raising clean hands 2010 - advancing learning, health and participation through wash in schools

8/9/2019 Raising Clean Hands 2010 - Advancing Learning, Health and Participation through WASH in Schools

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Raising Clean Hands Advancing Learning, Health and Participation through WASH in Scho

Joint Ca to Action 2010

CARE Dubai Cares E or Uni ersit Center for G oba Safe Water

IRC Internationa Water and Sanitation Centre Sa e the Chi dren

UNICEF Water Ad ocates WaterAid Water For Peop e WHO


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Thanks are due to all the WASH in Schools partners who participatedin the development and publication o Raising Clean Hands: Advancing Learning, Health and Participation through WASH in Schools.

We wish to thank the peer reviewers working on WASH in SchoolsProgramming: Brooks Keene and Peter Lochery o CARE; Beau Crowderand Yousu Caires, Dubai Cares; Matthew Freeman, Emory UniversityCenter or Global Sa e Water; Marielle Snel, IRC International Water andSanitation Centre; Seung Lee, Save the Children; Therese Dooley, MuratSahin, Peter van Maanen, Rita Jen, Ann Thomas, Mac Glovinsky and TiyaHabachy, UNICEF; John Sauer and Andra Tamburro, Water Advocates;Oliver Cumming, WaterAid; Peter Mason, Water For People; Yves Chartier,WHO; and Catherine Rutgers, Catherine Rutgers Inc. this valuableassistance contributed greatly to the quality and completeness o theJoint Call to Action or WASH in Schools.

Acknow edge ents


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Summary: Call to Action or WASH in Schools . . . . . . 2

About WASH in Schools . . . . . . . . . . . . . . . . . . . . . . . . 4

WASH in Schools Improves Childrens Health . . . . . . 6

WASH in Schools Boosts School Attendanceand Achievement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

WASH in Schools Promotes Gender Equality . . . . . . 10

WASH in Schools Reaches the Community becauseChildren Are Agents o Change . . . . . . . . . . . . . . . . . 14

Six Points o Action or WASH in Schools . . . . . . . . . 16

Contents

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4/24Joint Call to Action or WASH in Schools

Ful lling every childs right to water, sanita-tion and hygiene education remains a majorchallenge or policymakers, school adminis-trators and communities in many countries.In a group o surveyed developing coun-tries, less than hal o primary schools haveaccess to sa e water and just over a thirdhave adequate sanitation. Lack o coveragedata or WASH in Schools is one barrier tosecuring the rights o children. O the 60developing countries surveyed, only 33provided data on access to water in primaryschools and 25 have data on sanitation. 1

Great strides have been made, nonethe-less, to sa eguard the well-being o childrenin schools. Millions o schoolchildren nowhave access to drinking water, sanitation

acilities and hygiene education. And theexperience gained over the past decade

can be well applied to sustaining WASH inSchools programmes that improve health,

oster learning and enable children to partic-ipate as agents o change or their siblings,their parents and the community at large.

As citizens, parents, policymakers andgovernment representatives, we all havea role in making sure that every childreceives the bene ts o WASH in Schools: Clean water or drinking and washing.

Dignity and sa ety through ampletoilets and washstands, separated or

girls and boys. Education or good hygiene.

Healthy school environments throughsa e waste disposal.

Summary: Call to Action for WASH in Schools1

0

20

40

60

80

Access to WASH in Schoo s Re ains a Cha enge

P e r c e n

t a g e

Water faci ities Sanitation faci ities

46% 37%

Source: Extracted rom 60 UNICEF country o ce annual reports, o whichonly 33 contained in ormation about the proportion o primary schools withadequate water supply and 25 had data on sanitation acilities.


5/24Raising Clean Hands

Because e er chi d deser es to be in aschoo that offers safe water, hea thfu

sanitation and h giene education, we ca forrenewed co it ents to:1. Increase investment in WASH in Schools, mobilizing resources to

secure childrens health, now and or generations to ollow.

2. Engage those who set policies at the global, national, sub-nationaland local levels to support WASH in Schools.

3. Involve multiple stakeholders community members, civil societyadvocates, media, students, school sta , local and regionalauthorities, national ministries o education, water and health,non-governmental organizations and public-private partnerships in the cooperative plans and actions that sustain WASH in Schools.

4. Demonstrate quality WASH in Schools programmes that yield ahealthy school environment.

5. Monitor WASH in Schools programmes to ensure accountability andevaluate progress.

6. Contribute evidence that provides a solid base or in ormeddecision-making and e ective distribution o unds.

UNICEF/PAKA2008-0798/

This Call to Action or WASHin Schools is the result o col-laboration between CARE,Dubai Cares, Emory UniversityCenter or Global Sa e Water,IRC International Water andSanitation Centre, Save theChildren, United NationsChildrens Fund (UNICEF),Water Advocates, WaterAid,Water For People and the WorldHealth Organization (WHO).It calls on decision-makers toincrease investments and onconcerned stakeholders to planand act in cooperation so thatall children go to a school withchild- riendly water, sanitationand hygiene acilities.



Water, sanitation and hygiene educationin schools WASH in Schools provides

sa e drinking water, improves sanitationacilities and promotes li elong health.WASH in Schools enhances the well-being o children and their amilies, andpaves the way or new generations ohealthy children.

Each year, children lose 272 million schooldays due to diarrhoea, 2 and an estimatedone in three school-aged children inthe developing world are in ested withintestinal worms. 3 Not only do theseillnesses rob children o school attendanceand achievement, they are underlyingcauses o malnutrition and stunting.

WASH in Schools signi cantly reduceshygiene-related disease, 4 increasesstudent attendance and learningachievement, and contributes to dignityand gender equality. Despite thisknowledge, more than hal o all primaryschools in the developing countries withavailable data do not have adequatewater acilities and nearly two thirds lackadequate sanitation (see chart, page 2).Even where acilities exist, they are o tenin poor condition. 5

Among its many bene ts: WASH in Schools provides healthy,

sa e and secure school environmentsthat can protect children rom healthhazards, abuse and exclusion. It helpsensure quality education, because

children who are healthy and wellnourished can ully participate inschooling and gain its maximumbene ts. Quality education, in turn,leads to better health and nutritionoutcomes, especially or girls.

WASH in Schools encourageschildrens pride in their schools and

communities by providing dignity andprivacy. It enables children to becomeagents o change or improving water,sanitation and hygiene practices intheir amilies and communities.

WASH in Schools is an investmentin schoolchildren and the health o

uture generations. It helps childrenrealize their ull potential now andprepares them or healthy living asadults, able to share this legacy when

they become parents.

Improved water, sanitation and hygieneeducation helps ul l every childsright to health and education. WASH inSchools enjoys widespread recognition

or its signi cant role in achievingthe Millennium Development Goals particularly those related to universalaccess to primary education, reducingchild mortality and increasing gender

equality, as well as the targets orimproving water and sanitation.

WASH in Schools supports global e ortsto make the partners vision a reality: aworld where all children go to school andall schools provide a sa e, healthy andcom ortable environment where childrengrow, learn and thrive.

About WASH in Schools2



WASH IN SCHOOlS INSPIRES FAmIlIES:Sierra leones Schoo Hea th C ubsOnly 6 per cent o the rural population in Sierra Leone has access to improved sanitation. This de cit issevere, but communities are nding that working with schoolchildren is one o the best ways to promotegood hygiene and sanitation.

Through the School Health Clubs o Port Loko District, or example, children are encouraging their amiliesto build latrines and end open de ecation.

As explained by Fatmata, age 12, We learn about good hygiene through games and sports but we also

have a serious responsibility we pass these messages on to our amilies and riends. Since Fatmatas atherdied, li e or her amily has been tough. With nine children to support, her mother had little money to spendon perceived luxuries such as sanitation, and the entire amily had to use the surrounding bushes as a latrine.

I used to be so a raid o going to the toilet, especially because o the snakes, said Fatmata. But theintroduction o School-Led Total Sanitation, a new community-based approach to eliminating open de ecation,prompted her mother to take action. With help rom neighbours, she built a latrine using local materials, andthe amily uses it on a daily basis. Through the dedication o School Health Club members and their teachers,the majority o amilies in the surrounding villages now have access to a latrine.

Source: Quarterly Report: WASH Sierra Leone, UNICEF, AprilJune 2009.

UNICEF/NYHQ2009-0858/



WASH in Schools is a rst step towardsensuring a healthy physical learningenvironment. Schools with quality WASHprogrammes can lessen the spread odisease. One study showed that morethan 40 per cent o diarrhoea cases inschoolchildren result rom transmissionin schools rather than homes. 6 Damageto childrens mental and physicaldevelopment is reduced when the spreado disease is stopped.

The burden of disease is higha ong chi drenChildren su er a disproportionate shareo the WASH-related disease burden,particularly in developing countries.Among children under 14, more than20 per cent o deaths and years livedwith disabilities are attributable tounsa e water, inadequate sanitation orinsu cient hygiene. 7

Worms a ect an estimated 400 millionschool-aged children in the developingworld. 8 Chronic hookworm in estationsare associated with reduced physicalgrowth and impaired intellectualdevelopment, 9 and children enduringintense in estations with whipwormmiss twice as many school days as theirin estation- ree peers. 10

WASH in Schoo s is effecti e

Improving WASH conditions in schoolshelps prevent in estation withsoil-transmitted worms, o which 100per cent o annual cases worldwide areattributable to inadequate sanitationand hygiene. 11 Deworming services,

supported by hygiene education, helpchildren avoid rein estation, and waterand sanitation acilities prevent children

rom re-exposure.

Soap makes a di erence. Households thathave hand-washing soap show a 53 percent lower incidence o diarrhoea amongchildren under 15 years old. 12 When handwashing is practised in acilities such asday-care centres and primary schools,studies show a 30 per cent reduction indiarrhoea cases. 13 Washing hands withsoap could reduce acute respiratoryin ections including pneumonia, whichkills more children than AIDS, malaria andmeasles combined 14 by 25 per cent. 15

Because sa e water, improved sanitationand good hygiene practices are so directlylinked to better health, reducing thedisease burden through WASH in Schoolsalso cuts corresponding costs in healthprogrammes. But healthy behaviour mustbe supported by acilities and supplies.

Toilets and washstands, or example,need to be customized to t childrenssmaller size, and WASH acilities that aretraditionally designed or the averagechild must consider the act that childrenhave a wide range o abilities and needs.The additional cost o accessible acilitiescan be minimal i they are planned romthe outset. WASH in Schools raisesawareness about inclusive education andseeks to enhance accessibility o child-

riendly acilities and services bringingthe large numbers o children withdisabilities who are o ten excluded intothe school community.

WASH in Schools ImprovesChildrens Health3



Good hand-washing practices also needto be supported with adequate supplies osoap, an issue that needs to be addressedin many schools:

A study in Kenya revealed that less than2 per cent o children in schools washedtheir hands with soap, which was avail-able in less than 5 per cent o acilities. 16

An evaluation conducted in Indiashowed that hand washing be ore eat-ing in school was ar more requentin districts with WASH in Schools pro-grammes than in control districts. Butsoap was used by only 2 per cent or lesso children when washing their hands,severely cutting its e ectiveness. 17

The evaluation o School Sanitation andHygiene Education pilot programmes insix countries Burkina Faso, Colombia,Nepal, Nicaragua, Viet Nam and Zambia revealed that the availability o soapwas a major problem in most o the

schools. Reasons include high costs andthe ear that it will be stolen. The lack osoap was jeopardizing the educationale ort to promote use and resulted in alow proportion o students washing theirhands with soap. 18

Where schools are having troublekeeping soap on hand, schooladministrators have provided creativesolutions, such as liquid soap, soap barsattached to a rope and washcloth, and

Tippy Taps, large containers o soapywater that dispense just enough liquid ora single proper hand washing. In othercases, WASH in Schools has generatedmaterial support rom national ministryand local government budget allocations,in addition to contributions romlocal communities.

WASH in Schoo s recei essupport in India, fro studentsto a minister of EducationIn Rajasthan, India, the state government andUNICEF have pooled resources to turn handwashing into a peoples campaign to enhanceawareness and change behaviour as asustainable practice. For Global HandwashingDay 2009, members o the school cabinetdemonstrated Sa Hathon Ka Jadoo , themagic o clean hands, by explaining thatclean hands means washing with soap.

The schoolchildren appealed to EducationMinister Master Bhanwarlal Meghwal to makea regular provision o soap in the school. TheMinister warmly responded to the childrensrequests and reminded o cials present tostreamline the process o procuring unds or

the School Development and ManagementCommittee. He also requested that thesarpanch (village head) and the communityensure availability o soap in every school.

Source: UNICEF India, Rajasthan Pledges ToSave Lives by Washing Hands, Jaipur, Rajasthan,India, 2 November 2009, www.unice .org/india/ wes_5906.htm2.

UNICEF/NYHQ2009-124



Education and health work in synergy.Nutrition de ciencies, diarrhoea andworm in estations are all related toinadequate water, sanitation andhygiene and all a ect schoolparticipation and learning.

Adequate supplies o sa e water, locatednear homes and schools, boost schoolattendance. Project evaluations andresearch ound a 15 per cent increasein attendance in Bangladesh whenwater was available within a 15-minutewalk compared to one hour or more.Similarly, a study in the United Republico Tanzania shows a 12 per cent increasein school attendance when water isavailable within a 15-minute walk. 19

A programme in Chinese primaryschools to promote hand washing bythe continuous provision o soap andselection o a student hand-washingchampion resulted in healthier childrenwho had 54 per cent ewer days oabsence. 20 Children in primary schoolsin Bogot who reported proper hand-washing behaviours in school acilitieswere 20 per cent less likely to reportabsenteeism than those in schoolswithout good hygiene practices. 21

Failing to curb in estations such as worms,however, threatens childrens cognitivedevelopment and allows a recurrentcycle o missed school, poorer schoolper ormance and increased poverty.

WASH in Schools Boosts SchoolAttendance and Achievement4

Opportunities through WASH in Schoo s

ImPROvED HyGIENE

lESS DISEASE

INCREASED ATTENDANCEINCREASED PERFORmANCE

ECONOmIC GROWTH


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WASH IN SCHOOlS ImPROvESHyGIENE BEHAvIOURS AND HEAlTH:Chi d-to-chi d in TajikistanIn Tajikistan, more than 40,000 children in100 schools bene ted rom child-to-child peereducation, specialized hygiene education materials,the provision o hand-washing stands, and theconstruction o latrines between 2006 and 2008.

Baseline and end-line surveys with a comparisongroup showed large improvements in keybehaviours due to the programme. Hand washinga ter toilet use increased rom 12 per cent to 94 percent. Observation showed that the percentage ohouseholds that had soap near the toilet increased

rom 11 per cent to 86 per cent.

Diarrhoea rates were reduced rom 37 per cent to11 per cent, and pinworm prevalence cut rom35 per cent to 17 per cent.

Source: Case Study: School WASH improves hygienebehaviors and health, Save the Children USA, 2009.

Save the Children/Chris M

Raising Clean Hands

Safeguarding cogniti ede e op entIn the developing world, anestimated 47 per cent o children59 years old are in ested withthree main types o soil-transmittedworms: hookworm, roundworm orwhipworm. 22 The most signi cantrisk o hookworm in estation isanaemia. In children, anaemia canlead to developmental and behav-ioural disturbances that can dimin-ish their ability to learn.

The average IQ loss per worm in es-tation is 3.75 points, representing633 million IQ points lost or thepeople who live in the worldslow-income countries. 23

A recent randomized impact evalu-ation o a deworming programmein western Kenya demonstratesthat the worm burden in childrencontributed to 25 per cent o overallschool absenteeism rates. 24 The to-tal time or schooling lost to worm-associated absenteeism amounts tomore than 200 million years; almostall this loss occurs in low- andmiddle-income countries. 25

Sa e water, sanitation and hygieneare major actors in protecting chil-dren rom worm in estations andother illnesses. The evidence is clearthat WASH in Schools can have apositive impact on enrolment lev-els, ratios o girls to boys attendingschool, quality o education andachievement. By providing accessto WASH acilities and encourag-ing behaviour change with theparticipation o children, the burdeno disease can be li ted and chil-drens opportunities expand.



As in other parts o society, genderdiscrimination is prevalent within schools.In many cases, this discrimination isrelated to cultural belie s and traditions;sometimes, it is caused by unrecognizedproblems and needs.

Girls are particularly vulnerable todropping out o school, partly becausemany are reluctant to continue theirschooling when toilet and washing

acilities are not private, not sa e orsimply not available. When schools have

adequate acilities particularly toiletsand washstands that acilitate menstrualhygiene a major obstacle to attendanceis removed.

Primary barriers or girls attendance toschool include:

Inappropriate hygiene acilities.Girls who have reached puberty and

emale school sta who are menstruat-ing need gender-related privacy. I noprivacy is provided, students may not

WASH in Schools PromotesGender Equality5

Creating school environmentsthat encourage girls to completetheir education has far-reachingimplications for womens health

and a nations economy.

UNICEF/NYHQ2008-1125/Nesbitt



use the acilities at schools, resultingin absenteeism rates that can reach1020 per cent o school time. 26

Sexual harassment in toilets. A surveyconducted in South A rica revealsthat more than 30 per cent o the girlsattending school had been raped atschool. 27 Many o the rapes occurredin school toilets, particularly thosethat are isolated rom the protectiveenvironment o the school.

Students, teachers and school administrators lack knowledge about

adolescents physical changes. Schools have an important role inenabling open discussions wherechildren eel ree to talk about issuessuch as menstruation. Because manychildren start school late and repeatgrades, adolescence begins whenthey are still in lower primary school.There ore, this type o educationshould be age-oriented rather thandetermined by grade level.

Girls do more sanitation- and water-related chores than boys.Fetching water or household andschool use puts an additional burdenon adolescent girls and en orcesthe belie that it is typically awomans task.

I pro ed WASH conditionse power gir s to attend schooWASH in Schools osters social

inclusion and individual sel -respect.By o ering an alternative to the stigmaand marginalization associated with theissues mentioned above, it empowersall students and especially encouragesgirls and emale teachers.

In Alwar District, India, the schoolsanitation programme increased girlsenrolment by one third, leading to a25 per cent improvement in academicper ormance or both boys and girls. 28 A WASH in Schools evaluation in Kenyaindicates that girls were absent less inschools where there was more handwashing and very high toilet use. 29

In Bangladesh and India, innovativeprojects have demonstrated thatmenstrual hygiene can be incorporatedinto broader WASH in Schoolsinterventions. Training and in ormation

or peer groups o children andemale teachers have shown how

women and girls can be empoweredthrough improved menstrual hygienemanagement. Creating schoolenvironments that encourage girlsto complete their education has ar-reaching implications or womenshealth and a nations economy.

Girls who can take advantage oopportunities or education are betterable to protect themselves romexploitation and AIDS, and more likelyto develop skills to contribute to theirsocieties. 30 I they become mothers,they are more likely to raise healthy,well-nourished, educated children.

Women who have been to school areless likely to die during childbirth;each additional year o education isestimated to prevent two maternal

deaths or every 1,000 women.31

Research also shows that or every10 per cent increase in emale literacy,a countrys economy can grow by0.3 per cent. 32



WASH ust be sustained in schoo sduring e ergencies

During emergencies, schools are o ten theplace where displaced people seek shelter.Although it is essential that schools are ableto provide sa e havens or communities,this can both displace children rom theireducation and overload/damage WASH

acilities. Preparedness measures, includinginstallation and repair o permanent school

acilities, need to be accompanied by plansto provide additional, temporary WASH

acilities in schools so a surge o populationcan be accommodated or the crisis period.Subsequently, repairs must be made oncepopulations have le t. Temporary learningspaces in camps or other locations outsideo schools also need to be supported with

temporary WASH acilities.

Point-of-use water treat ent reachesco unities through schoo s

An increasing body o evidence shows that waterquality interventions have a greater impact onreducing sickness and death rom diarrhoeathan previously thought, particularly when

interventions are applied at the point o use, suchas schools and households, and combined withimproved water handling and storage.

In Cambodia, a study o ceramic- lteruse showed the lters removed bacteriacontaminants e ectively or at least three to

our years. Costing less than $10 each, theseeasy-to-use lters can be built and installedusing locally available materials. The ltersare introduced in schools, using catchy musicvideos and puppet shows to teach goodhygiene practices.

Schoolteachers act as distributors, selling thelters in their communities and earning extra

income. Michael Sampson, ounder o thenon-pro t organization Resource DevelopmentInternational, explained that lter ownershipempowers the Cambodians to solve theirown problems helping themselves andbuilding their sel -esteem. More than 100,000Cambodian households now use the lters.

Sources: UNICEF Handbook on Water Quality , NewYork, 2008; and www.america.gov, Ceramic Filters orDrinking Water Improving Health in Cambodia, U.S.Department o State, Washington, DC, 21 October 2008.

Matt Freeman o Emory University Center or Global Sa e Water



Co unities support WASH inSchoo s: mothers take action inCentra A erica

School Water, Sanitation, and Hygiene PlusCommunity Impact (SWASH+) is a programmethat trains members o rural parent-teacherassociations (PTAs) to manage WASH inSchools unds in El Salvador, Guatemala,Honduras and Nicaragua. Participating PTAscontract skilled labour, purchase materials andsupervise construction projects, includingrestroom acilities and hand-washing stations.

SWASH+ puts women in charge o localdevelopment, and their response refects anew sense o accomplishment. Seven PTA

members in our community received trainingon how to manage unds, and we learned alot, said Sara Gonzalez, a PTA president inHonduras. The students have unctioningrestrooms and a hand-washing station, andnow we are considering doing a small projectto repair the roo o the school on our own.

Source: Empowering PTAs in Honduras, Water ForPeople, 28 September 2009.

WASH in faith-re ated schoo ing

Good sanitation and hygiene habits andthe protection o environment are valuescommon to all aiths. So are many o the valuesdeveloped in the li e-skills and value-basededucation approaches. With globally about 64%o schools being aith-related, there are uniqueopportunities and bene ts rom linking spirituallearning with learning on water, sanitation,hygiene and the environment, and theimprovement o water and sanitation acilitiesin schools. Materials on designs, strategies,approaches and results are widely available what remains is their adjustment and use in

aith-based education and the development oschool water, sanitation and hygiene educationprogrammes as part o the education systemso individual aiths. Annemarieke Mooijmanand Christine Sijbesma, Faith in Water: Watersupply, sanitation and hygiene acilities andrelated education in aith-based schools, IRCInternational Water and Sanitation Centre, 2009.

UNICEF Mali/2009/Dicko



Forty per cent o the global population some 2.65 billion people live withoutaccess to proper toilet acilities, and 883

million dont have access to sa e water.33

More than 4,000 children under age ve dierom diarrhoea every day. This is a global

crisis, and WASH in Schools can help.

WASH in and through schools is oneo the best routes to reach entirecommunities. Directed engagementwith students can lead to communityadoption o good WASH behavioursand technologies 34 as well as improvedhealth. 35 Because children are agentso change, education or good hygienepractices in schools links students,

amilies and communities:

Children are ast learners. Comparedto adults, children can more easilychange their behaviour or developnew long-term behaviours as a resulto increased knowledge and acilitatedpractices. Children and youth mayquestion existing practices in their

households, and by demonstratinggood hygiene, they become agentso change within their amilies and

communities. Children are role models. What they

learn at school is likely to be passed onto their peers and to their own childreni they become parents.

Teachers are infuential. Whensupported by school management,they have an important role indeveloping students capacities tobecome community role models.

Chi dren can ead change inco unitiesSchool-Led Total Sanitation, a community-based approach to eliminating open de -ecation, capitalizes on the crucial role thatchildren can play as promoters o sanita-tion and hygiene in their communities.

A programme implemented in 2005 by theGovernment o Nepal and UNICEF draws

on a wide range o success ul CommunityApproaches to Total Sanitation. TheNepalese initiative created a completepackage o sanitation and hygiene pro-gramming that begins at the school andextends throughout the community.

Children are central in catalysing improvedsanitation in schools, homes and commu-nities. Through participatory approaches,motivational tools, fexibility or innovationand building ownership at the local level,

School-Led Total Sanitation is acceleratinglatrine coverage across Nepal and creat-ing a social movement or communitiesto become ree o open de ecation. As oJune 2009, School-Led Total Sanitationreached approximately 90,000 householdsand 500,000 people in 15 districts through300 schools. More than 1,000 settlementsin 10 districts in Nepal have been declaredopen-de ecation ree.

WASH in Schools Reaches the Communitybecause Children Are Agents of Change6

Global Handwashing Day, frst celebratedin 2008, provides an opportunity orschoolchildren to reach out to theircommunities with the li e-saving messageo hand washing with soap.

On 15 October each year, playgrounds,classrooms, community centres andpublic spaces are flled with activitiesto encourage hand-washing behaviourchange. In 2009, close to 200 millionchildren participated in these celebrationsin 80 countries across all fve continents.



Based on this success, School-Led TotalSanitation was incorporated in the 2009 NepalSanitation Master Plan, and the Governmentis replicating the programme in all 75 districts.Countries including Pakistan and Sierra Leonehave also adopted this approach. 36

Childrens involvement with WASH in theircommunities can be promoted with a mini-mum investment through such activities as

environmental health clubs, drama groups andstudent ocus groups. One example o this isthe experience o Malawis Sa e Water Clubs.

In 2007, Sa e Water Clubs were launched in11 schools in Neno District, Malawi, reachingabout 5,500 students. The Sa e Water Clubspromote the importance o clean water, goodhygiene and improved sanitation. Club mem-bers create their own songs, dramas andgames to communicate sa e water and hy-giene messages within their schools

and communities.Since the programme began, there has beena 90 per cent reduction in absenteeism due todiarrhoeal disease in the participating schools,even during the peak o the rainy season. Asa result o the students bringing the sa e wa-ter message to their homes and amilies, thecommunity clinic reported a 35 per cent de-crease in diarrhoeal disease cases in 2007. 37

WASH IN SCHOOlS ISCREATIvE: Schoo chi drenin Indonesia bring a essageto the co unitIn a project called Dokter Kecil, or LittleDoctors, primary-school clubs or Grade46 students promote good hygienethrough community theatre and otherinteractive events. To convey lessons onthe importance o washing hands withsoap be ore preparing ood or eating anda ter using the toilet, the children produceplays or their parents and other

community members.The students also take charge oJumat Bersih (Clean Friday), a nationalmovement that began in 1994 andencourages hygiene promotion,particularly hand washing with soap,during meetings on Islams holy day.

The little doctors are becoming leaders,learning to communicate clearly ande ectively, analyse and solve problems,and negotiate solutions. People love

drama, and parents especially love tosee their children per orm, said onesupervising teacher. It is ar moree ective than telling people directly tochange the way they do things.

Source: UNICEF Indonesia.

U

N I C E F / P A K A 2 0 0 8 - 1

0 3 6 / N o o r a n

i

WaterAid/Brent Stirton



The goal o the partners includingCARE, Dubai Cares, Emory UniversityCenter or Global Sa e Water, IRC

International Water and SanitationCentre, Save the Children, UNICEF, WaterAdvocates, WaterAid, Water For Peopleand WHO is to ensure that all schoolsprovide hygiene education programmesand have adequate, child- riendly waterand sanitation acilities.

Current and uture generations ochildren must grow up with sa e waterand good sanitation in their schoolsand communities. Children carryingmessages about the importance oconserving water, washing hands withsoap and using a clean toilet at homewill help their siblings and parents havea better li e.

We have proo o the impact o WASHin Schools. We have guidelines on theessential components and best

practices. We know how to makeWASH in Schools interventions betterand more sustainable.

Because every child deserves WASHin Schools, we are calling or renewedcommitments to:1. Increase in est ent in WASH in

Schoo s, mobilizing resources tosecure childrens health, now and orgenerations to ollow.

2. Engage those who set po icies at theglobal, national, sub-national and locallevels to support WASH in Schools.Widespread communication andadvocacy will be vital to establishing

Six Points of Action forWASH in Schools7

UNICEF/NYHQ2008-0138/Pirozzi



0

20

40

60

80

100

2002 2003 2004 2005 2006 2007 2008

WASH in Schoo s a Priorit for De e op ent Agencies

N u m

b e r o

f c o u n

t r i e s

The number o UNICEF-supported countries implementing WASH in Schoolsprogrammes has nearly doubled since 2002.

Source: Extracted rom UNICEF Water, Sanitation and Hygiene Annual Report 2008, New York, 2009, p. 23.

81 85 8688

7673

47

national plans o action and bringing allstakeholders rom the health, education,WASH, nutrition and ood security sectors

to act together to ul l the promise owater, sanitation and hygiene in schools.

3. In o e u tip e stakeho ders community members, civil society advo-cates, media, students, school sta , localand regional authorities, national ministrieso education, water and health, non-gov-ernmental organizations and public-privatepartnerships in the cooperative plans andactions that sustain WASH in Schools.

4. De onstrate qua it WASH in Schoo sprojects that yield a healthy schoolenvironment. Sustainable programmesenhance childrens capacities to learnand achieve. These programmes

incorporate construction, maintenance orrehabilitation o child- riendly water andsanitation acilities, hygiene education to

change behaviour, and participation ostudents, teachers, administrators and theneighbouring community.

5. monitor WASH in Schoo s progra esto ensure accountability and evaluateprogress. The global goals or WASHin Schools will not be reached unlessprogramme coverage is included inexisting national and global data-collection systems, such as EducationManagement In ormation Systems, andmapped out on a continuous basis.

6. Contribute e idence that provides a solidbase or in ormed decision-making ande ective distribution o unds. Gathering



and sharing comprehensive data,disaggregated by gender, accessand quality o services, will equippolicymakers with indispensabletools and provide project participantswith invaluable guidance.

maintain the o entuThe number o countries thatincorporate hygiene education in theirnational curricula or have developednational plans to provide water,sanitation and hygiene educationto all primary schools is steadily

increasing. In a survey conducted in2008 among 60 developing countries,27 had created and approved plans toprovide WASH in all primary schoolsand an additional 19 were working onnational plans. 38

This is a call to immediate action,renewed commitment and increasedinvestment in WASH in Schools, withthe vital goal o increasing accessto improved services throughout

the world. Urgent action is neededto protect all children, help themsurvive, be healthy, participate ully inopportunities or education, contributeto the development o nations andbreak the cycle o poverty.

It is the right o every child to behealthy and learn with dignity. Everychild has a right to WASH in Schools.

In partnership with those whoare dedicated to the health andeducation o children, we arecommitted to an ambitious butimperative vision: every childgoes to a school that provides sa ewater, good sanitation and hygieneeducation a school where they canlearn, play and grow.

UNICEF/NYHQ2008-1128/Nesbitt



1 United Nations Childrens Fund country o ce annualreports, 2008.

2 Hutton, Guy, and Laurance Haller, Evaluation o the Costs and Benefts o Water and Sanitation Improvements at the Global Level , Water, Sanitation and Health Protectiono the Human Environment, World Health Organization,Geneva, 2004.

3 Savioli, Lorenzo, et al., Schistosomiasis and Soil-Transmitted Helminth In ections: Forging control e orts,Transactions o the Royal Society o Tropical Medicine and Hygiene , vol. 96, no. 6, NovemberDecember 2002,pp. 577579.

4 Prss-stn, Annette, et al., Sa er Water, Better Health: Costs, benefts and sustainability o interventions toprotect and promote health , World Health Organization,Geneva, 2008, p. 10.

5 Although availability o in ormation or WASH in Schools isimproving, there is still a lack o reliable data at the globallevel. Analysis in this report is based on UNICEF 2008annual reports rom 60 developing countries.

6 Koopman, James S., Diarrhea and School Toilet Hygienein Cali, Colombia, American Journal o Epidemiology , vol.107, no. 5, 1978, pp. 412420.

7 Prss-stn, Annette, et al., Sa er Water, Better Health: Costs, benefts and sustainability o interventions to protect and promote health , World Health Organization, Geneva,2008, p. 10.

8 Hall, Andrew, et al., A Review and Meta-Analysis o theImpact o Intestinal Worms on Child Growth and Nutrition,Maternal & Child Nutrition , vol. 4, no. s1, 14 February 2008,pp. 118236.

9 Albonico, Marco, et al., Controlling Soil-TransmittedHelminthiasis in Pre-School-Age Children throughPreventive Chemotherapy, Neglected Tropical Diseases ,Public Library o Science (PLoS), San Francisco, CA, vol. 2,no. 3, 26 March 2008, p. e216, www.plosntds.org/article/ in o%3Adoi%2F10.1371%2Fjournal.pntd.0000126,accessed 29 November 2009.

10 World Health Organization, Report o the Third Global Meeting o the Partners or Parasite Control: Deworming

or health and development , WHO, Geneva, 2005, p. 15.

11 Prss-stn, Annette, et al., Sa er Water, Better Health: Costs, benefts and sustainability o interventions toprotect and promote health , World Health Organization,Geneva, 2008, p. 8.

12 Luby, Stephen P., et al., E ect o Handwashing on ChildHealth: A randomised controlled trial, The Lancet , vol.366, no. 9481, 16 July 2005, pp. 225233.

13 Ejemot, Regina I., et al., Hand Washing or PreventingDiarrhoea, Cochrane Database o Systematic Reviews ,Issue 1, article no. CD004265, 23 January 2008, http:// mrw.interscience.wiley.com/cochrane/clsysrev/articles/ CD004265/ rame.html, accessed 29 November 2009.

14 United Nations Childrens Fund and World HealthOrganization, Pneumonia: The orgotten killer o children ,UNICEF and WHO, New York and Geneva, 2006, p. 4.

15 Health in Your Hands, Global Handwashing DayPlanners Guide, Global Public-Private Partnership orHandwashing with Soap, Washington, DC, 2008, p. 13.

16 Njunguna, Vincent, et al., The Sustainability and Impacto School Sanitation, Water and Hygiene Educationin Kenya, United Nations Childrens Fund and IRCInternational Water and Sanitation Centre, New York andDel t, Netherlands, 2008, p. 2.

17 Mathew, Kochurani, et al., The Sustainability and Impacto School Sanitation, Water and Hygiene Education inSouthern India, UNICEF and IRC International Water andSanitation Centre, New York and Del t, Netherlands, 2008,p. 16.

18 United Nations Childrens Fund and IRC InternationalWater and Sanitation Centre, School Sanitation andHygiene Education Results rom the Assessment o a6-Country Pilot Project, UNICEF and IRC, New York

and Del t, Netherlands, May 2006, p. 5.19 Redhouse, David, No Water, No School, Oasis , vol.

Spring/Summer, WaterAid, London, 2004, pp. 68,www.wateraid.org/international/about_us/oasis/ springsummer_04/de ault.asp, accessed29 November 2009.

20 Bowen, Anna, et al., A Cluster-Randomized ControlledTrial Evaluating the E ect o a Handwashing-PromotionProgram in Chinese Primary Schools, American Journal o Tropical Medicine and Hygiene , vol. 76, no. 6, 2007,pp. 11661173.

21 Lopez-Quintero, Catalina, Paul Freeman and YehudaNeumark, Hand Washing Among School Children inBogot, Colombia, American Journal o Public Health ,vol. 99, no. 1, January 2009, pp. 94101.

22 Hall, Andrew, et al., A Review and Meta-Analysis othe Impact o Intestinal Worms on Child Growth andNutrition, Maternal & Child Nutrition , vol. 4, no. s1, 14February 2008, pp. 118236.

Endnotes



23 World Health Organization, Report o the Third Global Meeting o the Partners or Parasite Control: Deworming or health and development , WHO,Geneva, 2005, p. 15.

24 Poverty Action Lab, Mass Deworming: A best-buyor education and health, Policy Brie case, no. 4,

Massachusetts Institute o Technology Department oEconomics, Cambridge, MA, October 2007.

25 World Health Organization, Report o the Third Global Meeting o the Partners or Parasite Control: Deworming or health and development , WHO,Geneva, 2005, p. 15

26 IRC International Water and Sanitation Centre,Adolescent Girls and School Hygiene, Sanitationand Water, School Sanitation and Hygiene EducationNotes & News , IRC, Del t, Netherlands, May 2005,pp. 18.

27 Ibid.

28 UN-Water, Sanitation Contributes to Dignity andSocial Development, International Year o SanitationFactsheet no. 3, UNICEF, New York, 2008, p. 1.

29 Njunguna, Vincent, et al., The Sustainability andImpact o School Sanitation, Water and HygieneEducation in Kenya, United Nations Childrens Fundand IRC International Water and Sanitation Centre,New York and Del t, Netherlands, 2008, p. 3.

30 Brocklehurst, Clarissa, The Case or Water andSanitation: Better water and sanitation make good

scal and economic sense, and should be prominentin PRSPs and budget allocations, Sector FinanceWorking Paper, no. 11, UNDP Water and SanitationProgramme, Nairobi, November 2004, p. 5.

31 United Nations Childrens Fund, The State o the Worlds Children 2004: Girls, educationand development , UNICEF, New York,December 2003, p. 20.

32 Brocklehurst, Clarissa, The Case or Water andSanitation: Better water and sanitation make good

scal and economic sense, and should be prominentin PRSPs and budget allocations, Sector FinanceWorking Paper, no. 11, UNDP Water and SanitationProgramme, Nairobi, November 2004, p. 5.

33 World Health Organization and United NationsChildrens Fund Joint Monitoring Programme orWater Supply and Sanitation, Progress on Drinking Water and Sanitation: Special ocus on sanitation ,UNICEF and WHO, New York and Geneva, 2008,pp. 25, 30.

34 Onyango-Ouma, W., J. Aagaard-Hansen and B. B.Jensen, The Potential o Schoolchildren as HealthChange Agents in Rural Western Kenya, Social Science & Medicine , vol. 61, no. 8, October 2005, pp.17111722; and Rheingans, R., et al., Can a School-Based Water, Sanitation and Hygiene InterventionCatalyze Changes in Household Behaviors andEnvironment? Evidence rom a randomized trial inwestern Kenya, Paper presented at the InternationalResearch Colloquium o the Network to PromoteHousehold Water Treatment and Sa e Storage,Dublin, 2123 September 2009.

35 Bowen, Anna, A Cluster-Randomized Controlled TrialEvaluating the E ect o a Handwashing-PromotionProgram in Chinese Primary Schools, AmericanJournal o Tropical Medicine and Hygiene , vol. 76,no. 6, 2007, pp. 11661173.

36 Adhikari, Shova, and Namaste Lal Shrestha, SchoolLed Total Sanitation: A success ul model to promoteschool and community sanitation and hygiene inNepal, Chapter 9 in Beyond Construction: Use by all A collection o case studies rom sanitationand hygiene promotion practitioners in South Asia ,WaterAid and IRC International Water and SanitationCentre, London and Del t, 2008, pp. 113125.

37 Population Services International, Learningabout Sa e Water in Neno District, Malawi, PSI,Washington, DC, 2009, p. 1.

38 United Nations Childrens Fund, UNICEF Water,Sanitation and Hygiene Annual Report 2008 , UNICEF,New York, May 2009, pp. 2324.


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Join us in Raising Clean Hands for WASH in SchoolsThe ollowing are partners in the initiative as o February 2010. To join us in raising clean hands or

WASH in Schools, please contact Murat Sahin, UNICEF adviser or WASH in Schools, at msahin@unice .org.


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Lack o reliable data is a major constraint or the advocacy and planning e orts o WASH in Schoolsprogrammes. Water and sanitation acilities and skills-based hygiene promotion activities are note ectively monitored at the global or national level. The data that are available show that:

If the Millennium Development Goals for waterand sanitation are reached, it is estimated thatabsenteeism in schools would be reduced by272 million school days per year.

Fewer than half of primary schools have adequatewater acilities, and nearly two thirds lack adequate

A girl can miss up to 10 per cent of her schooldays during menstruation, a loss that could beaverted through WASH in Schools programming.

Only 27 out of 60 developing countries surveyedhave a national plan o action that provides space

or WASH in Schools.

Ensure e er chi d goes to a schoo with WASH water, sanitation and h giene education. Despite widespreadknowledge o the relationship between poor WASH quality and the burden o disease on children, manycountries have inadequately addressed water and sanitation acilities in their schools. Policymakers as well asschool administrators have been unable to devote adequate attention to WASH in Schools programmes, andas a result, schools either do not have WASH acilities or they are in poor condition due to lack o maintenance.

This Call to Action or WASH in Schools puts orward a six-point plan towards providing each and everyschoolchild with access to quality water, child- riendly sanitation and hygiene acilities, and hygiene education

or li elong health.

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raising clean hands 2010 - advancing learning, health and participation through wash in schools

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