WELL BRIEFING NOTE 30                              Go Back

In Ghana, SSHE falls within the national School Health Education Programme (SHEP). This was instituted in 1992 by a government directive stipulating that the Ghana Health and Education Services were to deliver a comprehensive, community-based programme focusing on health and education and health services in schools. The SHEP creates community awareness of children’s health needs, and mobilizes commitment by the community and schools, to improving child health and to facilitating effective learning.

Implementation of SHEP has raised certain problems, due to weak collaboration between the Education and Health Services, and the lack of adequate government funding which has dramatically slowed down its development. The Community Water and Sanitation Agency (CWSA) responsible for small towns and rural water and sanitation services, has provided support to SHEP since 1994, working in communities to supply potable water and constructing household latrines. Schools were given their own latrines and handwashing facilities, with appropriate training about school hygiene activities and the operation and maintenance of the facility. Active collaboration was achieved between CWSA and the Education Service, from regional to district level, although the Health Service was not included in this.

Since 2005, new strategies for supporting the water and sanitation sector have been implemented by key development partners. DANIDA supports four of the country’s ten regions, with SHEP seen as a stand-alone component, receiving direct support under the umbrella of the national SHEP office. A SSHE Component Coordinating Committee has been set up, involving members from the various stakeholder bodies concerned, to strengthen inter-sectoral collaboration and sustainability in these areas. In other regions, still very little collaboration exists among decentralized departments to implement SSHE. Moreover, since SSHE became a component on its own, the level of collaboration with the CWSA has declined.

The Ministry of Local Government and Rural Development is a key stakeholder in SSHE implementation. The Environmental Health and Management Department has a mandate to enforce environmental health standards. Environmental Health Assistants regularly visit schools and other premises, checking food hygiene, cleanliness (including that of water and sanitation facilities) and undertaking hygiene promotion. Efforts have been made towards inter-sectoral collaboration by including national SHEP officials in planning activities, in order to achieve greater impact. This does not happen at district level, with little harmonization of planning by the District Health Management team, the District Education Office and the Environmental Health and Management Department.

All key sector agencies with a role to play in SSHE implementation recognize the need for strong intersectoral collaboration; however, there is the belief that the Ghana Education Service should take the initiative to foster this. This results in a lack of consistent effort within the different government administrative levels.

Challenges and responses

Institutional Models in India

For the past ten years, the Government of India has been committed to implementing SSHE in its upper, secondary and early childhood programmes. The Total Sanitation Campaign (TSC) was one reform brought about by the community-based Central Rural Sanitation Programme (CRSP), which included school sanitation. TSC focuses on community-led and people-centred initiatives, emphasizing Information, Education and Communication (IEC) for demand generation, hygiene education, human resource development, and capacity building, along with providing sanitation hardware to households, schools and nurseries.

Government partnerships with UNICEF have played a significant role in the  evolution of SSHE in India. Educational reform through the District Primary Education Programme focused on water and sanitation in unserved schools in 15 states and has subsequently scaled up to become the Sarav Shiksa Abhiyan. This aims to ensure universal elementary education by 2010 by planning for decentralized management and capacity building. SSHE is also strengthened by the Accelerated Rural Water Supply (ARWSP) and Department of Drinking Water Supply programmes. This inter-sectoral involvement requires concerted efforts to integrate water supply, sanitation, health and hygiene education.

SSHE in India aims to promote sanitation and hygiene in schools to achieve lasting behaviour change. It also seeks to promote the right of the child to a healthy and safe learning environment, while taking into account local needs and preferences. These include both hardware and software components:

• The child as an agent of change (teacher-Child-Family-Community);

• Hygiene education using a life-skills approach;

• Child-friendly (especially girl-child and the disabled) water and sanitation;

• Regular health checks and de-worming;

• School as the knowledge centre with the teacher as facilitator / motivator;

• Institution building of school WATSAN / Health Committees;

• Promotion of school environmental cleanliness;

• Equitable involvement of the community and Parent Teacher Associations;

• Capacity development of a wide range of concerned actors; and

• Strengthening school-based monitoring systems.

Policy level of SSHE

Central Government policy requires all states to implement SSHE programmes as a priority and to develop action plans to ensure education, water and sanitation coverage of all schools. To promote inter-sectoral coordination, a State Water and Sanitation Mission has been constituted to act as a task force. District committees coordinate and supervise water and sanitation reforms, ensuring inter-sectoral coordination of key district departments and NGOs.

Capacity building

Four regional resource centres exist to train state and district level resource institutions for the SSHE programme. Districts also use the District Institute for Education and Training (DIET) for capacity building.

Inter-sectoral coordination

SSHE is an integrated intervention involving various sectors, so inter-sectoral coordination is very important. The Department of Drinking Water Supply has made efforts to forge linkages between departments (e.g. Department of Elementary Education and Literacy (DEE&L), Health, Women and Child Development, and Social Justice and Empowerment), to ensure that the SSHE programme is prioritized.

Challenges and responses

• Policy - the Government of India has provided political and financial support for SSHE provision in all rural government schools, with inter-sectoral and inter-departmental coordination put in place to meet goals set.

• Monitoring -  monitoring of the programme covers physical and financial coverage as well as tracking process indicators, especially at school level. It is planned to make regular use of an external monitoring agency.

• Hygiene education -  incorporating hygiene education into the curriculum is problematic. Many initiatives have been developed to this end, with the subject now being an element of teacher training. This area of the curriculum has been extended with funds earmarked for it.

• Construction and design issues - technology and design issues in construction have been prioritized in the implementation of the TSC. Toilets are often not child-friendly, coupled with inadequate ventilation, light, water supply and hand washing facilities.

• Programme implementation - even where the programme is in operation, difficulties still exist. Concerns centre on the provision of training programmes for effective and focused implementation.

Lessons Learned