sshe in kenya

sshe in east africa


hygiene and sanitation with infrastructure




                                                                                Go Back  

WELL FACTSHEET - Regional Annex East Africa     

School Sanitation and Hygiene Education (SSHE)

Author: Gerald Rukunga and David Mutethia, AMREF, January 2006

Quality Assurance: Marielle Snel 


School Hygiene and Sanitation Education is becoming an area of focus as far as promotion of hygiene and sanitation activities are concerned. The increasing attention follows the fact that substantial learning time is wasted if the rate of absenteeism from common preventable diseases such as diarrhoea is very high.

 A safe environment in schools influences children’s health and wellbeing. Water and sanitation facilities are increasingly recognized as fundamental for promoting appropriate hygiene behaviour and children’s wellbeing. However, many schools experience unsanitary conditions that vary from inappropriate and inadequate sanitary facilities to the outright lack of latrines and safe water for drinking and support to hygiene promotion. Provision of adequate water and sanitation facilities coupled with proper hygiene in schools are essential for: 

  • Enhancing effective learning

  • Attracting enrolment in schools, particularly girls

  • Sustaining a reduced burden of disease and worm infestation among pupils

The year 2015, which is a landmark for some of the key global resolutions and commitments, is fast approaching yet it remains largely uncertain whether the targets will be met. In the context of school health, by 2015 the target is to educate 80% of primary school children on hygiene,  to equip all schools with facilities for sanitation and hand washing and educate all children about hygiene.

However, the sanitary conditions of schools in rural and urban areas in developing countries are often appalling, creating health hazards. Increasing the number and standard of school latrine facilities would decrease the drop out rates and other negative impacts especially for adolescent girls. Experience has shown that the mere provision of facilities does not make them sustainable or ensure the desired health impact. It is the use of the facilities and change in the related hygiene behaviours among the beneficiaries that provides health benefits.

Substantial learning time is wasted if the rate of absenteeism from school due to common preventable diseases such as diarrhoea is very high. For example, 400 million school age children are infected by intestinal worms, which sap their learning abilities.

SSHE in Kenya

The water, sanitation and hygiene situation in Kenyan schools is below desired standards. Only 29% of schools in the country have access to water and sanitation facilities.  Accessibility to water and sanitation facilities in schools in Kenya is rated under three categories by the Ministry of Education Science and Technology (MOEST). When less than 40 children share one latrine, the accessibility is considered fair, forty to one hundred children using one latrine is classified as bad and dangerous if over 100 pupils share a single latrine. A study by MOEST (2003) shows that the majority of public primary schools in Kenya are in the ‘dangerous’ category. The study has further established that over 90% of primary schools in rural Kenya lack access to safe water and do not have even the simplest hand washing facility.

Lack of facilities and poor hygiene affect both girls and boys, although inadequate sanitary conditions at school have a stronger negative impact on girls. More than a half of the schoolgirls who drop out of school in upper primary classes do so because they miss school periodically particularly during their menstrual periods. This is due to various factors,  among them lack of sanitary pads, lack of separate toilet facilities and easy access to water sources within the schools.  Schools are a key factor for initiating change by helping to develop useful life skills on health and hygiene. Children are often eager to learn and willing to absorb new ideas. New hygiene behaviour learned at school can lead to life-long positive habits.

SSHE in East Africa

The East African countries have incorporated school hygiene and sanitation in schools in their environmental health interventions, and policies have been developed to support this initiative. Although the main focus is provision of water and sanitary facilities, there are considerations to include other elements of school health, as advocated for by the World Health Organization (WHO).

In line with this resolution the governments of Kenya, Uganda and Tanzania are increasingly promoting primary schools enrolment and retention. One such effort is geared towards provision of free primary education. With the introduction of free primary education in Kenya there has been a drastic increase in school enrolment (about 7.2 million). Average class sizes have risen from 50 to between 60 and 70, with one teacher per class, while water and sanitation facilities remain the same.

PHASE (Personal Hygiene and Sanitation Education)

Kenya is currently implementing a national tool on Personal Hygiene and Sanitation Education (PHASE). This model was developed by the African Medical and Research Foundation (AMREF) in collaboration with the government through the Ministries of Education and Health with funding from GlaxoSmithKline. The PHASE model is designed to build the capacity of primary school children to take responsibility for their own health and also convey hygiene messages to their communities for sustainable hygiene behaviour change.

Through PHASE teachers and pupils are trained on appropriate hygiene practices. The teachers act as trainers of facilitators while pupils are trained using health clubs and child to child approaches. In this way the trained teachers and pupils continue to train the others including neighbouring communities. Similarly school management committees are supported to develop water and sanitation facilities including latrines, hand washing facilities and waste disposal systems.

Improved SSHE leads to health, social and economic benefits including increased learning opportunities for children and a reduction in the deaths related to preventable causes among children. Increasing the number and standard of school latrine facilities would decrease the drop out rates especially for adolescent girls.

The conceptual model of Phase

In East Africa the greatest challenge is to provide access to safe and adequate water and sanitation facilities especially for schools in the rural areas and informal settlements which are characterized by high poverty levels. Lack of these facilities is therefore identified as the single most serious setback to the effective implementation of free primary education.

Hygiene and Sanitation coupled with Infrastructure

In addressing behaviour change through hygiene promotion to complement the water and sanitation infrastructure, three key factors have to be addressed:

  1. Predisposing factors - knowledge, attitudes and belief

  2. Enabling factors - availability of resources

  3. Reinforcing factors - ability to sustain appropriate sanitation and hygiene behaviour

Experience has shown that hygiene and sanitation improvement in schools through the models aforementioned is more effective if coupled with infrastructural development including construction of classroom facilities. The net effect of these integrated interventions is improved academic performance, reduced girl- child drop out rates and reduction in the prevalence of water and sanitation related diseases among the school children.


  1. Government of Kenya (2003). Millennium Development Goals; Progress Report for Kenya, Nairobi, Kenya

  2. Misheck Kirimi and Pauline Mwaniki (2004). Kenya focuses on School Water, Sanitation and Hygiene. NETWAS International, Nairobi, Kenya at: 

  3. IRC/UNICEF 2001-2003 School Sanitation and Hygiene Education available at 

  4. African Institute for Health Development (2004. Personal Hygiene and Sanitation Education (PHASE) - End of Project  Evaluation Report 2004.  

  5. Ministry of health Uganda (2000). National Sanitation Guidelines. Nariobi, Kenya

This Regional Annex was compiled by Gerald Rukunga and David Mutethia, both from AMREF Kenya under the WELL Partnership. For further information Contact Gerald Rukunga AMREF Kenya at:



Home > Resources > Fact sheets > Evaluation of hygiene promotion