SWASH+ Program
A model of School WASH
Date, May 8Th 2012
Presenter: Sam Ombeki
About Safe Water System (SWS)
 A water quality intervention at point of use (POU).
 Does not require skills, redefined as an inexpensive
means of providing safe water in areas lacking
safe water supply – typical in rural communities.
 Has three components namely;
1. Water treatment
2. Safe storage
3. Behaviour change
 SWS with adequate sanitation and good hygiene,
the health outcomes are even greater.
SWS: Goal
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Goal: To achieve sustainable improved health
status of vulnerable communities with special
focus to children under five years old.
Broad Objective: To contribute to the reduction
of diarrhoea diseases due to unsafe water, low
sanitation and poor hygiene practices.
Linkage: Goal is linked to CARE’s mission & MDG
by targeting the poor communities.
SWS: Background
 Inception in Kenya dates back to 1999.
 Initial design – learning cum development
program implemented by CARE in partnership
with CDC as the technical advisor.
 Program grafted on a CARE WatSan, WASEH
 An impact evaluation conducted by CDC
showed a risk reduction of diarrhoea illnesses
by 56% amongst households using SWS
SWS: Implementation stages
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Products – dosage standardization, branding,
safe storage modification & IEC materials.
Field trials – products placement, social
mobilization, marketing and capacity building
Evaluations – selecting evaluation cohorts,
monitoring adoption, evaluating impact
Dissemination – results from evaluations shared
Expansion – strategize for scale up approaches
SWS: Expansion/Scale up
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Partnership model: Rigorous efforts in Nyanza &
elsewhere through NGOS & CBOS.
Clinics model: Piloted at Homabay hospital and
later expanded to Siaya and presently in more
than 100 health facilities (Nyanza)
Schools model: Piloted in one school, expanded
to 70 schools and replicated in more than 300
schools by SWASH+ Program (Nyanza).
The School Model: SWASH+
• What: SWASH+ is a five-year applied research project
• Goal: To identify, develop, and test innovative approaches to schoolbased water, sanitation and hygiene in Nyanza Province, Kenya
• Partners: CARE, Emory University, the Great Lakes University of Kisumu,
the Government of Kenya, the Kenya Water for Health Organisation
(KWAHO), and Water.org (formerly Water Partners International)
• Where: Research and implementation conducted in Nyanza Province,
Kenya
SWASH+ Impact Assessment
Schools
Why School WASH?
• At baseline, approximately 49% of
schools provided drinking water to
pupils
• Only 11% provided water for
handwashing.
• In schools selected, there were 79.5
pupils per latrine on average (GoK
ratios are 25:1 for girls, 30:1 for boys)
The Questions that Led to the
Project
1.
Do school WASH interventions
reduce absenteeism and
illness?
2.
What impact do school WASH
interventions have on the
community?
3.
How can school WASH
interventions be sustained and
brought to scale?
But SWASH+ goes beyond
knowledge for knowledge’s sake
• Overall goal points to
scaled-up and sustained
implementation of school
WASH in Kenya
• SWASH+ was designed with
three components: direct
implementation, applied
research, and advocacy
The Three Components Of
SWASH+
• The 3 components
- Direct implementation
- Research
- Advocacy/collaborative
learning
Direct implementation
Research
• Direct implementation and
research were started first
• Advocacy and collaborative
learning were incorporated
later
Advocacy/Collaborative Learning
Project Timeline
March 2010
February 2012
Soapy Water Study completed
Mid-term Assessment completed
Project
complete
June 2010
Petition letter to MoE
November 2010
Jun 2007
September 2009
Latrine Maintenance Study completed
Baseline completed
MoU signed with GoK
August 2008
Sep 2006 - Aug 2007
Yr 1: Research & Impl.
Sep 2007 - Aug 2008
Yr 2: Research & Impl.
Sep 2008 - Aug 2009
Yr 3: Research & Impl
Sep 2009 - Aug 2010
Yr 4: Research, Impl. & Adv.
September 2006
September 2010 - February 2012
Yr 5: Research, Impl. & Adv.
February 2012
August 2009
WASH intervention in 300 schools completed
Sep 2009
Final Impact Assessment completed
Major Accomplishments
• Implemented “base package” of water
treatment and hygiene promotion in 300
schools and 31 health clinics
• Constructed 1,227 latrines in 153 schools
• Constructed 23 boreholes and 92 rain
water harvesting systems
• Conducted de-worming in 185 schools
• Overall about 120,000 pupils have been
reached through direct implementation
Major Accomplishments cont’d
• Together with the Ministry of Education,
undertook a pilot of the KESSP Direct
Funding Model.
– Trained DICT members from 3 districts on
the School Infrastructure Program &
WASH
– Conducted WASH training for zonal
technical committees (3) and head
teachers, school infrastructure
committees, and patrons in 18 schools
– Conducted research on the
effectiveness of the model, including the
effectiveness of roles, monitoring, and
budgeting
Major Accomplishments cont’d
• Conducted controlled quantitative
studies in 185 schools and surrounding
communities, in addition to qualitative
studies, on numerous topics, including:
Quantitative Studies
Qualitative Studies
Mixed Methods
•Impact
•Sustainability
•Diffusion of behaviors
from school to home
•WASH knowledge,
attitudes and practices
•Washrooms
•Rainwater Harvesting
•Soapy water
•Anal Cleansing
•Menstrual Management
•Girls’ Urinals
•Latrine Maintenance
•KESSP Process
•School WASH Budget
Allocation
•School WASH Service
Delivery
•School WASH
Accountability
Findings
• We found some
answers to the three
questions we started
out with
1. Do school WASH interventions
reduce absenteeism and illness?
• Yes ! Girls’ absenteeism reduced substantially in
intervention schools near a water source that
received hygiene and water treatment
interventions. In two geographic clusters studied,
absenteeism was reduced by 55.5% from
baseline levels among girls (equivalent to 6.1
days less of absence per year).
• These impacts are due to relatively low-cost
changes such as soap and water for hand
washing and treated drinking water, where water
access already exists
• Significant variability in results may indicate
impact is highly dependent on leadership at
school level
1. Do school WASH interventions
reduce absenteeism and illness?
• Improved access to school WASH
can also have a significant impact
on the prevalence and intensity of
soil-transmitted helminth infection
• Children attending intervention
schools experienced a 45%
reduction in the odds of the
prevalence of heavy infection of
Ascaris
2. What impact do school WASH
interventions have on the community?
• There is a modest but statistically significant
influence of school WASH on behaviors in the
household. It is one of several factors that have an
impact on household behavior
• For example, those having seen a friend, family
member or neighbor use WaterGuard are more likely
(2.2 times greater odds) to use it, as well as those
having discussed it with a child (1.4 times greater
odds)
3. How can school WASH
interventions be sustained and
brought to scale?
Sustainability is elusive: While 87% of
schools provided drinking water in a
surprise visit after 3 years, only 27% had
treated it; while 55% had hand washing
water, only 8% had soap available
111 Intervention
Schools
(Incomplete data on 4
schools)
HW containers:
75 schools
(68% of all schools)
Water available:
61 schools
(55% of all schools)
Soap Available:
9 schools
(8% of all schools)
Potential Barriers:
Broken containers? Broken taps?
No Supply Chain? Not a priority?
Potential Barriers:
No water source? Water not put
in containers? Not a priority?
Potential Barriers:
Stolen? Never purchased? No
Budget? Not a priority?
3. How can school WASH interventions
be sustained and brought to scale?
• School WASH must be implemented
in a holistic fashion in terms of:
– Infrastructure, behavior and attitudinal
change, and education at school and
community level
– An enabling environment of
accountability for results, adequate
resources, supply chains, clear roles and
responsibilities
Infrastructure is the tip of the
Infrastructure
pyramid, not
the foundation
Supply Chains
Cultural Norms and
Behaviors
Systems of Accountability and
Support
Funding and Resources
Challenges: Budget
• According to SWASH+ research and
experience, there are serious
weaknesses in the current system for
example, in funding school WASH
• Evidence has shown that the budgets
provided for WASH are too low or are
diverted to other uses depriving the
pupils’ right to WASH while at school.
Challenges and Solutions: Monitoring
• Decentralized: District officials are too far removed from schools to
provide effective support. Zonal-level monitoring should be
considered.
• Integrated: Data collection and support from key ministries (MoE,
MoPHS) should be well-coordinated at the locational/zonal level,
perhaps within a single tool and set of indicators.
• Consistent: The same system should be used across schools and
regions to enable comparative decision-making.
• Supportive: Current monitoring is seen as policing. A new system
should move towards a supportive role, as school actors are often
stretched in managing services.
• Incorporating downward accountability: There should be a model for
downward accountability so that pupils or parents can grade the
quality of services received from school administrations.
Conclusions
• School WASH matters – it has demonstrated impacts
on absenteeism, health, and psychological
wellbeing
• It must be adequately resourced
• There must be a system of accountability for results
• There must be awareness of its importance and a
corresponding change in behavior
• It must be understood as a continuous system of
service delivery, not a series of one-off interventions
Thanks!
Please visit www.swashplus.org for more information