The WASH in Schools Situation Across the EAP Region a Preliminary Look

The WASH in Schools

Situation across the East

Asia Pacific Region:

A preliminary look

BRIEF ON THE WASH IN SCHOOLS SITUATION EAST ASIA PACIFIC REGION

ii Brief on the WASH in Schools Situation in the East Asia Pacific Region

Acronyms

ACRONYMS III

BRIEF ON THE WASH IN SCHOOLS SITUATION IN THE EAST ASIA PACIFIC REGION IV School and Community WASH Linkages v Life Skills Based Education v Technology vii Institutional Setting & Co-ordination vii Financing Options vii Partnerships & Stakeholder Participation viii UNICEF WASH in Schools viii

SUMMARY OF THE UNICEF WASH IN SCHOOLS PROJECT COUNTRY STATUS SURVEY XI

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Acronyms AI Avian Influenza ARI Acute Respiratory Infection CFS Child Friendly School EPRP Emergency Preparedness and Response Plan FRESH Focusing Resources on Effective School Health IEC Information, Education, and Communication INGO International Non-governmental Organisation JICA Japan International Cooperation Agency LSBE Life Skills Based Education LoA Letter of Agreement MDGs Millennium Development Goals MNE Multinational Enterprise MoE Ministry of Education MoET Ministry of Education and Training MoH Ministry of Health MoPH Ministry of Public Health MoU Memorandum of Understanding MTSP Medium-term Strategic Plan NGO Non-governmental Organisation PBA Programme Based Approach PTA Parent Teacher Association UNICEF United Nations Children's Fund UNESCO United Nations Education, Scientific, and Cultural Organization WASH Water, Sanitation, and Hygiene WES Water and Sanitation WHO World Health Organization

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Brief on the WASH in Schools Situation in the East Asia Pacific Region The positive effects of maintaining child-friendly standards of water, sanitation and hygiene in school abound. Water and sanitation-related diseases including diarrhoea and worm infections among school children, staff and family members decrease; healthy environments add to the quality of education and enhance the learning environment, girls are more likely to attend and complete a full cycle of schooling, and children learn positive hygiene practices that can influence sustainable changes in the community. In spite of the anecdotal and quantitative evidence proving the benefits of water, sanitation and hygiene (WASH) in schools, the East Asia Pacific (EAP) region is characterised by inadequate water supply, sanitation and hygiene education in schools, particularly in rural and impoverished communities. While the Millennium Development Goal (MDG) targets of increased school enrolment and gender parity are on track in some countries, the number of school children with access to an adequate amount of safe water and clean, private latrines lags far behind. This has to change. Water, sanitation and hygiene in schools is a pre-requisite for meeting and sustaining the MDGs of achieving universal primary education, promoting gender equality and reducing child mortality. ‘Vision 21’ includes a target of 80 per cent of primary schoolchildren receiving hygiene and facilities for sanitation and handwashing by 2015. Strategy 8 of the ‘Dakar Framework for Action’ produced at the World Education Forum in 2000 is to create safe, healthy, inclusive and equitably resourced educational environments. According to the UNICEF ‘Water, sanitation and hygiene strategies for 2006-2015’, the overall objective of UNICEF in WASH is to contribute to the realisation of children’s rights to survival and development through global and national promotion of sector investment and support to programmes that increase equitable and sustainable access to, and use of, safe water and basic sanitation services, and promote improved hygiene. UNICEF aims to work in close partnership with UN sister agencies in support of nationally identified priorities evolving from national development plans in support of accelerated achievement of the MDGs.1 For the 10-year period 2006 to 2015, UNICEF support for WASH in schools will be guided by two overarching targets, which have been widely recognised by governments and the international community:

Target 1: Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation (Millennium Development Goal 7: Target 10).

Target 2: Ensure that all schools have adequate child-friendly water and sanitation facilities and

hygiene education programmes (now widely recognised as a sector priority — endorsed at the World Summit for Sustainable Development and by the Commission for Sustainable Development).2

The revised WASH strategies have been developed in tandem with the formulation of the ‘UNICEF medium-term strategic plan (MTSP) 2006-2009’ and are designed to directly contribute to the MTSP targets in the focus areas of young child survival and development and basic education and gender equality. Children commonly miss school because they are too busy hauling water or are at home sick with a water-related disease. Girls, particularly those who have reached the age of menses, often drop out of school when toilet and washing facilities are not private, are unsafe or non-existent. Even when children attend school, they scarcely reach their full learning potential because of development problems caused by worm infections and diarrhoea. As a key strategy in meeting children’s rights to quality education and ensuring the attainment of core learning outcomes, UNICEF has long supported the provision of water, sanitation and hygiene education

1 United Nations Children’s Fund, UNICEF water, sanitation and hygiene strategies for 2006-2015, UNICEF, New York, 2006, p. 7-8. 2 The Plan of Implementation of the World Summit on Sustainable Development emphasises sanitation in schools as a priority action. The 13th Session of the United Nations Commission on Sustainable Development in 2005 reiterated this position and also emphasised the need for hygiene education in schools.

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in school systems across the EAP region. In recognition of the impact of school-based water and sanitation interventions on educational access, attendance and learning environment and process, UNICEF’s ‘Education Strategy for 2006-2015’ clearly highlights ‘life-skills based’ water, sanitation and hygiene education as a global priority. Furthermore, the provision of appropriate hygiene facilities and supplies in schools is identified within the strategy as an important contribution to achieving a holistic Child Friendly School model. Water and sanitation (WES) programmes across the region have set aside resources to improve the health of children through increased access to facilities for sanitation and hand-washing in schools. The UNICEF East Asia Pacific Regional Office conducted a survey on WASH in Schools activities in 11 EAP countries. The following are summaries of the key findings in the areas of School and Community WASH Linkages, Life Skills Based Education, Technology, Institutional Setting & Co-ordination, Financing Options, Partnerships & Stakeholder Participation, and UNICEF WASH in Schools projects. School and Community WASH Linkages Putting school WASH policy into practice demands stronger linkages between WASH in schools and WASH in communities. In areas such as Mongolia the schools are connected to community water sources, hence when the community is lacking in water supply so are the schools. Whenever Myanmar supplies WES to schools it supplies the same to communities. In Viet Nam parents contribute to the operation and maintenance (O&M) costs of sanitation facilities. In the tsunami-affected areas of Thailand, hygiene promotion campaigns targeted school children and their communities. In Bangladesh, school girls from the slums participated in monitoring the sanitation situation in their neighbourhood. These are all good examples of how UNICEF country offices have successfully linked school and community WASH. Still, more needs to be done. An untapped force lies within parents and Parent Teacher Associations (PTAs). According to the 11 EAP countries that participated in an EAPRO survey to summarise the WASH in schools efforts across the region, 70 per cent reported functioning PTAs – however, the main function was the operation and maintenance of facilities. PTA meetings can be an optimal place to get parents involved in planning school hygiene activities for children, while educating and motivating them to adopt positive hygiene behaviours that can impact the community on a larger scale. In Myanmar the community has been involved in, and exposed to hygiene messages through the mass media. The country office collaborated with the film censor Boards to make an agreement for short advertising spots in every picture on WASH, free of charge. The Motion Picture Association also agreed that when artists shoot films, they would contribute some time to producing a short advertising spot on health and hygiene issues. Myanmar has kept artists involved and interested in this initiative by inviting them to the opening of, for example, water systems. In the case of Myanmar, linking community and school WASH was done through a public-private partnership in which services where donated. Commonly, a challenge countries face forming school and community WASH linkages is funding. How can school and community WASH be jointly implemented when projects funds/plans for the two are separate? Some possible solutions are piloting a holistic approach to school and community WASH on a decentralised level; getting households actively involved in assessing and monitoring the WASH situation in the community and school, balancing the investment in technology for schools and communities; plan for schools ability to provide water to the community; and aligning external plans and investment on school and community WASH. Life Skills Based Education Life skills based education (LSBE) with a hygiene focus is one element supporting the behaviour change communication component of WASH in schools. It is often referred to as the “software”, while water supply and sanitation is the “hardware”. Life skills based education increases school children’s knowledge on hygiene and encourage them to form new attitudes and adopt positive hygiene behaviours. In the 11 EAP countries hygiene is most commonly taught in Hygiene and Health classes, in the primary school

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level. The most popular risk practices targeted are handwashing with soap and the safe disposal of human excreta. While children are exposed to hygiene messages it does not always translate to a demonstration of knowledge – internalised learning based on fact, experience or traditional belief – or behaviour change. Some key knowledge challenges in addressing the priority hygiene behaviours of school-age children reported include the safe disposal of human excreta not practiced at home; and that children don’t know handwashing with soap prevents diseases. The key practice challenges include an inadequate amount of clean water and soap at school. In this case the knowledge and practice challenges are inextricably linked: Children cannot internalise the concept that handwashing with soap is an important hygiene practice, if soap and clean water is not available. Hygiene promotion through LSBE has to be supported with supplies and services. A component of routine (and more recently Avian Influenza) support to WASH in schools, are the supply of Hygiene Kits to schools (some include soap), which countries such as Lao, Thailand, and Myanmar have refined or developed to include teaching aides for teachers and students. Children’s participation in LBSE is overwhelmingly reported as attending hygiene classes (73%). This participation can be meaningful depending on the teaching methodology and learning materials used. In Indonesia, 200 school WASH programmes have established child health clubs where students monitor the hygiene behaviours of their community. Every sixth grader is responsible to monitor a dozen neighbouring households. Students developed indicators of hygiene practices through school-level hygiene assessment and planning. In Viet Nam, children actively participate in monitoring for correct use, maintenance and advocacy. These are good examples of child participation in hygiene-related LSBE. Another factor in participation is the chosen communication channels. For hygiene promotion in schools the most common are flip charts and story cards. Thailand is the only country that uses puppets, a tremendous tool for education. Because of the puppet’s independence from the human agent, it can convey emotion without causing embarrassment, it can deal with taboo issues without causing shame, and it can overcome stigmas linked to discussing sensitive and controversial issues without incurring blame or recriminations.3 Some countries are tying school sanitation to Avian/Pandemic Influenza (AI) preparedness. Thailand recently launched its school AI campaign using posters and textbooks for various grade levels. The implementation process began with a series of workshops and trainings to 1) develop Emergency Preparedness and Response Plans (EPRPs) for schools, 2) develop life-skills based hygiene education curriculum for Grades K-12 on Avian influenza and an EPRP, and 3) orient and train on EPRP. The pilot took place at 39 schools in 17 provinces was followed by a 10 October 2006 launch with the Ministry of Education, and Ministry of Public Health. This process took from eight to nine months and targeted risk practices such as handwashing with soap, which not only helps prevent Avian Influenza, but dramatically reduces incidences of diarrhoea and other sanitation-related diseases. A challenge with LBSE is that it is difficult to maintain students’ interest especially with the ‘taught’ and ‘caught’ curriculum common to hygiene promotion in schools. We expect a lot from LBSE (in terms of behaviour change) and perhaps we need to be more realistic in what can be accomplished within the confines of the school. Many of the country offices recognise the need to improve school hygiene education and are doing so through teacher training on child-centred learning methodologies. We have identified a great need to develop hygiene education curriculum based on competencies expected in children by age, which requires a more unit-based planning of lessons rather then the planning of separate lessons. The UNICEF East Asia Pacific Regional Office has collected “early learning standards” from eight countries in the region to initiate this process. Besides health and hygiene education in the curriculum, it also important to have the same included in the teacher training curriculum. In Viet Nam, this shortcoming was identified, and the WES & Education sections are working with Ministry of Education & Training (MoET) for the development of a teacher’s guidebook on this. In Myanmar, LSBE training has been incorporated into the standardised- and follow-up 3 AREPP: Theatre for Life Trust, Introduction to simple puppetry techniques: Participatory Puppet Projects for Classroom and Community Activities, Capetown, 2004, p. 7.

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teacher training at teacher’s colleges. In Indonesia, information, education and communication (IEC) materials (some based on competencies) have been developed for WASH in schools. In the Democratic People’s Republic of Korea (DPRK), where the WASH programme is relatively new, UNICEF assisted the Ministry of Education with a workshop introducing the concept of life skills based education. Technology Choice of technology depends on available financial resources, national and local standards, implementation of the Child Friendly School model, and climatic conditions. In the DPRK, winter temperatures range from -0°C to 25°C. Mongolia and China have similarly low temperatures. Materials used for constructing wells, the size and shape of water storage tanks, the treatment of water, and types of concrete used for latrine pits vary from cold- to warm-weather areas. Supplying heaters to warm water for handwashing is an issue as children are more likely to wash hands at critical times if the water is not cold. In the southern part of the EAP region, droughts and monsoons affect technology choice. Myanmar receives about 5,000 mm (197 in) of rain annually. The country office has capitalised on this climatic condition by installing rainwater collection equipment to provide water in schools and communities. Even with the many variables in technology choice the most common water sources to schools are hand pumps and tap water. Several countries have experience with the use of simple water quality tests kits such as H2S strips, which were used in Viet Nam. Some countries fully implement the UNICEF Child Friendly School (CFS) model in their technology choices for school water and sanitation design. The CFS model is the gold standard but has implications of cost, cultural relevance, and stakeholder preference. In Viet Nam children reported that a child-friendly latrine was one that is safe to access, well-lit and ventilated, nice and safe to use, and at the right place. Consultations with children, teachers and technical staff led to the design and implementation of a child-friendly latrine design which the Ministry of Education and Technology (MoET) plans to adopt as a national standard. This design is more costly than the general school latrine, but is an outcome of stakeholder consultations. The benefits are twofold: the latrines are more likely to be used, and the participatory process helps create an informed demand for WES facilities in Viet Nam. Institutional Setting & Co-ordination Co-ordination and creating an enabling environment poses specific challenges for WASH in schools as it is a cross-cutting initiative. Of the 11 EAP countries, most reported that national water and sanitation policies exist; only 20 per cent reported that none were in place. The most common co-ordination mechanisms are local organisations and inter-ministerial groups. Co-ordination must emerge as a priority in order to bridge the Ministry of (Public) Health, Ministry of Education, and other relevant governmental departments in the planning, implementation, and sustaining of WASH in schools. We must define the roles and responsibilities of key ministries either through a formal Memorandum of Understanding (MoU), Letter of Agreement (LoA), or verbal acknowledgement of who does what. New partners must be engaged in the government, private sector and community as the first step in facilitating co-ordination. Financing Options Capital costs includes the construction of new schools and rehabilitation of existing schools; and purchasing and installing furniture, equipment, heaters, latrines, water connections and hand pumps. These costs vary from school-to-school but are mostly covered by UNICEF project funds. In Myanmar the PTA splits the financing of capital costs with UNICEF. Advocacy with donors must take front-and-centre in the event that the construction of a CFS latrine costs more than a general school latrine, and to promote a balance between funding for WASH in schools and communities. In addition, public-private partnerships should be further explored to diversify the capital structure of water and sanitation financing. A good example of this is the Coca-Cola Philippines ‘Little Red Schoolhouse’ project, in which not only schools were built but water and sanitation facilities were provided. While UNICEF may not be funding WASH in schools in all areas, it’s still the role of the agency to influence policy, build capacity and create enabling environments.

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Funding for operations and maintenance (O&M) is also a factor in WASH in schools financing. It is important to consider what has to be paid and who can contribute. These questions are vital to planning as the O&M of water and sanitation facilities is typically not included in a school's annual plan and therefore does not appear as a line item in the budget. One way to facilitate greater linkages between school and community WASH and instil a sense of ownership is through the community’s participation in the O&M of facilities. This can be done a number of ways including PTA contribution to O&M costs as done in Myanmar, the Philippines and Viet Nam. Partnerships & Stakeholder Participation The MDGs provide a framework for the entire UN system to work coherently together towards a common end. Of the 11 EAP countries, 50 per cent reported no active support from, or partnerships with sister UN agencies for WASH in schools. This trend has to reverse if we are to meet the MDGs of achieving universal primary education, promoting gender equality and reducing child mortality. The UN agencies partnering with UNICEF for WASH in schools in the 11 EAP countries are the World Health Organization (WHO), UNESCO, United Nations Environment Programme, and the United Nations Department of Economic and Social Affairs. On the national level we should work in partnership with the government to ensure integration, and link facility design into the budget programme in the initial stages. Supporting governments should be our continued focus in the context of their Poverty Reduction Strategy Plans and sector-wide/programme based approaches. Programme based approaches (PBAs) – with or without basket funding – is the short answer to advocating WASH in schools at the highest levels. With a PBA, pilot projects can be shared and its impact and processes demonstrated for mainstreaming and scaling up. Even in the absence of a PBA, professional sectors such as education, health, water supply and sanitation, and planning and construction must co-ordinate human, intellectual and financial capital. Some means to achieve this include joint planning, technical training, financial support, the provision of equipment and supplies, and networking and knowledge management. In a majority of the 11 EAP countries partnerships and capacities were built and sustained through technical training, and networking and knowledge management. Stakeholder participation in WASH in schools should include school children, teachers and headmasters, households (including women and children), and the wider community. Meaningful participation transforms individuals from beneficiaries to active participants in their personal health and well being of their communities. School children in the 11 EAP countries participate in WASH in schools by attending hygiene class; monitoring for soap in school latrines; engaging in role plays, wall paintings, games, and puppetry; and keeping sanitation facilities clean. PTAs participate by assisting with the capital investment (Myanmar) and O&M costs of sanitation facilities. This list can be expanded, and whatever means of participation is pursued should take place throughout the entire project cycle. Such participation is a prerequisite for sustainability and is a basic requirement of the human-rights based approach to programming. UNICEF WASH in Schools WASH in schools falls under the Education, Health and Nutrition, and/or Water and Sanitation sections (WES) depending on the country. In the DPRK and Myanmar the WES section implements WASH in schools. In Mongolia and Timor-Leste, the Health and Nutrition sections are responsible for WASH in schools. In Thailand, the Education section implements WASH in schools. Only in Cambodia, Lao, and Viet Nam is WASH in schools represented by the WES and Education sections. This is a strong indication of the need for internal co-ordination and joint planning before UNICEF can facilitate co-ordination externally. The primary UNICEF-assisted WASH in schools activities are cash support and operations and maintenance of facilities. The least implemented activity was de-worming possibly due to de-worming activities of the Japan International Cooperation Agency (JICA) and WHO in some schools. A challenge facing WASH in schools is that many of the projects are pilots while there is a global push for going to

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scale. The feeling of being stuck in demonstration mode can be a result of the level the country is at regarding experience in the WASH sector, the pressure to spend funds designated for WASH in schools in a short amount of time, and not enough in-country co-ordination and advocacy. Costing is also an issue as quality WES designs can be more expensive. A debate is brewing on how to build to scale with quality but limited financial resources. One side of the debate posits that we should focus more on building on success than going to scale, or go to scale with partners rather than going to scale alone. Improved supply of safe water in schools and improved access to sanitary latrines in schools was the most common cited key result of the WASH in schools project. While the hygiene education component conveyed through LSBE improved knowledge of children regarding sanitation and hygiene, and improved knowledge among teachers/educations regarding sanitation and hygiene. The least commonly cited key result was reduction in childhood diarrhoea and other water-related diseases due to a lack of baseline data and a more standardised approach to WASH in schools monitoring. This is a challenge as WASH in schools initiatives should be evidence-based, and support the MDG of reducing child mortality, which is increased by sanitation-related diseases such as diarrhoea and acute respiratory infections (ARIs). Though ‘hardware’ gains are easy to measure, i.e. number of latrines and hand pumps installed, ‘software’ gains such as knowing and demonstrating positive behaviour change is more difficult to measure. Sixty four percent (64%) of the 11 EAP countries reported that teachers monitor/assess hygiene behaviours, and the most popular monitoring method was observation. An informal discussion with students and self-report of child tied as the second most common monitoring tool. In Myanmar, the country office uses Knowledge, Attitude and Practice (KAP) surveys to undertake some behaviour change monitoring. The UNICEF commitments to WASH in schools that were highlighted at the East Asia Pacific Water, Sanitation and Hygiene Workshop include: DAY 1

Objective To view the intersections between various education/WES frameworks and their potential in guiding WASH in Schools.

Session I: Objective To strengthen commitment and joint understanding between Education and WES country teams from the region on ‘WASH in Schools’.

WHAT UNICEF IS COMMITTED TO IMPLICATIONS FOR GOOD PROGRAMMING

FRAMEWORKS Full partnerships within FRESH initiative.

• Close and regular communications and co-ordination with WHO, UNESCO, the World Bank and NGO partners on global, regional and national levels.

UNICEF STRATEGIES New WASH strategy has two targets: 1) contributing to achieving MDG Goal 7: Target 10, and 2) ensuring water, sanitation and hygiene in schools.

• Seeking new partners in public and private sectors.

• Internal co-ordination between relevant sections.

• Fund-raising, advocacy to implement renewed WASH in schools service focus.

Session III: Objective To identify the factors which hinder effective joint WES + Education programming and provide recommendations on how to overcome.

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ISSUES & CHALLENGES

Scaling up WASH in schools with quality (post-Oxford Roundtable Proceedings and Framework for Action, 2005)

• Providing leadership for building national partnerships to scale up with quality.

• Pooling funding or inter-sectoral fund raising allows for a comprehensive WASH in schools package to be developed and supported.

Session IV: Objective To identify monitoring mechanisms for WASH in Schools.

MONITORING & INDICATORS

Strengthen national situation assessments and data collection for advocacy.

• Developing good indicators and monitoring, tying in with Education Information Management Systems (EMIS).

DAY 2 Objective To share practical experiences, resources and tools relating to water, sanitation and hygiene education leading to agreed definitions for key concepts.

Session I: Objective To provide those involved in developing a WASH in Schools programme with relevant information and tools for effective planning and implementation.

Child-friendly water and sanitation facilities

Child-friendly facilities developed as a result of children’s participation and that promote safety, use, and sustainability.

• Balancing quality facilities with low-cost replicable designs and easy O&M features.

Evidence base for hygiene promotion

Improving baseline data. • Strengthening EMIS systems, monitoring and evaluation of WASH in schools.

Session III: Objective To gain a regional overview of costing standards and issues for WASH in Schools.

Mobilising greater resources and influencing national development of budgets to include investments in WASH in schools.

• Better costing information (capital and O&M) for tracking and advocacy (more detail, more transparency).

Session IV Objective To better understand the stages/content involved in planning a WASH response in emergencies and the role of WASH programmes in relation to Avian Influenza.

Emergency WASH in schools

Core Commitments for Children in Emergencies Avian Influenza preparedness

• Emergency preparedness and response plans (EPRPs).

• Positioning of supplies, human and financial capital.

• Pre-testing of hygiene messages among target groups and development of IEC materials.

• Pre- and post-emergency life

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skills based hygiene education in schools and communities to lessen humanitarian consequences of a disaster.

Summary of the UNICEF WASH in Schools Project Country Status survey Life Skills Based Education Key KNOWLEDGE challenges in addressing the priority hygiene behaviours of school age children is the safe disposal of excreta not practiced at home (82%), and that children don’t know washing hands with soap prevents disease (64%). Key PRACTICE challenges in addressing the priority hygiene behaviours of school age children is the inadequate supply of soap at school (91%), and an inadequate amount of clean water at school (64%). HYGIENE and HEALTH are the two most common subjects for hygiene education, both (64%). Most common RISK PRACTICES targeted are hand-washing with soap (82%), and safe disposal of human excreta (55%). HYGIENE AND ENVIRONMENTAL HEALTH is adequately promoted in the curriculum (55%), according to the 11 EAP countries surveyed. FLIP CHARTS (64%) and STORY CARDS (27%) are the most common communication channels used to disseminate hygiene messages to children in schools. MONITORING of hygiene practices is undertaken by teachers (64%) The three most common MONITORING TOOLS are observation (45%), and informal discussions with students (27%), and student-run monitoring system (27%). Though 55% said monitoring for the PRESENCE OF SOAP in schools does not take place, and when it does take place the most common method is SPOT CHECK OBSERVATION (36%). Technology WES COVERAGE ranged from %0-25 (43%) and %51-75 (29%) out of the seven countries that had data. The WATER SOURCE most common to schools was hand pump (82%), and tap water (55%) Water source depends on topography, e.g. Myanmar has tons of rain each year so rainwater collection a smart technological choice. FLUSH TOILETS were the most common latrine in schools (67%), followed by SQUAT POT and VIP TOILET, both (27%). Countries reported SEPARATE LATRINES for girls and boys (82%). The GIRLS PER STALL ratio of 26-50 girls: 1 stall (44%) and 51-75 girls: 1 stall (44%). The BOYS PER STALL ratio was reported 0-100 boys: 1 stall in (100%) of the responding countries. URINALS are used (64%) with the most common BOYS PER URINAL ratio of 41-60 boys: 1 urinal (57%). The MAINTENANCE OF FACILITIES was reported to be done by cleaning committees, external cleaning personnel, and individual students (40% in each instance). HANDWASHING facilities are not automatically installed in most cases (66.7%).

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The most common STANDARDS FOR SANITATION FACILITIES that existed include the number of pupils per stall (55%), and the provision of hand-washing facilities with sanitation facilities (55%). Eighteen per cent (18%) of the countries reported that no standards existed. MONITORING for water and sanitation facilities takes place primarily on status of water supply/systems (73%), and water quality (18%). Actual versus planned use is barely monitored (9%) though these figures could help with establishing cost. Institutional Setting & Co-ordination NATIONAL WATER AND SANITATION POLICIES exists for most countries (64%). LOCAL WATER AND SANITATION POLICIES existed 36% of the time. Only 18% reported that no policies existed. Hygiene education is part of the OFFICIAL CURRICULUM (45%). NATIONAL AND LOCAL GOVERNMENT is reported to contribute to WASH in schools (45%). Only two countries (Thailand and Viet Nam) reported spending on both the national and local levels (18%). LOCAL ORGANISATIONS and INTER-MINISTERIAL STEERING GROUPS represent the most common co-ordination mechanism (45%), followed by UN AGENCIES (27%). Countries responded that the NATIONAL WASH SITUATION had not been adequately assessed and analysed (73%). Financing Options UNICEF PROJECT FUNDS (82%) are the most common method of financing capital costs for WASH in schools. PUBLIC-PRIVATE PARTNERSHIPS are not being fully explored. PTAS, GOVERNMENT BUDGET ALLOCATIONS, and UNICEF PROJECT FUNDS are the most common financial sources for the O&M of school WES facilities, each (27%). Long-term capacity building of relevant professionals supported primarily by TECHNICAL TRAINING (64%), and NETWORKING & KNOWLEDGE MANAGEMENT (45%). Partnerships & Stakeholder Participation Most of the countries reported that no UN ORGANISATIONS (45%) are active in supporting WASH in schools. The most involved UN organisation is WHO (18%). KEY DONORS FUNDING WASH IN SCHOOL initiatives are AusAID (36%), the World Bank and NATCOMs, both (27%). PTAS have a role in WASH in schools (73%), mainly operations and maintenance. Formal LINKAGES BETWEEN WASH IN SCHOOLS AND COMMUNITIES exist (82%). Common linkages are hardware-related i.e. school connected to community water source and supplying WES for schools and community at the same time. UNICEF WASH in Schools Project WASH IN SCHOOLS fall under one section - Education (9%), WES (27%), Health and Nutrition (18%); WES and Education sections (27%); and other (11%).

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Most common portion of the COUNTRY PROGRAMME BUDGET spent on WASH in schools is %0-10 (27%); %11-20; and %21-20, both (18%). NATCOMs (36%) are the most common source of funding for UNICEF’s WASH in Schools project, followed by AusAID (18%). Key activities are HYGIENE EDUCATION (64%), followed by CASH SUPPORT (45%). The least implemented activity was DE-WORMING (9%), which is possibly due to WHO and/or Japan International Cooperation Agency (JICA) initiatives in the schools. The GOVERNMENT (55%) was most frequently cited as implementing partner; followed by NGOS (36%). The most common KEY RESULTS from the project were improved supply of safe water in schools and improved access to sanitary latrines in schools; and improved knowledge of children regarding sanitation both hygiene (64%). The least commonly cited key result was reduction in childhood diarrhoea and other water-related diseases (45%).

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Cambodia Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

Water, Sanitation and Hygiene (WASH) in Schools

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Cambodia

Rationale for WASH in Schools

Primary school drop-out rates are persistently high (only 61% of students reached Grade 5 in 2000/2004).

Rural/urban coverage disparities are very high, and at only 8 %, rural sanitation coverage is the lowest in the region and the second lowest outside of Africa. Where rural community sanitation is low, school sanitation tends to also be low.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Cambodia, deaths among children under five years of age due to diarrhoeal diseases are reported at 16.6% (2000); deaths among children under five years of age due to pneumonia, 20.6% (2000).*

Arsenic contamination of aquifers is a significant problem, especially in the lowland areas near the Mekong River and its major tributaries.

Main Components

The Education, and Seth Koma (Community Action for Child Rights) sections support WASH in Schools. UNICEF-supported WASH in Schools activities include:

• Safe drinking water in rural communities and schools. • Improved sanitation for families and schools in rural areas. • Water quality monitoring including arsenic testing and mitigation.

All WASH activities include support to capacity building at central, provincial and local government levels.

* These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World Health Report, 2006 Edition'.

Basic Indicators Total population (1000s) 13,798 Under-five mortality rate (per 1000) 141 Total adult literacy rate (%) 74 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Social Sciences class Water source common to schools Hand pump Sanitation facilities common to schools Flush toilet

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Cambodia Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

WASH in Schools Activities Enabling Environments

• Development of new approaches to stimulate demand for sanitation. • Support for improving the competitive bidding and contracting process at the local

government level. • Institutional support to government to strengthen capacity for the implement the new

national policy.

Water and Sanitation Services

• Provision of safe water for over 41,000 school children through construction of wells in 131 schools (54 completed, 77 on-going).

• Water use and hygiene education and operations and maintenance training for school directors and teachers.

• Improved sanitation has been provided to over 21,000 children through construction of latrine blocks in 137 primary schools (54 completed and 83 on-going); and 304 community preschools (83 completed and 221 ongoing).

Hygiene Education/Behaviour Change Communication

• Hygiene education and operations and maintenance training for school directors and teachers.

• The new curriculum is not yet rolled out but a two-hour per week allotment for health education has been approved by the government, and is expected to be implemented next year.

• UNICEF is attempting to get teachers to work hygiene practices into their every day routines, for example, taking children to wash their hands.

• Teachers will learn child-centred teaching methodologies that can be applied to all subjects, particularly health and hygiene education through teacher training at the Teacher Creativity Center (TCC).

Policies to support WASH in Schools

• The new National Policy on Water Supply and Sanitation issued in 2003 promotes greater community participation, more active hygiene and sanitation promotion and increased involvement of the private sector in implementation.

• Two hours of health education per week approved by Government for school children.

Key Partners

Ministry of Rural Development at the central, provincial and district levels. Local Governments (Commune Councils). WHO, NGOs and external agencies including ECHO, AUSAID and UNICEF National Committees.

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: China Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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China


Through a recent UNICEF survey the WASH situation of about 15,000 rural schools in 8 counties has been established. The results showed that less than 10% of rural schools in the surveyed counties had access to safe water, latrines and hand washing facilities.

About 190 million children are infected with round worm; and another 70 million with whip worm; and over 40 million have hook worm.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In China, deaths among children under five years of age due to diarrhoeal diseases are reported at 11.8% (2000); deaths among children under five years of age due to pneumonia, 13.4% (2000).*

Diarrhoeal diseases and hepatitis are common among the 400 million school-attending children.

Large portions of China's water supply are contaminated by arsenic, a toxic substance distributed widely throughout the earth's crust.

Main Components WASH in Schools is one project under China’s 2006-2010 Water, Sanitation and Hygiene Programme. China plans to implement the following activities:

Develop, adopt, and pilot revised national technical standards (designs) and guidelines on WASH in Schools in five counties for adoption by rural communities and school authorities, particularly boarding schools, and nationally as part of the requirements for assessing schools qualification for nine-year compulsory education.

Establish a multi-level co-ordination mechanism for implementation of WASH in Schools. Develop and implement national, policy, standards and guidelines for public-private investment in WASH in schools;

Communication strategy for effective hygiene practices in child-friendly schools is developed and tested. Policy guidelines and standards for de-worming children in kindergarten and primary schools.

| * These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World Health Report, 2006 Edition'.

Basic Indicators Total population (1000s) 1,307,989 Under-five mortality rate (per 1000) 31 Total adult literacy rate (%) 91 WASH in Schools National school water/sanitation coverage In 2005, sample survey in 80 counties of 10 provinces, only 8% of schools with sanitation facilities Hygiene education in schools Health and Hygiene classes Water source common to schools Hand pump, Open well Sanitation facilities common to schools VIP toilets, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: China Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


• Carry out research, including a thorough national assessment of the risk of fluoride and arsenic contamination of water.

• Support water quality monitoring units at provincial, district and community levels.

• Support capacity building of local government in the treatment of water and improvement of sanitation facilities based on ecological sanitation concepts.


• Develop teaching materials on sanitation and hygiene. • Train teachers in use of hygiene education materials, construction of water

facilities, latrines, urinals and hand-washing facilities. • Carry out health assessments and de-worming of school-aged children. • Encourage child participation in keeping school environments clean and in

monitoring families in the improvement of sanitation, water supply and personal hygiene behaviours.


• Under ‘Safe Water Supply for Rural Areas’, the strategy to promote provincial and county level plans for increased investment in the provision of safe water for rural areas was advanced through advocacy campaigns targeting policy makers, training and awareness raising through the design and printing of an album on the progress/achievement of rural water supply in China. This resulted in the central government investing in over US$ 248 million on rural water supply throughout the country of which about US$ 88 million was allocated in seven project provinces. The Government has also started allocating funds for sanitation (around US$ 12 million), for the first time in 2005.

Key Partners

Government: Ministry of Water Resources, National Patriotic Health Campaign Committee Office, Ministry of Health, Ministry of Education, Provincial and County Governments, Department of Disease Control and Bureau of Water Resources

Bi-laterals: SIDA, UK/DFID, AusAID; Institutes: Chinese Academy for Science and Technology, Environmental Health Monitoring Institute

NGOs: All China’s Women Federation, Central Youth League and Civilization Establishment Offices

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: DPRK Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Main Components

The Water, Sanitation and Hygiene section supports the WASH in Schools initiative that is UNICEF Pyongyang is initiating.

UNICEF-supported WASH in Schools activities include: • Upgrading/constructing water supply systems and sanitation facilities for households and key child

care institutions within the targeted communities of Hyesan and Hoeryong cities. • Ensuring that families, teachers, and caregivers have the necessary knowledge on key hygiene

practices in Kosan, Kowon and Jongpyong counties. WASH in Schools Activities Water and Sanitation Services

• Due to child care institutions needs vis-à-vis the national programme, 70 hand pumps have been installed outside of focus counties.

• In Yonsan, Rinsan and Unryul counties, 12 childcare institutions have improved WES facilities.

• Two Pyongyang schools have improved WES facilities. • Environment-friendly waste disposal facilities (construction activities ongoing

as of December 05), constructed at 33 child care institutions.


Primary school drop-out rates and enrolment rates are not reported though UNICEF is working with the government to strengthen Education Management and Information Systems (EMIS).

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In the DPRK, deaths among children under five years of age due to diarrhoeal diseases are reported at 18.9% (2000); deaths among children under five years of age due to pneumonia 15.2 %, (2000).*

Rural/urban coverage disparities are reported as minimal at only 58%, urban and 60%rural.

Basic Indicators Total population (1000s) 22,384 Under-five mortality rate (per 1000) 55 Total adult literacy rate (%) - WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Social Sciences, Hygiene, Health, Life Skills, Science Water source common to schools Tap water Sanitation facilities common to schools Flush toilet, Simple pit latrine, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: DPRK Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


UNICEF assisted the MoE with a workshop introducing the concept of Life-skills Education and Early Childhood Development (ECD). MoE officials undertook study visits to Singapore and Thailand in connection with ECD, Child Friendly Schools (CFS) and Learner Assessment (LA).

Key Partners

Ministry of City Management (MoCM), Ministry of Education (MoE) External agencies including AUSAID

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Indonesia Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Indonesia


Although 89% of primary school students reached Grade 5 (2000/2004), disparities exist amongst rural and urban children. More children from urban areas (71.9%) go to junior high compared to those from rural areas (54.1%).1

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Indonesia, deaths among children under five years of age due to diarrhoeal diseases are reported at 18.3 % (2000); deaths among children under five years of age due to pneumonia, 14.4% (2000).*

The December 2005 Tsunami and March 2006 Nias earthquake necessitated the construction of 300 permanent schools and the rehabilitation of 200 schools, outfitted with child-friendly water and sanitation facilities. Ongoing hygiene promotion, operations and maintenance of facilities is needed to sustain gains in school water and sanitation coverage.

Main Components

The Water and Sanitation section supports WASH in Schools. UNICEF-supported WASH in Schools activities include:

• School Hygiene Promotion, Water and Sanitation in Maluku and North Maluku provinces and in Ambon city.

• Construction of school latrine units with hand-washing facilities and proper waste disposal. • Hygiene education, including training of trainers and training of teachers and reprinting and

distribution of existing hygiene education materials to schools. • Programme support costs, including one national officer for technical support, project

coordination and field monitoring. 1 United Nations Children’s Fund, ‘Fact Sheet: Girls education in Indonesia’ * These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World Health Report, 2006 Edition'.

Basic Indicators Total population (1000s) 220,077 Under-five mortality rate (per 1000) 38 Total adult literacy rate (%) 88 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Hygiene class Water source common to schools Hand pump, Open well Sanitation facilities common to schools Flush toilet, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Indonesia Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

Aceh/Nias Main Components

UNICEF entered Aceh and Nias after the Tsunami and Nias earthquake. The WASH in Schools programme is supported by the Education, and Water and Sanitation sections.

WASH in Schools activities include: • Water supply, hand-washing facilities and hygiene education in existing schools, temporary

schools and new, permanent schools. • The provision of separate toilets for boys and girls. • Hygiene education.


• UNICEF (Aceh and Nias) co-ordinated with the entire international relief community to discuss water, sanitation and hygiene with the local, Health and Education departments.

• Both WES and Education project staff briefed the Ministry of Health on the UNICEF-assisted WASH in schools strategy.


• WASH programme in 40 Ambon schools. • Sanitation and hand-washing facilities have been upgraded in 50 existing

schools and 200 temporary schools. • As part of the Aceh tsunami recovery programme, provided separate toilets

for boys and girls, water supply, hand-washing facilities and hygiene education in 450 existing schools, 200 temporary schools and 300 permanent new schools.


• Information, education and communication (IEC) materials (some based on competencies) developed for WASH in schools. More discussion will take place with government partners before the materials are used in the classroom.

• Hygiene education and teacher training package to be developed and implemented starting in 2006.

• Teacher guidelines developed on school level planning and monitoring.

Key Partners

Provincial and district-level authorities from the Ministry of Resettlement and Regional Infrastructure (responsible for water and sanitation facilities in communities and schools), and Ministry of National Education (responsible for hygiene education)

Community-based organizations; CARDI – international NGO United Nations Environment Programme (UNEP), World Food Programme (WFP)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Lao PDR Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Arsenic and fluoride contamination in groundwater is an emerging problem in Lao.

The sanitation gap is particularly wide, with 80% of people living in rural areas without access, compared to the 33% of those living in urban areas. School sanitation coverage tends to mirror that of community sanitation coverage.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Lao, deaths among children under five years of age due to diarrhoeal diseases, 15.6% (2000);deaths among children under five years of age due to pneumonia, 19.1% (2000) ∗

Main Components

The Education, and Water and Sanitation sections support WASH in Schools. UNICEF-supported WASH in Schools activities include the following:

• Primary school sanitation. • Participatory hygiene education. • De-worming of school children.


• Developed and expand appropriate sanitation technologies. • Established water quality control and surveillance system. • Integrate health and hygiene issues into primary school curricula. • Developed and disseminated Information, Education and Communication

(IEC) materials to increase community participation in WASH, and facilitate

∗ These are the latest Core Health Indicators from WHO sources, including 'World Health Statistics 2006' and 'The World Health Report, 2006 Edition'.

Basic Indicators Total population (1000s) 5,792 Under-five mortality rate (per 1000) 83 Total adult literacy rate (%) 69 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Life Skills, Health, and Hygiene classes Water source common to schools Hand pump, Tap water Sanitation facilities common to schools Flush toilet, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Lao PDR Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

linkages between school and community WASH.


• Improved access to clean water, segregated latrines in 69 primary schools. • De-worming of school children in 23 schools in Hin Hurb (Vientiane) and 10

primary schools in Sepone (Savannakhet province). • Modification of the school-latrine design.


• Training took place for 1,700 teachers from 12 provinces, after which they started to use the ‘Blue Box’ for participatory learning in the classroom.

Key Partners

Government: Nam Saat (Ministry of Health), Ministry of Education Bilaterals/multilaterals: SIDA, WSP-EAP, World Bank Other local institutions and NGOs: ADRA, SCF-UK, Lao Women’s Union, Lao Youth Union New Zealand UNICEF National Committee, World Health Organization (WHO)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Mongolia Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Mongolia


In the rural areas of Mongolia schools and communities use the same water source – thus school children have limited access to safe water and sanitation as 54% of the rural population is has access to safe drinking water, and 34% has sanitary latrines.

A survey to determine arsenic content in drinking water (2004) showed that the country average of arsenic content in well water is 0.014mg/l and 10% of all samples are arsenic positive.

Limited access to water compounded with poor water quality affects the teaching and learning environment.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. For Mongolia, deaths among children under five years of age due to diarrhoeal diseases are reported at 14.5% (2000); Deaths among children under five years of age due to pneumonia, 17.1% (2000).*

Main Components

The UNICEF Mongolia WASH in Schools project is in the initial stages. There are plans to mobilise resources in the coming year.

Mongolia has adopted Master Plan of Operations and WASH is one of the priority areas in the next period. Key Partners

Government of Mongolia, World Bank


Basic Indicators Total population (1000s) 2,614 Under-five mortality rate (per 1000) 52 Total adult literacy rate (%) 98 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Health class Water source common to schools Hand pump, Rainwater collection, Open well, Unprotected sources Sanitation facilities common to schools VIP toilet, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Myanmar Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Myanmar


Main Components

The Education, and Water and Sanitation sections support WASH in Schools activities. WASH in Schools activities include the following:

• Behaviour change communication and hygiene promotion activities in schools. • Provision of water and sanitation facilities to schools and rural health centres. • Water quality control and surveillance to ensure conformity to established norms and

standards.


Many drinking water sources in rural areas are not safe and the collection of water often requires walking more than 200 metres. The task of water collection often falls to girls and competes with enrolment, attendance and academic achievement.

At any point in time approximately 30% of all water systems are not functioning. Insufficient water supply is a factor in girls of menstruation age dropping out of school.

Primary school drop-out rates are persistently high (only 65% of students reached Grade 5 in 2000/2004).

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Myanmar, deaths among children under five years of age due to diarrhoeal diseases are reported at 21.1% (2000); deaths among children under five years of age due to pneumonia, 19.3% (2000).∗

Arsenic and fluoride contamination is a threat to water quality in many schools located in rural townships.

Basic Indicators Total population (1000s) 50,004 Under-five mortality rate (per 1000) 106 Total adult literacy rate (%) 90 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Life Skills, Health, Hygiene, and Science classes Water source common to schools Hand pump, Rainwater collection, Open well, Unprotected sources Sanitation facilities common to schools Flush toilet

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Myanmar Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


• Develop strategies and guidelines to facilitate decentralisation, integrated water, sanitation and hygiene, involvement of NGOs and private sector.

• Document experiences and lessons learned; conduct research and studies; exchange information; programme support.


• Constructed 72 tube-wells, 82 rainwater collection tanks, 143 gravity-flow water systems and 35 dug-wells in 313 schools and 43 communities.


• Life-skills are in the core curriculum for secondary school and the curriculum is competency-based and uses active learning.

• UNICEF and its counterparts have implemented a unit approach and built on the higher grades from information learned in the lower grades. Personalised questions have been added to link what children have already learned.

• Life-skills based education (LSBE) training has been incorporated into teacher training at teachers’ colleges and follow-up training. Both a teacher’s guide and a student’s guide have also been developed to promote hygiene in LSBE.

• Encouraged school children and basic health staff to act as agents of change in communities and households.

Key Partners

Department of Development Affairs, the Ministry of Health, the Ministry of Education and other concerned government departments at state/division and township level

Members of Donor Working Group on Water Sector; Parent Teacher Associations (PTAs), communities; private sector; NGOs

Department for International Development (DFID-UK), UNICEF Swiss and German National Committees

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Philippines Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Philippines


In the Philippines drinking water coverage declined in urban areas from 95% to 87%, partially due to a two-thirds increase in population. Access to safe drinking water is a factor in children becoming infected with worms, which affects their physical well-being and ability to learn in school.

Diarrhoea and pneumonia are two additional illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In the Philippines, deaths among children under five years of age due to diarrhoeal diseases are reported at 12 % (2000); deaths among children under five years of age due to pneumonia, 13.4% (2000).∗

Main Components

The UNICEF Philippines WASH in Schools project is in the initial stages. • In 2006 more than 50 schools were targeted for improved access to water and sanitation

facilities, and hygiene activities. UNICEF-supported WASH in Schools activities for 2007-2009 will include:

• Provision of safe water. • Basic school sanitation. • Hygiene education. • Teacher training.

WASH in Schools Activities Water and Sanitation Services

• Three hundred (300) priority schools in CPC areas of the country will have increased access to an adequate amount of safe water, basic school sanitation and hygiene education (2007-2009).


Basic Indicators Total population (1000s) 81,617 Under-five mortality rate (per 1000) 34 Total adult literacy rate (%) 93 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Planned for 2007-2009 Water source common to schools Hand pump Sanitation facilities common to schools Squat pot, Pour flush, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Philippines Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

• School and community WASH linkages will be strengthened through the provision of basic sanitation facilities for 45,000 people (including women and children) from 7,500 households of impoverished barangays. (2007-2009).


• This year a series of flip charts entitled ‘Pointers to Good Health’ was completed and disseminated in selected schools and communities to promote positive hygiene practices.

• Hygiene promotion planned for 45,000 community people (including women and children) through a sanitation-awareness campaign.

• UNICEF in co-operation with the Government has developed Early Childhood Development (ECD) curriculum standards, i.e. what children ages 0- to 6-years old should learn, to ensure basic competencies in health and hygiene.

• The WASH team is attempting to introduce a more localised teacher training, providing teachers with “how-to materials” to take back into the classrooms.

Key Partners

Local Government Units (LGUs) Swedish International Development Cooperation Agency (SIDA), the Government of Norway Procter & Gamble, Parent Teacher Associations (PTAs),

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Thailand Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Thailand has benefited from a booming private sector and impressive development but the schools that are located in conflict areas and are mostly attended by the poor, migrant and ethnic minority children commonly provide a lower level of access to safe water, sanitation facilities and hygiene education. A Multiple Indicator Cluster Survey (MICS) has recently been conducted and the subsequent analysis can be used to assess the WASH in Schools situation of children living in the 26 most vulnerable provinces (including the six tsunami-affected areas).

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Thailand, deaths among children under five years of age due to diarrhoeal diseases are reported at 21.9% (2000); deaths among children under five years of age due to pneumonia, 19.6%.*

Main Components

There had not been any WES/Health and Nutrition programme in Thailand for more than 10 years prior to the tsunami.

Post-tsunami UNICEF-supported WASH in Schools activities include: • Water supply schools, child-care centres. • Hygiene education. • Emergency preparedness and response.


Basic Indicators Total population (1000s) 63,694 Under-five mortality rate (per 1000) 21 Total adult literacy rate (%) 93 WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Health class Water source common to schools Hand pump, Rainwater collection, Tap water Sanitation facilities common to schools Squat pot, Urinals

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Thailand Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


UNICEF assisted 12 temporary schools and 2,000 families in temporary shelters with upgraded water and sanitation facilities, including purification equipment, latrines and drainage.

UNICEF initiated a two-year programme to reach 500 schools in six of the tsunami-affected provinces.


• UNICEF conducted a sanitation and hygiene information campaign designed to reach 300,000 schoolchildren and 500,000 members of the general community. As part of this campaign, UNICEF provided education materials and costs for teacher training.

• The ‘School-based Approach to Avian Influenza Prevention and Pandemic Influenza Preparedness and Response in Thailand’ project resulted in the development of five manuals covering Avian/Pandemic Influenza along with other high-risk diseases such as diarrhoea.

o Five (5) schools are developing Emergency Preparedness and Response plans for emergency situations including severe diarrhoea.

o Thirty nine (39) schools are implementing a life skills-based health education curriculum unit on avian and pandemic influenza, which includes behaviour practices that prevent diarrhoea such as handwashing with soap.

Key Partners

Ministry of Education, Ministry of Public Health, Government of Japan, Kenan Institute Asia

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Timor-Leste Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Timor-Leste


Incidences and eruptions of violence have exacerbated access to water and sanitation amongst schools and communities in Timor-Leste. Contaminated drinking water, inadequate sanitation and poor nutrition aggravate the health risks.

Infant and under-five mortality rates are relatively high, with malaria, diarrhoea and respiratory infections taking a heavy toll.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Timor-Leste, deaths among children under five years of age due to diarrhoeal diseases are reported at 21.9%, (2000); deaths among children under five years of age due to pneumonia, 19.6% (2000). *

Main Components

The UNICEF Timor-Leste WASH in Schools project is in the initial stages. UNICEF-supported WASH in Schools activities include:

• De-worming of school children. • Provision of water and sanitation systems to primary schools.


• More than 1,200 children received de-worming treatment in a pilot project at seven (7) schools.

• The initiative proved successful and will be replicated in at least 50 schools in 2006, with the objective of taking it to scale on a national level as part of the regular school health programme.

• Twenty-four primary schools received new water and sanitation systems.


Basic Indicators Total population (1000s) 887 Under-five mortality rate (per 1000) 80 Total adult literacy rate (%) - WASH in Schools National school water/sanitation coverage No data Hygiene education in schools Hygiene class Water source common to schools Hand pump, Tap water, Unprotected sources Sanitation facilities common to schools VIP toilet, Squat pot, Flush toilet

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Timor-Leste Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


• De-worming activities were followed up with a series of education and communication activities at the community level, involving staff from the ministries of education, health and water.

Key Partners

AusAID, Parent Teacher Associations (PTAs) United Nations Department of Economic and Social Affairs (UNDESA), the World Bank, UNICEF National

Committees (NATCOMs)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Viet Nam Data years: WES (2002), mortality/population (2004), literacy (2000/2004)


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Viet Nam


Although Viet Nam has experienced increased access to water and sanitation, water quality is a concern in communities and schools as Arsenic and fluoride contamination in groundwater is an emerging problem.

Primary school enrolment is over 90%, but one third of Viet Nam’s children do not complete Grade 5, and 70% of school dropouts are girls.

Diarrhoea and pneumonia are two illnesses that can be linked to inadequate access to safe water, sanitation facilities and hygiene education. In Viet Nam, deaths among children under five years of age due to diarrhoeal diseases are reported at 10.4% (2000); deaths among children under five years of age due to pneumonia, 11.5% (2000)*

Main Components

The Education, and Water and Sanitation sections support WASH in Schools activities. WASH in Schools activities include the following:

• Creating an enabling environment by establishing sustainable management structures and processes, including training of counterparts, reaching poorest households and maintaining water quality standards.

• Supporting community WASH through the construction of community water systems; water and sanitation facilities in schools and day care centres; and establishing local operation and maintenance systems.

• Increased focus on hygiene and sanitation, as well as inter-sectoral and community-focused approaches.

WASH in Schools Activities Enabling • Developed and expand appropriate sanitation technology options.


Basic Indicators Total population (1000s) 83,123 Under-five mortality rate (per 1000) 23 Total adult literacy rate (%) 90 WASH in Schools National school water/sanitation coverage Water, 65% - Sanitation, 42% (2003) Hygiene education in schools Health, and Hygiene classes Water source common to schools Hand pump Sanitation facilities common to schools Flush toilet, Urinals (boys/girls)

Data: UNICEF State of the World’s Children 2006 and WHO/UNICEF JMP WASH in Schools Country Profile: Viet Nam Data years: WES (2002), mortality/population (2004), literacy (2000/2004)

Environments • Developed, disseminated and monitored IEC material, increasing community participation in relation to WES to facilitate community and school WASH linkages.

• Supported and trained for Management Information Systems (MIS) database. • Supported policy development on Environmental Protection and People’s

Health, including a focus on child-friendly interventions. • Supported the systematic documentation of field experiences for in-country

and regional exchanges.


• Participated in the School Sanitation and Hygiene Education (SSHE) Global Pilot Project (2000-2004) that targeted 100 primary schools reaching 25,000 children.

• Supported gender sensitive and child-friendly WES designs in kindergartens and primary schools through the Institute of School Design Studies under the Ministry of Education and Training.

• UNICEF also supported a participatory assessment of the School Sanitation and Hygiene Education (SSHE) pilot project through the Centre for Environmental and Health Studies.


• Implemented teacher training in Life Skills and Hygiene Education, and developed a teacher’s guide book.

• Undertook desk review of all existing materials relating to Hygiene Education, and is planning to develop a guidebook, first for teachers and second for the students. The students’ book will include mainly pictures and illustrations.


National Target Programme II has a clear target of 100% WES coverage in schools by 2010.

The approved child-friendly latrine design will stimulate a high level of interest/commitment for:

o Incorporating WES facilities in the Ministry of Education and Technology (MoET) standard for new schools.

o Improving quality of WES facilities at other existing locations. o Guidance on monitoring quality of construction by schools/local

authorities.

Key Partners

Government: Centre for Rural Water Supply and Sanitation (CERWASS), the Department for Preventive Medicine; Thai Binh Medical College, National Institute of Occupational Health

Department for International Development (DFID-UK), the Danish International Development Agency (DANIDA), AusAID, World Bank, Asian Development Bank (ADB), World Health Organization (WHO), United Nations Development Programme (UNDP) and local and international NGOs

1

WATER, SANITATION AND HYGIENE IN SCHOOLS REGIONAL WORKSHOP 18-20 OCTOBER 2006

AMARI WATERGATE HOTEL BANGKOK, THAILAND

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ACRONYMS 4

INTRODUCTION 6

REVIEW CURRENT FRAMEWORKS RELATING TO WASH IN SCHOOL 8

OUTCOMES FROM THE SCHOOL SANITATION AND HYGIENE EDUCATION EVALUATION 12

A GLOBAL UPDATE ON WASH IN SCHOOLS 15

ASSESSING IMPACT AND EFFECTIVENESS 17

CHILD FRIENDLY WATER AND SANITATION FACILITIES IN VIET NAM 19

HYGIENE PROMOTION IN SCHOOLS: CURRICULA AND EXTRA-CURRICULA 23

THE EVIDENCE BASE FOR HYGIENE PROMOTION 26

FINANCING WASH IN SCHOOLS: WHAT DOES IT COST? 29

WASH IN EMERGENCY PREPAREDNESS AND RESPONSE, AVIAN INFLUENZA 32

WASH IN EMERGENCY PREPAREDNESS AND RESPONSE, CHILD FRIENDLY SPACES 34

TAKING WASH FORWARD IN THE REGION 36

PARTNERSHIPS FOR SUSTAINABILITY OF WASH IN SCHOOLS 38

GOVERNMENT/INTER-MINISTERIAL PARTNERSHIPS (INCLUDING SWAPS) 40

THE GLOBAL HANDWASHING INITIATIVE 42

CHILDREN AS CHANGE AGENTS 47

CHILDREN’S PARTICIPATION IN HEALTH AND HYGIENE ACTIVITIES 49

CHILDREN AS CHANGE AGENTS II 53

THE RELATIONSHIP BETWEEN WASH IN SCHOOL AND WASH IN COMMUNITIES 56

GENERAL PLENARY DISCUSSION 58

ANNEX I: WHO GUIDELINES ON MINIMUM STANDARDS FOR WASH IN SCHOOLS 59

ANNEX II: CHILDREN’S WATER MANIFESTO 90

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ANNEX III: INTERNATIONAL COMMITMENTS TO WASH IN SCHOOLS 92

ANNEX IV: WATER, SANITATION, AND HYGIENE IN SCHOOLS WORKSHOP AGENDA 93

ANNEX V: PARTICIPANT LIST 96

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Acronyms

ADB Asian Development Bank AI Avian Influenza AIDS Acquired Immune Deficiency Syndrome ARI Acute Respiratory Infection BCC Behaviour Change Communication CDC Centers for Disease Control and Prevention CFS Child Friendly School CFSp Child Friendly Space CHW Child Health Week CRC Convention on the Rights of the Child CTC Child-to-Child DFID Department for International Development EFA Education for All EPRP Emergency Preparedness and Response Plan EU European Union FTI Fast Track Initiative FQ Fun Quotient FRESH Focusing Resources on Effective School Health GIS Global Information Sharing project HIV Human Immunodeficiency Virus HPS Health Promoting School HWI Handwashing Initiative IEC Information, Education, and Communication INGO International Non-governmental Organisation IRC International Water and Sanitation Centre JICA Japan International Cooperation Agency JOICEP Japanese Organization for International Co-operation in Family Planning LSBE Life Skills Based Education LSHTM London School of Hygiene and Tropical Medicine LoA Letter of Agreement MDGs Millennium Development Goals MNE Multinational Enterprise MoE Ministry of Education MoET Ministry of Education and Technology MoH Ministry of Health MoPH Ministry of Public Health MoU Memorandum of Understanding MTSP Medium-term Strategic Plan NGO Non-governmental Organisation PBA Programme Based Approach PPP Public-Private Partnership PSI Population Services International PTA Parent Teacher Association SSHE School Sanitation and Hygiene Education SWAp Sector Wide Approach UNICEF United Nations Children's Fund UNESCO United Nations Education, Scientific, and Cultural Organization UNGEI United Nations Girls’ Education Initiative

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VIPP Visualisation in Participatory Programmes WASH Water, Sanitation, and Hygiene WES Water and Sanitation WFFC World Fit for Children WFP World Food Programme WHO World Health Organization

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Introduction We all know and can recite the mandates and rationale for water, sanitation and hygiene in schools: The Millennium Development Goals, Education for All, the Convention on the Rights of the Child, A World Fit for Children, and Vision 21 are just some of the commitments that UN agencies and concerned organisations recognise as the prelude to water, sanitation and hygiene (WASH) in schools. We all agree that now is the time to bridge the gap between policy and implementation of water, sanitation and hygiene and education, in support of child survival, children’s rights to quality education, and to ensure the attainment of core learning outcomes. The UNICEF East Asia and Pacific Region Water, Sanitation and Hygiene in Schools Regional Workshop took place from 18 to 20 October 2006 in Bangkok, Thailand, and gathered internal and external water and sanitation, education, and communication professionals to share challenges and opportunities for scaling up Wash in schools across the region. The workshop took a unique approach in that the first two days were internal UNICEF sessions designed to align the priorities of the Water and Sanitation (WES) and Education sectors for WASH in schools. The third day included government partners from the Thailand ministries of Public Health and Education, the World Bank in Viet Nam, UNESCO Bangkok, the Southeast Asian Ministers of Education Organization (SEAMO), Education International, Plan Asia Regional Office, Plan Viet Nam, the Child-to-Child Trust, Education International Asia Pacific Region, the American Red Cross IFRC, and external consultants. The objective was to share experiences and debate issues in support of stronger partnerships in the provision of water and sanitation facilities in schools for all children. The UNICEF Education Strategy for 2006-2015 clearly highlights life-skills based water, sanitation and hygiene education as a global priority in recognition of the impact of school-based WES interventions on educational quality, access, attendance, learning environment and process. Furthermore, the provision of appropriate hygiene facilities and supplies in schools is identified within the strategy as an important contribution to achieving a holistic Child Friendly School model. Accordingly, the UNICEF Water, Sanitation and Hygiene Strategies for 2006-2015 asserts that the overall objective of UNICEF in WASH is to contribute to the realisation of children’s rights to survival and development through global and national promotion of sector investment and support to programmes that increase equitable and sustainable access to, and use of, safe water and basic sanitation services, to and promote improved hygiene. UNICEF aims to work in close partnership with sister UN agencies in support of nationally identified priorities in support of accelerated achievement of the Millennium Development Goals (MDGs). Workshop participants affirmed that WASH is an important prerequisite for ensuring the right to basic education. Children commonly miss school because they are too busy hauling water or are at home sick with a waterborne disease. Girls, particularly those who have reached the age of menstruation, often drop out of school when toilet and washing facilities are neither private nor safe, or simply non-existent. Even when children attend school, they fail to reach their full learning potential because of worm infections and diarrhoea. Representatives from 10 East Asia Pacific UNICEF country offices shared how their water and sanitation programmes have allocated resources to improve the health of children through increased access to safe water, latrines and handwashing facilities in schools. The workshop sought to identify and build on best practices across the region by which UNICEF will co-operate with partners to ensure that all schools receive a basic package of water, sanitation and hygiene education by 2015. Specific objectives of the UNICEF internal sessions were to: • Strengthen commitment and joint understanding between Education and WES country teams from

the region on WASH in Schools. • Better understand the variety of experience available across the region and identify potential

resources for improved programming. To further identify regional areas of strength and common challenges.

• Identify monitoring mechanisms for WASH in Schools. • Provide those involved in developing a WASH in Schools programme with relevant information

and tools for effective planning and implementation. • To gain a regional overview of costing standards and issues for WASH in Schools. • Better understand the stages and/or content involved in planning a WASH response in

emergencies and the role of WASH programmes in relation to Avian Influenza (AI).

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• Highlight how WASH in Schools will be taken forward jointly within WES and Education sections. Providing children with safe, clean and reliable school WASH facilities helps create a learning environment that is pleasant and healthy. Providing children with child-centred hygiene education provides the foundation for a healthy and productive life; and creates an informed demand for safe water and hygienic sanitation facilities. Where properly integrated with community programmes, WASH in schools can transform children into change agents for the whole community.

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Review Current Frameworks Relating to WASH in School Cliff Meyers, Regional Education Advisor, UNICEF EAPRO It is important to be well versed in water, sanitation, and hygiene and some of its frameworks. The WASH overall objective is to contribute to the realisation of child rights to survival and development through support to programmes that increase equitable and sustainable access to, and use of, safe water and basic sanitation services, and promote improved hygiene. The revised WASH strategies have been developed in tandem with the formulation of the UNICEF medium-term strategic plan (MTSP) 2006-2009 and are designed to directly contribute to the MTSP targets in the focus areas of young child survival and development and basic education and gender equality. • Target 1: Halve, by 2015, the proportion of people without sustainable access to safe drinking

water and basic sanitation (Millennium Development Goal Target 10). • Target 2: Ensure that all schools have adequate child-friendly water and sanitation facilities and

hygiene education programmes (now widely recognised as a sector priority — endorsed at the World Summit for Sustainable Development and by the Commission for Sustainable Development).

WASH globally: Three packages of support 1. In 60 countries with high child mortality and low WASH coverage:

a) Support to water supply and sanitation services. b) Support to WASH in schools. c) The basic package.

2. In emergency countries: UNICEF Core Commitments for Children in Emergencies (CCCs) include WASH.

3. In all other countries where UNICEF supports programmes:

a) Hygiene improvements b) Drinking water safety c) Monitoring global indicators d) Emergency preparedness

UNICEF supports seven strategies in 54 priority countries. These strategies include: 1. Promoting a balanced national WASH programming

framework (3 pillars). 2. Supporting inter-sectoral approaches. 3. Providing catalytic and continuous support for scaling

up sustainable WASH programmes. 4. Supporting community management through effective

decentralisation processes. 5. Promoting safe and sustainable water supplies through

improved water resources management. 6. Focusing on sanitation, water quality and hygiene at

the household level. 7. Addressing a child’s right to health and education

through the provision of WASH in schools.

These strategies are global and are applicable to both WASH in schools and WASH in communities. One of the things we recognised in relation to education is that we won’t have much success in schools if WASH in communities is not being addressed alongside. WASH in relation to the MDGs and the Dakar Framework for Action So how does WASH in Schools link to the overall MDGS? With WASH in schools you have your own piece of the MDG puzzle. MGD 2 and MGD 3: These are not going to be achieved without having solid WASH in Schools programmes. So even in Dakar, we were already saying our targets have to be

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backed with strategies, and our strategies have to include water and sanitation to allow children to have quality education. The ‘Dakar Framework for Action’, for example, has a target and strategy regarding quality:

• Target 6: Improving all aspects of the quality of education for all, so that recognised and measurable learning outcomes are achieved by all, especially in literacy, numeracy, and essential life skills.

• Strategy 8: Create safe, healthy, inclusive, and equitably resourced educational environments

with clearly defined levels of achievement for all. Basic education and gender equality In the UNICEF medium-term strategic plan WASH cuts across four key result areas:

1) Early childhood education 2) Access 3) Quality 4) Education in emergencies

WASH is placed more in quality than in access. It’s not just for access that you include water and sanitation, now we are saying that a school is not a quality school unless you have water and sanitation, and hygiene. Draft Education Strategy In the ‘Draft Education Strategy’ there are two references to WASH. The first is in relation to quality, to establish child friendly schools and essential life skills as standard policy and practice: 1. Prioritise Child Friendly Schools (CFS) as a “one-stop” model for quality education processes and

standards. CFS is the main model that UNICEF uses and advocates for a holistic approach to quality education.

Providing essentials like nutrition, safety from violence and/or accidents, hygiene facilities and supplies and an environment that is generally conducive to good practices and learning achievement. Promoting Child Friendly Schools as a holistic model for inclusive and equitable quality education.

2. Boost Life Skills Based Education (LSBE) in 54 HIV priority countries and 56 WASH priority

countries.

UNICEF will work with UNESCO and other partners to consolidate and revitalise work on life skills as an emerging discipline that requires greater clarity. Revitalised life skills will not only deal with HIV/AIDS prevention in schools and for out-of-school children and youth, but will also renew support for nutrition and hygiene packages such as WASH and FRESH.

The ‘Draft Education Strategy’ is still in the process of finalisation. The Education priority countries have also used the WASH priority countries as criteria for their selection. Also the Regional Adolescent Education strategy prominently includes WASH. Out of 54 global priority countries, there are four Education priority countries, and eight WASH priority countries in the East Asia Pacific region:

Priority countries Cambodia, China, Myanmar, Papua New Guinea

Education

Not on list (FTI/ UNGEI)

Pacific Viet Nam Mongolia Timor Leste Lao PDR

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Priority countries Cambodia China Indonesia Lao PDR Myanmar Papua New Guinea Philippines Viet Nam

WASH

Not on list Democratic People’s Republic of Korea Timor Leste Mongolia Thailand

There is a concern whether countries that are not on the list will receive funding. So far the countries not on the priority list have not received financial support for water and sanitation. Focusing Resources on Effective School Health (FRESH) The FRESH framework takes you beyond the ‘education world’ and is broad reaching. A brief background: The FRESH initiative was launched at the World Education Forum by four key players: UNESCO, UNICEF, World Bank, and the World Health Organization and is experiencing a revival of sorts. Plan International is one of the strongest supporters in the region; and Education International, which represents 280 teachers' unions and professional organisations worldwide, and the Partnership for Child Development are core members of the global committee. The FRESH framework consists of four core components:

FRESH Core Components • Health-related school policies which

do not exclude pregnant girls, that encourage healthy tobacco-free lifestyles, and that help maintain the education system in the face of HIV/AIDS.

• Provision of safe water and

sanitation to provide a healthy learning environment that reinforces hygienic behaviours and provides privacy to promote participation of adolescent girls in education.

• Skills-based approach to health, hygiene, and nutrition education that focuses upon the development of knowledge, attitudes, values, and life skills needed to establish lifelong healthy practices and to reduce the vulnerability of youth and teachers to HIV/AIDS.

• School-based health and nutrition services that are simple, safe and familiar, and address

problems that are prevalent and recognised as important within the community, including the provision of counselling to cope with the HIV/AIDS epidemic.

There has been a debate concerning the most accurate term to use for water, sanitation, and hygiene in schools. Some call it FRESH, others refer to it as WASH, and many recognise it as SSHE (School Sanitation and Hygiene Education). UNICEF is encouraging the term ‘WASH in Schools’ and a move away from SSHE, with the understanding that WASH is one contribution to the FRESH initiative. Health Promoting Schools (HPS) While the World Health Organization originally focussed on de-worming, as a focal point of the Health Promoting School strategy, but this has expanded. WHO also states that Health Promoting Schools can be easily captured under the Child Friendly School umbrella. The Health Promoting School strategy includes:

1. Research to improve school heath programmes.

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2. Building capacity to advocate for improved school health. 3. Strengthening of national capacities. 4. Creating networks and alliances for the development of heath promoting schools.

WASH and Child Friendly Schools (CFS) The Child Friendly School model is central to UNICEF’s Education Strategy. Child-friendly schools are those that are: inclusive; effective; protective, safe and healthy; gender equitable; and promote the participation of the student, parent(s) and community. These five core dimensions of child-friendly schools are closely related to, and inter-dependent on WASH in schools. The WASH elements need to be featured in all dimensions of CFS so that all children can attend school. We are now seeing countries where children are involved in school self assessments, and their participation makes a difference in the dynamic of the school. When children report that the toilets are the worst part of their school it really has a strong impact. In this region the gender dimension of CFS has been a struggle because some say gender is not a problem because we see an equal number of girls and boys enrolled. But we are losing sight of what happens inside the classroom, are focussing too much on enrolment figures, and not looking enough at inclusion processes. Now we must look at integrating WASH with the child-friendly school concept. This integration starts first with the external capacity building of WES. We don’t see the WES unit getting as much capacity building as the others. One thing that we do see with WASH in schools is the involvement of the Ministry of Education in the implementation of the Child Friendly School model, yet the school construction person is not always a part of the WES team. We don’t explore public-private partnerships as much as we could. For example, this can be done by getting companies to adopt schools. We see this a lot in Latin America but less so in East Asia. We need to look at how to get education donors to invest in water supply. Without water – toilets and hygiene education lessons are often fruitless. The million dollar question is how do we get education donors to invest in water supply when the cost will be different from school-to-school? Last, we need to form stronger WASH in schools and community linkages. When you are supplying WASH in communities, you should already be taking in consideration the amount of water needed for the school. We need to support those linkages better from the beginning.

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Outcomes from the School Sanitation and Hygiene Education (SSHE) Evaluation Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO Obviously in the UNICEF world there are more than six countries that have been doing WASH in schools. We have been tracking activities in the various annual reports, and the last count indicated that almost 90 countries (2005) have been engaging in WASH in schools activities. It’s a phenomenon that has been growing every year but in 2000 there was a structured attempt to try out certain protocols and support life skills. Now we have a report and the documented findings of what went on in six countries. Six Pilot Countries Burkina Faso, Colombia, Nepal, Nicaragua, Viet Nam, Zambia Expected results 2000-2004 • Develop country-specific, child-centred teaching programme utilising life skills approach. • Support initiatives by different stakeholders at community level. • Document and disseminate experiences. • Increase global, regional and national awareness of, and commitment to SSHE. Design of pilot interventions • Mobilisation in and around schools in rural settings. • Collecting baseline date of various types. • Contribution of local govt or parents. • Construction/rehabilitation of water, sanitation and handwashing facilities. • Participation of children, including clubs. • Life skills education and material development. • Training/orientation of teachers, sometimes others. Assessment sought answers 1. What are main results of each pilot project? 2. What were major lessons learned (both positive and negative)? 3. What experiences, strategies, plans, resources or materials useful in other contexts? 4. Implications for scaling up? Judging the findings • Country teams determined the criteria for successful practice. • Achievement was set at 4/5 schools or 80 per cent children (teachers/of the community). • Comparison of project schools with control schools (Some control schools had interventions from

other agencies). Outcomes: Water • Facilities functioning: In each country still working in 80 per cent or more of project schools, within

200 m or within compound. • Some system for maintenance and repair in place • Storage: In 4/5 countries 80 per cent of schools stored drinking water in adequate fashion (but no

water quality testing) Outcomes: Handwashing • Handwashing with soap or ash: In none of the six countries were 80 per cent of children washing

their hands. • Less than 1/3 used soap – absent or difficult to access.

o But some improvement over pre-project practices where no handwashing was practiced. Outcomes: Toilets/Urinals • In 4/5 countries, numbers followed national norms of ratio of children per facility. (In some

countries the MoE has developed norms of their own). • Variation of norm: 25/toilet -> 100/toilet. • Designs: 3/5 reported CF features.

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o In one country, 1/10 latrines collapsed. • Use and cleanliness: Five countries, in 80 per cent or more of project schools, toilets used and

kept clean. o By children or by janitors.

• Project schools performed better than controls (in both use and cleanliness). Outcomes: For children • Knowledge: 80 per cent or more knew health reasons for washing hands (better than control). • Participation: Many groups/clubs, 4/5 studies showed in 80 per cent or more of schools these are

activities: o Designing facilities. o Monitoring handwashing. o Surveying community sanitation/hygiene needs. o Cleaning tasks.

Outcomes: Home and community • Home: In 4/5 countries, school-initiated activities reached to families:

o Behaviour change possibly due to other interventions because there were behaviour change activities going on at the time; therefore, it is difficult to contribute positive behaviour changes directly to WES projects.

• Community: In 4/5 countries, schools used as entry point to initiating community mobilization Outcomes: Institutional setting and co-ordination 1. Except for Colombia, there were three or more government institutions involved in addition to

NGOs and donor agencies 2. Different approaches to co-ordination 3. Scaling up in Viet Nam:

o Finalising child-friendly designs o Scaling child-friendly designs as standard for all schools o Training more than just teachers o Advocacy

Main conclusions

1. Greater emphasis needed on handwashing with soap: • We need more work on handwashing as we didn’t attain the success rate we had hoped for. • We have to explore the means to ensure the availability of soap:

o How do we ensure there is soap, and how do we ensure that the soap does not disappear?

2. Baseline data missing • Had to use control schools. • Reinforces the importance of investing in monitoring. If our role is to advocate, we need to invest

in monitoring. 3. Need to have better costing information.

• Finance as part of advocacy. • Resource mobilisation. • We want to be honest with donors. You have to be clear on what it is included and have to be

clear on what it is you are getting out of it. Question and Answer Q: Was there tracking of de-worming? A: This wasn’t part of the programming although it’s being done. We have some studies and evidence on the importance of de-worming and we will be looking at some of the evidence for hygiene promotion later on. For this pilot in the assessment we do have some data on the impact of de-worming. Q: How about the tracking of the impact of better environment in schools on children’s learning? This would be good advocacy material later.

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A: The answer is no at this point. To that degree it’s quite difficult. The pilot study was a conservative effort. There are some facts and figures but a lot of it is very qualitative. Some countries only looked at eight schools while others had up to 40 schools (Viet Nam). Q: You mentioned the availability of soap and water. Has this programme made an effort to connect soap making to adult education programmes? A: I don’t know specifically of this but maybe if we looked at country reports we would see some instances. It sounds like an interesting idea to contribute to achieving sustainability.

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A Global Update on WASH in Schools: Developments from a global perspective Therese Dooley, Senior Advisor for Sanitation & Hygiene, UNICEF New York There is a growing recognition that schools and learning centres need to be safe, healthy and protective (Quality Learning Environments); and that water, sanitation and hygiene are crucial factors for school attendance and completion, particularly for girls. There has been an evolution of global recognition that can be captured in the following timeline:

• 1993: The first studies and workshops by IRC and WHO showing SSHE experiences but mainly at small scale.

• 1998: The IRC-UNICEF SSHE manual building on country experiences. • 1999-2003: The pilot SSHE programme in six countries and other interested countries. • 1999 – 2004: Increase in programme support for SSHE/WES in schools and advocacy and

international call for action • 2005: Symposium SSHE: the Way Forward, Oxford roundtable. • 2006: UNICEF/IRC Global Information Sharing (GIS) project; and • 2006-07: Impact and Sustainability Study

Since Cliff and Mark have already expounded on the aforementioned topics I will focus on the final two points: UNICEF/IRC Global Information Sharing (GIS) project Some counties are building facilities and others are working on developing materials. It doesn’t mean that if you aren’t building latrines you aren’t doing WASH, countries are at different levels of implementation. The GIS project has seven main components: 1. Update and maintain WASH in schools Web site. The purpose is to have a Web site that everyone

can access and people can share and build information and to get this network kick started. 2. Create new content for the Web site. 3. WASH in schools network rejuvenated. 4. Publish two additional issues of the SSHE newsletter. The SSHE newsletter is published two to

three times per year and the latest one came out in October. 5. Produce and disseminate case studies and human interest stories (12 in total); they should be out

by November. 6. Translation (2006) of the World Bank/UNICEF toolkit (developed by WES team of the World Bank)

into French and Spanish. 7. Finalise the revision of the UNICEF school sanitation manual (the most downloaded manual on

the UNICEF WES Web site) that was published in 1998, but we have come a long way and learned a lot more.

2006-07: Impact and Sustainability Study People are asking, why is WASH in schools important? To answer that question UNICEF is embarking on an 18-month study. The following counterparts are involved:

• Scientific study looking primarily at the evidence base for WASH in schools. o LSHTM – health and hygiene behaviours o University of Utrecht – education focus o Research methodologies, planning and analysis – UNICEF M&E/WES units o Literature review, detailed research methodology, design workshop

• Two country studies (India and Kenya where WASH in schools have longest history). • National workshops, research process and immediate outcomes. • Reports with ideas for dissemination, and a document of field research with programming

implications. • Final document. • International Forum – December 2007. • Capacity Building on WASH in schools and knowledge management.

Public-private partnerships I would also like to talk a little bit about public-private partnerships because a lot is going on at the global level. It’s easy to count toilets and the number of children who stay in school, but it is hard to

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measure handwashing because it requires observations, which can be costly. UNICEF has formed a small-scale partnership with Procter and Gamble which focuses on water quality in schools. A larger, well-known public-private partnership in the region is with Unilever and its Lifebuoy Soap. It is basically targeting the handwashing practices of school-aged children. It’s not about a donation of soap – that is the mistake we make when we think about partnerships – we automatically think of someone donating something. Public-private partnerships can also allow us to work on behaviour and social change where there are marketing initiatives that trigger positive behaviour practices.

A third public-private partnership is the Global Water Challenge, a number of private companies, some big corporations that come together under the auspices of corporate social responsibility and contribute money for schools. We want to make sure that money is not just used to build schools but also for the software side of WASH in schools which includes hygiene education and promotion. Part of our challenge is finding ways to influence what they these corporations are doing, and making sure that WASH in schools is included.

Finally, a new innovation called “play pumps” is being introduced. Children play on these water pumps and in the process water is released for use in the school. India has been working on two additional pumps. There is a little controversy as to whether it’s forced play or child-initiated play. This will have to be worked out via consultations with children at the schools.

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Assessing Impact and Effectiveness: Reviewing potential indicators/standards George Attig, UNICEF Consultant, Mahidol University There are very few documents that contain information about indicators for WASH. So let’s start from the beginning with this question: What is an indicator? An indicator is a piece of information that indicates a state or level. An indicator can be a measurement, a number, a fact, an opinion or a perception of a specific condition or situation. They thus can be quantitative or qualitative. When we talk about percentages, portions or numbers that’s quantitative. When we talk about participatory aspects, that’s qualitative. An indicator can be written as a sentence, a question, or in any form as long as people understand its meaning. Indicators measure and monitor the achievement of expected results of activities (progress in achieving outputs; process indicators) and the degree to which these have achieved a desired state (outcome, impact) and thus the success of a programme. They answer questions such as, have the activities done had an affect or change for the better? Indicators are important to WASH in Schools, for all programmes for that matter, because they prove the success or effectiveness of a process through positive outcomes. Indicators are needed to open people’s (policy makers) eyes, create informed demand, gain additional resources (partners/funds), and start the scaling-up process. A key WASH issue that I have heard you all say is that there is no baseline data: Today we can talk about what indicators we need; indicators that can be monitored from the baseline to the end of a project’s donor life? Indicators need to be specific, understandable and directly measurable. They have to be easily acceptable and recognisable. There should be no assumptions or lingering questions such as “what do you mean by this”? Everyone has to see it and understand it. Indicators need to be objective and timely (one result, measures only one thing at a time; comparable data can be collected, especially at different assessment levels), and remains stable over time so that change can be measured. It’s difficult when an indicator has two pieces; therefore, it is better to look at one aspect at a time. Indicators have to be valid, i.e. they must measure the element they are supposed to measure. You must be vigilant on this, is the number of latrines a valid measure of use? I don’t know how many times I’ve seen the number of latrines for WASH in schools programmes as an indicator. And lastly, indicators must be practical. That means they are realistically achievable and data can be easily collected. Steps in developing and/or identifying indicators When we start to identify indicators we can break it down to manageable steps starting at: • Levels: You have child/family/school/system (wider government). What do you want to see

children, teachers, families and communities, doing with WASH? • What needs to be measured: Do you want to look at knowledge, use, polices, partnerships, etc.? • After developing trial measures/indicators you have to assess each trial indicator

1. Does the indicator measure what it is supposed to measure? 2. Is it useful? 3. Can data be easily collected? 4. Can it be monitored over time? 5. Select the best indicators for a specific project or programme?

Group Work: School WASH Indicators We will now divide ourselves into 4 groups (assessment levels), leaving the last set of indicators to cover as a group: Group 1 child-specific WASH indicators:

1. Children have access to safe drinking water from an improved water source. 2. Access to water and soap (or another acceptable alternative). 3. Consistent organised maintenance:

• Toilets. • Drinking water. • Hand washing facilities.

4. School children effectively use latrines. 5. Children take pride in their own and school’s hygiene (sustainability).

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6. Children help each other in using facilities and helping each other in maintaining facilities. 7. Students pass hygiene messages, practices to families. 8. Children help and participate in the making and monitoring of school’s plan of action in WASH

in schools. Group 2 school indicators:

1. Facilities • Latrine and handwashing facilities exist. • Latrine to student ratio. • Separate latrines for boys and girls. • Sanitation facilities are safe. • Handwashing facilities are close to the latrines.

2. Behaviour change • Is soap available? • Are paths overgrown, doors locked, etc. (access and use of facilities) • Clean school environment. • Tools exist in school to assist teachers in measuring behaviour change.

3. Enabling environment • Financial, operation, and maintenance plans in place. • Children receive hygiene messages in school.

Group 3 family & community indicators (agency perspective):

1. Percentage of household that have safe water systems (access). 2. Percentage of household using sanitary latrines. 3. Incidence of population with diarrhoea disease incidence within last two weeks. 4. Handwashing with soap and clean water. 5. Percentage of families/children encouraging children/families to adopt safe practices learned

in the school WASH programme. Group 4 system indicators:

1. Government commitment. 2. Policies plans and programmes/adequate national and lower level policy/legislation exists on

water and sanitation standards. 3. Adequate regulations and guidelines exist on WASH in schools for private and faith-based

educational institutions. 4. Co-ordination body exists at different levels. 5. Knowledge and information systems (EMIS) include key WASH indicators. 6. Ministries of health/education sharing same goals; have a coordinated strategy, vision,

resources. 7. Where education and heath sector plans exists, WASH in schools is a feature, component. 8. Whether the new schools being constructed include water and sanitation.

Due to time limitations we won’t get a chance to go over the last set of indicators: outcome/impact indicators. When you return to your country offices, you could think about specific school (or even national) WASH indicators that could be included as a statistical table for UNICEF’s ‘State of the World’s Children’ publication.

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Thursday, 19 October 2006 – Day 2 Child Friendly Water and Sanitation Facilities in Viet Nam Chander Badloe, Chief of Water, Environment and Sanitation, Section, UNICEF Viet Nam Viet Nam is one of the East Asia Pacific countries that has shown large increases in access to improved sanitation facilities from 1990 to 2004, though arsenic contamination in groundwater is an emerging problem. In Viet Nam there are 15,000 schools (kindergartens, primary schools, secondary schools). The nation has about 32 million children (about 40 per cent of total population), with a net primary enrolment of 97 per cent (2004-05). The national school WES coverage remains at 65 per cent for water, and 42 per cent for sanitation (2003). Viet Nam was one of the six pilot countries that participated in the SSHE Global Pilot Project (2000-2004) which sought to develop country-specific, child-centred teaching programme utilising life skills; support initiatives by different stakeholders at community level; document and disseminate experiences; and to increase national awareness of, and commitment to SSHE. The lessons that the Viet Nam country team learned from the SSHE Global Pilot Project include:

• The norms on urinals/cubicles vary considerably. There were also difficulties in ensuring adherence to technical specifications for design and construction quality.

• Water facilities were in working order in less than 80 per cent of the schools. • Water quality was not all tested. • Toilets and urinals are cleaned either by hired janitors or caretakers, or by children depending on

financial means of the school. • Availability of soap is a major problem. • Difficult to attribute changes in the community and at the household level to the school

programmes alone. • SSHE is the responsibility of a wide range of institutions and agencies, requiring a good level of

co-ordination. • Gender issues were addressed, with separate latrines for boys and girls, cleaning responsibilities

disaggregated by sex. The increased enrolment of girls has been mentioned as a positive effect of SSHE.

The Child-friendly WES design is important in Viet Nam because the child-friendly approach is not yet widely applied in school water, sanitation, and hygiene. It is becoming much more common, and in Viet Nam there is a movement toward child-safe approaches. Currently there are standard uniform latrine designs though many different designs are used across the country. It is therefore difficult to control the quality of WES construction because many people are doing different things. There are even new schools being built with no water and environment sanitation at all, but the Ministry of Education and Technology (MoET) is in the process of establishing a standard of design for use in all new schools. There are also many schools with insufficient/non-functioning WES systems. But WES in schools (and health centres) is in the National Target Programme II: 100 per cent by 2010. This is a major breakthrough because now the government is not only prioritising rural water and sanitation but for the very first time there is a very clear target for WES in schools. Child-Friendly WES design • (Jointly) developed key criteria (linked to child safe

environment/child safe community) • Linked to wider concept of child-safe environment,

facilities, etc. There was a distinction in the type of school, and took into consideration the age-group of children. Consultations – national and local levels, including with children.

• Came up with criteria via wide consultations. • Once completed, the MoET set target. By the end of

this year (2006) it will have revised the standard of designs. The MoET has strongly indicated that the CFS designs will be issued as a standard.

• Adaptation of designs and testing; approval

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Child-Friendly WES design process: Timeline This was quite a lengthy, intensive process to ensure that all stakeholders at the various levels were involved. Here you can see that it started in 2002 and will not be finalised until 2007.

After the review of available water and latrine designs, we embarked on consultations with children. From the children’s perspective, child-friendly latrines should be:

• Safe to access. • Well lighted and ventilated. • Nice and safe to use. • At the right place. • Clean and well-maintained.

We also did consultations with teachers and technical staff on the design. In the very early stages of the discussion there were only technical drawings, which are not very clear and don’t say much to people who are not engineers. So we learned to make sure that our presentations are clear, so that it becomes visual to all involved. Our experience was that after if we do construct what we know to be the preference of children/community as a result of consultations, the cost is slightly higher. But the other side of the costing debate is that following recommendations received from consultations results in a better quality, more used facility. Below is a rough estimate of the costs in Viet Nam which is slightly higher than the norm.

• Septic tank latrine + urinals + hand washing: $4,000-$5,600 • Dry latrine (double vault + urinals + hand washing): $2,000 • Maintenance: About $20 per school per month

Key lessons learned with Child Friendly WES design:

• Child-friendly design fits into the wider concept of CFS environment and/or child safe community and healthy living. It’s a perfect fit with the various ministries and headed in the right direction.

• It is critical to have all key partners on board (MoET and the Research Institute of School Designs). It also important to have the Involvement of other key institutions, particularly at the local or provincial levels.

• It is essential to incorporate children’s voices in all phases. As one of the children indicated, if we ask their opinion we have to try to respect that.

• The local viewpoint is important, particularly on operation and maintenance issues, construction quality, etc. The first reactions and views of teachers and headmasters vis-à-vis operations and maintenance were more practical because educators are at the schools and have valuable insight that outsiders would not otherwise be privy to.

• Testing is needed to improve the design. It takes time, it requires patience but it is essential.

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Opportunities and next steps within the Vietnamese context The National Target Programme II has a clear target of 100 per cent water and sanitation in schools by 2010. It is a big programme and significant amount of resources are being allocated. There is also an increased focus on child friendly environments and child friendly communities. The approved child-friendly design will stimulate high level of interest and commitment for incorporating WES facilities in the MoET’s standard for new schools; and improving quality of WES facilities at other existing locations. Now there needs to be more guidance on monitoring the quality of construction by schools and/or local authorities. Question and Answer Q: In your design you have separated urinals from places to defecate. Is there problem with usage (i.e. children defecating in urinals)? A: No. We haven’t had such problems. The truth is children tend to urinate in school more than defecate. The distinction is clear as to the places for urination and the places for defecation. There is also a regulation on the use of the toilets which is posted on the latrine. The partitions we have used in Viet Nam are an outcome of consultations with children who said they prefer privacy. This resulted in higher costs and in the adult’s mind cost comes into play but we have to remember the child’s preference. It’s not entirely OK if we are doing something that is not right/or preferred by the child. It may result in a slightly higher cost of the latrine but if we do consult children we need to, where possible, respect the suggestions coming up. Q: You have now reached a point where there are standard designs that will be routinely implemented so the children will no longer be consulted. How will you deal with that? A: The involvement of children will not cease after consultation. The facility is only child friendly if it is used extensively by children, and that is a continual process that takes place in the school with the normal health and hygiene education. The child-friendly latrine design is in the overall context of child-friendly facilities. Viet Nam, with support of the Swedish government and CIDA, declared that they have five safe communes that have met the criteria, which includes facilities. Q: Is there any standard on the ratio of children per stall? A: There are some guides, for example, one unit for 50 children. But the guides are translated into national context. Sphere has guidelines, and if there are shifts in schools then the number of stalls needed could be less. There is an IRC publication that helps project officers come up with ratios. Keep it practical: some schools only allow children to go out during a break which means you will have peak times and you might need different ratios although you have the same number of students as other schools. You should also look at the space within the school and sometimes there has to be compromises. Q: Did you consult with the user about the separation? It appears that the separation makes cleaning and maintenance more difficult. A: That brings back to mind the point that operation and maintenance doesn’t start after the construction but from the beginning. You have a valid point. Q: What about the cost-sharing mechanism. Did UNICEF provide 100 per cent of the cost? A: With the models we supported full cost. But the other way to finance WES in schools is cost-sharing where UNICEF pays half and the central government pays half – not the community. We tried cost-sharing with the community in the past and found that the community could not always support the cost, which of course affected quality. Q: Is operation and maintenance easier for different size/location of blocks? A: That is a very interesting perspective and my impression is that when looking at school facilities we are looking at one unit in one particular spot in an area. In terms of separating the facilities by age group so that age-appropriateness becomes a dimension, that also makes sense.

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Q: Have you done any advocacy? A: Advocacy is one of the keys required to propel the initiative into the broader plan. Otherwise it remains in pilot stage. We saw an opportunity through the National Target Programme II, and we did a lot of pushing for the government to include WES targets for all schools by 2010. I feel it is a bit ambitious but it also translates into the acceptance of the idea and the national commitment to WES in schools. The other key partner is the MoET itself. We worked side-by-side with them because at the end of the day, once it’s clear, they will issue CFS latrine designs as a MoET standard, which means it has to be used by anyone building schools in this area. Q: How is waste-water cleaned? A: The main systems are septic so the liquid and solid waste comes together after treatment. Handwashing water is often drained out to the sides of the school. Urine is drained into soak pits. Q: Is there a separate provision for drinking water and handwashing water? A: Water sources are different from province-to-province and from school-to-school. The bigger schools often have individual drilled underground water with pumping and distribution. But the smaller rural schools with two or three classrooms have simple water sources, often a dug-well. Water quality is not regularly tested in schools, or in rural settings. Now I think we have progressed from just looking at water quantity to include quality. Q: How can water quality be tested? A: You can put H2S test strips into the water to test quality. The kits cost less than USD$.10, and can be used by children. Banda Aceh has been using it for a long time and they have field monitors regularly checking on the water quality. It has also been used to monitor the water quality of housing providers. The downside is that the test strips can give false positives so you will need to double check. It also doesn’t tell the level of contamination only that the water is contaminated. We (Viet Nam) are developing a test kit that is locally made so the price is very reasonable. You can also consider water treatment where a safe water source doesn’t exist. Sometimes it’s about testing and other times it’s about treatment. If you lack funding you might have to do small-scale treatments. UNICEF has a global MoU with Population Services International (PSI); at the country level you can easily step in with that MoU as PSI is present in many countries. In addition, in most countries chlorine costs about USD$.15 and can treat about 1,000 litres of water so it is cost effective. Q: What is the process for using H2S strips? A: The process is:

• The person keeps the water sample against his/her body for 24 hours. • If the water is black that means you can get diarrhoea (from faecal pollution). • You can have students test it, then boil and test it again. It’s a good way to get them involved.

Pros and Cons

• Gives an indication but doesn’t tell the level of contamination. • Sometimes may give false results. • Important thing to generate interest in children (community) in water testing. • Can invite two people from Thailand University and they can convey the technology to local

technicians and they can start producing in their own countries. • Less than $.10, so it’s cost effective.

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Hygiene Promotion in Schools: Curricula and extra-curricula Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust Hygiene is not the same as geography and math. The whole thing is different and this worries people because they are used to working in their own boxes. It’s hard to break into government curriculum because it’s already written already and hygiene is left around the edges. I decided to go back to school in the past four or five years and looked at curriculum in health education and how you deliver it. I examined the planned content of health education (often centred on hygiene) in primary schools generally and with special emphasis on three countries I know well, India (Federal and Maharashtra State), Uganda and Zambia. I expected to find that health education and hygiene education was a ‘Cinderella’ subject with little commitment and low priorities; little content in the syllabus; and little enthusiasm to raise the status of the subject and/or use new approaches. I found instead that health education is enormously important. There were high priorities accorded at all levels (in Zambia a survey mounted by the Centers for Disease Control and Prevention (CDC) saw health hygiene as parents’ highest priority over literacy and numeracy). The curriculum was awash with health topics all over the place but chiefly in science social studies (civics), and physical education. So the actual content in terms of volume was there. There was also a considerable concern that schools and children should be doing more to raise hygiene standards, tackle pollution and prevent disease and ‘deadly habits’. People were worried that the schools were not delivering. And this concern was justified. Generally there existed:

• Lack of co-ordination and overlap. Between different subjects, if you learned about handwashing you learned in about five different places.

• Little appreciation of the needs, interests and capabilities of children at different levels particularly at lower primary level. Most of the stuff wasn’t geared toward the needs of young children. There were very little which raised the ability of children to think and act.

• A very sketchy appreciation of what active learning meant and why it was needed. Practically none of the active learning was closely linked with something called ‘life skills’, which every one was ‘for’ but few really understood or defined in the same way.

• Very few people understood about transferring active learning concepts into action. Everyone believed in life skills and non one knew what it was. When they talked about it they used large words: socioeconomic, interpersonal and empathy that no one understood very well but didn’t understand very well.

• Still largely time and space bound. Linked with lessons in schools. ‘Children for Health’ activities seen as a nice but optional and working generally from the school rather than in the school.

The schools realise that what they are doing at the moment doesn’t work. Here are some ideal changes in approach which would do much to set us on the right track. Think content and competencies, not curriculum and syllabus Let’s cut out all the talk about curriculum. People think curriculum is Bloom’s taxonomy. In actual fact we are choosing planned content in schools. We are not thinking planned content. We need to choose: • Aims and goals (knowledge to master; skills to develop; attitudes to foster and experiences to live

and learn from); • A plan (how much and in what order); • The right methods and approaches (because these get our knowledge known and our skills

developed). • The materials and experiences our children are going to be given. • What we assess and how.

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We need to take a new look at planning (as units) instead of individual lessons.

• Select a term on a subject. • Almost certainly units can be revisited in different ways over the three levels. • There are probably no more than a few topics on hygiene promotion. So you constantly

develop it over time. • Probably related to broad bands rather than individual classes perhaps e.g. in the

primary/basic cycle as early middle and upper primary e.g. sixth through seventh, eighth through 10th, and 11th through 12th.

• The plan then needs to list at least three headings o Knowledge and Skills o Action in class to support and develop these o Action round school and in families o With possibly a fourth (reinforcement in other subjects)

A new look at methodology as doing rather than ‘dancing’.

• A methodology which changes between what we do in school and what we do in the community. Obviously that will take place over several lessons and backed up by other subjects.

• Doing involves both “I can” and “we can”. • Projects using the Child-to-Child approach often see this as a step-by-step approach. • Involving children moving between school and community

A new look at our materials a focusing out rather than in.

• Textbooks aren’t good for hygiene education. If we use textbooks (aren’t workbooks better?) should they not let them focus out rather than in?

• The richest materials are in our own local environment and it is here that our study should focus.

• Are these changes do-able? They don’t involve any extra time or expense. Children would welcome them. They make learning much more fun.

But in reality these changes are quite threatening and fundamental because in almost every case they let the light into the safe self-contained world that the school has been used to for so long. We need to open the door to that world gradually so that the light does not blind those who take shelter within. These approaches let the community into the school and the school likes to be self-contained, and teach the lessons. So it won’t be all that easy but there are some things we can look at which might help us. Opening the Door Looking at what we mean and the implications of what we mean is not time wasted. In India there is a subject called Socially Useful and Productive Work, and in other countries there are Citizenship classes that can be used to teach hygiene education. Unpack the rhetoric Think through goals and definitions and their implications (if possible at ministry and project management level). What are these ideas and competencies we seek and what are the implications of changing attitudes in the light of real conditions and real cultural values?

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Link with high status subjects As we all know some school subjects in school are ‘more equal than others’. The most ‘equal’ are undoubtedly language and maths in that order followed closely by science. In many countries health and hygiene is linked with Physical Education (a very unequal subject), in some with Citizenship (even worse). Many would have Health and Hygiene as a separate subject, but how high would its status be? If there was a chance to link with these subjects we would have better opportunities to teach hygiene. In Uganda, thanks to UNICEF, health is located within the Science curriculum, ring-fenced in separate units with their own time allocations, and examined. It is taken seriously. Close links with Language are desirable and productive. We miss an enormous trick when we miss language. Children want to read, write, and produce plays. It doesn’t matter what they are writing about. Why not let them read and write about hygiene content? The same can be done with mathematics: Children can do activities such as measure the distance to the well, do statistics with the instances of diarrhoea, which can be brought in and everyone can accept. Demystify life skills Life skills are not only developed in class, but out of class. We want children to ‘notice things’ ‘solve problems’ ‘stand up for themselves’ ‘get inside other people’. Let us use these words rather than high language such as ‘psycho-social’ ‘cultural awareness or ‘empathy’. And remember, life skills have to be lived, in the play ground, at home, talking with older or younger children … not just taught in lessons. Work with the whole school (that involves a redefinition of school). Every one needs to know and be involved:

• Every teacher a teacher of health and hygiene • Every parent concerned with hygiene • Every worker an example for hygiene • Every passer-by able to assess the schools through how it looks and how its children behave.

Involve teacher educators Surely this should be part of hygiene and sanitation. This, however, is the weakest part in any system. Just as schools need to live water and sanitation every college needs also to develop in a way that includes hygiene education instruction. Their curriculum needs to parallel that of schools. Blow trumpets If we want schools to lead the way we must reward those who do. We should involve media; stage competitions and open days; wave flags: In Uganda there was the idea of a school flag. The school raised the flag when it met certain criteria and lowered the flag when it didn’t meet the criteria. In closing, we mustn’t just think of life skills as a series of lessons. We need to think instead of schools which try to meet competencies, which work with units, which exploit other subjects, which develop life skills in and outside the classroom and I think you would be surprised if you taught through programmes in this manner. For instance, if you yourself developed a programme based on competencies and took it to the director of education he/she might say “very well”, “how can we change and do things as you suggest”?

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The Evidence Base for Hygiene Promotion Emmanuelle Abrioux, Project Officer, Life Skills Education, UNICEF EAPRO Many may ask the question why WASH in Schools is needed. Evidence shows time-and-time again that inadequate access to safe water, hygienic latrines and handwashing facilities, combined with the lack of hygiene knowledge is the leading cause of disease and death among children younger than five-years old.

Causes of deaths among children under five, 2000-2003

• More than 3.5 million children younger than 5 die from diarrhoea and acute lower respiratory tract infection annually.

• The leading cause of younger than five deaths is pneumonia - accounting for more than 2 million under five deaths per year. Together, diarrhoeal diseases and pneumonia account for 36 per cent of all younger than five deaths globally.

• The major cause of diarrhoeal diseases is human excreta.

• Children in developing countries average from four to five bouts of diarrhoea each year, accounting for an estimated 4 billion cases annually.

Key evidence linking WASH services to disease, education and development As the numbers indicate, the lack of WASH is inexorably linked to the morbidity and mortality of children. Water, sanitation, and hygiene are important factors in the access to, and the quality of education as it is affects enrolment, attendance and drop-out. Numerous studies have documented the affect of WASH on girls’ education in particular. Girls tend to be water haulers and either miss school because they have to fetch water at home, or are sent out of class to fetch water at school. Girls who reach the age of menstruation miss class during their period, or drop out of school altogether if adequate amount of water and private and clean sanitation facilities are not available. Both girl and boy children are susceptible to helminth (intestinal parasitic worms) infections, which cause a number of health problems that affect physical and mental development, and attendance and performance at school. There is a dearth of anecdotal evidence on how WASH is linked to education and health, but there are two particular studies that quantified the linkages.

A 1985 study conducted by Steven Esrey looked water quality at the source and found that water quality impacts the incidence of diarrhoea. A 2004 meta-analysis conducted by Lorna Fewtrell and John Colford looked at water quality, water quantity, sanitation, and hygiene as it relates to incidence of diarrhoea. Through a comprehensive literature search and bibliographic review, 2,120 titles published prior to 26 June 2003 were screened, 336 papers were secured for a more thorough examination, and 64 of these papers (representing 60 distinct

studies) water quality, sanitation, hygiene or multi-factorial interventions and examined diarrhoea morbidity as a health outcome in non-outbreak conditions. In developing countries, interventions aimed to increase water quality, particularly point-of-use treatment, decreased levels of diarrhoeal illness. Water supply activities decreased diarrhoea, but this outcome was more common with the provision of household connections and water use without household storage. Hygiene activities, specifically those promoting handwashing were proven very effective. There was limited data on sanitation interventions, but those available implied success in reducing incidences of diarrhoea.

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The effect of handwashing on children’s health While water quality and quantity has a major effect on child health, hygiene practices such as handwashing with soap has also been proven to reduce incidences of diarrhoea, which contributes to absenteeism. A study on a one-year programme implemented in Pakistan studied the impact of handwashing with soap The study was a randomised controlled trial from 11 to 25 neighbourhoods in Karachi to assess the effect of handwashing promotion with soap on incidence of acute respiratory infection, impetigo and diarrhoea. The intervention took place in large squatter communities where 41 per cent of the deaths of children aged younger than 5-years old were due to diarrhoea, and 15 per cent due to respiratory tract infections. It included multi-modal interventions: fieldworkers visited weekly to distribute soap and conduct health education sessions to encourage handwashing. The key findings were that a large reduction in diarrhoea could be attributed to the use of water with soap. As far as the differentiation between plain soap and microbial soap, the researchers found that there was no statistical difference. Duration and frequency of intervention effectiveness was only noted only after eight weeks. In addition, the duration of behaviour change was not measured. The impact of participatory methodologies was an issue because success/failure of interventions was based on anecdotal evidence. Gender and age emerged as an issue because anyone in the household over 30 months was included and it involved both men and women. The programme would have been more effective if household members younger than 30 months were included and mothers were targeted for handwashing the hands of their infants as well. It is important to note that the availability of water and sanitation services essential. Impact of WASH on girls’ enrolment In the Alwar District in the state of Rajastan, India, girl’s enrolment increased over the years as school water and sanitation improved.

Impact of de-worming on cognitive performance and absenteeism in Jamaica Helminth infections affect not only a child’s physical health but also mental development and cognitive performance. A 1992 study conducted by Catherine Nokes et al. shows us very strongly the impact of de-worming on cognitive performance. Infected children who were treated showed a marked improvement in cognitive performance. Improvement in cognitive performance with de-worming of school children in Jamaica

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In 1993 Nokes et al. conducted a study on the impact of de-worming on school absenteeism. As you can see, those with highest rate of worm infections have the highest absenteeism. Thus, the Nokes’ study is one of many evidences that link the lack of water, sanitation, and hygiene to poor cognitive performance and attendance. School absenteeism and helminth infection in school children in Jamaica

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Financing WASH in Schools: What does it cost? Murat Sahin, Project Officer, Water, Sanitation and Hygiene, UNICEF DPRK We decided to do a costing exercise to generate an approximate estimate of the overall costs and resources required for WASH in Schools; to discuss explicitly the inputs required to achieve WASH in schools; and to provoke substantive discussion about practicalities of achieving WASH in Schools goals When we talk about costs we have to classify them into two categories: First there are capital costs, which are investments in fixed WASH assets and infrastructure. This includes regular capital investments for upgrading depreciating capital and establishing new training programmes). Second, there are recurrent costs, which are the regular costs of operating, maintaining and administering WASH programmes. Systems costs vary and include:

• Relative costs of systems, technologies • Hydro-geological and climatic conditions • Ground water based systems • Population densities • Community/partners cost sharing (includes hardware and software)

Different countries are using different technologies depending on the region, cultural appropriateness, cost, and other factors. What the costing exercise found in regards to rural water and sanitation is as follows: Rural sanitation

• VIP latrines: $200 per unit • Simple latrines: $100 per unit

Rural water

• Hand pump on dug well: $2,700 per unit • Hand pump on bore well: $1,000 per unit

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There are 17 countries promoting hand pumps.

WASH per capita As anticipated, the WASH per capita for UNICEF-supported systems varied by region.

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Financial allocation for hardware versus software Hardware can be described as sanitation facilities that include latrines and handwashing facilities; and technology and tools that deal with water supply and quality. Software deals more with hygiene education and promotion such as community management, training, institutional capacity building and such. UNICEF allocated 55 per cent of the WES budget for hardware, and 45 per cent for software. In 2004 UNICEF allocated $32 million from regular resources for water, sanitation and hygiene programming; and $160 million from other resources. (This large variation can possibly be attributed to the 2004 Indian Ocean tsunami and the 2005 Pakistan earthquake). MDG costing exercise in Tajikistan The Ministry of Education through a reform process began reviewing its budget vis-à-vis Education for All (EFA) and the MDG commitment. The target is increasing the gross domestic product share from 3.2 per cent to 5.3 per cent by 2009, where 1.5 per cent of the education budget is allocated for sanitation and hygiene promotion projects.

ALL PILLARS NEED INVESTMENT

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WASH in Emergency Preparedness and Response, Avian Influenza Katrin Imhoff, Education Officer, UNICEF Thailand The UNICEF Thailand office in co-operation with the Government of Thailand embarked on a school emergency preparedness and response planning (EPRP) project called School-based Approach to Avian Influenza Prevention and Pandemic Influenza Preparedness and Response in Thailand. It was conducted by the Kenan Institute Asia with funding support by UNICEF. The objectives were to strengthen the capacity of Thailand’s school system to develop healthy behaviours; and to develop plans for emergency preparedness and response, with a preliminary focus on Avian Influenza and Human Influenza Pandemic at school levels. At the same time we are working in emergency preparedness and response on the provincial level on up. Basically the process was as follows:

Activity Participants Outcomes

1. Workshop on developing a school EPRP process (8-12 May 2006)

Five public school principals from Tak, and Mae Hong Son Provinces

• Prototype EPRP planning process including risk analysis form and template for school EPRP on pandemic influenza.

• EPRP plans for five schools covering: pandemic

influenza, fire, forest fire, landslides, fighting in border area, flooding, vehicle accident, severe diarrhoea.

2. Workshop on developing a life skills-based health education curriculum unit (grades K-12) on avian and pandemic influenza (8-12 May 2006)

School teachers, education supervisors, public health officials from Tak, Mae Hong Son, and Nakhon Sawan Provinces

• Draft life skills-based health education curriculum unit and lessons plans (grades K-12) on avian and pandemic influenza.

3. EPRP orientation/training workshops (24-25 June and 1-2 July 2006)

39 public school principals from 17 provinces* in the north, northeast, central, and south of Thailand

• 39 schools are formulating EPRPs for pandemic influenza and at least one other high risk emergency situation (to be completed by Sept. 2006).

4. Avian and pandemic influenza life skills education orientation/training workshops (24-25 June and 1-2 July 2006)

22 education supervisors, 39 public school principals, 115 teachers from 39 public schools in 17 provinces in the north, northeast, central, and south of Thailand

• 39 schools are implementing a life skills-based health education curriculum unit on avian and pandemic influenza.

The workshop was developed with experienced participants, and there were five manuals developed from this workshop. The aim was to include avian influenza and to include other high-risk diseases such as diarrhoea. In the beginning there was pre-testing, then teachers taught it, then there was more feedback during activities and workshops carried out in October. It is fully aligned with the Thai health care system curriculum. At the same time behaviour change can be monitored and child-to-child activities implemented. We had a launch on 10 October 2006 and we will provide the materials to all learning institutions in Thailand (vocational schools, private schools, etc).

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Question and Answer Q: Each country got money for hygiene kits, how was this linked? A: We have only provided soap; we haven’t given any hygiene kits to those schools. Thailand is quite well-equipped in soap but it is still missing toilets. We had developed the hygiene kits but the Ministry of Public Health found that those items are there. What we working on are “Learning Kits”, in an emergency situations when children have to miss school; they can stay home and continue to learn. Q: Avian Influenza in relation to all of the other issues there is a potential for information overload. How did you handle that? A: That’s why we integrated it into the health curriculum. It touches on all the standards on the curriculum so it can be used in health education curriculum. We use Avian Influenza as an entry point. We took the same approach in the south of Thailand where there is violence, we have the learning kits for emergencies and they use it all of the time. A: Lao used posters and materials from Thailand. We [Lao Country Office] supplemented the “Blue Box” and spoke with the MoE and got them to allocate one hour per week for Avian Influenza prevention education. We divided the curriculum into two areas, Grades 1-2 (handwashing, and don’t touch dead/sick birds); and Grades 3-5 (handwashing, and don’t touch dead/sick birds, eat cooked poultry]. Q: Why do we have to do Avian Influenza? Health education is more practical. A: As an implementer we need to see both sides of the coins. We have to take the opportunity to re-instate whole health and hygiene education – Avian Influenza-related activities are too short to really have impact on behaviour change. In Thailand we don’t have Health/WES/Health Education officer, but since Avian Influenza became an issue, it helped us to open the door to the two core ministries (Ministry of Public Health and Ministry of Education). Before Avian Influenza became a priority each ministry was working on its own, for example, the MoPH has been doing work in Thailand a long time but alone. We have to think positively about this project and take it as important step to re-establishing health education on a broader scale.

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WASH in Emergency Preparedness and Response, Child Friendly Spaces Gary Ovington, Education in Emergencies Officer, UNICEF EAPRO If you think WASH is important in stable times it’s much more so in times of emergency. The first thing you will have to in an emergency response is an assessment. One useful assessment tool that was used in the Education sector for the very first time in Aceh was The Rapid Assessment of Learning Spaces (RALS). This assessment looks at factors such as pupil and teacher numbers, conditions at the schools both environmental and structural, the availability of water and sanitation infrastructure and other key information. WASH in Schools in the initial relief and subsequent recovery stages can be partially addressed through temporary learning spaces or Child Friendly Spaces (CFSp). The UNICEF Core Commitments for Children (CCCs) advocates that the building of safe environments for children and women is primarily defined as a protection issue, but at the same time, linked with the education sector. Centres set up as part of the CFSp approach, provide a protective space for children where they can engage in structured recreational and educational activities, as well as have access to basic primary health and nutrition services. The centres provide targeted programmes for pre-school children, primary school-aged children, youth and parents, and provide water points and latrines. Diagram of a Child Friendly Space (CFSp)

SPHERE standards SPHERE standards also address water, sanitation, and hygiene education/promotion in emergencies. In regards to health and hygiene education, SPERE standards call for health services that are based on relevant primary health care principles. The key indicators are that all people – including children – have access to health information that allows them to protect and promote their own health and well-being. This includes hygiene education in camps, shelters, public places, and/or schools or temporary learning spaces to include handwashing with soap, the safe disposal of excreta, handling safe water and food. SPHERE also addresses access to water quantity, and water quality; queuing time and the distance of water points from dwellings, which historically affects girls’ attendance in school. The access to and number of toilets; the design, construction and use of toilets; and vector control are also critical components. INEE Minimum Standards for Education in Emergencies The Inter-Agency Network for Education in Emergencies (INEE) is a global network of over 100 organisational and 800 individual members who are working together to ensure the right to education in emergencies and post-crisis reconstruction. The INEE has put together some standards that address water and sanitation in schools/learning spaces in both manmade and natural disasters. The standard in particular that includes water, sanitation, and hygiene is: Access and learning

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environment standard 3: facilities ⇒ Education facilities are conducive to the physical well-being of learners. Key indicators (and guidance notes for this standard) include:

1. Basic health and hygiene are promoted in the learning environment. 2. Adequate sanitation facilities are provided, taking account of age, gender and special

education needs and considerations, including access for persons with disabilities. Sanitation facilities should include solid waste disposal (containers, waste pits), drainage (soak pits, drainage channels) and adequate water for personal hygiene and to clean latrines/toilets. Learning environments should have separate toilets for males and females and adequate privacy. Sanitary materials should be available for girls and women of menstruation age.

3. Adequate quantities of safe drinking water and water for personal hygiene are available at the learning site. Water should be available within or in close proximity to the learning environment as per local/international standards.

These standards are highly optimistic and can even be difficult to meet under stable conditions; however, they are a good set of guides and have linkages to the SPHERE standards.

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Taking WASH Forward in the Region Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO One reason we organised this workshop is because we thought there was room for improvement. Another thing we hoped to get out of this was to increased information sharing on issues related to WASH in schools. Now that we have heard to a certain extent what our colleagues have going on in their respective countries, what other mechanisms do we have that are doable? What about those indicators? Is there a need to take that further? What about ideas on improving financial resources? Let’s look hear what ideas are out there on the areas of interest:

Topic What Who

Corrections/additions to mailing list Countries WASH in Schools network Designation of country focal point(s) Countries

Prepare regional write-up including country summary pages EAPRO Regional synthesis Corrections/additions to write-up Countries Return cost questionnaires to Murat with suggestions on framework for presentation (capital and recurrent)

Countries Cost information

Preparation and distribution of cost summary for region Murat Sahin, DPRK

Indicators – Sort through available survey tools and questionnaires and prepare a set of useful and regionally relevant indicators

Chander Badloe, Viet Nam

Baselines, assessments and monitoring

Promote core indicators for use with partners building on mid-decade assessment (MDA) indicators, and inclusion into EMIS for routine reporting

Countries

Prepare TOR for designing CF facilities and developing WASH in Schools strategies

Mongolia

Prepare TOR for programme design, development and monitoring

Indonesia

Community, school and health facilities strategies Timor Leste

Expressions of interest in technical assistance from regional or global sources

Review TORs and help identify suitable sources of technical assistance

EAPRO, WES-NY

Share KAPs and country situation analyses Countries Prepare comparative summaries of water quality in schools (H2S strips, testing kits, treatment options, etc)

EAPRO

Existing manuals with CF designs and bills of quantities (BOQs) Lao PDR, Viet Nam

ROSA publication on designs and BOQs under preparation WASH regional advisor, ROSA

Sharing of documented experience on demand creation for sanitation in Myanmar

Waldemar Pickardt, Myanmar

Blue Box of Lao PDR – presentation available on workshop CD Lao PDR WASH resource library on CD finalised and distributed to country offices

Waldemar Pickardt, Myanmar

Occasional updates - WASH in Schools info sharing project and sustainability/impact study

Therese Dooley, New York

Viet Nam website – repository of hygiene promotion materials http://www.cerwass.org.vn/wesieclib/uni/home/index.php

Nguyen To Tran, Viet Nam

Information, documentation and experience sharing: Locations of special resources

Updates on handwashing partnership with Unilever Therese Dooley, NY

FRESH networking Upcoming preparations and participation in 2007 Mekong sub-regional workshop on FRESH and HIV

EAPRO, Lao PDR, VN, Myanmar,

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Cambodia EASan 2007 Upcoming preparations and participation in regional sanitation

conference in June 2007 in Xi’an, China. Countries where UNICEF is to lead country preparations are: China, DPRK, Myanmar, Mongolia, and Timor Leste. WSP to lead country preparations in Viet Nam, Cambodia, Lao PDR, Philippines, Indonesia.

EAPRO, countries

Funding opportunities

SIDA interest in funding Ecosan in schools and communities Therese Dooley, NY

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Friday, 20 October 2006 – Day 3 Partnerships for Sustainability of WASH in Schools Mark Henderson, Regional Advisor for Water, Environment and Sanitation, UNICEF EAPRO We wanted to take the opportunity to have a third day to invite our counterparts – government, bi- and multi-lateral partners – engaged in WASH in Schools. The first session is an overview of partnerships for WASH in Schools, the second session is an overview on child participation, and the third session focuses on balancing school and community water and sanitation. Co-ordination among partners has been a common theme: donor co-ordination and integration at all levels is a challenge. At a global level UNICEF is involved in FRESH and the School Health Project. We also need to work with our partners to find a way to go to scale and ensure the quality and sustainability of services. Governments have many groups presenting priorities so the question becomes how do we ensure that governments can take it on themselves? How to secure funding for WASH in Schools is an area of concern for sustainable initiatives. Many times projects tend to be “donor driven” and funding is received in small packages. As a result, interventions get stuck in pilot mode and have difficulties going to scale. From the initial stages we should be working in partnership with the government to ensure integration, and link with facility design use into budget programme. While UNICEF may not be funding WASH in School in all countries, it’s still the role of the agency to influence policy, build capacity and create enabling environments. So the question arises, how do you create an enabling environment? That depends on the country: In some countries the funding is there but maybe the knowledge is not in the ministries that hold the funding. Sometimes we have to look at facilitating that enabling environment in countries. Building capacities both within UNICEF and with counterparts all feeds into sustainability. While funding can be a limitation, planning and the lack of financial and human resources, and lack of common language between sectors all hinders the success and sustainability of WASH in Schools programmes. A pillar of WASH in Schools, behaviour change communication often attempted through life-skills based education (LSBE), is an area in which we have to work more closely with the relevant ministries to improve upon. What we are finding is that it’s difficult to maintain students’ interest in LSBE. One of the underlying reasons is that we expect a lot out of life skills-based hygiene education (in terms of behaviour change). In addition we assume it has to be taught the way other subjects are taught; but whenever students are cooperating around schools, whenever parents come to schools we are ensuring the development of life skills. We also must remember that life skills are the way the schools are run, life skills have to be captured in the school environment. Sometimes we have to develop the skills of the teachers. There has to be a careful of provision of materials to make sure that they understand how to use it. If we want to improve impact and boost sustainability we have to look at baseline data and work with our government counterparts on information systems. The reality of the situation is that information and assessment is broader than baseline and there is a role for UNICEF to support national assessments which can then be discussed by the national steering committee, or the designated agency. Lastly how do we link WASH in School with WASH in communities. Ownership and needs are often defined by donors and not by community itself. We can address this through participatory planning, designing and mobilising community behind WASH. Keeping in mind the key issues we have discussed over the past two days, we wanted to bring our counterparts together to work on the way forward to addressing these important prerequisites to sustainability of WASH in Schools programmes. The objectives for the external session are:

• To share key discussion points and introduce focus on WASH partnerships. • To better understand the potential of institutionalising children’s participation in WASH

initiatives, and to identify and examine best practices and lessons learned in this area. • To explore the balance between WASH in Schools and WASH in communities.

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Words of Welcome Anupama Rao Singh, Regional Director, UNICEF EAPRO I would like to extend a warm and special welcome to our partners from our sister agencies and representatives of government with which we work, the World Bank and civil society partners. I apologise for not being here through the entire workshop but we have a lot going on in Bangkok at the moment. WASH from a UNICEF perspective is so important. In East Asia and the Pacific region about 944 million people still live without basic sanitation; and 402 million lack access to clean water. There has been progress but anyone who compares water and sanitation with progress within MDG indicators know that water and sanitation is far behind compared with poverty reduction, school enrolment and child mortality. As we all know that girls, when they have their period, water and sanitation can be the deciding factor as to whether they continue school. If you adjust statistically for China, the prevalence of malnutrition younger than 5-years old is as bad as sub-Saharan Africa. It’s just because some parts of China, the numbers have improved but frankly we are no better than sub Saharan Africa in the area of child survival. Amongst all the different agencies working on these issues I am delighted that this meeting is taking place and I am able to attend. It would be good to bring other initiatives of the agencies in the region together as this is the strategy our board has approved. We need to look at the commonalties and differences between FRESH and WASH and see how we can work together. It is especially important for key agencies such as the World Food Programme, which has invested resources in school feeding, on how we can maximise results with regards to improved school attendance, achievement, and the overall health and nutrition status of children. With international financing institutions one of the issues that we see is how do we take the outcomes to bi-lateral partners with funding and donors of area, and to commitments that were made in Paris as far as harmonising aid and making it more effective. Today we have a unique opportunity to bridge our partners for a discussion on water, sanitation and hygiene and schools. I have been travelling a lot recently and as I was reflecting on today’s meeting there were two issues that I wanted to bring to you what is going to happen in the context of the larger development debate and lessons learned: Today is the last day in Manila on the Asia Pacific Forum. The Asian Development Bank, World Bank, DFID (Department for International Development), and the Government of Japan were hosts. As a run up to this were case studies evaluating aid effectiveness and the indicators of the Paris Declaration from the perspective of partner countries. What emerged as most useful were programme-based approaches (PB As), which consist of the coming together of government and partners around sectors. That seems to move forward the fastest and is not contingent on pooled resources or budget support. All of the partners in Lao supporting education without project appraisal visits, pooled unspent financial resources and generated enough money to provide basic textbooks for every child in Lao for the 2006 academic year. Everyone came around specific result aimed for achievement rather than process. If we can come up with real results in today’s meeting, we can find ways to form pragmatic partnerships because none of us can do it alone, but real opportunities and possibilities exists if we all work together. Today you will be looking at what works, please also spend time on debating what is needed to take successful initiatives to scale. That is critical if we are to meet the goals that we have set. Taking things to scale demands different support rather than just project support. Finally, I am delighted that this meeting is taking place and that we have our partners here to help further this important initiative.

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Government/Inter-Ministerial Partnerships (including SWAps) Cliff Meyers, Regional Advisor for Education, UNICEF, EAPRO Sector Wide Approaches (SWAps) and Programme Based Approaches (PBAs) There are gold-standard SWAps – and there are PBAs which are looser confederations of donors supporting sub-sector plans. The example given on textbooks in Lao was a good illustration of a PBA. Some of the key characteristics are:

• Single Planning Process • Joint reviews and missions • Single reporting process

You don’t need ‘basket funding’ and abolition of all ‘projects’ to qualify as a SWAp. The key element is government leadership. Transactional costs rarely decline, and government capacity to lead takes time to build. In Cambodia it took four or five years for the government to get strong enough to take leadership. SWAps/PBAs and WASH There is real potential when we sit at the table. Through dialogue with SWAp partners, we can advocate WASH issues at the highest levels. Pilot projects can be shared – impact and processes demonstrated – for mainstreaming and taking to national scale. This is also a potential to leverage resources if targets are in the sector plan. We can focus on EMIS (Education Information Managements Systems) and monitoring of SWAp success to include WASH indicators in EMIS. Issues with SWAps/PBAs and WASH Education sector may not prioritise WASH. This is not always true but it’s sometimes the case. Historically, water and sanitation may not be managed by Education sections, but by Physical Facilities Ministries or other Departments not covered by the SWAp. Procurement can be an issue: whose procurement procedures become the SWAp standard? In SWAp, standard procurement procedures, that’s where NGO partners and UN partners can be more proficient. The European Union (EU) and the World Bank procedures are so cumbersome that it can kill all initiative so we have to also look at that. The lack of fixed costs for water facilities scares of some donors. So the question is how do you arrive at fixed costs for water because water is not a fixed cost, it depends on how long the pipe, how deep well, and so on. Decentralisation is not always SWAp friendly; in this case you can push for greater public-private partnerships. What are the experiences with WASH and SWAps? Cambodia is a good example of an education SWAp, but WASH is not an issue. The SWAp is run by mini-or rural-development and the Ministry of Health is not so much involved as the Ministry of Education. We have a good SWAp but no WASH. In Myanmar there are similar interests and the MDGs give clear common goals and procedures. The issues with SWAp are that competition is still quite strong for government resources. A second problem is that SWAp is related to good governance so in countries without good governance a SWAp can run into problems. The last concern is accountability, how can we be more specific with funds if pooling resources? The first step is getting an enabling environment in place and getting all to agree. This can be done, for example, by getting the respective ministries to sign a MoU. In Lao, under the PBA, the books got out. In Tanzania, the Education SWAps are connected with poverty reduction strategies. So if we try to connect with the overall country agenda, it will be more successful. Joint programming Joint programming can be formalised with a Memorandum of Understanding or can be more informal with Letters of Agreement. The WFP and UNICEF have a partnership related to nutrition and feeding. JICA, JOICEP, and the WHO maintain one related to de-worming and sanitation and hygiene education. Water Aid and UNICEF participate in cost-sharing on water sanitation community development projects

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What are the key issues and lessons learned on joint programming in the region? Key issues with Plan Viet Nam are that we are one of 50 INGOs in water and sanitation. We should not forget that people are doing things for themselves funded by overseas remittances. That sum of money well overshadows official sources and we should do advocacy to ensure that it’s spent wisely. We have looked to other NGOs and UN agencies and recently teamed up with UNICEF because of our joint interest. When you find another partner who is equally enthusiastic and interested in what you are doing, and you put one and one together it really does make eleven. There are two lessons learned from UNICEF Viet Nam: Whatever is discussed in the context of partnership or joint programming the key is to have a set of principles, clear and agreed upon because that is something that cuts across the promotion of national ownership and commitment. It is also important to have flexibility in partnerships and SWAps, and to have options available. Public-private partnerships Public-private partnerships often look for visible projects to support so WASH can leverage from these partnerships. Working with Unilever and others as funding and advocacy partners; and the use of local procurement to build capacity and local market strength are some examples of PPPs. Smaller-scale private sector ‘adopt-a-school’ efforts (examples from Colombia) are ways to exploit PPPs. The ‘Global Compact’ for corporate responsibility is one way of making sure that WES is taken care of in the community. Positive experiences with public-private partnerships Traditionally there is this tension surrounding the privatisation of water. But with water, the private sector helps out a lot in the Philippines. With a recent typhoon public officials looked at three industries: water, telephone, and electro-power. The water and power sectors agreed to do an audit in the schools in the area and the results worked in their favour. We have to look at each country on case-by-case basis. The tendency is to go to the big boys with a bowl in hand. Looking at the core expertise of these local and national multinational enterprises, and seeing how we can tap into them is the way forward on this issue.

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The Global Handwashing Initiative Nga Nguyen, Handwashing Initiative, The World Bank in Viet Nam Why handwashing with soap? About a year and half ago we had WES guru who pushed handwashing with soap and people in the government they laughed. They said handwashing is for kids we don’t need to wash our hands with sop. But now a year and a half later people are taking it serious in Viet Nam Reviews suggest that handwashing with soap can reduce the risk of:

• diarrhoeal infections by 47 per cent • respiratory tract infections from 19 per cent to 45 per cent • intestinal infections by 48 per cent

It is estimated globally that handwashing can save more than a million lives. It is feasible and cost effective; is often called the “do-it-yourself” vaccine; and is especially important in this region because handwashing with soap can prevent SARS and Avian Flu. The Problem

• Each year, an estimated 14,000 children die from diarrhoea • Diarrhoea is the second leading cause of illness among children under five, accounting for

almost 18 per cent of morbidity and mortality cases in hospitals • Acute respiratory infections (ARIs) caused over 30 per cent of child hospital deaths (1998) • Diarrhoea affects nutrition and in Viet Nam we still have 34 per cent of children under five

suffer from malnutrition (1998) • Estimated rate of handwashing with soap is only 3 per cent (when we interviewed women in

Viet Nam said they wash hands only when they could see dirt) When addressing handwashing in Viet Nam we need to look how we can we catalyse behaviour change? In Viet Nam, we need a modern, consumer-based approach built upon what the consumer does, and wants. We took this approach in the Viet Nam National Handwashing Initiative (HWI) with the objective of:

• Reducing morbidity and mortality among children younger than five through an integrated communications campaign promoting handwashing with soap to prevent diarrhoeal diseases.

And we do that through Public-Private-Partnerships (PPPs) to effectively promote handwashing with soap. How is the HWI special?

• It treats people as consumers, not as victims • Is large-scale, replicable and likely to be cost-effective • PPP is a model for other sectors

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Approach I: TV and Radio

• Advantage: Audience reach o TV – 70 per cent o Radio – 50 per cent

• Disadvantage

o Mass Media is effective in raising awareness but cannot alone change behaviour. Approach II: Health Education

• Disadvantage o Messages were not reaching mothers.

Approach III: Private sector community marketing events We hired private marketing firms. At Supermarket when a new soap comes out, we had one-on-one personal communication. When someone is in areas that are more media-dark then we would hire private marketing firms to come and do events where mothers are likely to be. What’s new to this approach? • 1 message • 1 audience per phase

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Benefit to public health • Efforts toward achieving the Millennium Development Goals • Reduced infections • Increased resources • Expertise Benefit to industry • Increase in soap volume: Most activities do not include a provision of soap. Our approach is soap

is cheap; it’s getting people into the habit of using it. • Expanded markets: If they are focusing more on the poor it’s a much larger profit margin. • Influence: now we have access to the various ministries. • Motivation • Good citizenship

Steps for Viet Nam Handwashing Initiative Step I: Consumer Research: messages will be used to devise creative strategy Step 2: Pre-test Step 3: Launch Where are now on step one in Viet Nam: • 8 provinces • 16 focus group discussions

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• 54 behavioural trials: With the behavioural trials we would say, for example, use soap for 14 days only for handwashing, and then they return to tell us what happened. We would note all of the positive aspects of using the soap.

• 54 in-depth interviews • 500 structured observations: From 6 a.m. to 9 a.m. we sit in people’s homes and observe when

mothers are using soap, washing hands, etc. Partners in the HWI

In Ghana we did research with mothers and kids at same time because we were targeting our messages for mothers. In Senegal we did research with mothers first, then with school-age children. In Senegal: • Numerous school hygiene programmes exist and hygiene and sanitation messages are often

included in the curriculum; however, • Educating children about hygiene is important, but not enough for behaviour change; what we

need to is, • Understand children’s motivations!

o Children do not always model their behaviour after adults (and we need to understand that).

o Children need to “fit in” and peer social norms shapes a big component of their social lives.

Research in Dakar, Senegal Objective I was to find out, what are the risky practices? Method(s)

1. Structured observations at juncture points (after use of toilet and before eating). We also did that in schools for months, seeing the practices, the ratio of latrines to children in schools, etc.

2. Children drawing activities conducted by children in bathrooms. Objective II was to understand the motivations for hygiene Method(s) • Handwashing stands for each classroom with prominent bar of soap and classroom ownership of

soap. • Clean toilets with water buckets and incense to keep toilets smelling nice. • Large campaign with slogan, “Handwashing Is In” and teachers’ involvement in explaining activities.

Group debriefing done by children who developed and acted out a drama to provide feedback. We wanted to do things that were cool, allowed them to fit in, and we wanted to work with teachers.

Objective III was to find out how do children communicate? Method(s) • Diaries of their busy schedules, so that we would understand when hygiene messages would best fit

into their lives.

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• A fake 10 pound note and asked them, “What would you spend it on?” so that we would understand children’s priorities.

Results coming soon! Let’s Collaborate for Cleaner Hands Question and Answer Q: When taking on a PPP how are partners chosen keeping in mind the distinction between local versus multinational enterprises (MNEs)? A: The local soap company Lix Detergent Co. about a $2000 in advertising budget so a PPP is not feasible. Small local companies can participate in training given by large MNEs as long rivals aren’t invited. Q: How do you balance between competitors? A: It’s a really delicate balance; you have to play a game with the MNEs. I sent letters out to all of the companies; local companies may not participate because they don’t have time or money for advertisements. A: UNICEF doesn’t allow branded campaigns but after funds run out the private sector can take it on and brand it. It can improve sustainability after the public funds out.

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Children as Change Agents Joachim Theis, Project Officer, Youth and Partnership, UNICEF EAPRO Different countries use varying ages to define childhood, adolescence and adulthood. For the purposes of today’s discussion we will use the UN definition which defines a child as a person who is from 0-to 17-years old; an adolescent, a person who is 10- to 19-years old, a young person, someone who is 10- to 24-years old, and a youth, as a person who is 15- to 24-years old.

Children, WASH and health Children are especially vulnerable to water and sanitation-related diseases:

• 4,000 children die every day from diarrhoeal diseases alone. • Millions of other children are made sick, weakened or are disabled by diarrhoea and other

water-and sanitation-related diseases. • WASH and HIV/AIDS: People with compromised immune systems are especially susceptible

to faecal-oral transmission of diarrhoea-causing germs. Many adolescents (primarily girls) are caring for sick relatives. They need knowledge and skills related to WASH.

Children, WASH and education Water, sanitation and hygiene impact a child’s right to education. About 400 million school children have reduced learning abilities due to intestinal worm infections. The overall quality of education is affected by the lack of water and sanitation. Girls drop out of school because of household chores (e.g. fetching water), and due to the lack of adequate sanitation facilities in schools. Separate sanitation facilities in schools improve girls’ enrolment and retention. UNICEF promotes private toilets for girls that are located in secure areas away from boys’ toilets and equipped with facilities for menstrual hygiene. Children, WASH and natural disasters Children are often the first victims of environmental degradation and natural disasters. They are also a force for environmental protection, reconstruction and relief efforts. Many lives can be saved when people are aware of risks and are prepared. Each year, 17,000 children die in Bangladesh due to floods. UNICEF is supporting an NGO programme teaching children to swim as way to prep for natural disasters.

“We as children and young people pledge to be involved in designing implementing and evaluating child managed water and sanitation projects and other initiatives.” (Children’s Water Manifesto Kyoto Japan March 2003)

Some may ask why children should participate in WASH. 1. Convention on the Rights of the Child states in Article 24 “To ensure that all segments of

society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene, environmental sanitation and the prevention of accidents.” Article 24, 2 (e)

2. In addition to this/Children and young people:

• Learn quickly and adapt readily. • Can acquire useful knowledge from participating in environmental activities.

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• “Are a source of creativity, energy and initiative, of dynamism and social renewal” (’We the Peoples’: The Role of the United Nations in the 21st Century, 2000).

• Can contribute meaningfully to environmental restoration and protection in their communities.

• Are forceful advocates who carry healthy lifestyle messages home and to their community. Now Hugh will discuss ways in which children can have meaningful participation in health and hygiene activities.

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Children’s Participation in Health and Hygiene Activities Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust There are many styles and example of child participation in more than 70 countries. Nearly all involve hygiene and sanitation programmes. Very few are called child-to-child programmes. Most involve a children-for-health approach. In the first place the idea as children as a messenger is a small part of it. There are many things that children can do in health and hygiene activities. One child for instance can help the baby by washing hands after the baby; two or three children can conduct a survey; a group of children can do a puppet show, can help in activities.

One child

Pass(es) knowledge to

younger child/children at home or in school

Two or three Children

Teach(es) skills to

same age child/children at home or in school

Demonstrate(s) by example to

their family/families

A group of children

Work(s) together with

the community

Visualisation in Participatory Programmes (VIPP) card exercise We will now split into groups and discuss ways that children can meaningfully participate in health and hygiene activities:

Group 1: Handwashing for seven-year olds Group 2: Diarrhoea for nine-year olds Group 3: Rubbish and flies for 11-year olds Group 4: Water supply for 13-year olds

Group task for each topic:

• What can one child do? • What can a group of two to three children do? • What can a larger group of children do?

Criteria for the activities:

• Important for health • Appropriate for the age of the child thus not too difficult and sufficiently challenging • Interesting and engaging

Because of time we will only focus on the following: What can individual children, and what can a group of children do to help better water and sanitation practices in families? GROUP 1: Handwashing for seven-year olds

• Monitor for behaviour • Monitor peers at school • Be role models to smaller ones

What can a group of children do? • Role plays and puppet shows

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• Singing • Pressure for handwashing • Create social norms

GROUP 2: Diarrhoea for nine-year olds

• Can take care of him/her self to prevent diarrhoea • Communicate to elders in house • Role model to younger children • Make oral re-hydration solution and demonstrate to other child

What can a group of children do?

• Puppet shows, plays on prevention GROUP 3: Rubbish and flies for 11-year olds

• Clean house, stop littering (and help others to stop) • Take action to cover food, particularly to rid flies • Use tools to kill flies • Relay messages to other children • Help take out garbage at home

What can a group of children do? • Pick garbage up • Can mobilise community

GROUP 4: Water supply for 13-year olds.

• Investigate messages about water supply, distribute information and talk to their peers What can a group of children do?

• Provide mutual support to each other. If a child is going on a survey in the community, looking at water resources, or practices at home, it’s a bit daunting for a single child; but two or three can help

• They can design posters, leaflets • They have a preference about involvement in WASH • They can be consulted/lobby

The largest criticism of the child-to-child approach has been in relation to cultural issues … many of it by persons who fail to realise how carefully most people who use the approach weigh and consider it before finding the most effective and sensitive channels. However there are some occasions in which the school and its children need to stand out against manifestly unhealthy or unjust practices and in this case the children must have the full hearted support of adults. Issue such as teenage pregnancy, female genital cutting, or children eating late in the evening – we can say this is wrong.

In regards to the acceptability of children telling adults, it’s about the way it is done It also will depend upon the age of the children, the issue being approached, and cultural considerations in relation the message; age, and attitudes. It may not be culturally acceptable to talk about the message but it may be OK to put on a play about it. There are some issues that the school has got to raise the flag, I haven’t heard of any health and hygiene issues, but I wonder if there are any: girls only hauling water; open defaecation and so forth.

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Less Appropriate More appropriate Your way is wrong. ⇒ Can we try this as well? Here is a new thing you should do. ⇒ Can I tell you what we learned at school? Wash your hands after cleaning the baby. ⇒ May I wash my hands now I have cleaned the baby? We have learned that this custom is not … ⇒ We have learned that this custom is … People shouldn’t act like that. ⇒ May we put on the play we prepared with the teacher?

We haven’t done this yet. ⇒ Can I help you?

Lessons from experience • Child participation is sustainable:

o Where children are given responsibility and support at the same time. o Where children can see that the activity enhances their image and promotes their rights. o Where children are able to learn and develop at the same time as contributing. o Where children are stimulated and have fun.

Please remember that children are children. In the early days of child-to-child we had our own jargon, the fun quotient (FQ). So please try to think in terms of high FQs rather than low FQs. Ethical practices to consider

• Using children as loud speakers. • Having them chant slogans about things they don’t understand. • Using them to do things that adults don’t want to do. • Choosing some children and putting them ‘over’ other children. The “Little Doctors”

programme in Indonesia where you had to be chosen and put on that white coat is probably not a good idea. Have to involve even the poorest and most deprived children have to be involved.

• Children ‘with more’, helping (and condescending) children ‘with less’. In India the “Blue Bell Schools”, the “better” schools going to the slums to help out. This is not a good idea.

Question and Answer Q: What is meaningful participation? A: Meaningful participation begins where children understand what they are doing. It needs to be meaningful to the community. It has to be an effective way that children contribute as citizens. We have to look at ethical standards, how we can avoid tokenism and manipulation. We have to make sure that children know what they are getting into, and that the process is democratic and fair. If we have to select children we must ensure that the selection criteria is transparent, that the environment is child friendly, and that there is some follow up. Q: How can we prevent favouring one child over another? A: We can set up health clubs, HIV/AIDS club and/or sanitation clubs. The problem with sanitation clubs is that many children say school sanitation club is not a good one because their job is to clean latrines. Also when we visit various schools and met heads of some clubs, then go back the following week, we find that the same children are the heads of other clubs. We have to look at the degree of control children have over their decisions. Quite often we have to start from zero because people have a lot of misunderstandings about child participation. It’s ok to start small and support something that doesn’t meet all of the requirements and is not fully sustainable, but it has to be heading in the right direction. The whole business of designing puppet shows, writing books is an example of things that can be done that are not practical, such as cleaning up. Q: Many children aren’t interested in WASH because they are focussing on their entrance exams. How do we handle that?

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A: It is true that academically-oriented students may not want to be involved. But for those who are dropping out of school, WASH may be very real and relevant to them. A: One thing we are trying to do is integrate hygiene into the traditional lessons. The challenge is translating knowledge into action; however, the complaint across the region is that the curriculum is crowded enough. A: In Bangladesh we involved adolescent girls from slums for participatory monitoring in hygiene. One adolescent girl was responsible for monitoring from eight to 10 households. In the end more than 5,600 children were involved in 14 municipalities. Now we have expanded the issue to early marriage and other social campaigns such as immunisation, and the initiative is now under supervision of mayor.

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Children as Change Agents II Joachim Theis, Project Officer, Youth and Partnership, UNICEF EAPRO Some of the challenges we face when dealing with young people’s participation in WASH is that it is so multi-faceted and we do it for different reasons. I think we start from a range of objectives, we achieve on those and then we carry on with others. It is important to know the reasons for young people’s participation in WASH:

1. Children’s access to health information Children who have access to information about health, water and sanitation are better able to survive and to protect themselves. Information is essential for children to realise their right to survival. Where children are denied access to information about health matters, their survival is put at risk (AI/HIV/AIDS/diarrhoea, etc). When speaking of access we have to look at the range of actors in society: It is the responsibility of governments, teachers the education system, parents, community and religious leaders, the media and private sector to ensure that children and young people have access to this vital information.

2. Develop children’s capacities Children who are able to express themselves and are being listened to at home and in school learn and develop better. They develop an interest in their own health and will take better care of themselves and others. If adults listen to children, give them time to articulate their concerns, provide them with appropriate information, children will acquire the confidence and ability to contribute to their own health care. It encourages children to take more responsibility for their own health Ex: Lao PDR Young people were trained to learn media skills in radio production to communicate health/WES. This was done in addition to training in technical and interview techniques.

3. Consulting children Research and assessment results are better if they are based on information from children and adolescents. Consulting children leads to better understanding of children’s own health care needs and concerns; people who are involved are often shocked by children’s opinion and helps shape new perspectives. Ex: Viet Nam Children are consulted for inputs before new WASH facilities are ready for use (to see if they like them…). This increases the chance that latrines and handwashing facilities will be used.

4. Young people’s control over decisions Water and sanitation services are better if children and young people have control over their design, operation and maintenance.

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Ex: Viet Nam Children actively participate in monitoring for correct use, maintenance and advocacy.

5. Children’s contributions Water, sanitation and health services are more effective if they include the contributions of children; this is probably the area where we start but we need to recognise that child participation is much broader, although this is an important area and attractive to adults Ex: Indonesia Child health clubs have been established in 200 school WASH programmes where students monitor the hygiene behaviours of their community. Every sixth grader is responsible for monitoring a dozen neighbouring households. Students developed indicators of hygiene practices through school-level hygiene assessment and planning. Children and young people are consulted, contribute and decide

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Benchmarking tool for children’s participation It is a long arduous process of moving up. Keep in mind that participation is a process, and it doesn’t happen overnight. This bench marking tool is worth studying, you can see how it can be adopted to the WASH situation for planning, monitoring and review. It gets around some of the things we are studying and in most situations we will be able to agree where we are.

Dimensions, standards and indicators • Impact of child and youth participation and degree of children’s control over decisions • Sustainability and institutionalisation of children’s participation

• Quality of children’s participation • Costs of children’s participation If no awareness ⇒ Resistance by adults If no youth mobilisation ⇒ Stagnation, loss of interest If no capacities ⇒ Ineffectiveness If no standards ⇒ Manipulation and abuse of children If no structures ⇒ Diffusion of efforts If no resources ⇒ Frustration of everyone

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The Relationship between WASH in School and WASH in Communities Hubert “Hugh” Hawes, Co-founder of Child-to-Child Trust Before we get started I want to get from the participants the definition of “school”.

• A community of learners • Child-friendly environment where children can learn and grow • Place here children grow academically and socially • A place where people can get their formal education • A place where people of learning where people can acquire knowledge in a positive way • A place which makes duty bearers feel that education takes place only inside the building • A place where children can learn the world The most common centre for violence against

children • An institution for transmitting scientific culture and norms for your children • A place that serves community’s learning needs

Those are interesting definitions but no one included parents, or siblings; it might be worthwhile to include parents, family, and community. It is amazing how we have closed the gates around the school. FRESH: Start local think national We all know what our national WASH priorities are but we don’t know how they play out at local level. We need is to involve local people in helping to decide what schools can do to help us. This involves breaking down the isolation of the schools. When we went to Pakistan we used the FRESH categories to look at schools and it was quite helpful. Let us try to do this using the FRESH framework.

FRESH components

Student Participation

Community Partnerships

Health and Education

School Health Policies

-Children help make the policy -Girls participate in facility ratio

Parent Teacher Associations (PTAs) that actively participate in decision-making processes

Child health weeks (CHWs), discussions with students, Civic Ethics and Codes of Conduct

Water Sanitation and the Environment

-Conduct simple survey drawing what happens -Participate in sanitation & hygiene committees -Self-cleaning of school environments -Promote hygiene through songs, drama, games, stories -Children’s participation in assessing child-friendliness of their school

-School clubs -Peer educators on WASH

Linking school to community water systems – PTA and water committee

Standards and standardisation at national and local level

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Skills-based health education

Participate in needs assessments

Skills transfer; local knowledge

Integrated curriculum, appropriate teaching techniques

School Health and Nutrition Services

M&E of services Healthy lifestyles at home and in schools

Referral to community-based youth friendly services

We need to broaden the concept of what we mean by skills. As far as school health, some see it as school nurse or feeding. If you look at it, there is a whole bunch that the school can do for itself. If you look at mental health, children force other people to notice a child who is unhappy or sleeping in class.

Examples of where hygiene education in schools can be linked to communities: • In the Philippines computers underused, so after class used by community • Development of teaching aids • IT for hygiene promotion • Teaching aid, materials shared with PTA members • Through assistance for homework • Mobile and public libraries • WASH methods part of the curriculum • Children take home workbooks and parents and siblings help and are exposed to messages • Transfer health stories into audio-visual format, animation • Children translate reading into drawings • Reading rooms for children, getting parents to read stories to their children in the evening

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General Plenary Discussion Therese Dooley, Senior Advisor for Sanitation & Hygiene, UNICEF New York

How can school and community WATSAN initiatives integrate closer at local level toward maximising the strengths of each? Not just education component, the facilities and the enabling environment. We need to consider is:

– What might this involve? – How can the process start? – How can it be helped to gain momentum?

• School is seen as an integrated part of the community. • Balanced approach to technology between community and schools. • At community level not as big of a problem, it can be a problem because we as development

agencies compartmentalise. • Need to approach WASH in schools holistically. • Community action planning process, looking at resources before school starts and go to water

sources and look at what’s available, etc. • Need to advocate for a policy change. • Community as a classroom, where children are encouraged to go into their environment to

learn about WES. • Before build WES facilities have community dialogue. • Children as advocators, child can bring good experiences good and bad to community. • Creating demand, having appropriate technologies in community.

School WASH and community WASH is often seen as two separate areas of programming. The issue of separation can be partly due to the fact that initiatives are project-based and there is an artificial separation created by funding and projects, but if begin to look at all WASH as community-based, we might already have the funds. We should use the community as a place of learning and draw from the community, remembering that the school is a community itself and the community involves parents. While WASH is handled by different ministries in the government we have to take every opportunity to facilitate and co-ordinate between the ministries. This afternoon we looked at how we can bridge this gap between communities and schools; now we can look at how we can tie it up.

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Annex I: WHO Guidelines on minimum standards for WASH in schools Draft for review, 31January 2006

I. Introduction 1 1.1 Purpose and scope of these guidelines 1 1.2 Policy rationale 1 1.3 Audience 2 1.4 Stakeholders, roles and responsibilities 2 1.5 Schools settings 3 1.6 Required inter-sectoral linkages 4 1.7 Relation to national standards and codes 4 II. Importance of APPLYING standards for water supply, sanitation and hygiene 5 2.1 Disease prevention 5 2.2 Learning 5 2.3 Gender 5 2.4 Change in the wider community 5 2.5 Life-long skills 5 III. Management of Standards at Local Level 6 3.1 Positive policy environment 6 3.2 Steps in managing standards 6 3.3 Local body for managing standards 6 3.4 Using the guidelines to create minimum standards for specific school settings 7 3.5 Assessment and planning 7 3.6 Phased improvements 8 3.7 Technology choice, operation and maintenance 8 3.8 Ongoing monitoring, review and correction 9 3.9 Staff requirements and training 9 3.10 Hygiene behaviour 9 IV. Guidelines 111. Water Quality, 132. Water Quantity, 153. Water facilities and access to water, 164. Hygiene promotion 175. Toilets,, 186. Control of vector-borne disease,, 207. Cleaning and waste disposal 218. Food storage and preparation, 22 V. Summary of Guidelines 24 VI. Further Reading 25 VII. Glossary 26 VIII. Reference 27 IX: Assessment Checklists for Water Supply, Sanitation, and Hygiene in Schools 29

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I. INTRODUCTION

1.1 Purpose and scope of these guidelines These guidelines recommend a basis for creating the minimum conditions required for providing schooling in a healthy environment for schoolchildren1, teachers and other staff. They can be used to do the following:

1. Develop specific national standards in the area of water supply, sanitation, hygiene and waste

management for various types of school in different contexts. 2. Assess the situation regarding water supply, sanitation, hygiene and waste management in

existing schools to evaluate the extent to which they may fall short of the defined standards. 3. Plan, and carry out, improvements so that the standards are met. 4. Ensure that the construction of new schools meets minimum standards. 5. Prepare and implement comprehensive and realistic action plans so that acceptable standards

are maintained.

The guidelines deal specifically with water supply (water quality, quantity and access), hygiene promotion, sanitation, control of vector-borne disease, cleaning and waste disposal and food storage and preparation. They are designed for use in low-cost settings where simple and affordable measures used when improving existing schools or building new ones can make a significant improvement to hygiene and health. The word ‘school’ is used in this document to include primary and secondary schools, boarding and day schools and kindergartens or pre-school settings.

1.2 Policy rationale

High standards of water supply, sanitation, hygiene and waste management in schools have a number of positive effects. The disease burden among children, staff and their families is reduced; healthy children in healthy environments learn more effectively; there can be greater gender equity in access to education and meeting hygiene-related needs; educational opportunities are created to promote safe environments at home and in the community; and schoolchildren can learn and practice life-long positive hygiene behaviours.2 However, despite these important benefits, acceptable standards of water supply, sanitation and hygiene are not met in many schools world-wide. Efforts to increase school enrolment have been successful, but the number of children in schools with inadequate water supply, sanitation and hygiene has also grown. It has been estimated that approximately half of primary schools in the developing world lack water supply and three quarters lack adequate sanitation3. The international policy environment increasingly reflects these issues. Providing adequate standards of water supply, sanitation and hygiene in schools is of direct relevance to the Millennium Development Goals on achieving universal primary education, promoting gender equality and reducing child mortality. It is also supportive of other goals, especially those on major diseases and infant mortality. At the same time the Millennium Project and the UN Secretary-General have highlighted the importance of rapidly addressing 'quick wins' - identifying specifically provision of services to schools and health care facilities. Targets promoted by Vision 21 include 80 per cent of primary schoolchildren educated about hygiene and all schools equipped with facilities for sanitation and handwashing by 2015. Strategy 8 of the ‘Dakar Framework for Action’ produced at the World Education Forum in 2000 is to create safe, healthy, inclusive and equitably resourced educational environments.

1 The word ‘schoolchildren’ is used in this document to include children of all ages in various school or pre-school settings, and includes children who may also be referred to as ‘pupils’ or ‘students’ 2 Snel et al., eds. 2004 3 UNICEF 2005, personal communication.

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Putting policy into practice in this area demands stronger linkages between professional sectors such as education, health, water supply and sanitation, planning and construction. 1.3 Audience These guidelines are written for use by education managers and planners, architects, urban planners, water and sanitation technicians, teaching staff, school boards, village education committees and similar bodies. They are encouraged to work together to create minimum standards that are relevant, achievable and sustainable. 1.4 Stakeholders, roles and responsibilities The following table presents the major stakeholders and their roles and responsibilities in implementing these guidelines, to promote health and learning in schools.

Stakeholder group How they are affected by inadequate water, sanitation and hygiene in schools

How they can contribute to improved water, sanitation and hygiene in schools

Schoolchildren -High exposure to water, sanitation and hygiene-related disease risk -Absenteeism because of illness or unacceptable water and sanitation conditions -Poor learning because of disease

-Comply with procedures for use and care of water and sanitation facilities, and observe appropriate hygiene measures -Participate in the design and construction process, and play an active role in maintenance of facilities -Monitor state and use of facilities

School children’s families

-Intermediate exposure to water, sanitation and hygiene-associated disease risk, indirectly from disease transmitted to their children at school -Personal and material burden of additional disease in the family

-Encourage children to comply with procedures for use and care of water and sanitation facilities, and observe appropriate hygiene measures at school and at home

Teachers -Low or intermediate exposure to water, sanitation and hygiene-associated disease risk De-motivating working conditions due to: - schoolchildren’s absenteeism and learning difficulties; - poor water and sanitation facilities

-Monitor state and use of water and sanitation facilities -Organise care and maintenance of facilities -Encourage schoolchildren to adopt appropriate behaviours at school and at home through hygiene education -Participate actively in achieving and maintaining standards

School directors or head teachers

-Low or intermediate exposure to water, sanitation and hygiene-associated disease risk -Professional and personal difficulties created by disease risk, absenteeism and learning difficulties faced by schoolchildren

-Plan and implement programmes to define, achieve and maintain standards -Create conditions in which staff are motivated to achieve and maintain standards -Develop and enforce rules for correct use and care of facilities

Local education authorities

-Impaired reputation as a result of inadequate environmental health conditions in schools -Difficulty in achieving and maintaining schoolchildren’s attendance and performance -Difficulty in recruiting and retaining staff

-Provide resources and direction for setting, achieving and maintaining standards -Advocate as appropriate at district or national level for adequate resources -Co-ordinate with local environmental health services

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Stakeholder group How they are affected by inadequate water, sanitation and hygiene in schools

How they can contribute to improved water, sanitation and hygiene in schools

Environmental-health authorities

No direct impact -Collaborate closely with local education authorities to provide specialist advice for identifying problems and recommending solutions for water supply, sanitation and hygiene

Parent teachers associations (PTAs), school governors, school committees and similar bodies

Challenges created by disease risk, absenteeism and learning difficulties

-Discuss options for improvements with school directors and teachers -Advocate locally for improvements in water supply, sanitation and hygiene in schools

Politicians -No direct impact for most -Direct concern for ministers of education in terms of budget and performance of ministry

-Provide /mobilise political and financial support for improvements

Construction industry (public and private)

No direct impact -Design, build or upgrade school facilities with suitable water and sanitation facilities

National and international funding bodies

No direct impact -Provide funding for appropriate new school facilities, upgrading or renovation of existing facilities and ongoing maintenance of standards

1.5 Schools settings These guidelines are intended for use in resource-scarce situations where simple, robust and affordable solutions are required for providing healthy school environments. They apply to a range of school settings. Three broad types of setting illustrate the issues involved in designing and applying standards for water supply, sanitation and hygiene, as follows:

1. Kindergartens / pre-school facilities providing day care and early learning for children from 2-to 5-years old. Children in this age group are particularly susceptible to infectious disease because of undeveloped immunity, and behaviours such as frequently putting their hands and objects into their mouths. They are also at an age where they are susceptible to physical injury, so require a safe physical environment and require a high level of care and attention. They are also at a stage during which essential hygiene behaviours are developed, so they need an environment in which positive behaviours are facilitated. This type of facility may be a formal structure with recognition and support from local authorities, but may often be run as an informal private or community-based service in a location that is not specifically designed for such purposes, by staff with little or no specific training. In many countries this is a loosely regulated area of activity.

2. Day schools, from 6-to 16-years old provide academic and, in many cases, recreational activities for children who return home every day, but who may often eat at or near the school. Problems faced by schoolchildren and teachers in this kind of school often include lack of basic water supplies and sanitation facilities, inadequate or hazardous outdoor space and overcrowded classrooms where noise, poor lighting, poor seating, excessive heat or cold, damp and poor indoor-air quality. Funding for improved conditions in schools may be lacking, but there may also be a strong desire and capacity for change among staff, schoolchildren and parents.

3. Boarding schools cater for children who for various reasons are unable to return home each day. In boarding schools, all meals, sleeping accommodation and washing facilities are provided. It is therefore of critical importance that water and sanitation facilities, and hygiene

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measures, conform to recognised standards. On the one hand, risks of transmission of communicable disease are raised because of the communal eating, sleeping, sanitation and hygiene arrangements in boarding schools, but on the other it is possible to provide adequate water, sanitation and hygiene standards for all children.

Within each of these broad types of school setting there is a great variation in access to financial and human resources and in the existing level of water supply, sanitation and hygiene. The guidelines in this document are aimed to help achieve acceptable standards in all schools, whatever the existing situation and current level of resources. Simple and low-cost measures exist for improving even the worst situations, and providing the first step towards acceptable long-term standards.

1.6 Required inter-sectoral linkages Technical support may be required from the water-supply and sanitation and public works sectors for ensuring the correct design and construction of buildings and sanitary infrastructure. The health sector should provide guidance on the environmental health aspects of school design, construction and maintenance. The health sector can also provide support by monitoring environmental health conditions, monitoring child health, providing selected health services (such as micronutrient supplements, treatments for helminth infections, vaccination campaigns or health inspections) and providing training and advice for teachers, schoolchildren and parents on water, sanitation and hygiene. 1.7 Relation to national standards and codes These guidelines are intended to support and complement existing national standards and codes, and do not modify or substitute for them. Readers should try to find relevant national standards through their ministries of health, education, environment, planning, or natural resources, or from professional bodies and training organisations.

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II. IMPORTANCE OF APPLYING STANDARDS FOR WASH 2.1 Disease prevention

Water-, sanitation- and hygiene-related diseases are a huge burden in developing countries. It is estimated that 88 per cent of diarrhoeal disease is caused by unsafe water supply, and inadequate sanitation and hygiene4. Many schools serve communities that have a high prevalence of diseases related to inadequate water supply, sanitation and hygiene, and where child malnutrition and other underlying health problems are common.

It is not uncommon for schools to lack drinking-water and sanitation facilities completely, particularly in rural areas, or for such facilities as do exist to be inadequate both in quality and quantity. Schools with poor water, sanitation and hygiene conditions, and intense levels of person-to-person contact, are high-risk environments for children and staff, and exacerbate children's particular susceptibility to environmental health hazards.

These guidelines are designed to help strengthen water supply, sanitation and hygiene measures in particular, while recognising the importance of, and links with, other areas of environmental health, such as air quality and physical safety.

2.2 Learning Children’s ability to learn may be affected in several ways. Firstly, helminth infections, affecting hundreds of millions of school-age children, can impair children’s physical development and learning ability through pain and discomfort, competition for nutrients, and damage to tissues and organs. Long-term exposure to chemical contaminants in water (e.g. lead) may impair learning ability. Diarrhoeal diseases, malaria and helminth infections force many schoolchildren to be absent from school. Poor environmental conditions in the classroom can also make both teaching and learning very difficult. Lastly, teachers’ impaired performance and absence due to disease has a direct impact on learning. 2.3 Gender Girls and boys are likely to be affected in different ways by inadequate water, sanitation and hygiene conditions in schools, and this may contribute to unequal learning opportunities. For example, lack of adequate, separate and secure toilets and washing facilities may discourage parents from sending girls to school, and can contribute to girls missing days at school or dropping out altogether at puberty. 2.4 Change in the wider community Children who have adequate water, sanitation and hygiene conditions at school are more able to integrate hygiene education into their daily lives, and can be effective agents for change in their families and the wider community. 2.5 Life-long skills The hygiene behaviours that children learn at school, made possible through a combination of hygiene education and suitable water and sanitation facilities, are skills that children are likely to maintain as adults and pass on to their own children.

4 World Health Organization 2004b

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III. MANAGEMENT OF STANDARDS AT LOCAL LEVEL 3.1 Positive policy environment Positive policies are required at national, district and school levels to encourage and facilitate the achievement of appropriate standards of water, sanitation and hygiene in schools. A supportive policy environment should allow stakeholders at district and school level to establish effective governance and management arrangements to, plan, fund, implement and coordinate improvements. 3.2 Steps in managing standards The essential steps in managing standards at national and local levels are as follows:

National level Local level

1. Develop a national policy framework that is supportive of improved conditions in schools.

1. Mobilise support from teachers, schoolchildren, families and other local stakeholders to achieve and sustain a healthy school environment.

2. Ensure appropriate institutional arrangements for setting and monitoring standards.

2. Create an appropriate local body to oversee the setting and implementation of standards.

3. Create a regulatory framework that encourages and supports the setting, application and monitoring of standards.

3. Define a set of standards, policies and procedures appropriate to the school or type of school concerned.

4. Provide expertise and resources for assessment and planning.

4. Assess existing conditions and plan improvements and new developments5.

5. Provide locally appropriate plans and specialist input for new structures and improvements to existing structures.

5. Plan improvements or new developments required, with specialist technical input if necessary.

6. Provide and/or facilitate funding for planned improvements and new developments.

6. Seek funding for planned improvements and new developments.

7. Ensure local oversight of improvements and new developments to encourage the application of appropriate standards.

7. Oversee implementation of planned improvements and new developments.

8. Operate a responsive national-level monitoring programme.

8. Monitor ongoing conditions and ensure remedial action where required.

3.3 Local body for managing standards Managing the various and interdependent aspects of water, sanitation and hygiene at the level of the school requires the involvement of all staff, as well as schoolchildren and parents (see Section 1.4). The most appropriate body to provide coordination at school level will depend on the type of school and the degree of involvement of the education authorities and local authorities, but this body should include parents, teachers and, where appropriate, schoolchildren. Options include existing structures such as a parent-teachers association or community education committee, or a specific structure such as a school health committee. Where there are deficiencies in present water supply and sanitation arrangements, it will be helpful for this body to create strong links with the local Department of Environmental Health, and to invite Departmental officials to its meetings on a regular basis.

Whatever the specific management arrangements put in place, there should be a clearly identified body with authority to carry out steps 3 to 8 in Section 3.2 above.

5 In the case of new schools or extensive renovation/extension of existing schools, it is essential that plans for water supply, sanitation and hygiene facilities are integrated with plans for buildings and outdoor spaces.

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3.4 Using the guidelines to create minimum standards for specific school settings The guidelines in Section 4 reflect general principles in support of creating healthy school environments. They can be used, as follows, for creating specific standards appropriate for individual schools or types of school.

Review the eight guidelines, which are narrative statements describing the situation to be aimed for. Identify major areas that require attention in relation to specific guidelines. Consider local conditions that might affect the way that the guidelines are interpreted in practice. Note that local constraints, such as lack of funding or lack of a suitable water source, should not be taken into consideration at this stage. The aim is first to define appropriate standards required for providing a healthy school environment in a particular setting, then to seek ways to meet those standards, rather than defining limited standards that are insufficient.

Use national standards and/or the indicators under each guideline to define specific standards, such as the number of users per toilet or the quantity of water per person per day required. See the guidance notes for advice on taking account of local conditions when setting specific standards and on intermediate steps to achieving standards.

3.5 Assessment and planning Once specific standards have been defined for a particular school or type of school, they can be used as a checklist to determine how and to what extent the existing situation falls short of them. This will identify specific problems that need addressing. See the assessment checklist at the end of this document.

It is important to analyse the reasons for shortfalls in as inclusive a way as possible, because solutions will mostly require the participation of all parties concerned: schoolchildren, teachers, head teachers/school directors, maintenance staff and education managers. A useful tool for this analysis is the problem tree (see the box below). Objectives should be understandable and motivating to all those concerned by their achievement, and progress towards achieving them should be possible to measure and describe easily and clearly.

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The problem tree/solution tree is a simple method to identify problems, their causes and effects, and then define objectives for improvement that are achievable and appropriate to the specific conditions of each school. It is performed as a group activity through the following steps. 1. Discuss any major aspects of the current situation where water supply, sanitation and hygiene standards defined for the school are not met. Write each one in large letters on a piece of paper (e.g. A6 size) or a postcard. 2. For each major problem, discuss its causes by asking the question “why?”. For each of the contributing problems identified, ask the question “why?” again, and so on until root causes for each problem have been revealed and agreed. Write all the contributing problems in large letters on a piece of paper or postcard and stick them on a wall, arranged in a way that reflects their relation to each other and to the major problem. 3. For each of the contributing problems noted, discuss possible solutions. Check that these solutions contribute to solving the major problems identified by asking the question "what" to identify the effects of the action. Some solutions proposed will probably have to be abandoned because they are not realistic, given current conditions, or because they do not have sufficient impact on the major problems. 4. Once a number of feasible solutions have been agreed, they should be phrased as objectives. For each objective, the group can then discuss and agree strategy (how the objectives can be reached), responsibilities (who will do what), timing and resources. 3.6 Phased improvements Many schools are currently very far from achieving minimum standards for water, sanitation and hygiene, and may have no suitable facilities at all, because of lack of resources, skills or adequate institutional support. It is recognised that achieving the standards will often not be possible in the short term. Therefore, steps should be taken both to prioritise necessary improvements and to work in a phased way so that the most urgent problems can be identified and targeted immediately, and other benefits subsequently achieved. See specific guidelines in Section 4 for advice on intermediate measures for situations where minimum standards cannot be reached in the short term. 3.7 Technology choice, operation and maintenance It is most important that maintenance, repair and eventual replacement of water and sanitation facilities are taken into account during the design and construction phases. As far as possible, facilities should be hardwearing, durable and possible to maintain without specialist skills. Technology should be chosen taking account of local capacities for maintenance and repair. It may be necessary in some cases to choose a lower level of service in order to avoid essential equipment that cannot be repaired when it breaks down. For example, it may be better to keep an open well, rather than equip it with a cover slab and pump, until there is a reliable system in place for maintenance and repair of the pump.

Responsibilities for operation and maintenance should be clearly defined, and appropriate skills provided. See Section 3.9. Maintenance, repair and replacement of facilities should be planned and budgeted for from the beginning of a programme to improve facilities or build new ones. Some form of local income-generating system may be required if institutional funding is not certain. 3.8 Ongoing monitoring, review and correction Maintaining acceptable standards requires ongoing efforts at all levels. The role of the school health committee or equivalent body in ensuring regular monitoring of water, sanitation and hygiene conditions is critical. The local department of environmental health should be a major partner, providing expert monitoring and advice. For example, schools should be included in regular water-quality surveillance and control programmes.

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A monitoring system should use a limited set of indicators that are easily and regularly measured to identify problems and correct them in a timely way. For example, water shortages at handwashing points may be monitored by teachers or schoolchildren according to an organised schedule, and signalled immediately to caretakers or maintenance staff, where these exist, for action. If the school is connected to the local water distribution system, the frequency and duration of water shortages may also be recorded so that water-supply reliability can be measured over time.

Recording forms may be developed at school level or district or national level for standardised monitoring reports, to enable collation and comparison of data from all schools.

3.9 Staff requirements and training Many activities that are important for creating healthy school environments are performed routinely by staff and schoolchildren as they use and care for classrooms, outdoor space, toilets etc. One important decision that has to be made regarding the maintenance of facilities is whether or not schoolchildren should be responsible for cleaning toilets and other sanitary facilities. The benefits of involving schoolchildren include cost saving, encouraging schoolchildren to take care not to dirty the facilities and to clean up after themselves and the opportunities this provides for teaching important hygiene skills. However, great care must be taken to ensure that such an arrangement works effectively in practice, without exposing schoolchildren to disease risk, and without placing an unfair burden on one group of children in particular.

Water supply, sanitation and hygiene should be given a central place in the training and supervision of all teachers, as they provide role models for schoolchildren and are largely responsible for encouraging the participation of schoolchildren in maintaining a healthy school environment. In addition, the subject should be taught as a curriculum component for those who teach related subjects such as biology.

Head teachers/school directors have a very important role to play, through their work with teachers and other staff, schoolchildren, parents and local authorities. They should be made aware of the importance of water, sanitation and hygiene in schools, and provided with guidance and support so that they can promote the development and maintenance of a healthy school environment.

In some schools there may be other staff, such as cleaners and kitchen staff, who are specifically responsible for maintaining healthy conditions. In their training and management, they should be given a strong awareness of the importance of their role and should be able to apply basic principles of hygiene to their daily work.

3.10 Hygiene behaviour Many children learn some of their most important hygiene skills in school or pre-school settings, and for many this is where they are introduced to hygiene practices that are not promoted or may not be possible in the home. Teachers can be very effective hygiene promoters, building valuable life skills through hygiene education and by acting as role models for schoolchildren.

However, good hygiene behaviour and the effectiveness of hygiene promotion in schools are severely limited where water supply and sanitation facilities are inadequate or inexistent. Teachers cannot credibly convey the importance of handwashing if there is no water in the school, or promote the use of latrines if they themselves avoid using their use because they are dirty or unsafe.

It is therefore important to achieve the right balance between hygiene education and ensuring acceptable environmental health conditions. One cannot be effective in promoting health without the other.

More broadly, health should be promoted in all aspects of the school environment and activities. Adequate water supply, sanitation and hygiene are crucial foundations of this goal.

IV. GUIDELINES This document is intended to be used as a basis for setting standards at national level. The guidelines, indicators and guidance notes in this section are intended to be used, together with existing national standards and guidelines, for creating standards, policies and procedures to be used in each school.

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• The guidelines are in the form of a statement that describes the situation to be aimed for and maintained.

• Each guideline is specified by a set of indicators that can be used as benchmark values for the following activities: - assessing existing situations; - planning new facilities or improvements to existing ones; - monitoring progress; - monitoring ongoing maintenance of standards.

The indicators provide benchmarks that reflect current understanding of appropriate levels of service required to create and maintain healthy school environments. They are adapted from a number of documents that guide practice in schools and other relevant settings, and the main documents from which they are drawn are shown as footnotes and presented in the reference list. Specialist technical terms are explained in the Glossary in Section 7. The indicators need to be adapted in the light of national standards, local conditions and current practices. They mostly concern results, e.g. the quantity of water available or the ratio of schoolchildren to toilets. However, the process indicators are also very important. These concern the means by which outputs are to be achieved and maintained. They are presented in the guidelines and relate closely to the management issues in Section 3.

• The guidance notes provide advice on applying the guidelines and indicators in practice and highlight the most important aspects that need to be considered when setting priorities for action. They are numbered according to the indicators to which they refer.

Additional information on assessment, implementation and monitoring can be found in the reference list and Section 6 (Further reading).

The guidelines and indicators are designed to help set standards for creating healthy school environments for the long term. For schools that are a long way from meeting standards, a basic minimum level of facilities essential for preserving health should be provided as a temporary measure until adequate long-term facilities are provided.

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Essential short-term measures required to protect health in schools 1. Fence the school grounds so that a clean environment can be maintained.

2. Provide basic sanitation facilities that enable schoolchildren and staff to go to the toilet without contaminating the school grounds or resources such as water supplies. This may entail measures as basic as digging temporary pit latrines or defining defecation areas outside the school and rotating those areas to avoid a rapid build-up of contamination.

Note that the risk of transmission of soil-based helminths is increased with the use of defecation fields. The use of shoes or sandals provides protection from hookworm infections.

3. Provide water for handwashing after going to the toilet and before handling food. This may be done using simple and economical equipment, such as a pitcher of water, a basin and soap or wood ash.

4. Provide safe drinking water from a protected groundwater source (spring, well or borehole), or from a treated supply, and keep it safe until it is drunk. Untreated water from unprotected sources can be made safer by simple means such as boiling or filtering it. Schoolchildren and staff may have to bring water from home if the school does not have a safe water source nearby.

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1. Water Quality6,7 Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose intended

Indicators

1. Microbiological quality of drinking-water E. coli or thermotolerant coliform bacteria are not detectable in any 100-ml sample.

2. Treatment of drinking-water Drinking-water from unprotected sources is treated to ensure microbiological safety.

3. Chemical and radiological quality of drinking-water Water meets WHO Guidelines for Drinking-Water Quality or national standards concerning chemical and radiological parameters.

4. Acceptability of drinking-water There are no tastes, odours or colours that would discourage consumption of the water.

5. Water for other purposes Water that is not of drinking-water quality is used only for cleaning, laundry and sanitation.

Guidance notes

1. Microbiological quality is of overriding importance. It is essential that the water supplied is free of pathogens and that it is protected from contamination inside the school itself. Drinking-water supplied to schools should meet national standards and follow WHO drinking-water quality guidelines. In practice, this means that the water supply should be from a protected groundwater source, such as a dug well, a borehole or a spring, or should be disinfected if it is from a surface water source. See indicator 2. Rainwater may be acceptable without disinfection if the rainwater catchment surface, guttering and storage tank are correctly operated, maintained and cleaned.

The local department of environmental health should be involved in monitoring the microbiological quality of the water in the school, as part of a routine surveillance and control programme.

2. Disinfection with chlorine is the most appropriate way of ensuring microbiological safety in most low-cost settings. Bleaching powder, liquid bleach, chlorine tablets and other sources of chlorine may be used, depending on local availability. At least 30 minutes’ contact time should be allowed between the moment when the chlorine is added to the water and the moment it is drunk, to ensure adequate disinfection. The free chlorine residual after the contact time should be between 0.5 and 1.0 mg/l.

Free chlorine residual (the free form of chlorine remaining in the water after the contact time) can be measured with simple equipment.

Chlorinated water should not be stored for more than 2 days, to avoid losing its residual disinfection capacity.

If the turbidity of the water is significantly greater than 1 NTU, it should be treated to remove suspended matter before disinfection, by sedimentation (with or without coagulation and flocculation) and/or filtration. It may be preferable in many situations to disinfect water up to 5 NTU without such prior treatment, as the disadvantages of adding a treatment process, in terms of increased cost, complexity and risk of error, may outweigh the benefits. As simple equipment (turbidity tube) is available for measuring turbidity as low as 5 NTU, this level may be used as an interim and local monitoring target.

Filtration, chlorination, solar disinfection or other small-scale technologies may be appropriate for treatment of water in schools that are not connected to piped supplies, as well as those that are connected to piped supplies whose quality is not consistently satisfactory8.

6 WHO 2004a 7 EEA/WHO 2002 8 WHO 2002

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3. Chemical constituents such as arsenic, fluoride and nitrates may be present in excess of guideline levels in groundwater supplies, and it may not be possible, in the short term, to remove them or to find an alternative source of water. In circumstances where WHO drinking-water quality guidelines or national standards for chemical and radiological parameters cannot be met immediately, an assessment should be made of the risks caused to schoolchildren and staff, given the levels of contamination, the length of exposure and the degree of susceptibility of individuals. Children of all ages, particularly younger ones, are more susceptible than adults to the harmful effects of chemical contaminants.

4. It is important that the taste and odour of drinking-water are acceptable to schoolchildren and staff, or they may not drink enough, or may drink water from other, unprotected sources, which would be harmful to their health.

5. Water used for sanitation, laundry and cleaning floors and other surfaces need not be of such high quality as drinking-water. However, water for handwashing and bathing and dishwashing should be of drinking-water quality, particularly if there are no specific drinking-water points. All water used for food preparation and washing utensils should be of drinking-water quality.

If water below drinking-water quality is used for certain purposes, it should be in separate, clearly marked containers or distribution systems, and necessary measures should be taken to ensure that the drinking-water supply cannot be contaminated by the lower-quality supply.

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2. Water Quantity9,10 Sufficient water is available at all times for drinking, personal hygiene, food preparation, cleaning and laundry Indicators

1. Basic quantities required Day schools -5 litres per person per day for all

schoolchildren and staff Boarding schools -20 litres per person per day for all residential

schoolchildren and staff -5 litres per person per day for all non-

residential schoolchildren and staff

2. Additional quantities required The following should be added to the basic quantities as necessary. Figures given are for day schools. They should be doubled for boarding schools. Flushing toilets -10 - 20 litres per person per day for conventional flushing toilets -1.5 - 3 litres per person per day for pour-flush toilets Anal washing -1- 2 litres per person per day

Guidance notes

1. These guideline figures include water used for drinking, hand hygiene, cleaning and, where appropriate, food preparation, and laundry. The figures should be used for planning and design of water-supply systems. The actual quantities of water required will depend on a number of factors, such as climate, availability and type of water-use facilities, and local water-use practices.

It is important that drinking water is available throughout the school day, and that children are encouraged to drink, as even minor dehydration reduces children’s ability to concentrate, and may damage their health in the long term. Many children walk long distances to school, often after having carried out household chores, and may arrive at school thirsty.

In schools without a safe drinking-water supply, children and staff may have to carry their drinking water with them to school.

2. The additional water quantities required for sanitation need to be adjusted for local conditions, including the exact type of toilets used (including the use of urinals), prevalent practices and the time that children and staff actually spend in school.

3. Water facilities and access to water11,12

Sufficient water-collection points and water-use facilities are available in the school to allow convenient access to, and use of, water for drinking, personal hygiene, food preparation, cleaning and laundry. Indicators

1. A reliable water point, with soap or a suitable alternative, is available at all the critical points within the school, particularly toilets and kitchens.

2. A reliable drinking-water point is accessible for staff and schoolchildren at all times.

9 WFP/UNESCO/WHO 1999 10 Sphere Project 2004 11 WFP/UNESCO/WHO 1999 12 Zomerplaag & Mooijman 2005

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3. One (1) shower is available for 20 users in boarding schools (users include schoolchildren and residential staff). Separate showers, or separate showering times, are provided for staff and schoolchildren, and separate showers or times are provided for boys and girls.

4. Laundry facilities, with soap/detergent and hot water and/or chlorine solution, are provided in boarding schools

Guidance notes

1. Basic hygiene measures by staff and schoolchildren, handwashing in particular, should not be compromised by lack of water or lack of access to handwashing basins or suitable alternatives. If soap is not available then schoolchildren should be encouraged to wash their hands with water and a small amount of sand soil or wood-ash. This should be avoided if it is likely to block the drainage system.

Water points should be sufficiently close to users to encourage them to use water as often as required. Staff toilets and schoolchildren’s toilets should have handwashing points, with adequate drainage, next to them. Children should also be encouraged to wash their faces to prevent eye diseases. A water point close to the classrooms may be useful for this.

Simple and low-cost handwashing points can be made in various ways, including the following: a pitcher of water and a basin (one person can pour the water for the other who washed their hands; the wastewater falls into the basin); a small tank (e.g. an oil drum) fitted with a tap, set on a stand and filled with a bucket, with a small soakaway or a basin under the tap to catch the wastewater; a ‘tippee-tap’ made from a hollow gourd or plastic bottle that is hung on a rope and that pours a small stream of water when it is tipped.

2. If possible, drinking water should be provided separately from water provided for handwashing and other purposes, even if it is from the same supply. Drinking water may be provided from a piped water system or via a covered container with a tap where there is no piped supply. Drinking-water points should be clearly marked.

3. If the age-range of schoolchildren is more than 3 or 4 years, separate showers or showering times may need to be provided for younger and older children.

Showers may be simple cubicles made from local materials, with stone or brick on the floor to provide a clean and draining surface. Users bring water to the cubicle in a bucket and pour it over themselves (or over the small child they are washing) with a large cup.

4. Hygiene promotion13 Correct use and maintenance of water and sanitation facilities is ensured through sustained hygiene promotion. Water and sanitation facilities are used as resources for hygiene education. Indicators

1. Hygiene education is provided for schoolchildren as part of the school curriculum.

2. Positive hygiene behaviours, including mandatory correct use and maintenance of facilities, are systematically promoted among staff and schoolchildren

3. Facilities and resources enable staff and schoolchildren to practice behaviours that control disease transmission in an easy and timely way.

Guidance notes

1. Hygiene education should be a core part of teacher training, and refresher trainings should be carried out regularly to sustain knowledge and awareness. Hygiene education, using a variety of participatory and other learning methods, should enable schoolchildren to develop the knowledge, attitudes and life skills they need for adopting and maintaining healthy lifestyles, particularly with respect to water, sanitation and hygiene.

13 WHO 2003a

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2. A healthy school environment and appropriate use of water supply, sanitation and hygiene facilities should be systematically promoted through the application of clear regulations and the participation of staff, schoolchildren and parents in planning and managing facilities and the school environment.

One particularly important aspect is the cleaning and maintenance of facilities. Schoolchildren may be required to carry out activities such as cleaning toilets, carrying water to the school or within the school and collecting solid waste. These activities should be organised fairly and transparently, within the limits of schoolchildren’s age and ability, and should not be used as a punishment.

Schoolchildren are heavily influenced by the example set by school staff, their teachers in particular, who should provide positive role models by consistently demonstrating appropriate hygiene behaviours.

3. Staff and schoolchildren should not be expected to adopt behaviours that are inconvenient, uncomfortable or impractical. For example, staff cannot be expected to set a good example to schoolchildren if they cannot wash their hands after using the toilet because there is no water.

Where improvements to facilities are required at the school, their planning and construction can be used as an effective tool for hygiene education.

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5. Toilets14,15,16

Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for schoolchildren and staff. Indicators

1. There are sufficient toilets available - 1 per 25 girls / female staff, and 1 toilet plus 1 urinal (or 50 cm of urinal wall) per 50 boys / male staff17.

2. Toilets are easily accessible – no more than 30 m from all users

3. Toilets provide privacy and security

4. Toilets are appropriate to local cultural and social conditions

5. Toilets are hygienic to use and easy to clean

6. Toilets have convenient handwashing facilities close by

7. There is a cleaning and maintenance routine in operation that ensures that clean and functioning toilets are available at all times

Guidance notes

1. The number of toilets and urinals required for each school depends on the numbers of children and staff, but also on when the schoolchildren and staff have access to the toilets. If access is restricted to break times, then peak demand could be high, particularly if all the classes have breaks at the same time.

Urinals for girls and women, as well as for boys and men, have been used with success in some countries. They are quicker and cheaper to build than toilets, they reduce the smells in latrines and they are easy for young children to use.

Separate toilet blocks, or toilet areas separated by solid walls and with separate entrances, should be provided, rather than separating boys and girls facilities by lightweight partitions. Doors should reach down to floor level.

For children up to the age of about nine, separate toilets for boys and girls may not be necessary.

It may be appropriate to provide separate toilets for staff and schoolchildren, particularly where special toilets are provided for young children.

If the school has no formal kind of toilet (e.g. latrines), it is probably best to improve the existing system (e.g. defecation fields) and continue using it until a sufficient number of toilets are available to provide accessible and hygienic facilities for everyone. If just one or two latrines are provided for a whole school, the area around them is likely to become rapidly contaminated and the latrine pits will fill in a short time. Defecation areas can be improved by providing correct drainage to avoid contaminating the nearby environment, setting up a rotation system and using shallow trench latrines rather than open defecation.

2. In principle, toilets should be as close as possible to classrooms and playing areas, to ensure they can be used conveniently and safely. Entrances should be positioned to provide maximum discretion in entering and leaving a toilet block. In pre-school facilities, toilets may need to be adjacent to the child-care space, as young children frequently need supervision when going to the toilet.

The location of toilets should also take into account the need to minimise odours (taking account of prevailing winds) and avoid contamination of water supplies and food. Particular care should be

14Franceys et al. 1992 15 Zomerplaag & Mooijman 2005 16 WHO 1997 17 WFP/UNESCO/WHO 1999

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taken when siting latrines and septic tanks with soakaway pits or infiltration trenches. All latrines and infiltration systems should be located at least 30 m from any groundwater source, and at least 1.5 m above the groundwater table.

3. In order to minimise the risk of violence, including sexual violence, toilets should be carefully located, should be lockable (to protect people while using them), and they and their access routes should be lit at night.

4. The cultural and social conditions prevalent in the community to which the schoolchildren belong should be taken into account in the design and siting of toilets. The segregation of boys and girls toilets is one of the most common requirements of parents.

Younger children may require toilets of different dimensions than those of older children and adults, and specific features need to be taken into account to make the toilets easy and comfortable to use. For example, the squatting hole in a pit latrine may need to be smaller and footrests may need to be closer together.

Children with physical disabilities may require additional modifications to standard toilet designs, to enable them to use the toilets with as much autonomy as possible.

5. Toilets should be designed and built so that they are hygienic to use and do not become centres for disease transmission. Surfaces that may be soiled should be of smooth, waterproof and hardwearing material that can be cleaned with water and that is resistant to cleaning products.

The most important part of a latrine, in terms of cleaning, is the slab, which should be made of concrete or some other hardwearing and smooth material. Other parts of the latrine, such the superstructure, can be made with cheaper local materials.

The design of the toilet should include measures to minimise odours and control fly and mosquito breeding.

6. A toilet is not complete without a handwashing point with soap and adequate drainage. All toilets designs should include convenient handwashing facilities so that handwashing after using the toilet can become a single routine activity for schoolchildren and teachers. Effective handwashing facilities may be built at little cost, with locally available materials (see Guideline 3).

7. Toilets should be cleaned whenever they are dirty, and at least once per day, with a disinfectant used on all exposed surfaces. Strong disinfectants should not be used in large quantities, as this is unnecessary, expensive, potentially dangerous, and may damage the sanitation system.

If no disinfectant is available, plain cold water should be used with a brush to remove visible soiling.

6. Control of vector-borne disease18,19,20 Schoolchildren, staff and visitors are protected from disease vectors. Indicators

1. The density of vectors in the school is minimised

2. Schoolchildren and staff are protected from potentially disease-transmitting vectors

3. Vectors are prevented from contact with schoolchildren and staff or substances infected with related vector-borne diseases

Guidance notes

1. Appropriate and effective methods for reducing vector numbers depend on the type of vector, the location and number/size of breeding sites, vector habits, including places and times of resting, feeding and biting, and chemical resistance of specific vector populations.

18 WHO 1997 19 WHO 2003b 20 Rozendaal 1997

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Basic environmental control methods, such as proper excreta disposal, food hygiene and drainage should be the basis of any strategy. The location of new schools should be chosen, if possible, to avoid local disease-vector risks.

Mosquitoes and flies can effectively be excluded from buildings by covering opening windows with fly-screen and fitting self-closing doors to the outside. Resting sites for mosquitoes inside buildings should be minimised by the use of smooth finishes where possible.

The use of chemical controls, such as residual insecticide spraying, in and around the school requires specialist advice, which should be available from the local Department of Environmental Health.

2. Schoolchildren and staff may be protected from certain vectors through the use of barriers (e.g. covered food storage to prevent contamination by rats and flies, or insecticide-treated bednets against mosquitoes in boarding schools) or repellents.

3. Schoolchildren and staff with vector-borne diseases such as malaria, lassa fever and typhus should be identified and treated rapidly. They should not attend school during the infectious period so that the related vectors do not transmit the disease from them to other people in the school. In addition, regular inspections should be carried out to detect and treat body lice and fleas.

The school premises and, to the extent possible, the immediate surroundings of the school, should be kept free of faecal material to prevent flies and other mechanical vectors from carrying pathogens.

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7. Cleaning and waste disposal21 The school environment is kept clean and safe. Indicators

1. Classrooms and other teaching areas are regularly cleaned, to minimise dust and moulds.

2. Outside and inside areas are maintained free of sharp objects and other physical hazards.

3. Solid waste is collected from classrooms and offices daily and is disposed of safely.

4. Wastewater is disposed of quickly and safely. Guidance notes

1. Dust and moulds contribute to infectious respiratory disease, asthma and allergies. For cleaning of floors and walls, wet mopping with hot water and detergent, if available, is recommended, rather than sweeping. Floors and other washed surfaces should be made of a suitable non-porous material that is resistant to repeated washing with hot water and detergents. If this is not possible then daily sweeping should be carried out.

2. Schoolchildren and staff should not be exposed to unnecessary risk of injury during the time they spend in the school. This can be avoided by promoting proper disposal of solid waste in the school, regular cleaning of all inside and outside areas of the school and monitoring and reporting on broken furniture, window glass etc. so that temporary or permanent repairs can be made rapidly.

3. Most solid waste produced in schools is non-hazardous and can be collected, stored if needed and then disposed of in the municipal waste-collection system or burned or buried in a suitable location on-site. If waste is burned in or near the school grounds, this should be done when the schoolchildren are absent. Waste produced in school laboratories should be managed by a qualified laboratory technician or teacher according to national or international guidelines. It should not be mixed with waste from offices and classrooms.

4. Schools may produce wastewater from one or more of the following: handwashing points, flushing toilets, showers, kitchens, laundries and laboratories.

If the school is connected to a properly built and functioning sewer system, this is the most appropriate wastewater disposal option.

In other situations, soakaway pits or infiltration trenches should be used. These should be equipped with grease traps, which should be checked weekly, and cleaned, if needed, to ensure the systems operate correctly. All systems that infiltrate wastewater into the ground must be sited so as to avoid contaminating groundwater. There must be at least 1.5 m between the bottom of the infiltration system and the groundwater table, and the system should be at least 30 m from any groundwater source.

All wastewater drainage systems should be covered, to avoid the risks of disease-vector breeding and direct contamination.

8. Food storage and preparation22 Food for schoolchildren and staff is stored and prepared so as to minimise the risk of disease transmission. Indicators

1. Food handling and preparation is done with utmost cleanliness 2. Contact between raw foodstuffs and cooked food is avoided 3. Food is cooked thoroughly

21 WHO 2003b 22 WHO 2001

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4. Food is kept at safe temperatures 5. Safe water and raw ingredients are used

Guidance notes

1. Food handlers must wash their hands after using the toilet and whenever they start work, change tasks, or return after an interruption. Soap and water should be available at all times during food preparation and handling, to ensure that handwashing can be done conveniently.

Kitchen staff and carers with colds, influenza, diarrhoea, vomiting and throat and skin infections) should not handle food, and all infections should be reported.

Eating utensils should be washed immediately after each use with hot water and detergent, and air dried. The sooner utensils are cleaned; the easier they are to wash. Drying cloths should not be used, as they can spread contamination.

Food-preparation premises should be kept meticulously clean. Surfaces used for food preparation should be washed with detergent and safe water and then rinsed, or wiped with a clean cloth that is frequently washed. Scraps of food should be disposed of rapidly, as they are potential reservoirs for bacteria and can attract insects and rodents. Refuse should be kept in a covered place and disposed of quickly and safely. See Guideline 7.

Food should be protected from insects, rodents and other animals, which frequently carry pathogenic organisms and are a potential source of contamination of food. See Guideline 6.

2. Separate equipment and utensils such as knives and cut ting boards should be used for handling raw foods. Food should be stored in containers to avoid contact between raw and prepared foods It is particularly important to separate raw meat, poultry and seafood from other foods.

3. All parts of foods cooked must reach 70 °C to kill dangerous microorganisms. To ensure this, soups and stews should be brought to boiling, and meat should be heated until juices are clear, not pink. Cooked food must be reheated thoroughly.

4. Cooked food should not be left at room temperature for more than 2 hours. All cooked and perishable food to be stored should be refrigerated promptly (preferably below 5°C). Food should not be kept for too long in a refrigerator.

Cooked food to be served should be kept hot (more than 60°C) prior to serving.

5. Only safe water should be used for food preparation. For specification of safe water, see Guideline number 1.

Fruit and vegetables should be washed with safe water. If there is any doubt about the cleanliness of raw fruit and vegetables, they should be peeled or cooked just before serving.

Non-perishable foods should be stored safely in a closed, dry, well-ventilated store and protected from rodents and insects. They should not be stored in the same room as pesticides, disinfectants or any other toxic chemicals. Containers that have previously held toxic chemicals should not be used for storing foodstuffs.

Food should not be used beyond its expiry date.

6. In many situations, schoolchildren buy food from street vendors outside the school, or bring food to school with them. In these cases, the school hygiene committee or equivalent should seek ways with the vendors or the families of the school children to ensure that food is prepared hygienically. If schoolchildren carry meals with them to school, they should avoid foods that carry a high risk if stored at ambient temperature.

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V. SUMMARY OF GUIDELINES

1. Water Quality Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose intended

2. Water Quantity Sufficient water is available at all times for drinking, personal hygiene, food preparation, cleaning and laundry

3. Water facilities and access to water Sufficient water-collection points and water-use facilities are available in the school to allow convenient access to, and use of, water for drinking, personal hygiene, food preparation, cleaning and laundry.

4. Hygiene promotion Correct use and maintenance of water, sanitation and hygiene facilities is encouraged by hygiene promotion. Water, sanitation and hygiene facilities are used as resources for hygiene education.

5. Toilets Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for schoolchildren and staff.

6. Control of vector-borne disease Schoolchildren, staff and visitors are protected from disease vectors.

7. Cleaning and waste disposal The school environment is kept clean and safe.

8. Food storage and preparation Food for schoolchildren and staff is stored and prepared to minimise the risk of disease transmission.

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VI. FURTHER READING

Assessment, planning and monitoring WFP/UNESCO/WHO (1999) Annex 8 World Health Organization (1997) Appendix C Zomerplaag & Mooijman 2005 pp 41-45 United Nations Children’s Fund (1998) Operation and maintenance Brikké F, Bredero M (2003) Community participation United Nations Children’s Fund (1998) Chapter 6 Hygiene promotion World Health Organization (2003a) United Nations Children’s Fund (1998) Water quality, control and treatment World Health Organization (2004a) World Health Organization (2002) World Health Organization, Fact sheets 2.8 to 2.28 Water supplies and water-use facilities World Health Organization (1997) Appendix B WFP/UNESCO/WHO (1999) Annex 8 School toilets World Health Organization (1997) Appendix B Franceys R et al. (1992) Zomerplaag J, Mooijman A (2005) Vector control Rozendaal JA (1997)

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VII. GLOSSARY Coagulation-flocculation: coagulation is the lumping of particles that results in the settling of impurities. It may be induced by coagulants (e.g. lime alum and iron salts). Flocculation in water and wastewater treatment is the agglomeration or clustering of colloidal and finely-divided suspended matter after coagulation by gentle stirring by either mechanical or hydraulic means, such that they can be separated from water or sewage. Colour comparator (or colour-match comparator): equipment used to measure a chemical parameter (e.g. chlorine in water) by adding a specific reagent (e.g. DPD) to the sample and comparing the colour obtained with a colour scale. Disinfection: a process of removing/de-activating microorganisms without complete sterilization. DPD: reagent used for determining chlorine in water by colour comparison (abbreviation of N,N-diethyl-p-phenylenediamine) Infiltration trench: a shallow trench, containing gravel and a porous pipe that enables water to percolate into the soil over a larger area, and therefore with a greater infiltration capacity, than a soakaway pit. Sedimentation: the act or process of depositing sediment from suspension in water. The term also refers to the process whereby solids settle out of wastewater by gravity during treatment. Soakaway pit or soakpit: a simple excavation in the ground, either lined or filled with stones, that allows water to percolate into the surrounding soil. Thermotolerant coliform bacteria or faecal coliforms: in relation to water-quality indicators, bacteria in the coliform group able to form colonies at 44 °C. Typically, most thermotolerant bacteria are of the species Escherichia coli, which is always derived from faeces. Turbidity: cloudiness in water caused by particles in suspension, which makes chemical disinfection of the water less effective. Turbidity is commonly measured in NTU (Nephelometric Turbidity Units) and can be determined visually using simple equipment.

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VIII. REFERENCES

Brikké F, Bredero M (2003). Linking technology choice with operation and maintenance in the context of community water supply and sanitation: a reference document for planners and project staff. Geneva, World Health Organization / Delft, IRC Water and Sanitation Centre. Available at www.who.int/water_sanitation_health/hygiene/om/ European Environment Agency, World Health Organization (2002). Children’s health and environment: a review of evidence. Luxembourg. Office for Official Publications of the European Communities. Available at www.who.int/phe/health_topics/children/en/index.html Franceys R et al. (1992). A guide to the development of on-site sanitation. Geneva, World Health Organization. Rozendaal JA (1997). Vector control: methods for use by individuals and communities. Geneva, World Health Organization. Snel M et al., eds. (2004). School sanitation and hygiene education. Symposium proceedings and framework for action. Delft, IRC International Water and Sanitation Centre. Sphere Project (2004). Humanitarian Charter and minimum standards in disaster response. Geneva, The Sphere Project. Available at www.sphereproject.org United Nations Children’s Fund (1998). A manual on school sanitation and hygiene. Water, Environment and Sanitation Technical Guidelines Series No. 5. New York, NY. Available at ww.irc.nl/ WFP/UNESCO/WHO (1999). School feeding handbook. Rome, World Food Programme. World health Organization (1997). Primary school physical environment and health. Information Series on School Health: Document 2. Geneva. World Health Organization (2001). Five keys to safer food. Poster WHO/SDE/PHE/FOS/01. Geneva. Available at www.who.int/foodsafety/consumer/en World Health Organization (2002). Managing water in the home: accelerated health gains from improved water supply. WHO/SDE/WSH/02.07. Geneva. Available at www.who.int/entity/water_sanitation_health/dwq/wsh0207/en and www.who.int/entity/household_water/ World Health Organization (2003a). Skills for health, skills-based health education including life skills: an important component of a child-friendly/health-promoting school. Information series on school health: document 9. Geneva. Available at www.who.int/school_youth_health/resources/en/ World Health Organization (2003b). The physical school environment: an essential component of a health-promoting school. Information series on school health: document 2. Geneva. Available at www.who.int/school_youth_health/resources/en/ World Health Organization (2004a). Guidelines for drinking-water quality, 3rd ed. Vol.1, Recommendations. Geneva. Available at www.who.int/water_sanitation_health/dwq/ World Health Organization (2004b). Water, sanitation and hygiene links to health. Facts and figures. Geneva. Available at www.who.int/water_sanitation_health/publications/facts2004/en/index.html

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Zomerplaag J, Mooijman A (2005). Child-friendly hygiene and sanitation facilities in schools: indispensable to effective hygiene education. Delft, IRC International Water and Sanitation Centre. Available at www.irc.nl/

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IX. ASSESSMENT CHECKLIST FOR WASH IN SCHOOLS Each set of questions in the following checklist relates to the indicators presented under the relevant guideline in Section 4. The questions in the checklist are designed to help assess whether or not a school meets the guidelines in this document. Questions may be answered with a ‘yes’, a ‘no’ or a ‘not applicable’. A ‘no’ answer to any question should alert the assessor to remedial action required, either in the design and construction of facilities or their operation and maintenance. Guidance on action to take can be found in the guidance notes under each guideline in Section 4 and in the documents listed in the further reading list in Section 6.

1. Water Quality Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose intended

Design and construction Operation and maintenance

1. Is water from a safe source (free of faecal contamination)? Is water protected from contamination in the school?

Is the safety of the water source monitored regularly? Is the quality of the water supplied to the school monitored regularly? Are water storage and use facilities at the school adequately maintained to avoid contaminating the water?

2. If necessary, can water be treated at the school?

If water is treated at the school, is the treatment process operated effectively? Are there sufficient supplies and adequately trained staff to carry out treatment? Is the quality of the treated water monitored regularly?

3. Does the water supply meet WHO guidelines or national standards regarding chemical or radiological parameters?

If necessary, are measures in place to avoid over-exposure of susceptible children to chemical contaminants?

4. Is water acceptable (smell, taste, appearance)?

If the water is not acceptable to some or all of the schoolchildren and staff, do they use a safe alternative supply of drinking-water?

5. Is the school water supply designed and built so that low-quality water cannot enter the drinking-water supply and cannot be drunk?

Are procedures for protecting drinking-water in the school followed consistently?

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2. Water Quantity Sufficient water is available at all times for drinking, personal hygiene, food preparation, cleaning and laundry


1. Does the water supply have the capacity required? Is there a suitable alternative supply in case of need?

Is sufficient water available at all times for all needs? Is the water supply operated and maintained to prevent wastage?

3. Water facilities and access to water Sufficient water-collection points and water-use facilities are available in the school to allow convenient access to, and use of, water for drinking, personal hygiene, food preparation, cleaning and laundry


1. Are there sufficient water points in the right places for all needs?

Is water accessible where needed at all times? Is there always soap or a suitable alternative at handwashing points?

2. Are there sufficient, clearly identified drinking-water points?

Are drinking-water points properly used and adequately maintained?

3. In boarding schools, are there sufficient showers?

Are showers properly used and adequately maintained?

4. In boarding schools, are there sufficient laundry facilities?

Are laundry facilities properly used and adequately maintained?

4. Hygiene promotion Correct use and maintenance of water, sanitation and hygiene facilities is encouraged by hygiene promotion. Water, sanitation and hygiene facilities are used as resources for hygiene education.


1. Is hygiene education part of the school curriculum? Is staff trained in providing hygiene education?

Is hygiene education actually provided? Are hygiene-education methods used effectively?

2. Is hygiene promoted systematically? Do schoolchildren participate actively in maintaining hygiene? Does staff provide positive role models for hygiene behaviours?

3. Are school facilities designed to be easy to use and maintain hygienically?

Are school facilities maintained so as to be easy to use hygienically?

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5. Toilets Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for schoolchildren and staff.


1. Are there sufficient toilets at the school? Are there sufficient toilets actually in use?

2. Are the toilets situated in the right place?

3. Do the toilets provide privacy and security?

Are there working locks on the toilet doors?

4. Are the toilets appropriate to local culture and social conditions?

Are the toilets being used according to their design?

5. Are the toilets hygienic to use and easy to clean?

Are the toilets clean and without too much smell?

6. Are there handwashing facilities close by?

Is there water and soap available?

7. Is there are cleaning and maintenance plan?

Is there an effective cleaning and maintenance routine in operation?

6. Control of vector-borne disease Schoolchildren, staff and visitors are protected from disease vectors.


1. Is the site for the school protected from disease vectors? Are school buildings designed and built to exclude disease vectors?

Are local vector-breeding sites avoided or controlled? Are inbuilt protective measures effectively used and maintained?

2. Are barriers and/or repellents used to reduce exposure to vectors?

3. Are schoolchildren and staff with vector-borne diseases kept at home and treated rapidly? Are there regular inspections to detect and treat body lice and fleas? Are the school grounds kept free of faeces?

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7. Cleaning and waste disposal The school environment is kept clean and safe.


1. Are floors smooth and easy to clean? Are buildings designed and built to avoid damp and moulds?

Are teaching areas regularly cleaned? Are teaching areas clean?

2. Are the school premises free of sharp objects and other physical hazards?

3. Are there adequate bins and other equipment for managing solid waste?

Is solid waste collected daily and safely disposed of? Is hazardous waste managed appropriately?

4. Is the wastewater drainage system correctly designed and built?

Is the wastewater drainage system correctly used and maintained?

8. Food storage and preparation Food for schoolchildren and staff is stored and prepared so as to minimise the risk of disease transmission.


1. Are food storage and preparation areas designed and built so as to be easy to keep clean?

Do food handlers wash their hands when necessary? Are food storage and preparation areas kept clean? Are food storage and preparation areas protected from insects and rodents?

2. Are there facilities and equipment provided for preventing contact between cooked and raw foodstuffs?

Is contact between raw foodstuffs and cooked food prevented?

3. Are cooking facilities adequate for heating food sufficiently?

Is food cooked thoroughly?

4. If cooked food is stored, is there a fridge at the school for this?

Is food kept at safe temperatures?

5. If dry foods are stored at the school, is the store appropriate?

Are only safe water and ingredients used?

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Annex II: Children’s Water Manifesto Drafted at the Children’s World Water Forum, 21 March, 2003, Shiga, Japan In the name of love, peace and harmony – we, the 109 children and young people of the world representing 32 countries – pledge to seek the support of decision-makers in planning, designing, implementing and evaluating programmes related to children, water, sanitation and hygiene. We want the decision-makers to guarantee the participation of children and young people, according to the Convention on the Rights of the Child (CRC), to ensure the participation, protection, survival and development of children and young people through promoting a safe environment for their healthy development and wellbeing. We assert the following: Governments are obliged to:

• Ensure that children and young people are involved in the decision-making and policymaking processes beginning from the planning stages through the implementation and evaluation of household water-related programmes/issues, including access, safety, conservation and use of water.

• Improve water and sanitation facilities, particularly for girls so that they can stay in schools, and therefore allocate sufficient budget for water and sanitation programmes in schools. Reallocate investments on armaments as budgets to support school programmes and child-friendly facilities.

• Strengthen partnerships and cooperate with children and young people with NGOs, governments, municipalities, private companies and media to strengthen school programmes and establish child-friendly facilities.

• Encourage free exchange and sharing of information, technology and experiences across industrialised and developing nations, specific to household water security.

• Take preparatory measures towards strengthening the infrastructure and basic services during emergencies and train children and young people to exchange ideas and support during emergencies.

• Respect children and young people’s opinions and different cultures in relation to water use and sanitation, as well as provide safe water areas for children and young people’s play.

• Promote strong environmental, child-friendly education on issues related to diversified water use for boys, girls, teachers, parents and community leaders.

• Support children and young people’s projects and activities relating to water and the environment that affect the access to potable water and sanitation.

We as children and young people pledge to:

• Establish action groups, clubs, organizations and networks of children and young people for activities on water, sanitation and hygiene – locally, nationally and internationally.

• Be responsible for peer-to-peer education as young facilitators and child-to-adult education on conservation of water, sanitation and hygiene.

• Develop and use child-friendly resource materials and use child peer-education methods, such as drama, poetry, drawing and websites to create more awareness on environment, water and sanitation issues.

• Work with decision-makers to promote better water and sanitation facilities at schools in rural and urban areas and in the community so that girls do not drop out of schools or face abuse.

• Be involved in designing, implementing and evaluating child-managed water and sanitation projects and other initiatives.

• Form a Global Children and Young People’s Alliance on water, sanitation and hygiene.

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Statement of the Working Group on Water and Sanitation in Schools We believe that poverty is the most critical cause for lack of safe water, sanitation facilities and hygiene in schools around the world. We need to make water sanitation and hygiene in schools a greater priority for governments and decision makers. Building on the CRC, we assert our rights to be informed and to participate in matters that affect our lives. We assert the following: Governments are obliged to:

• Improve water and sanitation facilities, particularly for girls so that they can stay in schools and therefore allocate sufficient budget for water and sanitation programmes in schools.

• Reallocate investments on armaments as budgets to support school programmes and child-friendly facilities.

• Strengthen partnerships and cooperate with children and young people, involving NGOs, governments, municipalities, private companies and media to strengthen school programmes and establish child-friendly facilities.

• Provide stronger written commitments, with established targets, timed goals and accountability for the improvement of sanitation conditions in schools.

We children and young people resolve to:

• Form children and young people’s committees, groups, clubs or organizations in schools to influence local, national and international decision-making processes related to sanitation and child-friendly sanitation facilities.

• Form a global children and young people’s alliance on water sanitation and hygiene. • Develop and use child-friendly resource materials and use child peer-education methods such

as drama, poetry, drawing and websites to create more awareness on environment, water and sanitation issues.

• Work with decision-makers to promote better water and sanitation facilities at schools in rural and urban areas and in the community so that girls do not drop out of schools or face abuse.

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Annex III: International Commitments to WASH in Schools 23 The eight interlinked United Nations Millennium Development Goals (MDGs) propose to eradicate poverty using integrated approaches to ensure that social, economic and political dimensions are addressed. The Goals and targets focus on capacity-building and empowerment of the poor as actors in their own development. They call for halving the proportion of people living without sustainable access to safe drinking water by 2015 and to “halve by the year 2015, the proportion of people who do not have access to basic sanitation.” There is a call for action at all levels, including for the improvement of sanitation in public institutions, especially schools; the promotion of safe hygiene practices and the promotion and outreach to children as agents of behaviour change. The Education for All, Dakar Framework for Action (2000) stressed the importance of “the creation of safe, healthy, inclusive and equitably resourced educational environments conducive to excellence in learning.” The Second World Water Forum’s Vision 21, part of the action plan of the international water community, set specific goals so that by 2015, 80 per cent of primary schoolchildren are provided hygiene education and all schools are equipped with sanitation and handwashing facilities. These ambitions are echoed in the World Fit for Children (WFFC) outcome document of the UN 2002 Special Session on Children. Investments in school water, sanitation and hygiene education endorse the fundamentals of child protection as articulated in the Convention on the Rights of the Child (CRC), with a direct bearing on the right of all children everywhere to a quality education. Article 24 of the CRC recognizes the rights of the child to the enjoyment of the highest attainable standard of health, and to facilities for the treatment of illness and rehabilitation of health. The Convention also outlines commitments to:

• Reduce the number of primary-school-age children who are out of school by 50 per cent, and increase net enrolment or participation in alternative, good-quality primary education programmes to at least 90 per cent by 2010.

• Eliminate gender disparities in primary and secondary education by 2005; and achieve gender equality in education by 2015, with a focus on ensuring girls’ full and equal access to and achievement in basic education of good quality.

Education, a tool for empowerment and sustainable development, serves as a door to the overarching goal of poverty reduction, with girls’ education a key to unlocking its full transformative potential. This is recognized in the MDGs targets for education and gender, in turn taking up the World Education Forum’s Education for All (EFA) goals of eliminating gender disparity in primary and secondary education by 2005, and in all levels of education no later than 2015. As well, they intend to ensure that by 2015 all children everywhere, boys and girls alike, will be able to complete a full course of primary schooling. The United Nations Girls’ Education Initiative (UNGEI), led by UNICEF, is spearheading partnerships and programme approaches to accelerate progress towards the 2005 Gender Parity target in education. As a first goal to come due, it serves as the first test of credibility of the commitments of the international community. It is widely recognised that without significant progress in education, achievement of the other goals will be hindered.

23 UNICEF, IRC, Oxford Roundtable Final Report, Oxford, 2005, p. 62.

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Annex IV: Water, Sanitation, and Hygiene in Schools Workshop Agenda

Day 1: WASH- KEY CONCEPTS

Key Objective: To strengthen commitment and joint understanding between Education and WES country teams from the region on ‘WASH in Schools’.

Wednesday, October 18th

Session 1 Objective: To view the intersections between various education/WES frameworks and their potential in guiding WASH in Schools.

Facilitator/ Resource Person

08:30-09:30 • Welcome and introduction to the regional workshop • Administrative and personal arrangements • Introductions

09:30-10:30 • Review Current Frameworks relating to WASH in Schools • Outcomes from SSHE Evaluation • A Global Update on WASH in Schools

Mr Cliff Meyers

Mr Mark Henderson Ms Therese Dooley

10:30-11:00 Tea Break

Session 2 Objective: To better understand the variety of experience available across the region and identify potential/relevant resources for improved programming. Further, to identify regional areas of strength and common challenges.

11:00-13:00 Presentations of country “WASH in Schools” posters.

13:00-14:00 Lunch Break

Session 3 Objective: To identify the factors which hinder effective joint WES + Education programming and provide recommendations on how to overcome.

14:00-15:30 • Problem analysis/tree on WASH (main issues in programmes and responding with potential resources and tools relating to water, sanitation and hygiene education).

• Cross Sectoral Programming: Overcoming Challenges for WES + Education Partnerships.

Ms Therese Dooley

Ms Emmanuelle Abrioux

15:30-16:00 Tea Break

Session 4

Objective: To identify monitoring mechanisms for WASH in Schools.

16:00-17:30 Assessing Impact and Effectiveness: Reviewing potential indicators/ standards.

Mr George Attig

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Day 2: WASH IN PRACTICE- BALANCING SOFT & HARDWARE ISSUES Key Objective: To share practical experiences, resources and tools relating to water, sanitation and hygiene education leading to agreed definitions for key concepts.

Thursday, October 19th Session 1 Objective: To provide those involved in developing a WASH in Schools programme with

relevant information and tools for effective planning and implementation.

08:30-09:30 • Child Friendly Facilities (Technology, design, use and maintenance).

Mr Waldemar Pickardt Mr Chander Badloe

9:30-10:00 • The evidence base for hygiene promotion in schools Ms Emmanuelle Abrioux

10:00-10:15 Tea Break

Session 2 Objective: To provide those involved in developing a WASH in Schools programme with relevant information and tools for effective planning and implementation.

10:15-12:00 • Hygiene promotion in schools: Curricula and Extra-curricula.

Ms Therese Dooley Mr Hugh Hawes

Session 3 Objective: To gain a regional overview of costing standards and issues for WASH in Schools.

12:00-13:00 • Financing WASH in Schools: What Does it Cost? Mr Murat Sahin


Session 4 Objective: To better understand the stages/content involved in planning a WASH response in emergencies and the role of WASH programmes in relation to Avian Influenza.

14:00-15:00 • WASH in Emergency Preparedness and Response (Avian Influenza)

• WASH in Emergency Preparedness and Response (Child Friendly Spaces).

Ms Katrin Imhoff Mr Gary Ovington

15:00-15:30 Tea Break

Session 5 Objective: To highlight how WASH in Schools will be taken forward jointly within WES and Education Sections (Annual Work Plans, Regional Planning)

15:30-17:00 • Country Group Work: Annual Work Plan elaboration

Mr Mark Henderson

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Day 3: PARTNERSHIPS FOR SUSTAINABILITY OF WASH IN SCHOOLS Key Objective: To identify and examine best practices and lessons learned from WASH in Schools programmes in the region, with a particular focus on school/community linkages and children and young people’s participation.

Friday, October 20th Session 1 Objective: To share key discussion points and introduce focus on WASH partnerships.

08:30-08:45 • Words of Welcome: Ms Anupama Rao Singh, Regional Director, UNICEF East Asia and Pacific Office

8:45-09:15 • An Overview of Key Discussion Points

09:15-10:15 • Government/Inter-Ministerial partnerships (including SWAps) Mr Cliff Meyers, UNICEF EAPRO

• The Global Handwashing Initiative, Ms Nguyen, National Handwashing Initiative, The World Bank in Viet Nam

10:15 – 10:45 Tea Break

Session 2 Objective: To better understand the potential of institutionalising children’s participation in WASH initiatives, and to identify and examine best practices and lessons learned in this area.

10:45-13:00 • Children as Change Agents Mr Joachim Theis, UNICEF EAPRO; and Mr Hubert “Hugh” Hawes, Child-to-Child Trust


Session 3 Objective: To explore the balance between school and community water, sanitation and hygiene improvement initiatives.

14:00-15:30 • The relationship between WASH in schools WASH in communities.

15:30-15:45 Workshop Closure

Session 4 (Internal UNICEF session)

16:00-17:00 • Overview of recommendations relating to partnerships for WASH in schools. • Defining further steps for strengthening WASH.

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Annex V: Participant List

Cambodia Ms Julia Rees

Project Officer Community Action for Child Rights Programme UNICEF/Phnom Penh [email protected] Ms Kerstin Karlstrom Project Officer Education UNICEF/Phnom Penh [email protected]

DPR Korea Mr Murat Sahin Project Officer Water, Sanitation and Hygiene UNICEF/Pyongyang [email protected]

Indonesia Ms Afroza Ahmed Project Officer Water, Environment and Sanitation UNICEF/Jakarta [email protected] Mr Yang Zhenbo Project Officer Water, Environment and Sanitation UNICEF/Banda Aceh [email protected] Ms Ewinur C Machdar Assistant Project Officer Water, Environment and Sanitation UNICEF/Nias [email protected] Ms Ari Rahayu Hadinoto Assistant Project Officer Water, Environment and Sanitation UNICEF/Banda Aceh [email protected]

Lao PDR Ms Southalak Sisaleumsak Assistant Project Officer Water, Environment and Sanitation UNICEF/Vientiane [email protected] Mr Bandith Leuanvilay Assistant Project Officer Water, Environment and Sanitation UNICEF/Vientiane [email protected]

Mongolia Ms Budragchaa Uranchimeg Project Officer Education

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UNICEF/ Ulaanbaatar [email protected] Ms Gochoo Soyolgerel Project Officer Health/Nutrition UNICEF/ Ulaanbaatar [email protected]

Myanmar Mr Waldemar Pickardt Chief WASH UNICEF/Yangon [email protected] Ms Aye Aye Yee Assistant Project Officer Life Skills Education UNICEF/Yangon [email protected]

Philippines Ms Ma. Lourdes de Vera-Meteo Chief and Programme Officer Education Section UNICEF/Manila [email protected] Mr Bishnu P Timilsina Water, Environment and Sanitation (Engineer) UNV UNICEF/Manila [email protected]

Thailand Ms Katrin Imhof Project Officer Education UNICEF/Bangkok [email protected] Mr Gulam Rasul Project Officer Health & Nutrition (Tsunami) UNICEF/Bangkok [email protected] Ms Reawadee Eiamsuntonhwit Assistant Project Officer Water, Environment and Sanitation UNICEF/Bangkok [email protected] Ms Pornthida Padthong Assistant Communication Officer UNICEF/Bangkok [email protected] Ms Achara Jantarasaengaram Asst Programme Communication Officer (AI) UNICEF/Bangkok [email protected]

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Timor Leste Mr Bishnu Pokhrel Project Officer Water, Sanitation, and Hygiene UNICEF/Dili [email protected]

Viet Nam Mr Chander Badloe Section Chief Water, Environment and Sanitation UNICEF/Hanoi [email protected] Ms Le Anh Lan Assistant Project Officer Child Friendly Primary Education Project UNICEF/Hanoi [email protected] Ms Tran Thi Thu An Assistant Project Officer Hygiene UNICEF/Hanoi [email protected]

UNICEF/NYHQ Ms Therese Dooley Senior Advisor, Sanitation & Hygiene UNICEF/NY [email protected]

UNICEF/EAPRO Ms Anupama Rao Singh Regional Director UNICEF/EAPRO [email protected] Mr Cliff Meyers Regional Advisor Education UNICEF/EAPRO [email protected] Mr Mark Henderson Regional Advisor Water, Environment and Sanitation UNICEF/EAPRO [email protected] Ms Emmanuelle Abrioux Project Officer Life Skills Education UNICEF/EAPRO [email protected] Ms Anna Dammert Assistant Programme Officer Education UNICEF/EAPRO [email protected]

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Ms Aya Aoki Project Officer Girls’ Education UNICEF/EAPRO [email protected]

Resource Person Mr Hubert “Hugh” William Hawes Co-founder Child-to-Child Trust, UK [email protected] Mr George Attig Consultant Mahidol University Nakhon Pathom, Thailand [email protected] Mr Gary Ovington Project Officer Education (Emergencies) UNICEF/EAPRO [email protected]

Rapporteur Ms Lisa Nicol Woods Communications Consultant UNICEF/EAPRO [email protected]

Secretariat Ms Srisamorn Silawatanawongse Programme Assistant Education UNICEF/EAPRO [email protected] Ms Nataya Tanyasiri Messenger UNICEF/EAPRO [email protected]

Government & UN Agencies

Ms Teechat Boonyakarnkul Director, Sanitation and Health Impact Assessment Division Department of Health Ministry of Public Health Bangkok Ms Srisamorn Boonkitchinda External Relation Officer Bureau of Policy and Planning Bangkok Ms Pensri Kramomtong Chief of Schoolage and Youth Health Group Department of Health Ministry of Public Health Bangkok Mr Satavat Kumut Architect, General Administration bureau Department of General Administration Bureau Ministry of Education Bangkok

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Ms Chantra Tantipong Educator, Academic Affairs and Educational Standards Bureau Ministry of Education Bangkok Ms Roseanne Wong HIV/AIDS Prevention Education and School Health Officer HIV/AIDS Coordination & School Health Unit UNESCO/Bangkok Mr Glen Kurokawa Consultant Regional Unit for Social & Human Sciences in Asia and the Pacific UNESCO/Bangkok Mr Edilberto C de Jesus Director SEAMEO Bangkok Mr Benet Benoza Program Officer Development SEAMEO Bangkok

NGO & Other Partners

Mr Aloysius Mathews Chief Coordinator Education International Asia Pacific Region Malaysia Ms Hoa-Phuong Tran Regional Learning & Education Advisor Plan Asia Regional Office Bangkok Mr John Collette Water and Sanitation Advisor Plan Vietnam Mr John McGown Water and Sanitation Delegate for American Red Cross International Federation of Red Cross and Red Crescent Societies Bangkok

Documents

The WASH in Schools Situation Across the EAP Region a Preliminary Look