EXPERIENCES FROM CWSA IN THE
IMPLEMENTATION OF SCHOOL HEALTH
EDUCATION PROGRAMME (SHEP) IN GHANA
By: MRS. THEODORA ADOMAKO-ADJEI & EMMANUEL T NYAVOR
SOGAKOPE, 18/09/07
Outline of Presentation
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Programme background
Objectives
Achievements
Findings of a multi-country research
Challenges and the Way forward
Research Areas
Programme background
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The NCWSP has an objective to maximise
health benefits through integration of
water, sanitation and hygiene promotion
The CWSA has , as part of its intervention
strategies for improving Water Supply
and Sanitation facilities, a School Health
Education Component aimed at promoting
personal hygiene, environmental
cleanliness and nutrition in the basic and
second cycle schools.
Programme background
OBJECTIVES
 Develop adequate,safe and sustainable
water and sanitation facilities in schools in
order to improve health of teachers and
pupils
 To improve good hygiene and sanitation
practices in schools with the aim of
improving the health of teachers, schools
and families.
Programme background (contd)
CWSA collaboration with GES began in July 1994
CWSA interventions in schools include:
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Provision of institutional latrines (and handwashing
facilities)
Provision of water facilities (where applicable)
Training of District School Health Co-ordinators, Circuit
Supervisors, Headteachers & School Health Teachers
Training of school health committees
School hygiene competitions.
Research/studies.(KABP, Evaluation and sanitation study
Development & production of hygiene promotion
materials
Objective of Training School Health Committees
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Develop the capacities of teachers,
parents and food vendors in the
schools provided with water and
sanitation facilities and to outline
strategies for the integration of
educational activities that lead to
sustainable changes in hygiene
behaviour in the schools, home and
the communities.
Achievements
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Developed the curriculum on Water,
Health and Sanitation for Ist and 2nd
cycle institutions. (This has been been reviewed
by SHEP HQTS)
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Total of 2303 KVIP latrines constructed
from 1994-2006
Formed School Health Committees in
1556 schools
Trained 1556 School health Committees
Trained 3515 School health teachers
Training Outcomes
Most School Health Committees now receives full
support from Parent Teachers Associations (PTAs)
& Schools Management Committees (SMCs) in the
implementation of SHEP through the provision of
facilities such as:
- liter bins with covers
- dual purpose water storage facilities
- urinals
- school canteens
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Training Outcomes contd
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Most schools now have adequate and
hygienic drinking water storage
containers/ hand washing facilities)
A significant increase in the number of
pupils with individual drinking cups
A significant number of pupils now wash
hands with soap under running water
after visiting the toilet
School health committees ensure that
food vendors are medically certified and
sell food under hygienic conditions.
DIFFERENT WATER STORAGE FACILITIES DESIGNED
DURING TRAINING
PUPILS NOW WASH HANDS WITH SOAP UNDER
RUNNING WATER AFTER VISITING THE LATRINE &
BEFORE EATING
A PUPIL USING HER INDIVIDUAL DRINKING CUP TO
DRAW WATER FROM A RECEPTACLE IN A SCHOOL
Training Outcomes (contd.)
Training Outcomes (contd.)
Training Outcomes (contd.)
Challenges
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Problem of Ownership & Management of institutional
latrines (the schools do not have a budget for operation and
maintenance)
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Abuse and vandalization of school latrines (e.g. stealing of
vent pipes & taps on handwashing facility)
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Delays in payment of 10% capital cost contribution by
the schools
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High turn over of trained School Health Coordinators and
headmasters
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Inadequate hygiene promotion materials in schools
Challenges contd
Ineffective monitoring supervision by DA & GES;
resulting in:Shoddy work by some contractors
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AN EXAMPLE OF A SHODDY WORK DUE TO
POOR SUPERVISION
Challenges continued
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Lack of co-ordination among the stakeholders involved in
water, sanitation and hygiene provision
Some School Authorities and SMCs are not committed to
school sanitation and hygiene education activities
Absence or dormant school health committee
School authorities not adhering to latrine user education
(eg. alternate use of pits, putting all anal cleansing
materials into the pit)
An example of non adherence to user
education
Sustainability of changes in
hygiene behaviour
A multi-country study financed by the
EC and DGIS (2000-2003)
Study objective
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To asses the level of sustainability of behavioral
changes 1 to 3 years after a hygiene promotion
intervention.
Research partners
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Network for Water and Sanitation International
(NETWAS), Kenya
WaterAid Uganda
Community Water and Sanitation Agency, Ghana
Nepal Water for Health Organisation (NEWAH)
COSI-Foundation for Technical Cooperation, Sri
Lanka
Socio-Economic Unit Foundation (SEUF), India
London School of Hygiene and Tropical Medicine
German Agency for Technical Cooperation (GTZ)
IRC-International Water and Sanitation Centre
Key behaviours studied in schools
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Ten schools were surveyed for
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hygienic storage of water as seen through
observation,
skills in hand washing through demonstration,
knowledge about critical times of hand washing
and hygienic use and maintenance of
institutional latrines
Drinking Water Storage in Schools
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Hypothesis:
If there is a project intervention
in the community, then safe
water is available in the school
This hypothesis was not proven as
many schools were not having any
water storage receptacle and the
few available were empty.
Drinking Water Storage in Schools
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CONCLUSION:
JUST HAVING A PROJECT INTERVENTION IN THE
COMMUNITY IS NOT SUFFICIENT TO ENSURE THE
AVAILABILITY OF STORED SAFE DRINKING WATER IN
THE SCHOOL.
IMPLICATIONS:
Drinking water storage in schools not getting the
needed attention.
Children are most likely dehydrated and this is
contributing to their stunted growth and learning
abilities.
HANDWASHING FACILITIES
The assumption that schools would provide handwashing facility if the project provide latrine did not
hold. Only 2 schools out of the 10 had handwashing facility, water and soap near the latrine for
student use.
CONCLUSION
Schools failed to honour their part in the provision
of hand washing facilities after construction of
school latrines.
Demonstration on Hand Washing
techniques (N=440)
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66% of school children use soap on both hands
during hand washing.
Out of these, 63.5% of them rub both hands in at
least three different directions
CONCLUSION:
It is statistically proven that children in schools
where latrines were clean did perfect
handwashing demonstrations.
IMPLICATION:
Promotion of Clean Latrines and Hand
Washing Facilities Should Be Intensified In
Schools.
Latrine Use and Cleanliness
Hypothesis
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If there is a well functioning system of latrine
maintenance (cleanliness as well as physical
maintenance), then user rate by children is high.
Cleanliness and maintenance of latrines seems to
deteriorate over time.
Only 2 out of 10 schools have clean and well-used
latrine (ie free from puddles of urine, anal cleansing
materials and faeces on floor).
Conclusion
If School Health Committees are functional, they have
big
impact
on
hygiene
behaviours.
Therefore
strengthen SHCs and put in more resources for
monitoring their performances and functionality.
Lessons
1.In schools where the authorities are committed:
 Knowledge seems very good among children
 Latrines were clean and used
 Behaviours such as how to wash hands have been developed
 Teachers have instituted a system for maintaining latrines
 Periodic educational sessions are organised
 Food vendors have been screened, certified and sell under
hygienic conditions
 Drinking water cum handwashing facilities are available and
litter bins have been provided
Lessons
(continued)
2. Merely constructing water and sanitation facilities is not sufficient
to induce good hygiene behaviours. Hygiene promotion
/education are needed to achieve this
3. Successful hygiene education leads learners to develop and
maintain new health behaviours
4.School hygiene programmes can easily fail if training and follow
up are not made and if education authorities at all levels are not
involved.
Lessons
(continued)
5. Regular supervision, follow up and monitoring is
essential for proper operation and maintenance
6. Follow up and supervision is necessary to
sustain SHEP activities, and to ensure that
teachers apply the participatory tools that they
learn to use during the training.
The Way Forward
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Integrate School Health education into the initial teacher
training programme as a curriculum policy of the GES
Need for periodic capacity building for institutional latrine
contractors and school heath committees
The roles and responsibilities of the various stakeholders
involved in the school hygiene programme need to be
redefined by SHEP Headquarters
Foster collaboration between DWST, GES, GHS and other
stakeholders through regular inter-sectoral meetings
The Way Forward (contd)
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District Directors of Education should ensure that school
health committees are formed/reactivated in all schools
District SHEP Coordinators, Community Health Nurses and
Environmental Health Officers should play a more visible role
in monitoring cleanliness in schools and supporting teachers in
the teaching of hygiene
DAs and GES should provide adequate resources to the field
staff to ensure regular monitoring and supervision of water
and sanitation facilities in schools/communities
The Way Forward (contd)
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SHCs and Circuit Supervisors should ensure
that all schools have water storage containers
fitted with tap. (the practice of communal
hand washing in a bowl should be
discouraged)
There is the need to explore technological
options that could be more ‘child and genderfriendly’.
Possible Research Areas
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Investigating the sustainability of hygiene
behaviour changes in schools and communities
(this should be done in all the ten regions)
Assessing the impact of the use of children as
change agents in the beneficiary communities.
Assessing the filling rate of institutional KVIP
latrines
Investigating the suitability/user-friendliness of
Institutional KVIP latrines
Pathogenic safety test for ‘compost’ (decomposed
faeces from KVIP latrine)