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School Sanitation and Hygiene Education

Author: Mariëlle Snel, May 2003

Quality Assurance: Sandy Cairncross


School Sanitation and Hygiene Education (SSHE) is a very attractive issue not only from the political but also from a social perspective. It is based on the premise that children have a right to basic facilities such as school toilets, safe drinking water, clean surroundings and information on hygiene. If these conditions are created, children come to school, enjoy learning, learn better and take back to their families concepts and practices on sanitation and hygiene. In this way, investment in education is more productive. Such conditions have an even greater positive outcome for girls who often stay way from or drop out of schools which do not have toilet facilities. This fact sheet gives an overview on issues which arise in school sanitation and hygiene education (SSHE).

Introduction / the story

The provision of safe water and sanitation facilities in schools is a first step towards a healthy physical learning environment benefiting both learning and health. However, the mere provision of facilities does not make them sustainable or produce the desired impact. It is the use of technical facilities and the related appropriate hygiene behaviours of people that provide health benefits. In schools, hygiene education aims to promote those practices that will help prevent water and sanitation-related diseases as well as promoting healthy behaviour in the future generation of adults (Burgers, 2000).

The combination of adequate facilities, correct behavioural practices and education is meant to have a positive impact on the health and hygiene conditions of the community as a whole, both now and in the future. The success of a school hygiene programme is therefore not determined only by the number of latrines constructed and the number of hand pumps installed or water connections built. Nor is the success of a programme determined simply by what children know. Knowledge that is not applied to hygiene behaviour in practice has no impact on health.

The problem and the needs 

School sanitation and hygiene education (SSHE) therefore refers to the combination of hardware and software components that are necessary to produce a healthy school environment and to develop or support safe hygiene behaviours. The hardware components include drinking water, hand washing and excreta disposal,  plus solid waste disposal facilities in and around the school compound. The software components are the activities that promote conditions at school and practices of school staff and children that help to prevent water and sanitation-related diseases and parasites (UNICEF and IRC, 1998).

Investing in school sanitation and hygiene education has many benefits. It is in essence an investment in our future, which promotes:

Fig. 1 School and surrounding

  • Effective learning: Children perform better when they function in a hygienic and clean environment.

  • Increases enrolment of girls: The lack of private sanitary facilities for girls can discourage parents from sending girls to school and contributes to the drop out of girls, particularly at puberty.

  • Reduces incidence of disease and worm infections: If school sanitation and hygiene facilities are absent, or are badly maintained and used, schools become health hazards.

  • Environmental cleanliness: Presence and the proper use of facilities will prevent pollution of the environment and limit health hazards for the community at large.

  • Implementing children’s rights: Children have the right to be as healthy and happy as possible. Being clean, healthy and having clean water and proper sanitation facilities contribute to a happy childhood.

SSHE- situational analysis

Unfortunately, the high expectations of school health and hygiene education programmes have not always been fulfilled. In many countries, schools are not safe for children due to neglect of the operation and maintenance of facilities. In addition hygiene education given to children has not always been relevant or effective. Schools too often suffer from:

  • Non-existent or insufficient water supply, sanitation and hand-washing facilities;

  • Toilets or latrines that are not adapted to the needs of children, in particular, girls;

  • Broken, dirty and unsafe water supply, sanitation and hand washing facilities;

  • Unhealthy and dirty classrooms and school compounds;

  • Children with poor hand washing habits and practices

Figure 2: Graph on the co-relation between worm infection and absenteeism (epg: eggs/gram of stool).

Under these conditions, schools become unsafe places where diseases are transmitted (WHO, 1997). Poor health of children affects their ability to learn and therefore influences their prospects in life. A study by Nokes et al (1993), for example, shows that children with worm infections have higher absenteeism than non-infected children. Basically, this means that children with worm infections spend less time and are disadvantaged in the learning process. Effective school sanitation and hygiene education should help reduce these infections.

Figure 3: Girl pumping water

The actors and their roles

The SSHE programme should relate, and be relevant,  to all key groups in the community, including the poor, all social and language groups, and women. When working with local groups in communities, it is of course easiest to begin with those who are already involved and are strongest and then expand. This means that in different communities somewhat different groups may be involved initially in the programme.

      The vision: Main actors involved and their roles

A school sanitation, water and hygiene education programme

  • Child - a key resource

  • School - knowledge centre

  • Teacher - sensitive leader

  • Community - an equal partner

  • Government - committed facilitator

A way of stimulating this selection locally, and extending participation to all key groups, is an important point to include in the SSHE programme plan.

These may include:

Community members

District/country personnel and institutions

Children, parents, teachers and head teachers
Health workers and volunteers
Traditional leaders

Community groups and institutions
Parent-teacher associations (PTA’s) and Education Committees
Water and Sanitation Committee Local government and Development Committees
Women’s groups and Self-Help (and savings) Groups
Youth Groups

District officials, chief managers, chief administrators
Engineering department
Education department, school facilities
Training and curriculum institutions
Education officers and supervisors
Teachers and head teachers
Health department
Rural development department
Various NGOs (non-governmental organizations) and their field workers

Adapted from Snel, M., Ganguly, S., Kohli, C., and Shordt, K. 2002

Gender and poverty-sensitive approach

When undertaking planning and assessing the possible actors and roles in developing a SSHE programme, it is important to take gender and poverty issues into account. Without this, one loses sight of the needs and interests, and the special skills and insights, of women and poorer families. One also needs to have an understanding of gender dynamics specific to the culture and social norms. How do boys and girls perceive each other’s roles and responsibilities? What is their concept of sharing both the burdens and the benefits generated through the improved water and sanitation situation? One must take account of issues such as:

  • Who decides on technology?

  • Who collects water?

  • Who cleans the toilets?

  • Who is on committees?

  • Who decides on payments and collects money?

  • Who provides free labour?

  • Who participates in O&M?

  • Who teaches children how to use facilities?

  • Who decides on programme strategy in the district? In the village?

  • Whose children benefit most? Benefit least?

  • Who pays? How much? and Who does not pay?

  • Who serves the tea in meetings?

  • Who washes the dishes?

  • Who speaks the most?

Gender and poverty-sensitive approaches can help school water and sanitation projects succeed in achieving their objectives for all: girls and boys, men and women, rich and poor members of the community. Agencies and project staff should know that a gender-sensitive approach is not difficult. But before agency and project staff can implement a gender and poverty-sensitive approach in policy making, the design of technologies, project planning and implementation, they should understand some basic aspects of gender,

Elements of programme strategy

There are various elements in a SSHE programme strategy which need to be considered. These elements include the following

  • Striving for a common goal, common purpose, common policy and common planning

  • Focusing on the child as the key resource

  • Focusing on schools as the knowledge centre

  • Focusing on education for behaviour change

  • Acknowledging the teacher as the facilitator

  • Concentrating on result oriented/effective delivery system

  • Recognizing that the community is an equal partner

Common goal

Striving for a common goal, common purpose, common policy and common planning is critical in a SSHE programme. This entails the need for a local SSHE micro-plan to be developed as it is first necessary to have identified the key actors and to have information about the school from a baseline survey, no matter how small. It is also important to keep in mind the need to take account of gender and poverty issues as reflected in the previous section. The purpose of preparing a micro-plan at an early stage is to have a basis for the preparation of the district and area SSHE plans, and an idea of how human and financial resources should be allocated. This indicative micro-plan will form the basis for the work plan. Thus, beginning with a survey and analysis of the actors, the preparation of a draft micro-plan leads to the formulation of a higher quality and realistic plan that is based on the real situation in the communities. Because local situations differ considerably, micro-plans may inevitably also differ.

Child as the key resource

As children are the key resource and the future parents, what they learn is likely to be applied in the rest of their lives. Moreover, they already have important roles in their household (e.g. taking care of younger brothers or sisters) and they may share concerns regarding existing practices in the household. If children are brought into the development process as active participants, they can become change agents within their families and a stimulus to community development. They are eager to learn and help, and if they see environmental care and their role in this as important, they will take care of their own health and the health of others. Being tomorrow’s parents, children are also likely to ensure the sustainability of a programme’s impact.

School as knowledge centre

Currently many schools are not knowledge centres as they lack safe drinking water and sanitation facilities.

Given this situation, the need to build school sanitation and water facilities, and ensure basic school infrastructure is understandable. However, this is not sufficient. There are other vital tasks that schools must also undertake. A fundamental shift is required from the earlier emphasis on sanitation and water facilities alone toward combining this with behavioural change.

Education for behaviour change 

Forming consistent behaviours and attitudes is one of the primary objectives of an effective school health programme. It is important that children know about risks to their health and how to avoid these. The focus on sanitation and water infrastructure must be combined with a broader agenda that includes education and consistent behaviours.

Figure 4: Diagram of Hubley’s model

Teacher as facilitator

For teachers to become facilitators they must be able, in simple ways at least, to become guides and motivators fulfilling the promise of the school as a resource base, providing opportunities for peer learning child-to child, school child to non-school going child, child to family, and school to community support.

Teachers are a large and enthusiastic resource that should be supported in their efforts to make the school a child friendly and healthy environment. The participation and willingness of school management teams and the teachers, especially the head teachers are crucial.

    Some of the issues regarding training include:

  • Developing and production of teaching materials: This entails developing and producing hygiene education materials, which can be reproduced on a large scale, so that they are not too costly and allow for easy adaptation to local circumstances.
  • The basic insights into the more technical aspects of sanitation facilities at the school. This is in reference to teacher training specifically in terms of how sanitary facilities work in practice which includes the construction, operational and maintenance aspects.
  • The organizational issues of sanitary facilities. This also refers to ways they can monitor behavioural changes.
  • Focusing of teacher training. This entails training of teachers on: the subject of SSHE; how to use the materials of SSHE; how to organize/implement a SSHE programme; and how to plan for the replacement of facilities.
  • Outreach programmes to the community. For the support of the communities as well as to ensure that the learned behaviour can also be practiced at home.
  • Focusing on monitoring, evaluating and documentation of SSHE experiences for teachers in schools around the world.

Alliance building

Good co-ordination is essential for school water and sanitation programmes, as indeed, it is for all community development efforts. For SSHE, the challenge is to ensure that education, engineering, health, non-governmental and local government institutions really work together. This applies to the state, district, area and community level; and, theoretically, programmes should begin by organising a strong co-ordination mechanism at each level.

Co-ordination serves at least two purposes. The first is to ensure that the programme is given priority. This means that the key agencies (Education/Health/Rural Development Departments, Local Government, NGOs) want the programme, release funds for it and demonstrate commitment by working well and on time. Assigning priority to SSHE also involves providing, motivating and supervising the staff. Secondly, co-ordination should serve to ensure that both the software and hardware programme are integrated as intended.

Result oriented/effective delivery system

SSHE programmes do not end when the water and sanitation facilities have been constructed. In fact, construction marks a new beginning as children participate in water/sanitation related education activities and start to use the facilities. The period following construction usually receives too little attention from programme planners and implementers.

One main purpose of a SSHE programme is for children to use the facilities and through this, develop consistent hygiene behaviours. Thus, all children should be able to:

  • drink clean water in the school

  • use latrines for urination and defecation

  • wash hands with soap and water after using the latrine and before eating

In order for children to use the facilities as intended, there must, of course, be enabling factors and materials. It is, for example, counterproductive to tell children to wash their hands with water and soap if there is no soap available for them to use. Enabling factors are the materials and actions that help people (children) perform particular behaviours. Some enabling factors to help children use the facilities as intended are:

  • Allow sufficient time for the children to use the latrine.

  • Fill water storage containers in the morning and refill them at mid-day or when needed.

  • Provide each latrine with a bucket, mug and a cleaning brush.

  • Provide each handwashing facility with a bucket, mug and soap.

  • Allow drinking water to be stored in containers with covers and have at least one ladle and two tumblers. It is useful to have a platform to raise the containers off the ground and to have soap for washing the vessels and tumblers .

Community as an equal partner

Too often school latrines and water points become dirty and run down. As a result, they are not used and create a health hazard. Lack of maintenance can be part of the responsibility of the school members (teachers and students) and well as that of the community.

Currently, teacher training and supervision too often overlook the specific details of how to use the facilities and how to organise the children, and possibly parents, to clean and maintain them. Cleaning and maintenance are very important!

There are 3 kinds of maintenance:

  • Upkeep; cleaning and maintenance activities to be done by teachers, children and other users on a regular basis.

  • Minor repairs and preventive maintenance such as greasing, bolts, fixing taps, cracks, and broken doors, once a week at least.

  • Major repairs such as the repairs that cannot be done by children, teachers or their parents. They can be referred to the village mechanic, a block mechanic or engineering divisions.

The cleaning and maintenance activities are to be done by teachers, children and other users on a regular basis. Examples are:

  • latrines: sweeping floors (daily), washing floors and pans (every few days at least), cleaning walls (once a week),

  • water point: cleaning drains and removing visible garbage around water point (once a day), checking for preventive maintenance,

  • water storage: cleaning inside of water storage containers (at least once a week), cleaning dippers and cups (once a day),

  • handwashing facilities: removing visible garbage and draining puddles of water, cleaning drains, ensuring that soap and water are present (once a day),

  • garbage pit: burning refuse (once a week).

      Some of the lessons learnt include:

  • Adopting participatory planning practices;
    Ensuring participation of marginalised groups (women, girls, minorities and ethnic groups);
  • Building a positive, receptive community environment;
  • Building training capability through existing institutions
  • Synchronizing and co-ordinating the software/hardware activities;
  • Establishing rigorous quality monitoring; and
  • Focusing on flexibility of design and allowing room for choice.

Issues to consider in SSHE

Based on the information so far, the following is a list of some of the steps which can be undertaken in order to overcome some of the main issues in SSHE. This list is not exclusive but rather provides some of the main points that should be considered for an effective and efficient SSHE programme.

Point 1: Establish working group of collaborative structures at the different levels (e.g. state, district) specifically on SSHE.

This entails that national level work on guidelines, policy and appropriate legislation to increase inter-sectoral collaboration between the various stakeholders in SSHE. This would also include research and development in SSHE such as technical designs, hygiene promotion techniques, to name a few issues.

Point 2: Review current situation at the most basic level in terms of practical as well as institutional issues.

Once a formed group has taken shape, one of the first tasks is to review the current situation to decide priorities for action. This might involve holding meetings with school staff, parents and other community members, and also carrying out research and data-gathering in the field

There is a continual need to review the current situation in terms of the practical as well as more institutional issues regarding SSHE.

Point 3: Prepare and implement micro plans as well as action plans which can be developed at the district level

The initial micro-plan and the eventual Plan of Action (PoA) define the rationale for the programme, the overall strategy, main actors and the financial allocations. It is an important document, but it is not sufficient to guide implementation. A plan is needed that details exactly how the programme will be carried out and who is responsible at each point. Thus, the PoA needs to be transformed into an interdisciplinary district work plan, showing activities, responsibilities, inputs and dates.

The district work plans should be prepared with sufficient knowledge of the local context, the local institutions and status of the schools. It is also important to prepare the district (or block) plan in consultation with all the groups that will be responsible. This ensures action and ownership

Point 4: Monitor and evaluate the existing SSHE programmes in terms of what has gone well and less well.

Monitoring should be an on-going activity in school sanitation and hygiene programmes. Monitoring is far more than collecting information to “see how things are going”. It is meant to improve programmes and activities over the short term. Monitoring involves checking, analysing and acting to improve a situation. The action should, of course, be taken at the lowest possible level, with cross checks to make sure that the situation has, in fact improved.

Point 5: Share experiences and lessons with others

Experiences that are gained should be shared with others. It is only by learning from experiences and sharing with others that one can build up a body of knowledge on effective SSHE. Some of the ways in doing this are as follows: prepare reports on SSHE projects which can be distributed to others; write an article on a SSHE project in one of the journals/newsletters focusing on this issue such as Notes and News (published for IRC); write a more detailed paper for an scientific/academic journal; prepare a case study using written information, video or slides on the project that can be circulated widely and be used in training courses; invite others to a workshop at the end of an activity where the results can be presented and the implications discussed; and finally undertake a presentation of a description of your project at a district, state level or national level or at a meeting.

Point 6: Develop stronger links between school sanitation and hygiene education and development.

There are major links between school sanitation and hygiene education and development. If SSHE continues to improve, various health, social and economic benefits will also accrue. Besides the number of deaths which would be avoided, children will have the chance for a better education. Increasing the number and standard of school latrine facilities would decrease the dropout rates especially for adolescent girls. Together, these improvement would also result in increased personal dignity and a greater sense of national pride.

Key References

Burgers, L. 2000. Background and rationale for school sanitation and hygiene education. New York., New York, USA: UNICEF.

Hubley, J. 1993. Communication health- An action guide to health education and health promotion. Macmillan Press. London.

Nokes, C., Bundy, D. 1993. Compliance and absenteeism in school children; implications for helminth control. Trans R Soc Trop Med Hyg: 87 (2); 148-152. March- April.

Snel, M., Ganguly, S., Kohli, C., and Shordt, K. 2002. School Sanitation and Hygiene Education- India. Resource Book. Technical Paper Series 39. IRC. Delft.

UNICEF and IRC, 1998. Towards Better Programming- A manual on school sanitation and hygiene. Guidelines Series. New York. http:www.irc.nl/sshe/resources/ch_intro.html

WHO, 1997. Primary school physical environment and health. WHO Global School Health Initiative. WHO Information Series on School Health: Document Two. Geneva. http://www.who.int/peh/ceh/links_resources.htm


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