-2002/Noorani; © UNICEF Sri Lanka/2014

WASH in Schools Distance-Learning Course: Learnings from the Field 2014

Contents

Introduction ......................................................................................................................................................................... 5

1. Afghanistan: Bottleneck analysis of the national WASH in Schools programme .................................. 6

2. Bangladesh: Bottleneck analysis of WASH facilities in primary schools .................................................... 14

3. Bangladesh: Bottleneck analysis of sanitation facilities in rural schools .................................................... 22

4. China: Bottleneck analysis of WASH in Schools in rural areas ........................................................................ 27

5. Ghana: Bottleneck analysis of teachers’ involvement in WASH in Schools ............................................... 37

6. Global: Bottleneck analysis of UNICEF headquarters support for WASH in Schools ............................ 45

7. Kyrgyzstan: Bottleneck analysis of WASH in Schools in rural areas ............................................................ 54

8. Lao PDR: Bottleneck analysis of WASH in Schools in educationally disadvantaged districts ................. 61

9. Mongolia: Bottleneck analysis of WASH in Schools in Khuvsgul province ................................................ 69

10. Nepal: Bottleneck analysis of the national WASH in Schools programme ................................................. 79

11. Sri Lanka: Bottleneck analysis of the national WASH in Schools programme ......................................... 87

AcronymsCFS child-friendly school

CGD-friendly child-, gender- and disabled-friendly

China CDC Chinese Center for Disease Control and Prevention

EcoSan ecological sanitation (toilets)

EMIS Education Management Information System

GES Ghana Education Service

IEC information, education and communication (materials)

KAP knowledge, attitudes and practices (survey)

KAP-B knowledge, attitudes, practices and beliefs (survey)

Lao PDR Lao People’s Democratic Republic

MHM menstrual hygiene management

MDG Millennium Development Goal

MICS multiple indicator cluster survey

NGO non-governmental organization

PTA Parent Teacher Association

SHEP School Health Education Programme (Ghana)

SHPP School Health Promotion Programme (Nepal)

SLTS School-led Total Sanitation

SLIP School Level Improvement Plan (Bangladesh)

SMC School Management Committee

PEDP3 Third Primary Education Development Programme (Bangladesh)

UNDP United Nations Development Programme

UNICEF United Nations Children’s Fund

WASH water, sanitation and hygiene

WinS WASH in Schools

WHO World Health Organization

JMP WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation



IntroductionEvery child has the right to a safe and healthy learning environment, including adequate water, sanitation and hygiene (WASH). Among its many benefits WASH in Schools (WinS) significantly reduces hygiene-related disease, increases student attendance and contributes to dignity and gender equality. As such, WinS is increasingly recognized as a critical component of sustainable development.

As the demand for WinS programmes increases, so too does the need for the knowledge and skills required to plan and scale up these programmes. The Center for Global Safe Water at Emory University and UNICEF created the WASH in Schools Distance-Learning Course to address this need. The course was introduced in November 2010 and supports applied learning on developing, executing and evaluating sustainable and inclusive WinS interventions in collaboration with local, sub-national and national stakeholders. To complete the distance-learning course, participants attend a series of online sessions, contribute to a discussion board and complete a number of written assignments. As of November 2014, 284 participants from over 60 countries have graduated from this intensive course of study. Beginning in January 2015, the class will be offered as a master’s course at Emory University’s Rollins Schools of Public Health, further expanding the reach of this novel and cost-effective programme.

The second edition of WASH in Schools Distance-Learning Course: Learnings from the Field captures 11 case studies completed as part of the course. Each case study assesses bottlenecks that constrain efforts to plan, deliver and sustain WinS programmes using a revised Tanahashi model.1 By identifying the most crucial bottlenecks, the authors were able to formulate a number of recommendations that will help to achieve our shared vision: a world where all children go to school and all schools provide a safe, healthy and comfortable environment where children grow, learn and thrive.

1 See: Tanahashi, T., ‘Health service coverage and its evaluation’, Bulletin of the world Health Organization, 56 (2), 1978: 295-303; and O’Connell, Tom and Alyssa Sharkey, Reaching Universal Health Coverage through District Health System Strengthening: Using a modified Tanahashi model sub-nationally to attain equitable and effective coverage, (New York: UNICEF, 2013).

5

A girl participates in a hygiene education class in the city of Mazar, north Afghanistan.

© UNICEF/AFGA2011-00065/Froutan

Shocib Sarkar, a Grade 3 student, washes his hands with soap at school in Sullah, Sunamganj, Bangladesh.

© UNICEF/BANA2014-00476/Mawa

AbstractWASH in Schools (WinS) is an increasingly important issue in Afghanistan. In 2010, the government approved a policy that aims to provide WASH facilities in 100 per cent of schools by 2015. However, significant challenges remain in making this goal a reality.

A modified Tanahashi Model was used to analyse and identify bottlenecks to planning and delivering WinS in Afghanistan around four areas: enabling environment, supply, demand and quality. Of the 13 indicators, 11 received scores of less than 40 per cent and are considered severe bottlenecks. While challenges were found across all four categories, the authors believe that the supply and enabling environment areas should be prioritized for action.

With regard to supply, the lack of essential commodities and human resources represent severe bottlenecks. For instance, only 13 per cent of schools were found to have hand-washing facilities. Within the enabling environment, the virtual non-existence of dedicated funding for WinS is a particularly severe constraint that requires action.

Country contextRecovering from three decades of war, Afghanistan is struggling to achieve universal access to safe drinking water and improved sanitation. Data from the Joint Monitoring Programme (JMP) for Water Supply and Sanitation indicate that the national coverage rate for improved drinking water is 57 per cent (82 per cent in urban areas and 51 per cent in rural areas). However, these figures do not take water quality into account.

A girl washes her hands at school in Herat, Afghanistan.

© UNICEF Afghanistan/2013/Pavone

Afghanistan6

1. AFGHANISTAN: Bottleneck analysis of the national WASH in Schools

programme Rania Elessawi, Cormac Rooney, Abdel Haseeb Aftab, Abdus Saboor and Storay Faizy (UNICEF)


Figure 1.1: Household access to improved drinking water, Afghanistan

National Urban Rural

% o

f h

ou

seh

old

s ac

cess

ing

im

pro

ved

dri

nki

ng

wat

er100

90

80

70

60

50

40

30

20

10

0

Source: Joint Monitoring Programme (JMP) for Water Supply and Sanitation, 2013.

57%

82%

51%

In 2010, the government approved a policy that aims to provide WASH facilities in 100 per cent of schools by 2015. In conjunction with the approval of the policy, the Ministry of Education, Ministry of Rural Rehabilitation and Development and Ministry of Public Health, along with UNICEF and the World Health Organization (WHO), signed a “Call to Action for Water, Sanitation and Hygiene in all Schools”. The adoption of the “Call to Action” has brought increased attention to WinS, which is now recognized by the government as an important factor in achieving its education goals. However, significant challenges remain in scaling up quality WinS programmes.

Methodology A modified Tanahashi Model was used to analyse and identify bottlenecks to planning and delivering WinS programmes in Afghanistan around four categories: enabling environment, supply, demand and quality. The four categories were analysed using 13 indicators, each of which was given a score out of 100.

7

The data used in the analysis was taken mostly from secondary sources, including:

• A 2010-2011 national survey carried out in 9,000 schools across 24 provinces. The survey, which was conducted by Organisational Development Consultants International on behalf of UNICEF, investigated the availability of key WinS facilities and services such as safe drinking water, sanitary toilets and hand-washing facilities.

• A 2012 knowledge, attitudes and practices (KAP) survey on WASH conducted by the Afghanistan Centre for Training and Development on behalf of UNICEF. While the survey was not focused on schools, it provides important information on WASH-related social norms and behaviours.

• The national Education Management Information System (EMIS).

• Relevant government documents, including WinS-related policies and standards.

Two girls wash their hands at Zarghona Girls School, Herat, Afghanistan. © UNICEF Afghanistan/2013/Pavone

8 Afghanistan

WASH in Schools Distance-Learning Course: Learnings from the Field 2014 9

Bottleneck analysisTable 1.1 Bottleneck table: Afghanistan

Category Determinant Indicator Source Score Bottle-neck Code

Enabling environment

Social norms1. Proportion of people who

report washing their hands after defecation

KAP Study on Hygiene: Baseline Report, 2012

7%

Legal and policy framework

2. Existence and adequacy of national WinS strategies, policies and standards

Desk review of relevant government documents

10%

Monitoring system

3. Degree to which WinS facilities and services are monitored through the national EMIS

Desk review of the national EMIS system

10%

Budget expenditure

4. Adequacy of funds allocated specifically for WinS

Situation Analysis of the WASH Sector in Relation to the Fulfilment of the Rights of Children and Women in Afghanistan, 2013

2%

Supply

Availability of commodities

5. Proportion of schools with safe drinking water

Final Analysis Report on WASH in Schools in Afghanistan, 2011

37%

6. Proportion of schools with sanitary toilets 40%

7. Proportion of schools with hand-washing facilities 13%

8. Proportion of schools where hygiene promotion materials are available

20%

Availability of human resources

9. Proportion of schools with teachers trained on hygiene promotion

UNICEF and Ministry of Education project data, 2013

5 to 10%

Demand

Financial barriers

10. Proportion of schools with dedicated budgets for the operation and maintenance of WASH facilities

Desk review of Ministry of Education annual budget allocation, 2013

0%

Socio-cultural11. Proportion of mixed-gender

schools with separate latrines for boys and girls

Final Analysis Report on WASH in Schools in Afghanistan, 2011

47%

Utilization12. Proportion of schools with

soap available for hand washing

8%

Quality Quality13. Proportion of schools

with menstrual hygiene management facilities

UNICEF and Ministry of Education project data, 2013

1%

Key:

Severe bottleneck: 0 – 39% Significant bottleneck: 40 – 59%

Not a bottleneck (on track): 60 – 100%

Enabling environmentSocial normsIndicator 1: Proportion of people who report washing their hands after defecation Social norms around key hygiene behaviours appear to be quite weak in Afghanistan. In a 2012 KAP survey, only 7 per cent of respondents (including both adults and children) reported that they wash their hands after defecation. Focus group discussions suggest that many respondents do not wash their hands with soap and water after defecating because instead they use stone, earth or toilet paper to ‘clean’ their hands.

Legal and policy frameworkIndicator 2: Existence and adequacy of national WinS strategies, policies and standardsThere have been recent improvements in the WinS-related legal and policy framework in Afghanistan. For instance, due to increased attention on safe drinking water, in 2013 the Ministry of Education and Ministry of Public Health signed a memorandum of understanding establishing cooperation for managing the quality of drinking water in schools. Subsequently, a manual on water quality in schools was drafted and disseminated in local languages. However, many challenges remain, including the lack of a national strategy for WinS. Further, while UNICEF has assisted in the development of a new recommended basic package of WinS facilities (including safe drinking water, toilets or latrines, hand-washing facilities and menstrual hygiene management (MHM) facilities in schools attended by girls), the package is yet to be endorsed by the Ministry of Education. The authors have given this indicator a score of 10 per cent as the inadequacy of the legal and policy framework represents a severe bottleneck to the scale up and sustainability of WinS programmes.

Monitoring systemIndicator 3: Degree to which WinS facilities and services are monitored through the national EMISIn theory, the national EMIS monitors a number of WinS-related indicators, including data on the number of schools with improved drinking water, improved sanitation facilities and hand-washing facilities. However, in practice the information collected through the EMIS is incomplete and inadequate. A number of additional WASH indicators, such as those related to the functionality and use of WASH facilities, should be added to the national EMIS.

Budget expenditureIndicator 4: Adequacy of funds allocated specifically for WinSDedicated funding for WinS is extremely limited in Afghanistan. A 2011 UNICEF estimate suggested that approximately US$139 million is needed annually to provide a basic level of WinS in the country, including the cost of ‘hardware’ (e.g. facilities such as hand-washing stations) and ‘software’ (e.g. capacity development and hygiene promotion). In 2013, the Ministry of Education did not allocate any dedicated funding for WinS. In the same year, external donors provided US$2.85 million specifically for WinS, representing approximately 2 per cent of the funds required. Lack of dedicated funding is a severe bottleneck that urgently needs attention.

Afghanistan10


SupplyAvailability of commoditiesIndicator 5: Proportion of schools with safe drinking waterOnly 37 per cent of the 9,000 schools surveyed across 24 provinces had safe drinking water available. Coverage rates were higher in urban schools than in remote, rural schools. It should be noted that these data were based on a self-reporting questionnaire sent to school administrators and were not verified.

Indicator 6: Proportion of schools with sanitary toilets While 40 per cent of the 9,000 schools had sanitary toilets available, this figure does not take into account the student to toilet ratio and does not consider the functionality or cleanliness of toilets. During discussions with students, many complained about the unsanitary conditions of latrines.

Currently, many schools in Afghanistan have traditional pit latrines or old ecological sanitation (EcoSan) toilets. With support from UNICEF, the government has recently developed new designs for EcoSan latrines that are more appropriate for the environmental context in Afghanistan. Revised designs will make construction of new toilets easier and more efficient. For larger schools (those with more than 16 classrooms), flush toilets are recommended. Implementation of these new designs and recommendations should help alleviate this bottleneck.

Indicator 7: Proportion of schools with hand-washing facilitiesOf the 9,000 schools surveyed, only 13 per cent had hand-washing facilities available.

Indicator 8: Proportion of schools where hygiene promotion materials are availableThe Ministry of Public Health has developed materials for teaching hygiene in schools, including a teacher’s guide and communication materials. However, these materials tend to be disseminated and used on a project basis and are not part of the standard curriculum. Hygiene promotion materials were available in approximately 20 per cent of the 9,000 schools surveyed.

Availability of human resourcesIndicator 9: Proportion of schools with teachers trained on hygiene promotionHygiene promotion has been gradually integrated into teaching training since the launch of donor-funded programmes that aim to promote child-friendly schools. However, progress has been slow as hygiene promotion is not yet included in the core teacher training programmes. UNICEF and Ministry of Education progress reports suggest that only 5 to 10 per cent of teachers are trained on hygiene promotion.

11

Wheelchair accessible toilets at Feroze Bahar School in Bamyan Province, Afghanistan. © UNICEF Afghanistan

Demand Financial barriers Indicator 10: Proportion of schools with dedicated budgets for the operation andmaintenance of WASH facilities There is no dedicated government funding for WinS in Afghanistan. The very limited funding that is available for WinS is provided by external donors and implemented by UNICEF and other development partners. These funds are typically used for constructing latrines, providing safe water, building hand-washing facilities and constructing MHM facilities. In general, funding is not available for the operation and maintenance of WinS facilities. This is a severe bottleneck that urgently needs to be addressed, as many WinS are non-functional and unclean.

Socio-cultural barriers Indicator 11: Proportion of mixed-gender schools with separate latrines for boys and girlsForty-seven per cent of the mixed-gender schools surveyed had separate latrines for boys and girls. Many of the schools without gender-segregated latrines also lack separate latrines for teachers. As a result, male teachers often use the same latrines as adolescent girls, which is problematic for reasons related to dignity and child protection.

Utilization Indicator 12: Proportion of schools with soap available for hand washingOnly 8 per cent of the 9,000 schools surveyed had soap available, making hand washing with soap virtually impossible. This is a severe bottleneck that urgently needs to be addressed.

QualityIndicator 13: Proportion of schools with menstrual hygiene management facilitiesMHM facilities are virtually non-existent in Afghanistan’s schools, representing a severe bottleneck that has a range of negative consequences for girls. In 2010 the Ministry of Education and UNICEF conducted a survey on MHM among 160 teenagers, 25 teachers and 50 mothers in 10 schools in Kabul and Parwan Provinces. The study found that 29 per cent of girls miss some time due to their menses, over 70 per cent do not shower during their menstrual period and that 50 per cent were not aware of menses until it started.

12

A menstrual hygiene management (MHM) facility at Wahdat School, Kabul, Afghanistan. © UNICEF Afghanistan

Afghanistan


ConclusionWhile significant progress has been made in the past several years, this bottleneck analysis highlights the significant challenges in scaling up WinS programmes in Afghanistan. Of the 13 indicators, 11 received scores of less than 40 per cent and are considered severe bottlenecks. Only two indicators, the proportion of schools where sanitary toilets are available and the proportion of mixed-gender schools with separate latrines for boys and girls, received scores of more than 40 per cent. However, even these relatively positive results are qualified by the fact that the indicators do not take cleanliness or functionality into account. Effective coverage rates might therefore be significantly less.

While challenges were found across all four categories, the authors believe that the supply and enabling environment areas should be prioritized for action.

Recommendations1. Develop a national WinS strategy, which links directly to the current Ministry of Education

strategic plan. The strategy should include clarification of the role of the Ministry of Education and other stakeholders. The strategy should also improve WinS-related monitoring in the EMIS, including the addition of indicators related to the functionality and use of WASH facilities.

2. Endorse the WinS basic minimum package for implementation in all schools.

3. Integrate hygiene education, including MHM, into the national teacher training curriculum and Ministry of Education staff training.

4. Determine unit costs for WinS interventions (both hardware and software) to facilitate resource mobilization.

5. Generate evidence on linkages between improved WinS and girls education.

6. Improve WinS-related monitoring in the EMIS, including the addition of indicators related to the functionality and use of WASH facilities.

References for AfghanistanAfghanistan Center for Training and Development (ACTD), Knowledge, Attitude, Practice (KAP) Study on Hygiene: Baseline Report, (UNICEF, 2012)www.humanitarianresponse.info/operations/afghanistan/document/knowledge-attitude-practice-kap-study-hygiene-actd

Government of the Islamic Republic of Afghanistan and UNICEF. Assessment of Knowledge, Attitude and Practice of Menstrual Health and Hygiene in Girls Schools in Afghanistan, 2010.

House, Sarah, Situation Analysis of the Water, Sanitation and Hygiene (WASH) Sector in Relation to the Fulfilment of the Rights of Children and Women in Afghanistan, (UNICEF, 2013).www.humanitarianresponse.info/system/files/documents/files/WASH%20SitAn%20-%20FINAL%20-%2031_8_13.pdf

Organisational Development Consultants International and UNICEF, Final Analysis Report on WASH in Schools in Afghanistan, (UNICEF, 2011).

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2. Bangladesh: Bottleneck analysis of WASH facilities in primary schools

Saiful Islam (Concern Universal), Ruhul Amin (Oxfam), Siddique Abu Baker (Caritas), Fiona Ward (UNICEF)

14

AbstractCompared to many other developing countries, access to WASH in Schools (WinS) facilities in Bangladesh is relatively high. An estimated 79 per cent of schools have access to potable water and 85 per cent of schools have at least one functional toilet. However, effective access to WinS is much lower due to the poor operation and maintenance of facilities. According to the preliminary findings of the 2014 Bangladesh National Hygiene Baseline Survey, only 24 per cent of schools have improved, functional, clean and unlocked toilets.

A bottleneck analysis was carried out to identify national-level factors that contribute to the poor operation and maintenance of WASH facilities in primary schools in Bangladesh. Twelve indicators were assessed across four categories: enabling environment, supply, demand and quality. Eight indicators scored 25 per cent or less, of which four scored 0 per cent. Of the remaining four indicators, three scored 30 per cent and one scored 50 per cent. It is clear that there are a number of critical national-level bottlenecks that need to be addressed to improve the operation and maintenance of WASH facilities in Bangladesh’s primary schools.

Girls outside new gender-segregated latrines at Chak Paylanpur Government Primary School, Pabna, Bangladesh.© UNICEF/BANA2013-00280/Haque/Drik

Bangladesh


Country contextWith an estimated 18 million children between the ages of 6 and 10 and approximately 104,000 primary schools, providing adequate WinS facilities and education to all children in Bangladesh is an enormous task. Issues related to population density and the physical environment, including vulnerability to natural disasters, further exacerbate the situation. Despite these challenges, compared to many other developing countries, access to WASH facilities in schools is relatively high. According to the government’s 2013 Annual Sector Performance Report, an estimated 79 per cent of schools have access to potable water and 85 per cent of schools have at least one functional toilet.

However, due to poor operation and maintenance of facilities, effective coverage, as defined by the proportion of students who regularly use clean and functional facilities, is much lower. The preliminary report of the 2014 Bangladesh National Hygiene Baseline Survey indicates that only 24 per cent of schools have improved, functional, clean and unlocked toilets. Unhygienic conditions and inadequate facilities contribute to low student utilization of WinS facilities, estimated by stakeholders to be approximately 25 per cent. Low utilization of WinS facilities has a number of negative consequences, including decreased school attendance and retention rates, especially among adolescent girls.

Methodology To identify national-level factors that contribute to the poor operation and maintenance of WASH facilities in primary schools in Bangladesh, a bottleneck analysis was undertaken. A modified Tanahashi model was used to identify bottlenecks around four categories: enabling environment, supply, demand and quality. The categories were assessed using one or more indicators, each of which was given a score out of 100.

Unfortunately, the almost continuous national strikes (hartals) and transport blockades from mid-November 2013 to mid-January 2014 prevented the authors from carrying out field visits. The majority of the indicators were therefore assessed through a desk review of relevant national documents and consultations with government officials, non-governmental organization (NGO) partners and other stakeholders via telephone and email.

15

Sakil Ahammed, Class VIII student, washes his hands with soap at Charadanga Boys High School, Rokonpur, Bangladesh.

© UNICEF/BANA2013-00329/Haque/Drik

Bottleneck analysisTable 2.1 Bottleneck table: Bangladesh



Legal/policy framework

1. Existence and adequacy of national WinS standards

Desk review of the national WinS standards

50%

2. Existence of government directives on national WinS standards

Desk review of government directives

0%

Budget/ expenditure

3. Adequacy of SLIP funding for the operation and maintenance of WinS facilities

Desk review of government orders on the operation and maintenance of WinS facilities

25%

Management/ coordination

4. Adequacy of support from the PEDP3 Disparity Working Group for the operation and maintenance of WinS facilities

Desk review of statement of commitment from the Disparity Working Group and discussions with stakeholders

25%

Supply

Availability of essential inputs

5. Publication of national WinS standards

Desk review of government documents

0%

6. Proportion of schools with copies of national WinS standards

Review of the distribution records, supplemented by spot checks

0%

Access to adequately staffed services and facilities

7. Proportion of schools with representatives trained on national WinS standards

Review of training records 0%

8. Proportion of head teachers who are aware of their responsibilities around WinS

Surveys at head teacher conferences, complemented by spot checks

20%

Demand

Financial access

9. Proportion of schools with a dedicated budget for the operation and maintenance of WinS facilities

Surveys at head teacher conferences, complemented by spot checks

30%

Cultural practices and beliefs/ Continuity of use

10. Proportion of schools where hygiene lessons are carried out as per the government schedule

25%

11. Degree to which hygiene lessons are taught in an interactive way

30%

Quality Quality

12. Number and adequacy of WASH-related indicators included in the Annual School Census

Review of the Annual School Census questionnaire

30%

Key:


Minor bottleneck: 51 – 75% Not a bottleneck (on track): 76 – 100%

Bangladesh16


Enabling environmentLegal/policy framework Indicator 1: Existence and adequacy of national WinS standardsNational WinS standards were drafted in 2012. While yet to be published due to unresolved technical issues, the document will provide standards on user to toilet ratios, minimum water requirements and water quality. Importantly, the draft standards clearly indicate that School Management Committees (SMCs) and Parent Teacher Associations (PTAs) are responsible for the planning and allocation of WinS resources and the maintenance of WASH facilities. Unfortunately, the draft standards do not contain concrete direction on either the practicalities of maintaining WinS facilities or minimum standards for cleanliness and maintenance. This indicator has been given a score of 50 per cent, representing a significant bottleneck.

Indicator 2: Existence of government directives on national WinS standardsCurrently, there is no government directive enforcing the national standards for WinS. The authors have given this indicator a score of 0 per cent, indicating a severe bottleneck that urgently needs to be addressed.

Budget/expenditureIndicator 3: Adequacy of SLIP funding for the operation and maintenance of WinS facilitiesThe Third Primary Education Development Programme (PEDP3) is a sector-wide fund that pools funding from nine donors and the national government, and allocates resources according to mutually agreed priorities. PEDP3 has supported the construction of WinS facilities, contributing to an increase in the proportion of schools with functional, gender-segregated toilets from 31 per cent in 2010 to 63 per cent in 2012.

However, very few resources are allocated to the rehabilitation of facilities or for training on the operation and maintenance of facilities. Through the PEDP3, each school receives BDT30,000 (US$390) annually via the School Level Improvement Plan (SLIP) grant. While the operation and maintenance of WinS facilities is listed as one of the options for the use of SLIP funds, this small grant is used to cover all discretionary purchases for schools, of which the maintenance of WinS facilities is only one of many competing priorities. Further, SLIP funds are often disbursed late or not at all. This lack of funding is a major contributor to the poor operation and maintenance of WinS facilities in primary schools across Bangladesh. This indicator has been given a score of 25 per cent, representing a severe bottleneck.

Management/coordinationIndicator 4: Adequacy of support from the PEDP3 Disparity Working Group for the operation and maintenance of WinS facilitiesThere are five separate authorities managing 34 types of primary schools in Bangladesh. Furthermore, primary and secondary education falls under two separate ministries, with primary schools falling under the auspices of the Ministry of Primary and Mass Education

17

and secondary schools falling under the authority of the Ministry of Education. Building consensus around WinS is therefore a challenge. A ‘Disparity Working Group’ has been established to support consensus building around WinS within the PEDP3. Although the group has recognized the importance of WASH facility construction, there is inadequate consensus on the importance of the operation and maintenance of facilities. On the basis of discussions with stakeholders from across the sector, this indicator has been given a score of 25 per cent.

SupplyAvailability of essential inputsIndicator 5: Publication of national WinS standardsWhile national WinS standards been drafted, due to unresolved technical issues they are yet to be published and disseminated. As a result, those responsible for WinS are not yet able to refer to the standards when planning or implementing WASH interventions.

Indicator 6: Proportion of schools with copies of national WinS standardsOnce the national standards are published, they will be printed and distributed to schools, greatly increasing the ability of head teachers, teachers and SMC members to work to meet the standards. However, due to delays in their finalization, no schools have yet received the new standards.

Access to adequately staffed services and facilities Indicator 7: Proportion of schools with representatives trained on national WinS standardsSchool representatives, including education officers, teachers and SMCs, will be trained on the national WinS standards once they are finalized and published. However, as the release of the standards has been delayed, training is yet to commence.

Indicator 8: Proportion of head teachers who are aware of their responsibilities around WinSThe forthcoming national standards will provide clarity on the WinS-related responsibilities of a range of stakeholders, including head teachers. However, as the standards are yet to be finalized and published, there remains significant confusion regarding roles and responsibilities around WinS. This indicator has been given a score of 20 per cent, representing a severe bottleneck.

Demand Financial accessIndicator 9: Proportion of schools with a dedicated budget for the operation and maintenance of WinS facilitiesInterviews with school administrators and other stakeholders suggest that approximately 30 per cent of schools have a dedicated budget for the operation and maintenance of WASH facilities, including supplies such as soap.

18 Bangladesh


Cultural practices and beliefs/continuity of use Indicator 10: Proportion of schools where hygiene lessons are carried out as per the government scheduleBased on surveys carried out at head teacher conferences and interviews with students, only 25 per cent of schools carry out hygiene lessons as often as prescribed by the government. This impedes the practice of key hygiene behaviours and the demand for well-maintained WASH facilities.

Indicator 11: Degree to which hygiene lessons are taught in an interactive wayIn general, the materials and teaching methods used during hygiene lessons are not very interactive, impeding the potential for learning. This indicator has been given a score of 30 per cent, representing a significant bottleneck. Revising the materials and methods to include games and more student participation would greatly enhance the capacity of students to practice key behaviours and increase their demand for clean and functional WASH facilities.

QualityIndicator 12: Number and adequacy of WASH-related indicators included in the Annual School CensusThe Annual School Census includes a number of WASH-related indicators. However, those included are quite basic and do not measure critical WASH parameters including access to soap, student to toilet ratios, cleanliness and functionality. As a result, the conditions and usage of WinS facilities are largely unknown, making it a challenge to advocate for improvements and lowering the perceived importance of the proper operation and maintenance of facilities. This indicator has been given a score of 30 per cent, representing a significant bottleneck.

Students attend class at Esamoti Government Primary School, Pana Sadar, Pabna, Bangladesh.© UNICEF/BANA2013-00252/Haque/Drik

19

ConclusionThere are a number of critical national-level bottlenecks that need to be addressed to improve the operation and maintenance of WASH facilities in Bangladesh’s primary schools. Of the 12 indicators assessed, eight scored 25 per cent or less, including four that scored 0 per cent. Of the remaining four indicators, three scored 30 per cent and one scored 50 per cent.

Although much progress has been made in recent years within the enabling environment, particularly through the PEDP3 pool funding mechanism and the development of national standards, the absence of the necessary government directive on the forthcoming standards and the lack of dedicated funds for the operation and maintenance of WinS facilities remain severe bottlenecks.

Within the supply category, delays in the finalization, publication and dissemination of the national WinS standards have led to bottlenecks in training education officers, teachers and SMCs on the implementation of the standards, which severely impedes the supply of adequate WASH facilities and services.

Low expectations, a lack of sense of responsibility amongst key stakeholders and passive hygiene sessions hinder the demand for quality WASH facilities and services. To ensure sustainable access to adequate, accessible, clean and functional WinS facilities, demand among users and parents needs to be increased. The Directorate of Primary Education can facilitate this process by updating the indicators in the Annual School Census and stimulating demand through regular and interactive sessions to ensure that students and other stakeholders understand the importance of having adequate and clean WinS facilities.

20

Dilapidated latrines at a rural school in Bangladesh.

©UNICEF/BANA2013/Ward

Bangladesh


Recommendations1. Finalize, publish and disseminate the draft national WinS standards.

2. Assist the government to issue an order on the implementation of the national WinS standards.

3. Increase the target on the proportion of schools with functional sanitation and water facilities to 100 per cent (from 80-95 per cent).

4. Develop standards related to the operation and maintenance of WinS facilities and incorporate them into the Fourth Primary Education Development Programme (PEDP4).

5. Include a budget for the operation and maintenance of WinS facilities in the SLIP grant system and establish standards for their timely disbursement.

6. Develop and implement a national dissemination and training plan for the forthcoming WinS standards, including the necessary budget allocation.

7. Develop and support a media campaign to create awareness around the forthcoming national WinS standards.

8. Establish a prize system to recognize schools that properly maintain clean and functional WinS facilities.

9. Schedule regular (at least once a month) sessions on hygiene promotion in school calendars.

10. Scale up School-led Total Sanitation (SLTS) across the country.

11. Increase the number of WinS-related indicators in the Annual School Census, including those related to usage and functionality.

References for Bangladesh (National)Bangladesh Bureau of Statistics, 2011 Census.

Barkat, Abul, et al., Assessment of Water, Sanitation and Hygiene (WASH) Conditions in Schools, (Dhaka: UNICEF / HDRC, 2011).www.hdrc-bd.com/admin_panel/images/notice/1390216706.assessment%20of%20water%20sanitation%20and%20hygiene%20%28wash%29%20condition%20in%20school.pdf

Directorate of Primary Education (Bangladesh), Bangladesh Primary Education Annual Sector Performance Report 2013, (Dhaka: Government of the People’s Republic of Bangladesh, 2013).

International Centre for Diarrheal Diseases Research, WaterAid Bangladesh and Ministry of Local Government Rural Development and Cooperatives, Bangladesh National Hygiene Baseline Survey: Preliminary Report, (Dhaka: WaterAid Bangladesh, 2014).www.ircwash.org/sites/default/files/bnhbs.pdf

United Nations Development Programme, 2013 Human Development Report, (New York: UNDP, 2013)www.undp.org/content/undp/en/home/librarypage/hdr/human-development-report-2013/

UNICEF, State of the World’s Children in Numbers, (New York: UNICEF, 2014). www.unicef.org/sowc2014/numbers/

WHO/UNICEF, Progress on drinking water and sanitation: Joint Monitoring Programme update 2014, (Geneva: WHO/UNICEF, 2014).www.unicef.org/gambia/Progress_on_drinking_water_and_sanitation_2014_update.pdf

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3. Bangladesh: Bottleneck analysis of sanitation facilities in rural schools

Walidul Islam (Concern Universal), Ranajit Das (Oxfam), Marcel Ratan Guda (Caritas), Furqan Ahmed, Nahid Mahmud and Mohammad Monirul Alam (UNICEF)

22

AbstractPast studies have suggested that while the availability of sanitation facilities in Bangladesh’s schools is relatively high, ‘effective coverage’, as defined by the proportion of students who regularly use clean and functional facilities, is much lower. The Tanahashi model, which uses five measures of coverage to assess the capacity of interventions to deliver their intended impact, was utilized to investigate this divergence. Quantitative data for the analysis were taken from a forthcoming post-graduate dissertation by Mohammad Monirul Alam. This information was complimented by focus group discussions conducted by the authors in ten schools.

The data confirmed that while the availability of sanitation facilities is very high (84 per cent), effective coverage is much lower (9 per cent), with coverage rates declining at each step along the coverage spectrum. The largest decline (25 per cent) was seen between ‘acceptability coverage’ and ‘contact coverage’. This decline is due to the high number of latrines that are not clean or not open for student use during school hours. The non-functionality and inaccessibility of latrines are also significant impediments to achieving effective coverage. The authors’ interviews with stakeholders suggest that unclean latrines are the result of a number of factors, including lack of responsibility for maintaining and cleaning latrines, insufficient resources for purchasing cleaning agents and maintaining latrines, lack of policies and standards on the construction of latrines, and the use of schools for other purposes, including emergency shelters.

Students wash their hands with soap and collect water from a newly installed hand pump at Putikhali Government Primary School, Rangamati, Bangladesh.


Bangladesh


Country contextBangladesh has one of the largest primary school systems in the world with more than 18 million students in over 104,000 schools. Past studies have shown that the availability of WASH in Schools (WinS) facilities in Bangladesh is relatively high. According to the government’s 2013 Annual Sector Performance Report, an estimated 79 per cent of schools have access to potable water and 85 per cent of schools have at least one functional toilet. However, due to poor operation and maintenance of facilities, effective coverage, as defined by the proportion of students who regularly use clean and functional facilities, is much lower. The preliminary report of the 2014 Bangladesh National Hygiene Baseline Survey indicates that only 24 per cent of schools have improved, functional, clean and unlocked toilets.

Methodology The Tanahashi model was used to identify bottlenecks that are impeding the effective coverage of school sanitation facilities in rural Bangladesh. UNICEF has adopted a modified Tanahashi model, which uses five measures of coverage to assess the capacity of interventions to deliver their intended impact:

• Availability coverage (People for which the service is available);

• Accessibility coverage (People who can access the service);

• Acceptability coverage (People for whom the service is acceptable);

• Contact coverage (People who actually use the service); and

• Effective coverage (People who receive quality care from the service).

Typically, the number of people accessing service provision decreases at each step along the five measures of coverage. Key bottlenecks can be identified by the size of the decrease in coverage from one measure to the next.

The authors selected an indicator to measure each of the five coverage measures. Quantitative data was taken from a forthcoming post-graduate dissertation by Mohammad Monirul Alam: ‘Maintenance of water and sanitation facilities in primary schools of Bangladesh: Issues and Challenges’. The data for the dissertation was collected through a combination of quantitative and qualitative methods in 142 schools in two districts of Bangladesh (Comilla and Rangamati). Structured interviews were conducted with 568 students (boys and girls from Grades 4 and 5) and 142 teachers or head teachers. Data collection methods also included extensive observations in all 142 schools.

This information was complimented by focus group discussions conducted by the authors in ten randomly selected schools. The discussions were conducted with students (Grades 1 to 5), parents and School Management Committee members.

23

Bottleneck analysisTable 3.1: Coverage indicators for school sanitation facilities in rural Bangladesh

Coverage measure Indicator Score

Availability coveragePercentage of required latrines available (the total number of improved latrines at surveyed schools divided by the number required based on a 50:1 student to latrine ratio)

84%

Accessibility coverage

Proportion of schools with an improved functional latrine within 50 metres of all users

65%

Acceptability coverage

Proportion of students who use an improved functional latrine that is within 50 metres of all users

51%

Contact coverageProportion of students who use an improved functional latrine that is within 50 metres of all users and which is clean and open for students during school hours

26%

Effective coverage

Proportion of schools with an improved functional latrine within 50 metres of all users, which is used by students, open during school hours, built with easy-to-clean materials, has cleaning agents available and has running water inside the latrine

9%

Source: Data from post-graduate dissertation by Mohammad Monirul Alam, collected through school visits (interviews and visual observation).

As shown in Table 3.1 and Figure 3.1, while availability coverage is very high at 84 per cent, effective coverage is only 9 per cent, with coverage rates declining at each step along the coverage spectrum. The largest decline (25 per cent) is seen between acceptability coverage and contact coverage. This decline is due to the high number of latrines that are not clean or not open for student use during school hours. The authors’ interviews with stakeholders suggest that unclean latrines are the result of a number of factors, including:

• Lack of sense of responsibility for maintaining and cleaning latrines;

• Insufficient resource base for purchasing cleaning agents and maintaining latrines;

• Lack of policies and standards on the construction of latrines, many of which are built with materials which are not easily cleaned; and

• Use of schools for other purposes, including emergency shelters.

In addition, many latrines are locked during school hours and are not available for student use.

24 Bangladesh


Figure 3.1: Coverage measures for WinS facilities in rural Bangladesh

Source: Data from post-graduate dissertation by Alam M. M., collected through school visits (interviews and visual observation).

Target Availability Accessibility Acceptability Contact Effective coverage coverage coverage coverage coverage

100

90

80

70

60

50

40

30

20

10

0

100%

84%

65%

51%

26%

9%

% o

f sc

ho

ols

The second largest decline between coverage types is seen between availability coverage and accessibility coverage. This 19 per cent decline indicates that many of the latrines that are available are not functional and/or not within 50 metres of all classrooms. A 17 per cent decline was found between adequate coverage and effective coverage. This decline is due to the non-availability of running water inside facilities (many are pour-flush latrines). There is also a significant gap (16 per cent) between the target of universal coverage of school sanitation facilities (100 per cent) and the availability of latrines (84 per cent). This is due to a lack of facilities in hard-to-reach areas and an inequitable allocation of resources.

25

A boy washes his hands at a sink that provides safe water at Kukimara Pre-Primary School in Rangamati, Bangladesh.


ConclusionWhile the availability of latrines is relatively high in rural schools in Bangladesh, effective coverage, as defined by the proportion of students who regularly use clean and functional facilities, is very low. The application of the Tanahashi model suggests that the most critical bottleneck to achieving effective coverage is related to the condition of latrines, many of which are not clean and are therefore not used by students. The non-functionality and inaccessibility of latrines are also significant impediments to achieving effective coverage.

Recommendations1. Incorporate the use of easy-to-clean materials in the construction of school latrines into

national WinS standards.

2. Incorporate the operation and maintenance of latrines and other WinS facilities into national WinS standards.

3. Allocate dedicated funds for the operation and maintenance of WinS facilities.

4. Allocate complementary funding for the repair and rehabilitation of latrines when schools are used as emergency shelters.

5. Involve school children in the cleaning and maintenance of sanitation facilities.

References for Bangladesh (Rural)Alam, M.M (2014). Operation and maintenance of water and sanitation facilities in primary schools of Bangladesh: Issues and Challenges, A research project data to be submitted in partial fulfilment of the requirements for the award of the degree of Master of Science (MSc), WEDC, Loughborough University, UK.

Barkat, Abul, et al., Assessment of the Water, Sanitation and Hygiene (WASH) Condition in School, (Dhaka: UNICEF / HDRC, 2011).www.hdrc-bd.com/admin_panel/images/notice/1390216706.assessment%20of%20water%20sanitation%20and%20hygiene%20%28wash%29%20condition%20in%20school.pdf

Directorate of Primary Education (Bangladesh), Bangladesh Primary Education Annual Sector Performance Report 2013, (Dhaka: Government of the People’s Republic of Bangladesh, 2013).

International Centre for Diarrheal Diseases Research, WaterAid Bangladesh and Ministry of Local Government Rural Development and Cooperatives, Bangladesh National Hygiene Baseline Survey: Preliminary Report, (Dhaka: WaterAid Bangladesh, 2014).www.ircwash.org/sites/default/files/bnhbs.pdf

Government of Bangladesh, WASH in Schools National Standard, (Dhaka: Government of the People’s Republic of Bangladesh, 2013).

O’Connell, Tom and Alyssa Sharkey, Reaching Universal Health Coverage through District Health System Strengthening: Using a modified Tanahashi model sub-nationally to attain equitable and effective coverage, (New York: UNICEF, 2013). www.unicef.org/health/files/DHSS_to_reach_UHC_121013.pdf

Tanahashi, T., ‘Health service coverage and its evaluation’, Bulletin of the world Health Organization, 56 (2), 1978: 295-303. www.ncbi.nlm.nih.gov/pmc/articles/PMC2395571/pdf/bullwho00439-0136.pdf

UNICEF (Bangladesh), Strategic Plan for MoRES Implementation in Bangladesh (2013 – 2014): Identification and Removal of Bottleneck towards Effective Coverage of Interventions for Children in Bangladesh, (Dhaka: UNICEF, 2013).

26 Bangladesh


4. China: Bottleneck analysis of WASH in Schools in rural areas

Hao Zhiming (UNICEF), Jiang Chaocheng, Jiang Linghui and Ngawang Tenzin (Save the Children)

27

AbstractChina’s large size, huge population and ethnic diversity make achieving adequate coverage of WASH in Schools (WinS) a significant challenge. An analysis was undertaken to identify bottlenecks to scaling up WinS in rural China. Using a modified Tahanashi model, 15 indicators were analysed around four categories: enabling environment, supply, demand and quality.

Of the 15 indicators assessed, four were found to be severe bottlenecks, nine were found to be significant bottlenecks and two received scores of over 70 per cent, indicating that they are not bottlenecks. Within the enabling environment, WinS-related regulations, standards and guidelines are relatively mature and comprehensive. However, their implementation and enforcement is a significant challenge that requires attention. The lack of designated funds for WinS from the central government is a severe enabling environment-related bottleneck as is the lack of coordination mechanisms among WinS stakeholders.

Two girls hold up their drawings on Global Handwashing Day in Sichuan, China.

© UNICEF China/2009/Yang Zhenbo

Within the supply category, the fact that only 10 per cent of schools have a health education teacher represents a severe bottleneck. There also exists a huge disparity in WinS-facilities coverage between rural and urban areas, making equality an important issue to be resolved.

The most significant demand-related bottleneck is the lack of appreciation and understanding within the education sector of the importance of WinS. The fact that only half of schoolchildren wash their hands after using the toilet is also a significant issue.

Country contextAccording to 2013 data from the national Education Management Information System (EMIS), China has approximately 97 million schoolchildren attending 229,000 primary schools (with 70 million students attending rural primary schools). In recent years, China’s rapid economic development has led to significant improvements in the country’s schools. However, these advances have also increased the disparity between rural and urban schools and between regions of the country. In eastern China, the economy is well developed and school infrastructure, including WinS, is relatively advanced. In the poorer western part of the country, school development, including WinS, has lagged significantly.

Government officials and the general public tend to place a very low priority on sanitation and hygiene in public institutions, including schools. As a result, WASH facilities in most schools are of inadequate quantity and poor quality, especially in rural areas. While there are sufficient rules and regulations in place, in some areas schools continue to be built without plans for WASH facilities as WinS is seen as a very low priority.

Methodology A modified Tanahashi model was used to identify bottlenecks to expanding and sustaining WinS programmes in rural schools in China. Four categories were analysed (enabling environment, supply, demand and quality) using 15 indicators, each of which was given a score out of 100.

Data were collected from a variety of secondary sources. Results from a 2007 Chinese Center for Disease Control and Prevention (China CDC) study on WinS in 16 provinces was used to assess a number of the indicators. A 2011 UNICEF baseline survey carried out in five provinces was also used extensively. Two indicators were assessed using 2013 data from the relatively new national EMIS.

While some of the data are national in scale, the bottlenecks and resulting recommendations are particularly relevant for rural schools, which tend to be much worse off they their urban counterparts.

China28


Bottleneck analysisTable 4.1 Bottleneck table: China

Category Determinant Indicator Source Status Bottle-neck Code


Legislation/ policy

1. Existence and adequacy of WinS regulations, standards and guidelines

Desk review of Ministry of Health/Ministry of Education guidelines

80%

2. Enforcement of WinS regulations, standards and guidelines

Desk review of Study on WASH in Schools in Rural Schools, 2007

35¨%

Budget/expenditure

3. Degree to which the central government allocates designated funds for WinS

Desk review of government budget documents

10%

Governance/partnership

4. Existence of WinS coordination mechanisms

Desk review of Ministry of Health/Ministry of Education guidelines

20%

Supply

Availability of essential commodities

5. Proportion of rural schools with access to appropriate construction materials for WASH facilities

Desk review of Technical Guidelines for Rural School Sanitary Latrines, 2007

90%

6. Proportion of rural schools with access to the centralized water supply system

EMIS, 2013

48%

7. Proportion of rural schools with access to sanitary latrines 49%

Access to adequately staffed services and information

8. Proportion of rural schools with health education staff

Study on WASH in Schools in Rural Schools, 2007

10%

Adequate geographical coverage

9. Proportion of rural schools with sanitary latrines EMIS, 2013 49%

Category Determinant Indicator Source Status Bottle-neck Code

Demand

Financial access

10. Proportion of schools with a budget for the operation and maintenance of their water supply

Baseline Survey on UNICEF WASH in Schools Project, 2011

45%

Social and cultural barriers

11. Degree to which the education sector appreciates the importance of WinS

Desk review of national education policies, strategies and budgets

20%

Continuity of utilization

12. Proportion of rural schoolchildren who wash their hands after using the toilet Study on WASH

in Schools in Rural Schools, 2007

50%

13. Proportion of rural schoolchildren who drink boiled/treated water

45%

Quality Quality

14. Proportion of rural schools where water quality meets national standards

Study on WASH in Schools in Rural Schools, 2007

37%

15. Proportion of rural schools that have an operation and maintenance plan for WASH facilities

44%

Key:

Severe bottleneck: 0 –29% Minor bottleneck: 30 – 69%


Enabling environmentLegislation/policyIndicator 1: Existence and adequacy of WinS regulations, standards and guidelinesAt the national level, WinS-related regulations, standards and guidelines are relatively mature. In 2004, the Ministry of Education and the Ministry of Health jointly released guidance on latrine construction in rural schools, providing standards on design and construction principles, management and maintenance. To help local authorities understand and follow these standards, in 2007 the Ministry of Health, UNICEF and China CDC developed Technical Guidelines for Rural School Sanitary Latrines. In addition to practical advice on the design, construction, management and maintenance of new latrines, the document also provides guidance on the modification of old latrines.

In 2010, the national government released China’s National Plan Outline for Medium and Long-Term Education Reform and Development, which acknowledges the relationship

30 China


between health and education, calling for health to be “uppermost on the mind”. In 2011, the Ministry of Education and the Ministry of Health released a regulation on “Affiliated Facilities Construction and Management in Boarding Schools”. The document provides standards for a range of WASH-related facilities in boarding schools, including water supply, latrines, hand-washing facilities, bathing facilities and garbage and sewage management. Based on the relatively mature and comprehensive nature of these standards and guidelines, the authors have given this indicator a score of 80 per cent.

Indicator 2: Enforcement of WinS regulations, standards and guidelinesThe enforcement of WinS-related regulations, standards and guidelines has been a significant challenge. For instance, the 2004 guidance on latrine construction in rural schools sets out a maximum student to latrine ratio of 15 girls per squat hole and 30 boys per squat hole (and no more than 40 boys per meter of urinal). A 2007 China CDC study that looked at 908 schools found that 75 per cent of schools met the standard for boys while only 42 per cent of schools met the standard for girls (with most schools having the same number of squat holes for boys and girls). The study found that lack of adherence to the standards have led to an especially challenging situation for girls, who typically need to wait in long lines to use the latrines.

Further, the quality of latrines in most rural schools was found to be much lower than national standards. In some cases, schools have given more attention to the beautification of latrines than to their quality. Based on the inadequate enforcement of Wins-related regulations, standards and guidelines, the authors have given this indicator a score of 35 per cent, representing a significant bottleneck.

Budget/expenditure Indicator 3: Degree to which the central government allocates designated funds for WinSCurrently, the central government does not allocate designated funds for WinS but instead provides funding for school infrastructure construction, often requiring local governments and beneficiaries to provide matching funds. This is often not possible in the poorer western and central provinces. As a result, spending on WinS facilities tends to be extremely inadequate, especially in rural areas.

Governance/partnershipIndicator 4: Existence of WinS coordination mechanismsWinS-related government programmes in China are very department-oriented and coordinated planning is virtually non-existent. The education sector focuses on academic results, without considering other aspects of schools, including WinS. The water sector works only to bring water to communities, typically ignoring water for schools. The health sector thinks mostly about medical treatment and less about prevention, often restricting services to hospitals, with no outreach to schools. There is also a lack of local school-centred and community-led participatory planning in education and WinS. Given this situation, the authors have given this indicator a score of 20 per cent, indicating a severe bottleneck.

31

Children wash their hands at Zhangliu Primary School, Gansu, China.

© UNICEF China/2011/Hao Zhiming

SupplyAvailability of essential commodities/inputsIndicator 5: Proportion of rural schools with access to appropriate construction materials for WASH facilitiesThe 2007 technical guidelines on latrines in rural schools provide construction guidelines and blueprints for four types of sanitary latrines. While construction materials were also suggested, the guidelines emphasize the need for construction to “suit local conditions”, allowing schools to be flexible in their choice of construction materials. The authors have estimated that approximately 90 per cent of rural schools are able to procure appropriate construction materials for WASH facilities.

Indicator 6: Proportion of rural schools with access to the centralized water supply systemIndicator 7: Proportion of rural schools with access to sanitary latrinesData from the national EMIS show that 48 per cent of rural schools have access to the centralized water supply and that 49 per cent have access to sanitary latrines. Both are therefore significant bottlenecks within the supply category.

Access to adequately staffed services and informationIndicator 8: Proportion of rural schools with health education staffCurrently, the quality of health education in schools is very poor. While data from China CDC and UNICEF suggest that more than 80 per cent of schools have health education classes, it is optional for the schools to offer these classes and the curriculum is generally not adapted to local conditions. Only 10 per cent of rural schools have a health education teacher and most schools have no plans to establish this post.

32 China


Adequate geographical coverageIndicator 9: Proportion of rural schools with sanitary latrinesThere is exists a huge disparity in WinS coverage between rural and urban areas in China. In fact, sanitary latrines are available in 91 per cent of urban schools but only 49 per cent of rural schools. Similarly, a centralized water supply is available in 88 per cent of urban schools but only 48 per cent of rural schools.

Demand Financial accessIndicator 10: Proportion of schools with a budget for the operation and maintenance of their water supplyOnly 45 per cent of schools have a budget for the operation and maintenance of their water supply. The lack of dedicated funding in the majority of schools leads to a situation in which many WinS facilities are unhygienic.

Social and cultural acceptabilityIndicator 11: Degree to which the education sector appreciates the importance of WinSIn China, government officials and the general public tend to place a very low priority on sanitation and hygiene in public institutions, including schools. The lack of appreciation of WinS within the education sector can be inferred from the fact that WinS facilities are generally given low priority during school construction. According to a 2011 UNICEF baseline survey, 12.5 per cent of new schools are being designed and constructed with no latrines planned. Those latrines that are constructed do not take gender or disability into account and some are constructed based on old, non-sanitary models (new models are seen as more complicated and costly than traditional pit latrines, leading some schools to avoid improved latrines even if they can afford them). Given this situation, the authors have given this indicator a score of 20 per cent, indicating a severe bottleneck.

A well-maintained school (left) and the school’s poorly maintained latrines (right) in Guizhou, China.


33

Continuity of useIndicator 12: Proportion of rural schoolchildren who wash their hands after using the toilet Approximately 50 per cent of rural schoolchildren wash their hands after using the toilet. However, the data came from a China CDC study that used self-reporting questionnaires; the actual situation may be lower as some children may know the advantages of hand washing with soap and report that they do so, but are unable to consistently undertake the practice due to a lack of facilities, soap, etc.

Indicator 13: Proportion of rural schoolchildren who drink boiled or treated waterOnly 45 per cent of rural schoolchildren drink boiled or treated water. In rural and remote areas, schools have no capacity to provide boiled water and schoolchildren either bring their own water to school or go without. In many cases, children drink water early in the morning before school, but are then unable to access safe drinking water for up to 12 hours.

QualityIndicator 14: Proportion of rural schools where water quality meets national standardsIn more than 63 per cent of the 800 rural schools sampled in the 2007 China CDC study the water supply did not meet national drinking water standards and in 90 per cent of these schools the water was contaminated with microorganisms. While this represents a significant bottleneck based on 2007 data, the situation has been improving in recent years as the country has invested heavily in water supply projects.

Indicator 15: Proportion of rural schools that have an operation and maintenance plan for WASH facilitiesThe operation and maintenance of WinS facilities is a significant problem in China, especially in remote rural areas. Only 44 per cent of schools have an operation and maintenance plan

An unhygienic solid waste disposal site outside a school in Guizhou, China.


34 China


for WASH facilities. These plans designate focal points responsible for a range of activities, including water disinfection, latrine cleaning and repair, solid waste disposal site cleaning and facility maintenance. In schools where plans are in place, WASH facilities are typically well used and maintained. But in other schools, especially in remote village schools, the operation and maintenance of WASH facilities is a serious concern. A China CDC study revealed that 50 per cent of water supply systems and 36 per cent of hand-washing facilities in rural schools were not well maintained.

ConclusionOf the 15 indicators assessed, four were found to be severe bottlenecks, nine were found to be significant bottlenecks and two received scores of over 70 per cent, indicating that they are not bottlenecks. Within the enabling environment, WinS-related regulations, standards and guidelines are relatively mature and comprehensive. However, their implementation and enforcement is a significant challenge that requires attention. The lack of designated central government funding for WinS is a severe enabling environment-related bottleneck.

Within the supply category, there exists a huge disparity in WinS-facilities coverage between rural and urban areas, making equity an important issue to be resolved. The most significant demand-related bottleneck is the lack of appreciation and understanding within the education sector of the importance of WinS. The fact that only half of schoolchildren wash their hands after using the toilet is also a significant issue.

Recommendations1. Strengthen WinS-related collaboration among government agencies, including the

National Development and Reform Commission, Ministry of Finance, Ministry of Education, Ministry of Health and Ministry of Water Resources.

2. Prioritize WinS in the national education budgeting process, including establishing a dedicated budget line for WinS.

3. Include additional WASH indicators in the national EMIS (including quantitative indicators).

4. Enforce WinS standards, regulations and guidelines, including in the school construction

inspection system.

5. Allocate adequate funds to support full-time health education teacher in schools (especially boarding schools).

6. Improve WinS capacity and knowledge among local construction companies and tradespeople.

7. Monitor WASH facilities for utilization and condition, repairing facilities when necessary. 8. Provide training to schools on WinS and student health.

9. Involve parents and community members in WinS management and monitoring.

10. Plan and implement health education and hygiene promotion campaigns in schools and communities.

35

References for ChinaChinese Center for Disease Control and Prevention, Study on WASH in Schools in Rural Schools, China, 2007.

Ministry of Education (China), Education Management Information System (EMIS), 2013.

Ministry of Education (China), National Development and Reform Committee (China), Ministry of Finance (China), Suggestions on improvement of basic education conditions in poverty areas, 2013.

Ministry of Water Resources (China), 12th Five Year Plan on Water Resources, 2011.

Ministry of Health (China), Ministry of Education (China), Guidance on Rural School Latrine Construction, 2004.

Ministry of Health (China), UNICEF, Chinese Center for Disease Control and Prevention, Technical Guidelines for Rural School Sanitary Latrines, 2007.

UNICEF, World Bank, UK Department of International Development, Baseline Survey for Western Provinces Rural WASH Project, 2005.

UNICEF, China Country Office, ‘Baseline Survey on UNICEF WASH in Schools Project’, 2011.

WHO/UNICEF, Progress on drinking water and sanitation: Joint Monitoring Programme update 2012, (Geneva: WHO/UNICEF, 2012).www.who.int/water_sanitation_health/publications/2012/jmp_report/en/

36 China


5. Ghana: Bottleneck analysis of teachers’ involvement in WASH in Schools

George Dorgbetor (UNICEF)

37

AbstractGhana’s WASH in Schools (WinS) programmes have realized significant improvements in recent years, including increased coverage of water and sanitation facilities and improved hygiene education. A bottleneck analysis was conducted to analyse WinS programmes in the country, with a special focus on teachers, who play a critical role in the implementation and sustainability of WinS activities. A modified Tanahashi model was used to assess 14 indicators around four key areas: enabling environment, supply, demand and quality.

Overall, the results of the analysis were mixed, with some indicators scoring quite highly and other receiving very low scores. Within the enabling environment, the policy and legal framework is relatively strong. However, the fact that government funding for WinS is virtually non-existent at both the national and local levels is a severe bottleneck that urgently needs to be addressed. Within the supply area, the lack of Wins-related information, education and communication (IEC) materials in schools is a severe bottleneck as is the lack of teachers trained in WinS programming. Demand-related aspects of WinS programmes were found to be very weak, with only 2 per cent of teachers conducting menstrual hygiene classes or undertaking menstrual hygiene management (MHM) activities. Quality aspects were found to be relatively strong, with 75 per cent of schools promoting WinS activities and 50 per cent of teachers incorporating water, sanitation and hygiene into their lessons.

School urinal made with local materials at Nsene Primary School, Nsene, Ghana.

© UNICEF Ghana/2013/Dorgbetor

Country contextThe Ghana Education Service (GES) is responsible for planning and delivering primary and secondary education in the country. Launched by the government in 1992, the School Health Education Programme (SHEP) is tasked with providing comprehensive health and nutrition education and ensuring the availability and use of water and sanitation facilities in schools.

Ghana’s WinS programmes have realized significant improvements in recent years. Data from the national Education Management Information System (EMIS) indicate that 61 per cent of schools have toilet facilities and 46 per cent have drinkable water available. While these coverage rates are an improvement compared to previous years, they do not take into account the status of the facilities, many of which are non-functional.

Methodology A bottleneck analysis was conducted to analyse the availability and sustainability of WinS programmes in Ghana, with a special focus on the role of teachers. A modified Tanahashi model was used to assess 14 indicators around four key areas: enabling environment, supply, demand and quality.

Data was collected through a variety of methods, including a desk review of relevant documents. The national EMIS and the results of the Government of Ghana/UNICEF 2013 WinS field monitoring activities were especially important in this regard. In addition, interviews with key informants and practitioners were conducted and visits were made to schools to observe and interact with teachers and students.

Children give officials from the Municipal Education Directorate and UNICEF a tour of their WinS facilities in Accra, Ghana. © UNICEF Ghana/2013

38 Ghana


Bottleneck analysisTable 5.1 Bottleneck table: Ghana



Social norms1. Proportion of male teachers

confident in talking about MHM

Government of Ghana/UNICEF field monitoring, 2013

50%

Policy framework

2. Existence and adequacy of WinS policies

Desk review of government policies 95%

Legal framework

3. Existence and adequacy of WinS standards and implementation guidelines

Desk review of government standards and guidelines

95%

Monitoring framework

4. Degree to which WinS facilities and services are monitored through the national EMIS

EMIS, 2012/13 5%

Budget/expenditure

5. Adequacy of government funding for WinS

Report on Tracking of Government of Ghana’s Releases of Budgetary Allocations to WASH Sector Ministries, Departments and Agencies, 2013

0%

Supply


6. Proportion of schools with WinS-related IEC materials

National Assessment of WASH in Schools in Ghana, 2013

5%

7. Proportion of schools with drinkable water

EMIS, 2012/13

46%

8. Proportion of schools with toilet facilities 61%


9. Proportion of schools with school-based health coordinators trained in WinS programming Government of

Ghana/UNICEF field monitoring, 2013

75%

Adequate coverage

10. Proportion of schools with more than two teachers trained in WinS

15%

39


Demand

Financial barriers

11. Proportion of schools with funding to repair and maintain WASH facilities


5%

Socio-cultural barriers

12. Proportion of teachers who conduct classes on MHM 2%

Quality

WinS promotion

13. Proportion of schools promoting WinS activities


75%

Integration of WinS into education curriculum

14. Proportion of teachers who incorporate WASH into their lessons

50%

Key:

Severe bottleneck: 0 – 49% Minor bottleneck: 50 – 74%


Enabling environmentSocial normsIndicator 1: Proportion of male teachers confident in talking about MHMIn schools where teachers have been trained on MHM, male teachers tend to be confident in talking about MHM (50 per cent).

Policy framework Indicator 2: Existence and adequacy of WinS policiesWith support from UNICEF, the GES recently developed and launched a national policy to direct the implementation of SHEP. The SHEP policy explicitly promotes the child-friendly school model, including the provision of safe drinking water, hand-washing facilities (including soap), child-friendly toilets and hygiene education. The new policy is comprehensive and this indicator has been given a score of 95 per cent.

Legal frameworkIndicator 3: Existence and adequacy of WinS standards and implementation guidelinesTo guide the implementation of the SHEP policy, the Government of Ghana has also developed WinS standards and implementation guidelines. The guidelines provide standard designs for WinS facilities, outline minimum student to toilet ratios, include instructions for the operation and maintenance of WASH facilities and recommend child participation

Ghana40


and community involvement in WinS programmes. As the standards and guidelines are comprehensive, this indicator has been given a score of 95 per cent.

Monitoring framework Indicator 4: Degree to which WinS facilities and services are monitored through the national EMISOnly two aspects of WinS are being collected by the national EMIS: water supply and toilet facilities. Ideally, the EMIS would monitor a larger number of parameters including hand-washing facilities, hygiene promotion activities and School Health Clubs, among others. As the lack of adequate monitoring is a severe bottleneck to scaling up WinS programmes in Ghana, this indicator has been given a score of 5 per cent.

Budget/expenditureIndicator 5: Adequacy of government funding for WinSGovernment funding for WinS is virtually non-existent at both the national and local levels. In a 2013 report, the Coalition of NGOs in Water and Sanitation, an umbrella organization, concluded that GES does not receive any funds to promote and improve WinS. School funding is provided by the government in the form of an annual ‘capitation grant’, through which each school is provided with a cash transfer based on the number of children enrolled. However, the capitation grant does not allocate specific funding for WinS. In addition, interviews with head teachers suggest that the size of the capitation grant is very inadequate and is often not received by schools in a timely fashion. The lack of dedicated and adequate government funding for WinS is a severe bottleneck; this indicator has been given a score of 0 per cent.

SupplyAvailability of essential commodities Indicator 6: Proportion of schools with WinS-related IEC materialsOnly 5 per cent of the schools assessed had WinS-related IEC materials available. This lack of IEC materials is a severe bottleneck to the scale up and sustainability of WinS programmes.

Indicator 7: Proportion of schools with drinkable waterIndicator 8: Proportion of schools with toilet facilitiesSixty-one per cent of schools assessed had toilet facilities and 46 per cent had drinkable water available. While these coverage rates are an improvement compared to previous years, they do not take into account the functionality and cleanliness of facilities. An assessment carried out for the GES found that WinS facilities were functioning properly in only 20 per cent of the schools visited. In 70 per cent of schools, facilities were poorly maintained and in disrepair. In 10 per cent of schools the facilities were hardly being used at all. Throughout much of the country, the cleaning and maintenance of WASH facilities is left mostly to older students or the ‘big boys’ in the school, with teachers and administrators having very little involvement.

41

Availability of human resources Indicator 9: Proportion of schools with school-based health coordinators trained in WinS programmingThe SHEP policy states that all schools should have a school-based health coordinator (typically a teacher at the school). Field monitoring data indicate that 100 per cent of schools have school-based health coordinators in place, 75 per cent of whom have been trained in WinS programming.

Adequate/geographical coverageIndicator 10: Proportion of schools with more than two teachers trained in WinSIn the majority of schools assessed, only head teachers and school-based health coordinators have been trained in WinS programming. In general, it is only in those schools being supported by UNICEF for their WinS activities where there are more than two teachers trained in WinS (15 per cent).

Demand Financial barriers Indicator 11: Proportion of schools with funding to repair and maintain WASH facilitiesGovernment funding for WinS is virtually non-existent in Ghana at both the national and local levels. This leads to a situation in which the vast majority of schools do not have funding to repair and maintain WASH facilities, many of which are non-functioning. This represents a severe bottleneck that urgently needs to be addressed.

A poorly maintained toilet facility at a school in Ghana.


42 Ghana


Socio-cultural barriers Indicator 12: Proportion of teachers who conduct classes on MHMOnly 2 per cent of teachers conduct classes on MHM or undertake MHM-related activities. The availability of teaching and training materials on MHM is inadequate, with female teachers relying mostly on their own experiences to support girls. Significantly, there is no system in place to ensure that teachers conduct classes on MHM and most schools do not have facilities designed to support MHM.

QualityWinS promotion Indicator 13: Proportion of schools promoting WinS activitiesApproximately 75 per cent of schools in Ghana promote WinS activities. Key activities in this regard include the promotion of hand washing with soap and personal hygiene education. While some of these activities are organized and undertaken by the school-based health coordinators, many schools rely on external organizations and non-governmental organizations (NGOs) to promote WinS activities.

Integration of WinS into education curriculum Indicator 14: Proportion of teachers who incorporate WASH into their lessonsSome aspects of WinS are integrated into the national school curriculum. Field monitoring and interviews with teachers indicate that approximately 50 per cent of teachers incorporate WASH into their lessons.

ConclusionOf the 14 indicators measured, seven were found to be severe bottlenecks to the scale up and sustainability of WinS programmes in Ghana. Three indicators were found to be minor bottlenecks and four are considered not to be bottlenecks, with scores of over 75 per cent. Within the enabling environment, the policy and legal framework is relatively strong. However, the fact that government funding for WinS is virtually non-existent at both the national and local levels is a severe bottleneck. The lack of an adequate monitoring system for WinS is also a severe bottleneck within the enabling environment.

43

Children practice washing their hands with soap at Sesekor Basic School, Assin Manso, Ghana.


Within the supply area, the unavailability of WinS-related IEC materials at schools represents a severe bottleneck, as does the lack of teachers trained in WinS programming. The maintenance of WASH facilities, many of which are non-functional, is also a significant problem. More positively, 75 per cent of schools have school-based health coordinators in place who have been trained in WinS programming.

The demand-related aspects of WinS were found to be very weak, with only 5 per cent of schools with funds for the maintenance and repair of WinS facilities and only 2 per cent of teachers conducting menstrual hygiene classes or undertaking MHM activities. Quality aspects were found to be relatively strong, with 75 per cent of schools promoting WinS activities and 50 per cent of teachers incorporating WASH into their lessons.

Recommendations1. Commit adequate, dedicated government funds to support WinS.

2. Improve and increase WinS-related training for teachers, especially at the college level.

3. Ensure the adequate supply of WinS-related IEC materials.

4. Adopt the ‘School Health Team’ approach within SHEP to facilitate in-service training of more teachers on WinS activities.

5. Revive and provide adequate support to the School Health Committee system to allow parent and community participation in WinS.

6. Strengthen coordination among WinS stakeholders including the government, United Nations agencies, donors, NGOs and private sector organizations.

References for GhanaCoalition of NGOs in Water and Sanitation (CONIWAS), Report on Tracking of Government of Ghana’s Releases of Budgetary Allocations to WASH Sector Ministries, Departments and Agencies, 2013.

Ghana Education Service, National Assessment of WASH in Schools in Ghana – Assessment Report, (Accra: Government of Ghana, 2013).

Ghana Education Service, School Health Education Programme (SHEP) Policy, (Accra: Government of Ghana, 2012).

Government of Ghana, Ghana Education Management Information System (EMIS) 2012/13.

Government of Ghana and UNICEF, WASH in Schools Field level monitoring; July – December, 2013.

Ministry of Education (Ghana), Education Strategic Plan (ESP) 2010-2020, (Accra: Government of Ghana, 2012).http://planipolis.iiep.unesco.org/upload/Ghana/Ghana_ESP_2010_2020_Vol1.pdf

44 Ghana


6. Global: Bottleneck analysis of UNICEF headquarters support for WASH in Schools

Louise Maule and Yodit Sheido (UNICEF), Elynn Walter (WASH Advocates)

45

AbstractWASH in Schools (WinS) is increasingly recognized as a critical component of sustainable development. This recognition is reflected in UNICEF’s programming, with nearly 100 country offices implementing WinS activities in recent years. This analysis examines UNICEF headquarters support for WinS programming at the country level. A modified Tanahashi model was applied to four focus categories: enabling environment, supply, demand and quality. Data collection methods included a desk review of relevant UNICEF documents and a survey of 19 UNICEF country offices.

The analysis found that good progress has been made to address key elements within the enabling environment, supply and quality categories. The limited adaptation and use of global resources at the country level (within the demand category) and the lack of a global monitoring system for WinS (within the enabling environment) were found to be significant bottlenecks that should be urgently addressed.

Children and a teacher stand outside latrines at Ecole Joyeux Lutins in Port-au-Prince, Haiti.

© UNICEF/NYHQ2011-0796/Dormino

ContextEvery child has the right to attend a school that provides safe water, sanitation and hygiene education. However, in low-income countries over half of all schools lack access to water and sanitation facilities and many do not provide hygiene education. WinS enhances the well-being of children and their families, and paves the way for new generations of healthy children.

The importance of WinS is being increasingly recognized and is included in a number of international declarations and frameworks for action. In 2002, the World Summit on Sustainable Development called for increased investment for sanitation in schools and identified children as “agents of behavioural change”. In the 2010 Parma Declaration, European Environment and Health Ministers committed to “provide every child with access to safe water and sanitation in homes, educational centres, health-care institutions and recreational settings by 2020.” The Global Partnership for Education Strategic Plan (2012-2015) incorporates the need for adequate sanitation to encourage girls’ enrolment and attendance.

The growth of the global WinS Network from 21 organizations in 2010 to 80 in 2014 provides another indication of the increasing importance of WinS for sustainable development.

Methodology This bottleneck analysis examines UNICEF headquarters support for WinS programming at the country level. A modified Tanahashi model was applied to four focus categories: enabling environment, supply, demand and quality. The categories were assessed using one or more indicators, each of which was given a score out of 100.

Data collection methods included a desk review of relevant UNICEF documents and a survey of UNICEF country offices. For the survey, 19 UNICEF country offices were randomly selected using lot quality assurance sampling, ensuring adequate representation across the seven UNICEF regions. For each of the selected countries, the UNICEF country programme documents and 2012 annual reports were analysed to determine the extent to which WinS is included in country programming. Each country office was asked to complete a brief survey. In total, 17 of the 19 country offices responded to the survey. As one of the country offices included in the sample was found not to have a WinS programme, it was removed from the survey data analysis.

It should be noted that the results of this analysis provide a rapid assessment and are not a statistically valid representation of all UNICEF country offices.

46 Global


Bottleneck analysisTable 6.1: Bottleneck table: UNICEF headquarters support for WinS programming

Category Indicator Source Score Bottle-neck Code


1. Existence of global UNICEF WinS strategies and policies

Desk review of UNICEF strategies and policies

80%

2. Proportion of country programme documents that include reference to WinS

Desk review of 19 country programme documents

53%

3. Proportion of country offices that reported WinS as a priority

Survey of 19 country offices

81%

69%4. Proportion of country offices that have sufficient funds for their WinS annual workplan

30%5. Existence of a formal global monitoring system for WinS

Desk review of WinS-related monitoring systems

Supply

6. Existence of sufficient global-level WinS standards and guidance Desk review 63%

7. Availability of global WinS publications at the country level

Survey of 19 country offices 88%

8. Availability of WinS training at the country level Desk review 80%

Demand

9. Proportion of country offices that have a dedicated focal point for WinS (who spends 50 per cent or more of their time on WinS)

Survey of 19 country offices

44%

10. Proportion of WinS focal points that have completed the WinS Distance-Learning Course

58%

11. Proportion of WinS focal points that participated in three or more WinS WebEx sessions in 2012

25%

12. Proportion of country offices that have adapted or translated two or more global WinS materials

25%

13. Proportion of country offices that requested WinS support from headquarters or their regional office in 2012

44%

Quality 14. Proportion of country offices who reported that the support received was adequate

Survey of 19 country offices 88%

Key:



47

Enabling environmentIndicator 1: Existence of global UNICEF WinS strategies and policiesUNICEF country offices depend on global organizational strategies and policies to guide the development and implementation of their country programmes. If WinS is to be effectively addressed by UNICEF at the country level, it needs to be adequately incorporated into the organization’s global strategies and plans. Within UNICEF’s current medium-term strategic plan (MTSP), the child-friendly schools model, which incorporates safe water and sanitation facilities for girls and boys, is emphasized as a vital component of Focus Area 2: Basic Education and Gender Equality. Significantly, the need to strengthen support for WASH interventions within the education sector was highlighted as a key adjustment for Focus Area 1: Young Child Survival and Development at the time of the MTSP extension in 2008. A specific indicator on WinS is also included in the revised MTSP results framework (Indicator 7.6: Proportion of primary schools with adequate water supply and sanitation facilities for girls and boys).

Within the organization’s sector strategy documents, WinS is integrated into UNICEF’s Education and WASH strategies for 2006-2015. Given this situation, the authors concluded that UNICEF’s global policies and strategies are not a bottleneck to the implementation of WinS programmes at the country level and have given this indicator a score of 80 per cent.

Indicator 2: Proportion of country programme documents that include reference to WinSIndicator 3: Proportion of country offices that reported WinS as a priorityIndicator 4: Proportion of country offices that have sufficient funds for their WinS annual workplan

A review of the country programme documents and 2012 annual reports for the 19 country offices found that just over half (53 per cent) included WinS in their results framework. More encouragingly, 81 per cent of survey respondents feel that WinS is a priority within their country programme, and over two thirds (69 per cent) of the country offices reported having sufficient funding for their WinS work plans in 2012 (see Figure 6.1).

Indicator 5: Existence of a formal global monitoring system for WinSA review of various monitoring and reporting mechanisms – including the Millennium Development Goals Monitor, the Joint Monitoring Programme (JMP) for Water Supply and Sanitation, UNICEF’s State of the World’s Children and UNESCO’s Institute for Statistics

Global48

Source: Authors’ survey of 19 UNICEF country offices

Figure 6.1: Reported availability of funds for UNICEF country office WinS workplans (2012)

25%

50%

19%

6%More than planned budget (>100%)

As planned (90 - 100%)

Less than planned budget (50% - 89%)

Significantly less than planned (< 50%)


database – confirmed that WinS is not being systematically monitored at the global level. Within UNICEF, data is extracted from country office annual reports but this information is incomplete (only 51 UNICEF country offices reported on MTSP indicator 7.6 in 2011) and is considered ‘informal’ due to gaps in country-level data. As the lack of a formal global monitoring system represents a significant bottleneck to WinS programming at the country level, the authors have given this indicator a score of 30 per cent.

SupplyIndicator 6: Existence of sufficient global-level WinS standards and guidanceThe authors identified eight areas around which guidance is needed to develop and implement WinS programmes, and mapped whether or not these are adequately covered by existing guidelines and tools.2 Seven of the categories were covered to some extent (with variations in comprehensiveness), while one category – costing/budgeting for WinS programming – was identified as requiring further development. This indicator has been given a score of 63 per cent, representing a minor bottleneck.

Indicator 7: Availability of global WinS publications at the country levelUNICEF headquarters and regional offices have been successful in disseminating key WinS materials to the country level, with 88 per cent of country offices reporting having copies of five or more priority documents available.

Indicator 8: Availability of WinS training at the country levelUNICEF headquarters has made significant progress in making WinS training opportunities available for all staff, including those at country offices. For instance, 284 participants (the majority of them UNICEF staff) have graduated from the WinS Distance-Learning Course, a five-month programme. Additional training and guidance opportunities include the WinS WebEx sessions, which use an online collaboration platform to provide updates on guidance and tools and an opportunity to showcase good practice. This indicator has been given a score of 80 per cent.

Demand Indicator 9: Proportion of country offices that have a dedicated focal point for WinS (who spends 50 per cent or more of their time on WinS)Although 75 per cent of the country offices sampled have a focal point for WinS, nearly half of these staff members spend less than half of their time on WinS programming. Overall, only 44 per cent of the country offices sampled have a focal point that spends more than 50 per cent of their time on WinS. Cross-analysis of the survey data reveals that country offices which have a focal point that spends 50 per cent or more of their time on WinS have higher scores for the remaining indicators in the demand area.

49

2 The eight areas are: standards; programme planning and design; costing / budgeting; infrastructure designs; operations and maintenance; advocacy and communications; curriculum development; and monitoring and evaluation.

Indicator 10: Proportion of WinS focal points that have completed the WinS Distance-Learning CourseFifty-eight per cent of the WinS focal points sampled have taken, or are in the process of taking, the WinS Distance-Learning Course, a very positive result after only a few years of the course being offered.

Indicator 11: Proportion of WinS focal points that participated in three or more WinS WebEx sessions in 2012Although two thirds (67 per cent) of WinS focal points participated in at least one WinS WebEx session in 2012, systematic participation was fairly low, with only 25 per cent of focal points participating in three or more sessions (see Figure 6.2).

Figure 6.2: Participation in WebEx sessions by WinS focal points (2012)


33%

17%

8%

42%

% o

f W

inS

fo

cal p

oin

ts

Indicator 12: Proportion of country offices that have adapted or translated two or more global WinS materialsVery few country offices have taken steps to translate or adapt any of the global WinS materials to the national context. Given that most of the globally available WinS guidance and tools specifically recommend adaptation to the local context, it is concerning to find that only 25 per cent of surveyed country offices have adapted or translated two or more of the global documents.

Indicator 13: Proportion of country offices that requested WinS support from headquarters or their regional office in 2012Forty-four per cent of country offices reported that they requested support from headquarters or their regional office for WinS programming in 2012.

50 Global


QualityIndicator 14: Proportion of country offices who reported that support received was adequateOf the forty-four per cent of country offices that requested WinS support in 2012, all felt their responses received adequate attention and were satisfied with the support provided, though one country office that did not specifically request support reported that in general, support was not adequate. The support provided included technical assistance and guidance by email or phone, in-country visits by headquarters or regional office staff and support for developing proposals and negotiating funding.

Conclusions and recommendationsOf the 14 indicators measured, two were found to be severe bottlenecks, three were categorized as significant bottlenecks, four were considered minor bottlenecks and five were found not to be bottlenecks. Within the enabling environment, the lack of a formal global monitoring system for WinS represents a significant bottleneck. Both the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda and the JMP have indicated that WinS should be part of the new set of global development goals. This represents a significant opportunity to raise the profile of WinS globally. It will be critical for UNICEF’s WASH and Education sections to coordinate high-level advocacy efforts to ensure that WinS goals and indicators are included within the post-2015 monitoring framework. Parallel advocacy and technical support to UNICEF country offices to ensure WinS indicators are included within country-level monitoring systems should also be prioritized.

Supply-related aspects of UNICEF’s global support for WinS programming were found to be quite strong. Progress has been made to address gaps in technical guidelines and tools, including programming within emergency contexts. The lack of materials to support national-level budgeting and costing for WinS programming is the remaining gap in this regard and should be addressed. Positive steps have also been taken to provide WinS-related training opportunities for staff at the country level, including through the development and delivery of an online learning course.

Demand-related aspects were found to be relatively weak, with two indicators categorized as severe bottlenecks and two others found to be significant bottlenecks.

A young girl uses a sanitary latrine facility at the Hamadab Primary School in Port Sudan, Sudan.

© UNICEF/SUDA2014-XX674/Noorani

The availability of global guidelines and tools has not led to translation and adaptation at the country level (only 25 per cent of country offices sampled had adapted or translated two or more global WinS materials). To rectify this situation, UNICEF headquarters could consider conducting WebEx sessions on the practical steps involved in adapting global materials to the local context, or including a chapter or separate supplement on the necessary steps to adapt a publication in future WinS publications. Headquarters and regional offices should also maintain a database and provide support in linking interested country offices with consultants or external partners who can translate publications.

Only 25 per cent of WinS focal points sampled participated in three or more WinS WebEx sessions in 2012, highlighting the need to review the content of these sessions, as well as the way in which they are ‘advertised’ and made available to staff at the country level. Feedback from survey participants indicates significant demand for sessions that are better tailored to their specific circumstances, including an increased focus on sharing country experiences. Headquarters staff should work with regional advisors to develop sessions for countries facing similar challenges (for example, the role that UNICEF can play in supporting WinS in middle-income countries) or region-specific sessions (including holding these in regional languages where possible). Making sessions open to government and other partners at the country level should also be considered.

A number of issues were identified in terms of outreach to WinS focal points. While the WASH Section at UNICEF headquarters circulates the WASH WebEx calendar each month, and ensures that recordings of all WebEx sessions are available on the WASH intranet, only half of the WinS focal points surveyed are based in WASH sections (see Figure 6.3) and are therefore included in these communications. While the WinS Advisor at UNICEF headquarters tries to maintain a separate WinS focal point email list, the information is not always up-to-date. WinS headquarters staff should work with regional education, health and WASH advisors to keep the WinS focal point list as up-to-date as possible, and to ensure that all WinS focal points are aware of the WASH WebEx calendar. Strategies to support country offices where UNICEF does not have a dedicated WinS focal point should also be developed.

The quality of support provided by headquarters and regional offices was found to be very high, with all country offices that requested support in 2012 reporting that their request received adequate attention and that they were satisfied with the support provided.

52


Figure 6.3: Section in which WinS focal point is based (2012)

WASH50%

Education25%

Health25%

Global


UNICEF headquarters has made significant progress in addressing gaps in support for WinS programming at the country level. Through advocacy and technical support to regional and country offices, UNICEF headquarters can ensure that WinS continues to build on this momentum. In order to monitor progress is addressing the bottlenecks identified in this analysis, it is recommended that subsequent reviews be conducted on a periodic basis.

References for global analysisAdams, John et al. (editors), Water, sanitation and hygiene standards for schools in low-cost settings, (Geneva: World Health Organization, 2009). www.who.int/water_sanitation_health/publications/wash_standards_school.pdf

Brikké, François and Maarten Bredero, Linking technology choice with operation and maintenance in the context of community water supply and sanitation, (Geneva: WHO and IRC Water and Sanitation Centre, 2003). www.who.int/water_sanitation_health/hygiene/om/wsh9241562153.pdf

Global Partnership for Education, Global Partnership for Education Strategic Plan 2012-2015, 2012. www.globalpartnership.org/media/docs/library/GPE_Stategic_Plan_2012-2015_English.pdf

IRC International Water and Sanitation Centre, Towards Effective Programming for WASH in Schools, (Delft: IRC, 2007). www.unwater.org/downloads/TP_48_WASH_Schools_07.pdf

United Nations, Report of the World Summit on Sustainable Development, (New York: United Nations, 2002).www.unmillenniumproject.org/documents/131302_wssd_report_reissued.pdf

UNICEF and IRC Water and Sanitation Centre, Towards Better Programming: A manual on school sanitation and hygiene education, (New York: UNICEF, 1998).www.unicef.org/wash/files/Sch_e.pdf

UNICEF, Child Friendly Schools Manual, (New York: UNICEF, 2009). www.unicef.org/publications/index_49574.html

UNICEF, Compendium of Temporary Learning Spaces (TLS), (New York: UNICEF, 2011). www.unicef.org/education/files/draft_21_11_11.pdf

UNICEF, Report on the midterm review of the medium-term strategic plan 2006-2009, (New York: UNICEF, 2008). www.unicef.org/about/execboard/files/E-ICEF-2008-18-Midterm-review-MTSP2006-2009.pdf

UNICEF, UNICEF Education Strategy, (New York: UNICEF, 2007). www.unicef.org/about/execboard/files/07-10_education_strategy.pdf

UNICEF, UNICEF water, sanitation and hygiene strategies for 2006-2015, (New York: UNICEF, 2005). www.unicef.org/about/execboard/files/06-6_WASH_final_ODS.pdf

UNICEF, Water, Sanitation and Hygiene for School Children in Emergencies: A Guidebook for Teachers, (New York: UNICEF, 2011). www.unicef.org/wash/schools/files/WASH_in__Schools_in_Emergencies_Guidebook_for_teachers_.pdf

UNICEF, Compendium of WASH in Schools Facilities in Emergencies, (New York: UNICEF, 2012). www.unicef.org/wash/schools/files/DRAFT_Compendium_of_WinS_Facilities_in_Emergencies.pdf

UNICEF, Water Sanitation and Hygiene (WASH) in Schools, Companion to the CFS Manual, (New York: UNICEF, 2012). www.unicef.org/publications/files/CFS_WASH_E_web.pdf

WASH in Schools Network, Raising Clean Hands, (New York: UNICEF, 2010). www.unicef.org/media/files/raisingcleanhands_2010.pdf

WASH in Schools Network, Raising Even More Clean Hands, (New York: UNICEF, 2012). www.unicef.org/wash/schools/files/Raising_Even_More_Clean_Hands_Web_17_October_2012(1).pdf

World Health Organization, Guidelines for Drinking Water Quality, (Geneva: WHO, 2011). www.who.int/water_sanitation_health/publications/2011/dwq_guidelines/en/index.html

World Health Organization, Parma Declaration on Environment and Health, (Geneva: WHO, 2010).www.euro.who.int/__data/assets/pdf_file/0011/78608/E93618.pdf

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7. Kyrgyzstan: Bottleneck analysis of WASH in Schools in rural areas

Esen Turusbekov, Rima Imarova, Marguba Eshbaeva and Farhad Imambakiyev (UNICEF)

54

AbstractUniversal access to functional WASH in Schools (WinS) facilities is important for the health and education of school children in Kyrgyzstan. However, WASH facilities in the country (including those in schools) have deteriorated rapidly since the collapse of the Soviet Union. This bottleneck analysis assesses WinS in Kyrgyzstan across four focus areas: enabling environment, supply, demand and quality. A desk review of relevant documents was complemented by key informant interviews, school visits and discussions with UNICEF implementing partners. The results confirm that the provision of functional WinS facilities is a significant challenge in Kyrgyzstan. Of the nine indicators measured, six received scores of less than 40 per cent, representing severe bottlenecks. Lack of adequate national funding is a particularly critical bottleneck that affects the supply of, demand for and quality of WinS facilities in the country.

Country contextMost of the water supply and sanitation infrastructure in Kyrgyzstan was built 40 to 50 years ago. Since the collapse of the Soviet Union, much of this infrastructure has deteriorated rapidly.

The Ministry of Health, the Department for Rural Water Supply, and local governments are jointly responsible for water and sanitation provision in the country. At the national level, challenges within the WASH sector include:

• Lack of a central coordinating agency;

• Absence of an official national strategy;

• Lack of a dedicated budget; and

• Out-dated standards for the design and construction of facilities.

As local governments are responsible for school infrastructure, in practice they bear responsibility for providing and maintaining

A girl drinks water from a hand pump at the Zhanbulat School in the district of Narynsky, Kyrgyzstan.

© UNICEF/NYHQ1997-0537/Murray-Lee

Kyrgyzstan


WinS facilities. While the lack of a monitoring mechanism makes it difficult to accurately measure access to WinS facilities, the best data available shows that school access to improved water supply and sanitation is significantly less than household access (see Figure 7.1).

Sources: JMP 2010; Education and Science in the Kyrgyz Republic, 2011

Figure 7.1: Household and school access to improved water and sanitation in Kyrgyzstan

Households Schools Households Schools

Access to improved water Access to improved sanitation

100

9080

70

6050

4030

2010

0

% c

ove

rag

e

98%

57%

93%

58%

Methodology This analysis identifi es bottlenecks to the sustainable scale up of WinS programmes in Kyrgyzstan. The authors conducted a problem tree and stakeholder analysis to identify key areas of analysis and then applied a modifi ed Tanahashi model across four focus areas: enabling environment, supply, demand and quality.

Data collection methods included a desk review of international, national and local documents, including a 2013 knowledge, attitude and practice (KAP) survey that was conducted in 37 schools and pre-schools in Osh, Jalal-Abad and Batken provinces. This information was complemented by key informant interviews with school administrations, teachers and UNICEF implementing partners. The authors also conducted observation visits to ten schools in Osh province.

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Bottleneck analysisTable 7.2: Bottleneck table: Kyrgyzstan



Legislation/ policy

1. Existence and adequacy of WinS policies and standards


60%

Budget/ expenditure

2. Adequacy of national funding for WinS

Desk review and key informant interviews with school administrators and local government staff

10%

Supply


3. Proportion of schools where toilet paper is available in latrines

Knowledge, Attitude and Practice Survey in 37 target schools and pre-schools in Osh, Jalal-Abad and Batken provinces, 2013

25%

Access to adequate services

4. Proportion of schools with access to improved sanitation

Education and Science in the Kyrgyz Republic, 2011

57%

Demand

Financial access

5. Adequacy of funding for the operation and maintenance of WinS facilities

Monitoring visits and key informant interviews with municipalities and school administrators

5%

Social and cultural practices and beliefs

6. Proportion of rural households that have completed improvements to their household latrine

Key informant interviews 25%

Continued use of services

7. Proportion of students who undertake hand washing on a regular basis

Knowledge, Attitude and Practice Survey in 37 target schools and pre-schools in Osh, Jalal-Abad and Batken provinces, 2013

33%

QualityQuality of services according to standards

8. Proportion of latrines in rural schools that provide privacy

Monitoring visits and focus group discussions with girls

13%

Key:



56 Kyrgyzstan


Enabling environmentLegislation/policy Indicator 1: Existence and adequacy of WinS policies and standardsThe WinS-related legal and policy environment is relatively strong in Kyrgyzstan. Access to water is a basic right guaranteed by the state, and the country has adopted the Convention on the Rights of the Child, which guarantees access to safe water for all children. The State Department of Sanitation and Epidemiological Surveillance has set ‘Sanitary Rules and Norms’ for WinS, which outline minimum standards for water quality and specify the design of sanitation and hygiene facilities.

However, some gaps exist, such as the lack of a national body to coordinate the various aspects of WinS. Further, there is no clear assignment of responsibility for the maintenance of WinS infrastructure. Given this situation, the authors have given this indicator a score of 60 per cent, representing a significant bottleneck.

Budget/expenditureIndicator 2: Adequacy of national funding for WinSThere is no dedicated national budget for WinS in Kyrgyzstan. School budgets are allocated annually from local governments, partly in the form of credit for the purchase of materials. In general, WinS is a relatively low priority for school officials, and often there is insufficient funding for schools to construct and maintain WASH infrastructure or to procure supplies such as soap. As the lack of adequate national funding for WinS represents a severe bottleneck, this indicator has been given a score of 10 per cent.

SupplyAvailability of essential commodities Indicator 3: Proportion of schools where toilet paper is available in latrinesA 2013 survey found that among 37 schools and kindergartens surveyed in southern Kyrgyzstan, only 25 per cent had toilet paper available in school latrines (according to self-reporting by teachers and pupils). In most cases, children use other things for anal cleansing (used paper, old books, clay, stones, etc.). The situation is similar with regard to soap; according to the same survey, 64 per cent of teachers and parents reported that their school had no soap for hand washing.

Access to adequate servicesIndicator 4: Proportion of schools with access to improved sanitationFifty-seven per cent of schools in Kyrgyzstan have access to improved sanitation. Since the break-up of the Soviet Union, sanitation in schools has been neglected and the condition of latrines has gradually deteriorated. When students in northern Kyrgyzstan were asked by the organization Ecological Movement how they would classify the condition of their school latrines, the vast majority classified them as “dirty”, including two-thirds of all girls surveyed. Students commonly described the school latrines as “not hygienic”, “intolerable”, and “disgusting”.

57

Girls are especially affected by unsanitary conditions and the lack of adequate facilities for menstrual hygiene management (MHM). Older girls reported that there is no water in or near latrines for cleaning, nor are there bins for the disposal of sanitary napkins. According to the Ecological Movement study, the lack of privacy makes girls “ashamed” to engage in proper menstrual hygiene.

Demand Financial accessIndicator 5: Adequacy of funding for the operation and maintenance of WinS facilitiesSchools receive an annual funding allocation from their local government to cover all costs, including staff salaries and expenses related to the maintenance of buildings. However, WinS tends to be a low priority for school administrators and the operation and maintenance of WASH facilities is often financed from ‘leftover’ funds (many school principals report that expenses for the operation and maintenance of WinS facilities are included in their budgets as “Other expenses”). As the amount of funding available for the operation and maintenance of WinS facilities is extremely inadequate, the authors have given this indicator a score of 5 per cent.

Social and cultural practices and beliefsIndicator 6: Proportion of rural households that have completed improvements to their household latrineIn general, open defecation is not practiced in Kyrgyzstan and most people have a reasonable understanding of the importance of sanitation. However, at the same time people generally avoid speaking openly about toilets and do little to improve household toilet facilities. Only 25 per cent of people interviewed by the authors reported that they had completed improvements to their household latrine (e.g. installation of ventilation pipes, painting or renovation, etc.).

Children wash their hands with soap at school in Kyrgyzstan.

© UNICEF/KIRA2013-00001

58 Kyrgyzstan


Continued use of servicesIndicator 7: Proportion of students who undertake hand washing on a regular basisAccording a 2013 KAP survey, only 33 per cent of students surveyed wash their hands at school on a regular basis. The same survey found that 53 per cent of students know that they should wash their hands before eating. This suggests that many pupils do not wash their hands at school due to the lack of hand-washing facilities and the unavailability of soap.

QualityQuality of services according to standardsIndicator 8: Proportion of latrines in rural schools that provide privacyOnly 13 per cent of school latrines, many of which are pit latrines built according to out-dated designs, provide privacy. This is a significant barrier for girls’ utilization of facilities, especially during menstruation. Girls of all ages report that they often enter the latrine block one-by-one and have friends guard the door while they use the toilet. This self-imposed privacy renders the number of holes in each latrine irrelevant, as only one or two holes are used at any given time.

ConclusionProblems with regard to WinS in Kyrgyzstan are pervasive and cut across the four focus categories. Of the nine indicators measured, six received scores of less than 40 per cent, representing severe bottlenecks. Within the enabling environment, legislative and policy aspects are quite strong. However, the lack of a dedicated national budget for WinS is a severe bottleneck. This lack of adequate national funding strongly contributes to the poor situation within the other categories, including supply. For instance, most schools cannot afford to purchase toilet paper, soap or other WinS commodities and do not have the funds to improve or maintain facilities. This in turn affects the demand for WinS (as indicated by the fact that only 33 per cent of students undertake hand washing on a regular basis) and the quality of facilities (only 13 per cent of rural schools assessed have latrines that provide privacy).

Recommendations1. Introduce a dedicated national budget for WinS.

2. Increase government and civil society investment in the maintenance and repair of existing WinS facilities.

3. Establish regular funding mechanisms for the cleaning and maintenance of WinS facilities.

4. Update national standards for WinS, including improved standards for school latrines to include provisions for privacy

5. Ensure that all newly constructed school latrines are built in accordance with global standards (including adequate privacy and accessibility for children with special needs)

59

Kyrgyzstan60

6. Ensure that hygiene education is taught systematically and appropriately in all schools.

7. Improve the monitoring of WinS infrastructure, with particular attention to functionality and maintenance.

8. Undertake a formal nationwide assessment of WinS, including collection of data regarding hygiene education and funding for the operation and maintenance of facilities.

References for KyrgyzstanCAIConsulting, Knowledge, Attitude and Practice Survey in 37 target schools and pre-schools in Osh, Jalal-Abad and Batken provinces: baseline report, (UNICEF, 2013).

Central Asian Alliance for Water (CAAW), Survey of Water, Sanitation, and Hygiene Situation in Schools and Primary Health Care Centres in Osh and Jalal-Abad, (UNICEF, 2011).

Ecological Movement (BIOM), Study of situation of water, sanitation and hygiene knowledge, attitude and practice in randomly selected schools and primary health care centres in Naryn, Issyk-Kul, Talas provinces in the northern region of Kyrgyzstan, (BIOM, 2011).

Junge, Nils and Suyunbek Syrdybaev, No one in charge: Kyrgyzstan’s Water supply and Sanitation Sector, (ADB, 2012).

National Statistics Committee of the Kyrgyz Republic and UNICEF, Education and Science in the Kyrgyz Republic, 2011.

Naumann, Matthew, Situation Assessment of children in the Kyrgyz Republic, (New York: UNICEF, 2011).www.unicef.org/kyrgyzstan/Situation_analysis_ENG.pdf

World Health Organization and UNICEF, Progress on Sanitation and Drinking-water: 2010 Update, (Geneva: WHO, 2010). www.wssinfo.org/fileadmin/user_upload/resources/1278061137-JMP_report_2010_en.pdf


8. Lao PDR: Bottleneck analysis of WASH in Schools in educationally disadvantaged districts

Mahboob Ahmed Bajwa and Southalak Sisaleumsak (UNICEF), Kaykhoun Khounvisith (Government of Australia), Vongtavanh Mueangchanh (Participatory Development Training Centre)

AbstractOnly 43 per cent of primary schools in the Lao People’s Democratic Republic (Lao PDR) have both functional toilets and water supplies. The government has acknowledged that more needs to be done to improve the quality and sustainability of WASH in Schools (WinS) in the country’s schools.

By assessing a range of indicators across four key areas (enabling environment, supply, demand and quality), this bottleneck analysis is intended to help the government of Lao PDR and partners to improve the planning and delivery of WinS.

Of the 10 indicators analysed, three were found to be severe bottlenecks, four represent significant bottlenecks, two are considered minor bottlenecks and one was found to be on track. Within the enabling environment, the legal and policy framework for WinS is relatively strong. However, the fact that WinS programmes in Lao PDR are almost totally dependent on external donors for funding represents a severe bottleneck. With virtually no teachers or school staff trained on the operation and maintenance of WASH facilities, human resource capacity is a significant bottleneck within the supply area. Demand-related bottlenecks were also found. Only 25 per cent of rural children use latrines at school even when they are available and functional, representing a severe bottleneck. Finally, the quality of facilities is also a concern. Only 30 per cent of rural schools have WASH facilities that are appropriately designed.

Country contextLao PDR has an abundance of water resources. However, very little of the water available is developed for drinking. According to 2014 data from the WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation, 28 per cent of the country’s population is without access to an improved water supply and 35 per cent live without improved sanitation (i.e. without access to an easily accessible, private and safe latrine). As a result, a high proportion of the population suffers from diseases related to poor water quality and inadequate sanitation.

Within the country, there exists a significant disparity between urban and rural areas in terms of access to water and sanitation facilities. There are also disparities between rural areas; sanitation coverage in rural areas with road access is twice that in rural areas without road access.

62

In the education sector, Lao PDR faces a number of challenges related to access, quality and equity. To help address these challenges, the government has developed the Education Sector Development Framework, which is being funded through the Education for All-Fast Track Initiative Catalytic Fund and implemented in 56 ‘educationally disadvantaged’ districts (i.e. districts with especially low enrolment rates). As part of these efforts, the Ministry of Education and Sports has launched the ‘Schools of Quality’ initiative. The initiative seeks to create learning environments that are healthy, protective, inclusive and gender-responsive.

With regard to WinS, the government has acknowledged that more needs to be done to improve the quality and sustainability of water and sanitation infrastructure and hygiene education in the country’s schools.

Methodology A modified Tanahashi model was used to identify bottlenecks to planning and delivering WinS programmes in Lao PDR around four areas: enabling environment, supply, demand and quality. The areas were assessed through the use of 10 indicators, each of which was given a score out of 100.

To measure the indicators, the analysis utilized mainly secondary data, including information from the national Education Management Information System (EMIS), UNICEF project data and relevant government documents. In addition, qualitative information was obtained from focus group discussions conducted in November 2012 with school principals, teachers, village chiefs and villagers.

While the data used in the analysis are national in scope, the findings are particularly relevant for schools in rural, educationally disadvantaged areas where the situation is particularly difficult.

Putsadee, 10, washes her hands at a newly-installed waterpoint at Meesai Public School, Lao PDR. © UNICEF/LAOA2011-00081/Tattersall

Lao PDR


Bottleneck analysisTable 8.1: Bottleneck table: Lao PDR




1. Adequacy of WinS legislation, policies and standards

Water, Sanitation and Hygiene in Primary Schools in South East Asian Countries, 2013

76%

Budget/expenditure

2. Adequacy of funds allocated to WinS

Annual Education Report, 2012 20%

Supply

Availability of essential commodities/inputs

3. Proportion of schools with functional toilets

EMIS, 2012/2013

53%

4. Proportion of schools with functional water supply facilities

56%


5. Proportion of schools with teachers trained on hygiene education

UNICEF programme monitoring data and focus group discussions

35%

6. Proportion of schools with teachers trained on the operation and maintenance of WASH facilities

0%

Geographical access

7. Proportion of rural off-road schools with WASH facilities 30%

Demand

Financial barriers

8. Proportion of schools with resources for the operation and maintenance of WASH facilities UNICEF programme

monitoring data and focus group discussions

30%

Utilization/social cultural barriers

9. Proportion of rural children using school latrines if available and functional

25%

Quality Quality10. Proportion of schools with

WASH facilities that are appropriately designed

UNICEF programme monitoring data 30%

Key:



63

Enabling environmentLegal and policy frameworkIndicator 1: Adequacy of WinS legislation, policies and standardsThere is increasing appreciation among policy makers in Lao PDR of the importance of WinS. Government targets seek to reach 50 per cent of primary schools with WASH facilities by 2015. The recently approved education quality standards also incorporate WinS.

However, the implementation of policies at the provincial and district level is limited. While the current policy framework is not a barrier to scale up, more effort is needed at the local level to translate policies into action. Additional local evidence for WinS and support for improved monitoring is also needed. As the Wins-related legal and policy framework is not a bottleneck to scale up, the authors have given this indicator a score of 76 per cent.

Budget/expenditureIndicator 2: Adequacy of funds allocated to WinSWinS programmes in Lao PDR rely mainly on external support, with the government allocating very limited funding. Budget/expenditure is therefore a severe bottleneck within the enabling environment and this indicator has been given a score of 20 per cent.

A teacher shows children how to wash their hands and explains the importance of proper hygiene at a primary school near Kapae Village, Lao PDR.

© UNICEF/NYHQ2012-1893/Noorani

Lao PDR64


SupplyAvailability of essential commodities/inputs Indicator 3: Proportion of schools with functional toiletsIndicator 4: Proportion of schools with functional water supply facilitiesFifty-three per cent of primary schools across in Lao PDR have functional toilets and 56 per cent have functional water supplies. Only 43 per cent of schools have both functional toilets and water supplies (see Figure 8.1). In general, coverage in urban schools is higher than in rural schools and coverage in rural schools with road access is higher than in rural schools without road access. ‘Complete’ schools (those with Grades 1 through 5) tend to have higher water and sanitation coverage than ‘incomplete’ schools.

Source: EMIS, 2012-2013.

Figure 8.1: Water and sanitation coverage in primary schools in Lao PDR, 2012

Functional water Functional Functional water supply toilets and toilets

Availability of human resources Indicator 5: Proportion of schools with teachers trained on hygiene educationWhile hygiene education has been incorporated into ‘School of Quality’ trainings for teachers and administrators, current modules do not focus on complementing knowledge with practical activities. Thus, while some schools have both the ‘hardware’ and ‘software’ components of WinS, they are not well integrated. UNICEF project data indicate that only 35 per cent of schools have teachers trained on hygiene education.

Indicator 6: Proportion of schools with teachers trained on the operation and maintenance of WASH facilitiesAlmost no teachers or school staff have been trained on the operation and maintenance of WASH facilities. As a result, broken WinS facilities are often left abandoned.

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Geographical access Indicator 7: Proportion of rural off-road schools with WASH facilitiesGeographic access is also a significant barrier to supply. Only 30 per cent of rural primary schools without road access have WASH facilities (less than rural schools with road access and much less than urban schools). Many of these schools are made from wood or bamboo and do not have electricity, water or latrines.

Primary school students carry water for use in school hygiene in Lao PDR.

© UNICEF/2009

Demand Financial barriers Indicator 8: Proportion of schools with resources for the operation and maintenance of WASH facilitiesApproximately 30 per cent of schools have resources for the operation and maintenance of WASH facilities. As per the 2009 School Construction Guidelines, routine maintenance of schools is considered ‘minor work’ and is the responsibility of local communities. Schools collect small student fees at the start of the academic year to support recurring costs. However, many communities, especially in rural areas, do not have sufficient funds and facilities are often neglected. In order to keep toilet facilities clean, many are kept locked during school hours, requiring students to request the keys to use them, thereby decreasing demand.

66 Lao PDR


Utilization/social cultural barriers Indicator 9: Proportion of rural children using school latrines if available and functionalOnly 25 per cent of rural children use latrines even when they are available and functional, representing a severe demand-related bottleneck. As most children in rural areas have no access to latrines at home, it is difficult to stop open defecation at school. In addition, young children are often afraid of using the latrines. The latest primary school curriculum includes lessons on the use of latrines. While welcome, this will not automatically lead to behaviour change as there remains a lack of emphasis on demonstrating the use of latrines and putting knowledge into practice.

QualityIndicator 10: Proportion of schools with WASH facilities that are appropriately designedWhile design and construction guidelines exist, the lack of sufficient funds often compromises the quality of WASH facilities; only 30 per cent of rural schools have WASH facilities that are appropriately designed. Further hindering quality, some designs are not appropriate to local conditions, including the risk of flooding and other natural disasters.

ConclusionOf the 10 indicators analysed, three were found to be severe bottlenecks, four represent significant bottlenecks, two are considered minor bottlenecks and one was found to be on track. Within the enabling environment, the legal and policy framework for WinS is relatively strong. However, the fact that WinS programmes in Lao PDR are almost totally dependent on external donors for funding represents a severe bottleneck.

Human resource capacity is a significant bottleneck within the supply area. Virtually no teachers or school staff have been trained on the operation and maintenance of WASH facilities. Geographic access is also a significant barrier to equitable scale up; only 30 per cent of rural off-road schools have WASH facilities.

Within the demand area, only 25 per cent of rural children, most of whom do not have latrines at home, use latrines at school even when they are available and functional. The quality of facilities is also a concern; only 30 per cent of rural schools have WASH facilities that are appropriately designed.

Recommendations1. Create a dedicated annual budget for WinS.

2. Develop stronger evidence on the negative impact of limited resource allocation for WinS and support the Ministry of Education and Sports to advocate for increased resources.

3. Strengthen the EMIS with regard to WinS and report data on an annual basis.

4. Ensure that all teachers are trained on the operation and maintenance of WASH facilities.

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5. Improve hygiene education, including increased use of the ‘Blue Box’, a participatory toolkit to engage teachers and children in the efficient use of WASH facilities.

References for Lao PDRMcLaughlin, Robert, Hygiene Education Toolkit Evaluation, (UNICEF and Ministry of Education (Lao PDR): 2010).www.unicef.org/evaldatabase/files/LAO-2010-001-2.pdf

Ministry of Education and Sports / Ministry of Health (Lao PDR), National School Health Policy, 2010.

Ministry of Education and Sports (Lao PDR), Annual Education Report, 2012.

Ministry of Education and Sports (Lao PDR), Education Management Information System 2012/2013, 2012

Ministry of Education and Sports (Lao PDR), School Construction Guideline, 2009

Ministry of Health (Lao PDR), National Plan of Action for Rural Water Supply, Sanitation and Hygiene, 2012.

UNICEF, Analysis of National Primary School Data for Water and Sanitation in Schools for 2008/2009 school year, 2010.

UNICEF, Water, Sanitation and Hygiene in Primary Schools in South East Asian Countries, (Bangkok: UNICEF, 2013)www.unicef.org/eapro/WashinSchools_Edu_24Dec13.pdf

WHO/UNICEF, Progress on drinking water and sanitation: Joint Monitoring Programme update 2014, (Geneva: WHO, 2014). www.who.int/water_sanitation_health/publications/2014/jmp-report/en/

68 Lao PDR


9. Mongolia: Bottleneck analysis of WASH in Schools in Khuvsgul province

Batnasan N. and Enkhbat N. (UNICEF Mongolia), Myagmar J. and Batbold O. (Ministry of Education and Science), Ariunaa P. (Action Contre la Faim Mongolia), Basandorj (Mongolian University of Science and Technology)

69

AbstractDue to its climate, which features extreme cold during the winter and permafrost throughout much of the country, building and maintaining WASH in Schools (WinS) infrastructure in Mongolia is both challenging and extremely expensive. This analysis focuses on WinS in Khuvsgul aimag (province), where much of the population is particularly vulnerable. To identify bottlenecks to planning and implementing WinS, ten indicators were assessed across four categories: enabling environment, supply, demand and quality.

Of the 10 indicators assessed, three were found to be severe bottlenecks, five represent significant bottlenecks and two were found to be minor bottlenecks. Bottlenecks within the enabling environment include a weak policy and legal framework as well as insufficient funding. Within the supply area, all schools and kindergartens have dedicated staff for the operation and maintenance of WASH facilities. However, limited progress has been made on the availability of essential services; only 29 per cent of schools and kindergartens have access to functional WASH facilities.

Under the demand area, the lack of a dedicated budget for the operation and maintenance of WASH facilities represents a severe bottleneck. The almost total lack of improved, gender-segregated toilets is another severe constraint that affects demand. Quality aspects were found to be relatively strong, with 54 per cent of schools meeting national standards for their water supply systems and 43 per cent of students stating that they always wash their hands before eating meals.

An outdoor latrine facility at a rural school in Mongolia.

© UNICEF Mongolia/Batnasan N

Country contextAccording to data from the WHO/UNICEF Joint Monitoring Programme (JMP) for Water and Sanitation, the proportion of Mongolia’s population with access to improved water sources was 85 per cent in 2012 (compared to 68 per cent in 2000), suggesting that the country has met the Millennium Development Goal (MDG) target for drinking water. JMP data also indicate that 56 per cent of the population was accessing improved sanitation facilities in 2012, suggesting that Mongolia has has not yet met the MDG target on sanitation. However, there are significant differences between JMP data and national estimates on both water and sanitation coverage in the country.

There exists a large urban/rural divide in access to water and sanitation, with rural coverage being much lower. However, even in urban areas, particularly the suburban areas of Ulaanbaatar, many people live without adequate WASH services.

A typical outdoor latrine at a rural kindergarten (left) and a new outdoor school latrine with light and heat (right).


While Mongolia is experiencing a period of rapid urbanization, the country remains sparsely populated. As many rural Mongolians continue to practise a nomadic lifestyle, moving several times a year in search of better pastureland for their herds, many rural children attend boarding schools. Most rural school dormitories face significant challenges in providing children with safe and healthy environments. Important factors in this regard include the use of non-standard buildings as dormitories, overcrowded rooms, lack of adequate heating systems and

70 Mongolia


inadequate WASH facilities. Most dormitories get water from outside water kiosks and wells. Outdoor latrines are often unhygienic and are usually located a significant distance from school buildings. The inadequate and unhygienic state of latrines often results in open defecation. There also exists a lack of menstrual hygiene management (MHM) facilities.

A typical dormitory WASH facility (left) and a new WASH facility at a kindergarten (right).


Methodology To identify bottlenecks to scaling up and sustaining WinS programmes in Mongolia ten indicators were assessed across four categories: enabling environment, supply, demand and quality.

The analysis focused on schools and kindergartens in Khuvsgul province, which is located within the Khangai region of Mongolia. JMP data indicate that much of the population of Khuvsgul province is particularly vulnerable.

The data used in the analysis were taken mostly from a UNICEF project baseline study conducted in 2012 in 12 schools and 12 kindergartens across Khuvsgul province (for a project supported by the Australian Government). The authors undertook field visits to the same schools and kindergartens. Other information was gathered through a desk review of relevant government documents.

71

Bottleneck analysisTable 9.1: Bottleneck table: Mongolia



Policy/legal framework

1. Existence and adequacy of WinS-related legislation, standards and policies

Desk review of government legislation and policies

30%

Budget/ expenditure

2. Adequacy of government funding for WinS

Desk review of government budgetary documents

5%

Supply

Availability of essential facilities

3. Proportion of schools and kindergartens with access to functional WASH facilities

WASH in Schools and Kindergarten Inception Report to the Australian Government, 2012 and authors’ field visits

29%

Availability of adequately staffed services, facilities and information

4. Proportion of schools and kindergartens with teachers/staff trained on hygiene promotion and dedicated staff for the operation and maintenance of WASH facilities

50%

Availability of soap

5. Proportion of schools and kindergartens with soap available at hand-washing stands

30%

Demand

Financial access

6. Proportion of schools and kindergartens with funds for the operation and maintenance of WASH facilities


5%

Cultural practices and beliefs

7. Proportion of schools with gender-segregated, improved indoor toilets

0%

Continuity of use

8. Proportion of schools maintaining WASH facilities as per national standards

38%

QualityQuality of services and goods

9. Proportion of schools with water supply systems that meet hygiene standards


54%

10. Proportion of schoolchildren who wash their hands with soap before eating

Global School-based Student Health Survey, 2010

43%

Key:



72 Mongolia


Enabling environmentPolicy/legal frameworkIndicator 1: Existence and adequacy of WinS-related legislation, standards and policiesThe Ministry of Education and Science is the lead agency for WinS programming in Mongolia. In 2004, the ministry approved child-friendly school (CFS) and child-friendly kindergarten policies, which cover most of the five dimensions of CFSs. In 2013, the government formed a WinS working group at the national level, which is responsible for developing standards, guidelines and monitoring systems. The working group consists of representatives from line ministries, United Nations agencies and non-governmental organizations (NGOs). However, clarity around the roles and responsibilities of national and provincial governments remains a challenge.

While the government has made efforts to develop WinS policies and legislation, they are generally not yet in place. The authors have therefore given this indicator a score of 30 per cent, representing a significant bottleneck.

Budget/expenditure Indicator 2: Adequacy of government funding for WinSIn 2011 only 1.7 per cent of the national budget for schools was dedicated to drinking water and wastewater management (the figure was 1.1 per cent for kindergartens). In rural areas, this funding is used mainly for the collection and transportation of water and the management of wastewater. In urban centres, the funds are used to pay water supply and wastewater management bills.

Within Khuvsgul province the percentage of the total school and kindergarten budget allocated to WinS in 2013 was 1.38 per cent and 0.3 per cent, respectively. There was no budget allocation for the maintenance and improvement of WinS facilities. As the portion of the education budget dedicated to WinS is inadequate at the national level and within Khuvsgui province, the authors have given this indicator a score of 5 per cent, representing a severe bottleneck.

Children use a WASH facility at a kindergarten in Mongolia.


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Supply

Availability of essential facilitiesIndicator 3: Proportion of schools and kindergartens with access to functional WASH facilitiesOf the 12 schools assessed during UNICEF’s 2012 baseline analysis, only one had indoor toilets (most have outdoor pit latrines). The average student to latrine ratio in the 12 schools and 12 kindergartens was 34:1 and 18:1, respectively.

Groundwater wells, lakes and rivers are the main sources of water for schools and kindergartens in Khuvsgul province. Of the 12 schools assessed, four collect water from a lake or river and the remaining eight have access to groundwater wells. The average time needed to carry water from the source to the school varies from five to 30 minutes.

Data on water availability was collected from six of the 12 schools. As indicated in Figure 9.1, water availability per student per day varies from 0.8 litres to 4.4 litres. The World Health Organization (WHO) recommends five litres of water per day for schoolchildren and staff and 20 litres per person per day for children in residential boarding schools.

Water for a school in Mongolia being transported by tractor.


Mongolia74


Source: UNICEF Mongolia, WASH in Schools and Kindergarten Inception Report to the Australian Government, Ulaanbaatar, 2012.

Figure 9.1: Water availability in six schools in Khuvsgul province (litres per student per day)

Galt Arbulag Khatgal Tarialan Ulaan-Unl Khankh village

School

5

4.54

3.5

32.5

21.5

1

0.5

0

Wat

er a

vaila

bili

ty (l

itre

s p

er

stu

den

t p

er d

ay)

4.4

2.01.7

0.8

4.1

1.5

The water supply situation in kindergartens is similar to that in schools. Data from three kindergartens show that the availability of water per child per day varies from 2.4 litres to 5.6 litres.

During fi eld visits, it was observed that none of the outdoor latrines have hand-washing stations (which is common due to the cold winter conditions). Children therefore have to go back to the classrooms or dormitories to wash their hands after using the toilet. Signifi cantly, the dining rooms located in dormitories and schools do not have hand-washing stations where children can wash their hands before meals.

Based on the fi ndings presented above, the authors estimate that 29 per cent of schools and kindergartens in Khuvsgul province have access to functional WASH facilities.

Availability of adequately staffed services, facilities and informationIndicator 4: Proportion of schools and kindergartens with teachers/staff trained on hygiene promotion and dedicated staff for the operation and maintenance of WASH facilitiesAll schools and kindergartens visited by the authors have dedicated staff for the operation and maintenance of WASH facilities. All reported that either a cleaner, heating system technician or water carrier is responsible for water collection and storage, as well as maintenance of water supply facilities. In addition, some schools have schoolteachers assigned to monitor water supply facilities. All schools use carts (manual or motorcycle-driven) to carry water from the source to the schools.

75

76

Each of the schools has a doctor or medical staff person who is responsible for children’s health. However, due to a lack of guidelines and manuals for teachers, there are no consistent approaches and methods for hygiene promotion and education. None of the teachers or school health professionals has received training on hygiene promotion and education.

Based on their visits, the authors estimate that 50 per cent of schools and kindergartens in Khuvsgul province have teachers and or staff trained on hygiene promotion and dedicated staff for the operation and maintenance of WASH facilities.

Availability of soapIndicator 5: Proportion of schools and kindergartens with soap available at hand-washing standsDuring the baseline survey, it was observed that soap is generally not available at hand-washing stations. However, children reported that they bring their own soap from home for hand washing. Based on this situation, the authors have given this indicator a score of 30 per cent, representing a significant bottleneck.

Demand Financial accessIndicator 6: Proportion of schools and kindergartens with funds for the operation and maintenance of WASH facilitiesThere is no dedicated budget for the operation and maintenance of WinS facilities. The schools and kindergartens visited during the 2012 baseline study reported that part of the budget allocated for water and wastewater management is used to maintain WinS facilities. Some schools also use these funds to support the salaries of the operation and maintenance staff. Given this situation, the authors have given this indicator a score of 5 per cent.

Cultural practices and beliefsIndicator 7: Proportion of schools with gender-segregated improved indoor toiletsNone of the schools visited had improved, gender-segregated toilets for students. This is similar to the situation found across the country, where outdoor latrines provide only limited privacy for girls.

Continuity of use Indicator 8: Proportion of schools maintaining WASH facilities as per national standardsThe authors estimate that approximately 38 per cent of schools and kindergartens in Khuvsgal province are maintaining WASH facilities as per national standards. Although all schools and kindergartens have access to drinking water, the quality and quantity of the water may not meet national standards.

Mongolia


QualityQuality of services and goodsIndicator 9: Proportion of schools with water supply systems that meet hygiene standardsOf the schools currently collecting their water from an unprotected source (such as a river or lake), 100 per cent reported that they treat the water by boiling, chlorination or other methods before consumption.3 However, regular monitoring and testing of water quality at source or the point-of-use is generally not done. Given this situation, the authors have given this indicator a score of 54 per cent.

Indicator 10: Proportion of schoolchildren who wash their hands with soap before eatingAccording to the 2010 Global School-based Student Health Survey, 43 per cent of students in Mongolia said that they always washed their hands before eating meals during the last month, while 33 per cent said they usually washed their hands before eating.

ConclusionOf the 10 indicators analysed, three were found to be severe bottlenecks, five represent significant bottlenecks and two were found to be minor bottlenecks. The analysis found that the enabling environment requires significant strengthening. Bottlenecks in this regard include inadequate legislation, policies and standards as well as insufficient funding.

Within the supply area, good progress has been made in terms of human resources. All schools and kindergartens assessed reported that they have dedicated staff for the operation and maintenance of WASH facilities. However, limited progress has been made with regard to the availability of essential services; only 29 per cent of schools and kindergartens have access to functional WASH facilities. The general unavailability of soap at hand-washing stations is another supply-related bottleneck that should be addressed.

Under the demand area, the lack of a dedicated budget for the operation and

77

Water for a school in Mongolia being transported by hand. © UNICEF Mongolia/Batnasan N

3 In Mongolia drinking unboiled water is uncommon in rural areas. Schools and kindergartens provide black tea or milk tea (traditional Mongolian tea, known as “Suutei Tsai”).

maintenance of WASH facilities represents a severe bottleneck. The almost total lack of improved, gender-segregated toilets is another severe constraint. More progress has been made within the continuity-of-use indicator, with 38 per cent schools and kindergartens maintaining WASH facilities as per national standards.

Quality aspects were found to be relatively strong, with 54 per cent of schools meeting national standards for their water supply systems and 43 per cent of students stating that they always washed their hands before eating meals during the last month.

Recommendations1. Develop a long-term national strategy on WinS.

2. Define minimum standards for WASH facilities and services at schools and kindergartens.

3. Improve the evidence base by:

• Documenting and disseminating lessons learned from the Khuvsgul province project;

• Conducting a nationwide WinS survey;

• Undertaking longitudinal research on the impact of WinS interventions; and

• Improving the national Education Management Information System (EMIS).

4. Design and implement a distance-learning course on WinS for teachers and school-based health professionals.

5. Develop and adapt a minimum ‘software’ package, including a hygiene education toolkit similar to the ‘Blue Box’ concept.

6. Implement an adaptation of the “Three Stars School”, including daily group hand washing and daily toilet cleaning.

7. Improve outdoor latrines or replace them with indoor toilets that are secure, accessible and hygienic.

References for MongoliaAdams, John et al. (editors), Water, sanitation and hygiene standards for schools in low-cost settings, (Geneva: World Health Organization, 2009). www.who.int/water_sanitation_health/publications/wash_standards_school.pdf

Badloe, Chander and Murat Sahin, Mongolia Mission Exit Brief - WASH in Schools, (Ulaanbaatar: UNICEF, 2013).

Government of Mongolia, Millennium Development Goals Progress, The Fifth National Report, (Ulaanbaatar, Mongolia, 2013).www.mn.undp.org/content/mongolia/en/home/library/National-MDG-reports/TheFirthNationalMDGReport/

Ministry of Education and Science, Mongolia, Statistical Yearbook, (Ulaanbaatar, Mongolia, 2012-3).www.meds.gov.mn/data/pdf/Secondary%20education20122013.pdf

Ministry of Health (Mongolia), Centers for Disease Control and Prevention, World Health Organization, Millennium Challenge Account and Public Health Institute, Global School-based Student Health Survey, Mongolia Country Report, 2010. www.who.int/chp/gshs/GSHS_Country_report_Mongolia2010.pdf?ua=1

UNICEF (Mongolia), WASH in Schools and Kindergarten Inception Report to the Australian Government, (Ulaanbaatar, 2012).

78 Mongolia


10. Nepal: Bottleneck analysis of the national WASH in Schools programme

Anu Paudyal Gautam, Nuria Lefcourt and Bishow Raj Bhatt (UNICEF), Samira Shakya (WaterAid), Shanta Karki and Ishor Ghimire (Red Cross Society)

AbstractThe government of Nepal has endorsed the Child-Friendly School Initiative, which outlines nine aspects of quality education, including child-, gender- and disabled-friendly (CGD-friendly) WASH in Schools (WinS) facilities. However, providing CGD-friendly WinS facilities remains a challenge in many schools in Nepal, especially in rural areas. A modified Tanahashi model was used to analyse the status and sustainability of WinS facilities and services across four focus areas: enabling environment, supply, demand and quality.

Of the 11 indicators assessed, three were found to be severe bottlenecks, two were categorized as significant bottlenecks, four were minor bottlenecks and two were found to be on track and not considered bottlenecks. Within the enabling environment, both social norms and the policy framework were found to be on track. However, the lack of government funding for the construction of CGD-friendly toilets represents a severe bottleneck. Supply-related aspects of WinS are relatively strong, with all three indicators receiving scores of between 50 and 70 per cent. Aspects related to demand were mixed. While 57 per cent of schools visited by the authors had a budget for the operation and maintenance of WinS facilities, only 39 per cent of schools with hand-washing facilities had soap available. Quality is a major challenge; based on the authors’ observations, only 19 per cent of students washed their hands with soap after using the toilet at school. Only 11 per cent of schools had toilets that are child friendly and accessible for children with a disability.

Children in Bajura District, Nepal.

© UNICEF Nepal/2011

Country contextThe WASH sector in Nepal is guided by the national Hygiene and Sanitation Master Plan, which was adopted in 2011. The plan emphasizes a standardized and harmonized approach to promoting hygiene and includes aspects related to WinS.

In 2010 the Ministry of Education endorsed the Child-Friendly School Initiative, which outlines nine aspects of quality education, including CGD-friendly WASH facilities. However, providing CGD-friendly WinS facilities remains a challenge, especially in rural areas. According to 2011 government data, of the 80 per cent of schools reporting the existence of at least one toilet, only 65 per cent had a separate toilet for girls. Maintaining facilities is also a challenge; many facilities are either unhygienic, non-functional or both. The lack of child-friendly facilities has a negative impact on school attendance and participation, especially among girls.

Methodology A modified Tanahashi model was used to analyse the status and sustainability of WinS facilities and services across four focus areas: enabling environment, supply, demand and quality. The categories were assessed using one or more indicators, each of which was given a score out of 100.

The authors used a number of methods for data collection. The majority of the data were collected during visits to 18 schools in six districts (Siraha and Panchthar in the Eastern Region, Bhaktapur and Lalitpur in the Central Region and Kapilvastu and Gulmi in the Western Region of the country). These schools were chosen to achieve a mix of urban and rural schools and a combination of open defecation free and non-open defecation free districts. As suggested by the Department of Education, the authors also visited a number of private schools.

During these visits, the authors visually inspected and assessed a number of factors, such as the availability of soap near hand-washing stations and the existence of incinerators or bins for the disposal of sanitary napkins. The authors also assessed children’s hand-washing behaviour through direct observation (a team member was stationed at hand-washing facilities located outside toilets for 15-30 minutes per school). Overall, 311 children were observed, 170 boys and 141 girls.

The visits also included structured interviews with students on their WASH beliefs and practices, and interviews with school administrators on their School Improvement Plan and the operation and maintenance of WASH facilities. Finally, focus group discussions were conducted with adolescent girls on menstrual hygiene management (MHM) facilities and practices.

80 Nepal


Bottleneck analysisTable 10.1: Bottleneck table: Nepal



Social norms 1. Proportion of students with access to a toilet at home

Authors’ interviews with students 79%

Policy framework

2. Existence and adequacy of national WinS policies and strategies


75%

Budget allocation and expenditure

3. Proportion of schools with toilets that meet national CGD-friendly standards for both genders

Desk review and authors’ school visits

17%

SupplyAvailability of essential commodities/inputs

4. Proportion of schools with access to drinkable and adequate water

Authors’ observations

69%

5. Proportion of schools with properly maintained WinS facilities

50%

6. Proportion of schools with access to permanent hand-washing stations

50%

Demand

Financial barriers

7. Proportion of schools with a budget for the operation and maintenance of WinS facilities

Authors’ interviews with school administrators

57%

Prioritization8. Proportion of schools with

soap available near hand-washing stations


39%

Socio-cultural barriers

9. Proportion of schools equipped with an incinerator or bin for disposal of cloth/sanitary pads

28%

Quality Hygiene practices

10. Proportion of students who practice hand washing with soap after using the toilet


19%

11. Proportion of schools with sanitation facilities accessible for children with a disability

11%

Key:



Enabling environmentSocial normsIndicator 1: Proportion of students with access to a toilet at homeSeventy-nine per cent of the students interviewed by the authors reported that they have toilets at home, reflecting a strong social norm with regard to sanitation. However, no visual confirmation was conducted to verify children’s responses and the self-reported nature of the measurement may have affected the results (the latest national census, conducted in 2011, indicated that 62 per cent of households in the country have toilets).

Policy frameworkIndicator 2: Existence and adequacy of national WinS policies and strategiesThe WinS policy framework is relatively strong in Nepal. The School Sector Reform Plan (2009-2015) is the government’s long-term strategic plan for education. The document sets out a number of ‘minimum enabling conditions’ for schools, including separate toilets for girls and boys and adequate drinking-water facilities. In addition, the Department of Education has developed the Child-Friendly School Initiative, which outlines several aspects of quality education, including CGD-friendly WASH facilities. Finally, the Millennium Development Goal (MDG) Acceleration Framework on Sanitation, which was launched by the National Planning Commission in 2012, set the goal of ensuring that “there shall be no schools without toilets” by 2015.

While the policy environment for WinS is relatively strong, some gaps exist, including the lack of an implementation strategy to ensure that all schools have toilets by 2015. As the policy framework does not represent a bottleneck to WinS scale up in Nepal, the authors have given this indicator a score of 79 per cent.

Adolescent girls produce sanitary napkins in Bajura District, Nepal.


82 Nepal


Budget allocation and expenditureIndicator 3: Proportion of schools with toilets that meet national CGD-friendly standards for both gendersOnly 17 per cent of school toilets observed by the authors met CGD-friendly standards for both genders. Each year the Department of Education builds 3,000 to 5,000 school toilets based on the CGD-friendly framework. In the 2013-2014 fiscal year, the department planned to spend US$5.55 million to construct 5,000 CGD-friendly toilets, 2,000 of which were to be girl-friendly, with incinerators for MHM. This level of annual funding is very inadequate and represents a severe bottleneck.

SupplyAvailability of essential commodities/inputsIndicator 4: Proportion of schools with access to drinkable and adequate waterSixty-nine per cent of the schools visited had water supplies that were both drinkable and adequate (functional more than five days a week). There were disparities found between urban and rural schools, with rural schools less likely to have drinkable and adequate water supplies.

Indicator 5: Proportion of schools with properly maintained WinS facilitiesApproximately half of the WinS facilities visited were clean and well maintained, with the others not passing a cursory visual inspection. This finding parallels 2010 data from the National Management Information Project, which indicated that almost 44 per cent of water and sanitation facilities in the country were in need of major repair, rehabilitation or complete reconstruction.

Indicator 6: Proportion of schools with access to permanent hand-washing stationsApproximately 50 per cent of schools have permanent hand-washing stations. Of these, only 28 per cent are child friendly, meeting minimum national standards. Most of the hand-washing stations observed by the authors were leaking and in need of repair.

Saru Saud, 7, drinks water in Achham District, Nepal.

© UNICEF/NYHQ2012-2002/Noorani

Nepal84

Demand Indicator 7: Proportion of schools with a budget for the operation and maintenance of WinS facilitiesFifty-seven per cent of the schools visited by the authors have a separate budget for the operation and maintenance of WASH infrastructure. Among those schools with dedicated budgets, the amount varied considerably, with 13 per cent of schools allocating less than NPR10,000 (US$100) and 4 per cent allocating more than NPR100,000 (US$1,000) annually (see Figure 10.1).

PrioritizationIndicator 8: Proportion of schools with soap available near hand-washing stationsOf the schools that had hand-washing stations on the premises, only 39 per cent had soap available near the hand-washing facilities.

Socio-cultural barriersIndicator 9: Proportion of schools equipped with an incinerator or bin for disposal of cloth or sanitary padsIn only 28 per cent of the schools surveyed were the girls’ toilets equipped with an incinerator or bin for the disposable of cloth or sanitary pads. However, during focus group discussions, girls claimed that in general they do not miss school due to social or cultural barriers related to MHM. Most of the girls do not feel isolated at home or in school during their periods, although a few girls mentioned sometimes feeling isolated in school because they are not able to participate or concentrate fully due to excessive bleeding or pain. Three out of 18 schools organize dedicated sessions on MHM for girls.

A girl washes herself at a hand pump in Bajura District, Nepal.


Figure 10.1: Budget allocation for the operation and maintenance of WASH facilities in schools visited by the authors (Nepalese rupees)

Source: Authors’ interviews with school administrators


QualityHygiene practicesIndicator 10: Proportion of students who practice hand washing with soap after using the toiletDuring the course of the authors’ school visits, 311 children were observed after using the toilet (170 boys and 141 girls). Only 33 per cent washed their hands after using the toilet and only 19 per cent washed their hands with soap. The proportion of girls who washed their hands with soap (23 per cent) was 8 per cent higher than among boys (15 per cent).

Table 10.3: Hand-washing practices among students

Children Number Percentage

All children

Observed after using the toilet 311

Who washed their hands 103 33%

Who washed their hands with soap 58 19%

Boys




Girls




Source: Authors’ observations

Indicator 11: Proportion of schools with sanitation facilities accessible for children with a disabilityWhile the Department of Education has disseminated blueprints for the construction of disabled-friendly toilets, only 11 per cent of the schools visited had disabled-friendly toilets. Many of those toilets that are disabled-friendly have been constructed by non-governmental organizations (NGOs).

ConclusionOf the 11 indicators assessed, three were found to be severe bottlenecks, two were categorized as significant bottlenecks, four were minor bottlenecks and two were found to be on track and not considered bottlenecks. Within the enabling environment, both social norms and the policy framework were found to be on track. However, the lack of government funding for the construction of CGD-friendly toilets represents a severe bottleneck.

Supply-related aspects of WinS are relatively strong, with all three indicators receiving scores of between 50 and 70 per cent. For instance, 69 per cent of schools visited by the authors had access to drinkable and adequate water supplies. Aspects related to demand were mixed. While 57 per cent of schools visited by the authors had a budget for the operation and maintenance of WinS facilities, only 39 per cent of schools with hand-washing facilities had soap available. Quality is a major challenge; based on the authors’ observations, only 19 per cent of students washed their hands with soap after using the toilet and only 11 per cent of schools had toilets that are accessible for children with a disability.

Recommendations1. Increase the budget allocation for WinS, providing adequate funding for gender-

segregated CGD-friendly toilets and MHM facilities for girls.

2. Train teachers and school administrators on CGD-friendly standards and facilities.

3. Prioritize the provision of hand-washing stations for all schools and integrate practical hygiene sessions into school curricula and daily routines.

4. Establish and support child clubs that promote the adoption of sanitation and hygiene behaviours and that monitor the operation and maintenance of WASH facilities.

5. Provide adolescent girls with information on menstruation hygiene and adequate facilities for MHM.

6. Assess national and local student to toilet ratios and introduce school benchmarking to ensure that minimum conditions are met.

7. Support School Management Committees to integrate WASH issues into School Improvement Plans (including the participation of children).

8. Develop a mechanism to hold schools accountable for the operation and maintenance of WASH facilities and ensure that funds are available for this purpose (either from the government or through local cost recovery mechanisms).

References for NepalCentral Bureau of Statistics (Nepal) and UNICEF, Nepal Multiple Indicator Cluster Survey 2010: Mid and Far Western Regions, Final Report. (Government of Nepal. 2012).

Department of Education (Nepal), Annual Report of Planning Department, Expenditures from RedBook allocation. Fiscal Years 2010-2013 (unpublished internal document).

Ministry of Education (Nepal), School Sector Reform Plan (SSRP) 2009-2015, (Government of Nepal, 2009). http://planipolis.iiep.unesco.org/upload/Nepal/Nepal_School_Sector_Reform_2009.pdf

National Planning Commission (Nepal), MDG Acceleration Framework: Improving Access to Sanitation. (Government of Nepal, 2012).

National Planning Commission, National Population and Housing Census, (Government of Nepal), 2011.http://cbs.gov.np/wp-content/uploads/2012/11/National%20Report.pdf

Steering Committee for National Sanitation Action (Nepal), Sanitation and Hygiene Master Plan, (Government of Nepal, 2011).www.washinschoolsmapping.com/projects/pdf/Nepal%20Government%20Sanitation%20and%20Hygiene%20Master%20Plan.pdf

86 Nepal


AbstractThe coverage of water and sanitation facilities in Sri Lankan schools has increased rapidly during the past several years. However, the impact of increased coverage on student behaviour and practices is not known. Decisions regarding ‘what to prioritize’ and ‘where to invest’ therefore remain somewhat ad hoc. This analysis identifies bottlenecks to expanding and sustaining WASH in Schools (WinS) programmes in Sri Lanka. A modified Tanahashi model was applied to four focus areas: enabling environment, supply, demand and quality.

Of the 11 indicators assessed, four received scores of more than 80 per cent, reflecting the fact that Sri Lanka’s WinS programme has realized a number of important successes. The fact that 80 per cent of schools met or surpassed the minimum number of toilets by 2012 is a remarkable achievement. Sri Lanka has also been successful in building gender-segregated facilities in schools.

The lack of funding mechanisms for cleaning and maintaining toilets is a key bottleneck that requires attention. Quality was also found to be a significant problem. Of the 900 schools in the North Central Province for which data was analysed, only 105 schools (12 per cent) had constructed improved sanitation facilities by the end of 2013.

Country contextSri Lanka is on track to achieve Millennium Development Goal (MDG) 7. According to the 2012 national census, 84 per cent of Sri Lankans have access to improved water sources and 86 per cent have access to improved sanitation. At the policy level, the WASH sector is well established and stable. However, significant challenges remain around equity, quality, functionality and sustainability.

The provision of water and sanitation in Sri Lankan schools was traditionally viewed as an infrastructure-based intervention. This perspective has shifted in recent years. In 2007 the Ministry of Education and the Ministry of Health jointly established the School Health Promotion Programme (SHPP). SHPP introduced sanitation guidelines that prescribe minimum facility to student ratios and created the mandate for establishing School Health Clubs/Committees. Significantly, the Ministry of Education has been mainstreaming child-friendly WASH concepts since 2011.

11. Sri Lanka: Bottleneck analysis of the national WASH in Schools programme

Dilrukshi Coomarasamy, Kanagasundaram Vasanthakumar, Saravanamuththu Sivanesasingam and Suranga De Silva (UNICEF)

While the coverage of water and sanitation facilities in Sri Lankan schools has been increasing rapidly, the impact of increased coverage on student behaviour and practices is not known. Decisions regarding ‘what to prioritize’ and ‘where to invest’ therefore remain somewhat ad hoc.

Methodology This analysis identifies bottlenecks to expanding and sustaining WinS programmes in Sri Lanka. A modified Tanahashi model was applied to four areas: enabling environment, supply, demand and quality. The categories were evaluated using a number of indicators, each of which was given a score out of 100.

The geographic scale of assessment varied across the four categories. As the national government is largely responsible for policymaking and resource allocation, national data was used to assess the enabling environment and supply categories. Conversely, the Provincial Departments of Education are the most relevant actors in the translation of national policy into local service delivery. The demand and quality categories were therefore assessed using data from the North Central Province. The province is one of five where UNICEF is supporting WinS activities with support from the Australian Government, making it possible to collect information for this analysis during routine monitoring visits (ten UNICEF-supported schools were visited by the authors).

Gender-segregated, disability-friendly toilets at Trincomalee St. Joseph’s College, Eastern Province, Sri Lanka.

© UNICEF Sri Lanka/2012

88 Sri Lanka


Bottleneck analysisTable 11.1: Bottleneck table: Sri Lanka



Social norms1. Proportion of the population

accessing improved sanitation

National Census, 2012 86%


2. Adequacy of WinS legislation, policies and standards

Desk review of circular 2007/21 on School Health Promotion

67%

Budget 3. Adequacy of government funding for Wins

Desk review of national budget, 2011 and 2012

50%

Supply

Commodities4. Proportion of schools that

meet the minimum student to toilet ratio

Annual School Census, 2012 80

Human resources

5. Proportion of provinces with School Health Coordinators School Nutrition

and Health Services Branch of the Ministry of Education

100%

Technical support

6. Proportion of provinces with School Works Engineers and Technical Officers trained on child-friendly WASH

56%

Demand

Financial sustainability

7. Proportion of schools with cost recovery mechanisms for cleaning toilets

Authors’ visits to ten schools in North Central province

40%

Socio-cultural stability

8. Proportion of schools with gender-segregated toilets 100%

Utilization9. Proportion of schools with

active student rosters for cleaning toilets 60%

Quality

Child friendliness

10. Proportion of schools with toilets designed as per 2010 standards Provincial

Department of Education (data for 900 schools in North Central province)

12%

Sustainability

11. Proportion of schools that have received a score of 60 or higher in the SHHP annual evaluation

18%

Key:



Enabling environmentSocial normsIndicator 1: Proportion of the population accessing improved sanitationEighty-six per cent of the population is accessing improved sanitation, reflecting a strong social norm.

Legal and policy frameworkIndicator 2: Adequacy of WinS legislation, policies and standardsLegal and policy aspects of the enabling environment are relatively well established. Six aspects of the legal and policy framework were assumed by the authors to be essential:

1. Norms on quantity;

2. Technical standards;

3. Knowledge promotion;

4. Evaluation of facilities and services;

5. Guidance on child friendliness; and

6. Evaluation of behaviour.

Aspects 1 to 4 are included in the current circular on school health promotion. Aspects 5 and 6 are not included at present but there is a process ongoing for their future inclusion. The authors have therefore given this indicator a score of 67 per cent (i.e. 4/6).

Girls drink water and wash their hands at a group hand-washing station at Badulla Orubendiwewa Central School, Uva Province, Sri Lanka.


90 Sri Lanka


BudgetIndicator 3: Adequacy of government funding for WinsBudgetary aspects of the enabling environment are less strong. Two aspects of the budgetary process were assumed by the authors to be essential:

1. Capital funds for facilities and knowledge promotion; and

2. Recurrent funds for operations, maintenance and evaluations.

Only aspect 1 is fulfilled at this time. This indicator has therefore been given a score of 50 per cent (i.e. 1/2).

SupplyCommoditiesIndicator 4: Proportion of schools that meet the minimum student to toilet ratioAccording to the 2012 Annual School Census, 80 per cent of schools meet or exceed the minimum student to toilet ratio, a remarkable achievement.

Human resources Indicator 5: Proportion of provinces with School Health CoordinatorsAll nine of Sri Lanka’s provinces have Provincial Health Coordinators in place. This position, which is usually a senior official in the capacity of Deputy Director of Education, is the key link between the national and provincial levels and is ultimately responsible for the SHHP in each province.

Provincial School Health Coordinators at a programme review meeting in Eastern Province, Sri Lanka.


Technical supportIndicator 6: Proportion of provinces with School Works Engineers and Technical Officers trained on child-friendly WASHIn only five of the country’s nine provinces (56 per cent) have the School Works Engineers and Technical Officers been oriented on child-friendly WASH guidelines. This is significant as the implementation of child-friendly WASH infrastructure is dependent on these cadres.

Sri Lanka92

Demand Financial sustainabilityIndicator 7: Proportion of schools with cost recovery mechanisms for cleaning toiletsThe principal was confident of being able to continue recovering the cost of cleaning toilets in only four of the ten schools visited. This suggests that financial sustainability is a severe bottleneck that should be urgently addressed.

Socio-cultural stabilityIndicator 8: Proportion of schools with gender-segregated toiletsMuch more positively, all ten schools visited in the North Central Province had gender-segregated toilets for both students and teachers.

UtilizationIndicator 9: Proportion of schools with active student rosters for cleaning toiletsSix of the ten schools were able to show the authors student rosters with assigned responsibilities for cleaning toilets. This indicator is significant because the existence of an accountability mechanism is a proxy indicator for the utilization of facilities.

QualityChild friendlinessIndicator 10: Proportion of schools with toilets designed as per 2010 standardsQuality was found to be a significant problem. Of the 900 schools in the North Central Province for which data was analysed, only 105 schools (12 per cent) had constructed improved sanitation facilities by the end of 2013.

SustainabilityIndicator 11: Proportion of schools that have received a score of 60 or higher in the SHHP annual evaluationOnly 18 per cent of the 900 schools in the North Central Province have received a score of 60 or higher (out of 100) in the annual evaluation undertaken as part of the SHHP. As the evaluation includes a range of WASH-related indicators (availability and adequacy of facilities, cleanliness, functioning of School Health Club/Committee and implementation of health knowledge promotion activities) this score is seen as a valid proxy indicator for sustainability.

Grade 5 students take their turn cleaning the toilets at Thalawa Central School, North Central Province, Sri Lanka.



Child-friendly toilets at Horana Sri Dharmaloka School, Western Province, Sri Lanka.


ConclusionOf the 11 indicators assessed, four received scores of more than 80 per cent, confirming that Sri Lanka’s WinS programme has realized a number of important successes in the past several years. The fact that 80 per cent of schools met or surpassed the minimum number of toilets by 2012 is a remarkable achievement, especially given that the figure was only 51 per cent in 2008. This success is a result of results-based planning and effective resource utilization.

The placement of Provincial School Health Coordinators in each of the country’s provinces has greatly promoted cooperation between the national and provincial levels and has helped to mainstream WinS in Sri Lanka. Prior to their placement, the planning and construction of WinS facilities was the sole domain of School Works Engineers.

Sri Lanka has also been successful in building and equitably maintaining gender-segregated facilities in schools. This may be the result of long-standing social norms around gender and will make addressing issues such as menstrual hygiene management (MHM) more feasible.

While the increased capital investment in WinS is significant, the absence of national or provincial budgetary mechanisms for recurring expenses remains a challenge that will increasingly hinder the maintenance of facilities over time. Funds are also not available at the school level, as the willingness to develop simple cost recovery mechanisms remains inadequate. This is not a reflection of an inability of the school or community to afford these costs but rather the relatively low priority given to the issue by most school-level decision makers. Efforts to change the attitudes of both school officials and parents are needed to ensure the long-term functionality of WinS facilities.

Despite the intense advocacy undertaken to promote child-friendly WinS, the actual implementation of the concept is slower than expected. This is mainly due to the large number of existing facilities that were built with conventional designs, the modification of which are not a current priority.

Finally, the sustainability of WinS is challenged by the slow uptake of the SHHP. Without annual assessments in critical areas such as knowledge promotion and behaviour change communication, the risk is that WinS will once again come to be perceived as a set of physical facilities.

Recommendations1. Conduct a bottleneck analysis with a larger sample size and at a uniform geographic

scale (either national or subnational). Based on this further analysis, re-prioritize WinS budgets, targeting the key bottlenecks.

2. Conduct a knowledge, attitudes, practices and beliefs (KAP-B) survey in a sample of schools (including both those with adequate and inadequate facilities), focusing on hand washing with soap, drinking water safety, MHM and the maintenance of facilities.

References for Sri LankaDepartment of Census and Statistics (Sri Lanka), www.statistics.gov.lk/

Katta, James, et al., ‘Sierra Leone: WASH in Schools programme status in rural target districts’, in WASH in Schools Distance-Learning Course: Learnings from the Field 2012, United Nations Children’s Fund, New York, 2012. www.unicef.org/wash/schools/files/WinS_Distance_Learning_Course_-_Learnings_from_the_Field.pdf

Khalil, Awatif, et al., ‘Sudan: Scaling up WASH in Schools’, in WASH in Schools Distance-Learning Course: Learnings from the Field 2012, United Nations Children’s Fund, New York, 2012.www.unicef.org/wash/schools/files/WinS_Distance_Learning_Course_-_Learnings_from_the_Field.pdf

Ministry of Education (Sri Lanka), www.moe.gov.lk/web/index.php?lang=en

Ministry of Education (Sri Lanka), School Health Promotion Circular, 2007.

Namgyal, Kencho and Emily Bamford, ‘Bhutan: School-level bottleneck analysis of sanitation facilities’, in WASH in Schools Distance-Learning Course: Learnings from the Field 2012, United Nations Children’s Fund, New York, 2012. www.unicef.org/wash/schools/files/WinS_Distance_Learning_Course_-_Learnings_from_the_Field.pdf

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The WASH in Schools Distance-Learning Course was developed by Emory University and UNICEF as a cost-effective capacity building initiative. This intensive distance-learning course supports applied learning on developing, executing and evaluating sustainable and inclusive WinS interventions in collaboration with local, sub-national and national stakeholders.

The course can be adapted by universities in developing countries to reach practitioners in the field, either face-to-face or through distance learning. By expanding the distance-learning experience, we will help build the capacity to fulfil our vision of bringing safe water, improved sanitation and hygiene education to schoolchildren across the globe.

Let us know how you have adapted this course, or if you are seeking support, by contacting Matthew Freeman, [email protected], or Murat Sahin, [email protected].

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