Sanitation & Hygiene In Sanitation & Hygiene In Basic Schools In GhanaBasic Schools In Ghana

The Links Between Sanitation in Schools and in The Links Between Sanitation in Schools and in HouseholdsHouseholds

BY BY JOAN AWUNYO-AKABAJOAN AWUNYO-AKABA

PRESENTATION OUTLINEPRESENTATION OUTLINE

Brief BackgroundBrief Background Problem StatementProblem Statement Study ObjectivesStudy Objectives Research MethodologyResearch Methodology Intervention ProcessIntervention Process RecommendationsRecommendations Conclusions Conclusions

BRIEF BACKGROUNDBRIEF BACKGROUND Thesis assessed S&H facilities in Thesis assessed S&H facilities in

basic schools. basic schools.

Focused on latrines, urinals, & potable Focused on latrines, urinals, & potable water use behaviours in schools. water use behaviours in schools.

Examined factors that promote or Examined factors that promote or constrain the sustainability of S&H constrain the sustainability of S&H practices in basic schools in Ghana. practices in basic schools in Ghana.

Brief Background (Brief Background (contcont)) Study - In the Ga West District/ Study - In the Ga West District/

Greater Accra Region, with a high Greater Accra Region, with a high rural profile (60%) (GSS, 2005). rural profile (60%) (GSS, 2005).

Basic schools in the study area are Basic schools in the study area are representative of over 60% of such in representative of over 60% of such in the rural communities makng up the the rural communities makng up the Ghanaian population (GPRS, 2003).Ghanaian population (GPRS, 2003).

PROBLEM STATEMENTPROBLEM STATEMENT Poor school sanitation and hygiene is Poor school sanitation and hygiene is

a major problem in developing a major problem in developing countries (IRC,2001).countries (IRC,2001).

General deplorable state of latrines & General deplorable state of latrines & urinals, lack of HW facilities, urinals, lack of HW facilities, inadequate and poor storage of inadequate and poor storage of drinking water & inappropriate refuse drinking water & inappropriate refuse disposal in schools .disposal in schools .

Problem Statement (Problem Statement (CONTCONT)) Huge investments made to improve schools Huge investments made to improve schools

S&H situation through CWSA have not S&H situation through CWSA have not brought about desired sustainable results. brought about desired sustainable results.

In Ghana, 31% of schoolchildren lack In Ghana, 31% of schoolchildren lack access to safe drinking water, whilst 78% access to safe drinking water, whilst 78% do not have access to good sanitation. This do not have access to good sanitation. This may contribute to poor hygiene behaviour may contribute to poor hygiene behaviour among schoolchildren (UNICEF, 2003).among schoolchildren (UNICEF, 2003).

STUDY OBJECTIVESSTUDY OBJECTIVES Explore & describe factors affecting Explore & describe factors affecting

sustainability of SSHE in basic sustainability of SSHE in basic schools in Ga West District - GRTARschools in Ga West District - GRTAR

Provide information for determining Provide information for determining factors that may promote or constrain factors that may promote or constrain the sustainability of school S & H the sustainability of school S & H practices.practices.

Specific ObjectivesSpecific Objectives Describe pupils’ perception of good Describe pupils’ perception of good

S&H in schoolS&H in school

Examined nature and methods of Examined nature and methods of teaching hygiene behavioursteaching hygiene behaviours

Examined extent to which facilities for Examined extent to which facilities for implementing and maintaining SSHE implementing and maintaining SSHE are made available to schoolchildrenare made available to schoolchildren

Specific Objectives Specific Objectives (cont.)(cont.)

Assessed children’s use of S & H facilities Assessed children’s use of S & H facilities provided at school & determine why & provided at school & determine why & when the facilities are used.when the facilities are used.

Examined systems that schools have in Examined systems that schools have in place for ensuring continued desirable place for ensuring continued desirable hygiene behaviours in school childrenhygiene behaviours in school children

Research Approach & DesignResearch Approach & Design

Cross-sectional descriptive study Cross-sectional descriptive study

Used varied methodological approaches Used varied methodological approaches for data gatheringfor data gathering

Different study populations to assess & Different study populations to assess & describe factors that may constrain or describe factors that may constrain or promote the sustainability of S &H promote the sustainability of S &H practices in basic schools. practices in basic schools.

Research Approach & DesignResearch Approach & Design(cont.(cont.))

This study is anthropological in its This study is anthropological in its

orientation as it tries to understand orientation as it tries to understand the S&H concepts and behaviours of the S&H concepts and behaviours of schoolchildren and the experience of schoolchildren and the experience of school authorities. school authorities.

SAMPLE & DATA COLLECTIONSAMPLE & DATA COLLECTION 10 schools (31%) with CWSA school latrine 10 schools (31%) with CWSA school latrine

facility randomly selected out of the universe of facility randomly selected out of the universe of 32 schools.32 schools.

246 randomly selected respondents from upper 246 randomly selected respondents from upper primary 4, 5 & 6; JSS forms 1 & 2 surveyed.primary 4, 5 & 6; JSS forms 1 & 2 surveyed.

4 FGD sessions - 52 discussants of male & 4 FGD sessions - 52 discussants of male & female students from same class levels female students from same class levels

In-depth interviews held with Head Teachers & In-depth interviews held with Head Teachers & SHC (20 respondents).SHC (20 respondents).

Observational checklist used to assess S&H Observational checklist used to assess S&H facilitiesfacilities

FINDINGSFINDINGS

Children’s Perception & ExpectationsChildren’s Perception & Expectations- Difficulty to demonstrate - Difficulty to demonstrate

understanding of good S&H conceptunderstanding of good S&H concept- Forgot about latrine and water use - Forgot about latrine and water use

behaviours.behaviours. - Environmental cleanliness only - Environmental cleanliness only

mentionedmentioned- Latrine and urinal facilities- Latrine and urinal facilities – – Clean not too Clean not too

pungent.pungent.

FINDINGSFINDINGS Roles Children Play Roles Children Play

-- Performed ALL S&H functions Performed ALL S&H functions

-- Guided by S&H prefects mainly. Guided by S&H prefects mainly.

-- Gender roles assessment - boys Gender roles assessment - boys did lessdid less

Findings (cont)Findings (cont)HYGIENE EDUCATION IN SCHOOLHYGIENE EDUCATION IN SCHOOL

Varied methods of delivery, & aspects of hygiene behaviours taught. Varied methods of delivery, & aspects of hygiene behaviours taught.

Non-uniformity of SSHE prog. contentNon-uniformity of SSHE prog. content

Lack of S&H learning materials and modelsLack of S&H learning materials and models

Lacked well-structured S&H ProgmLacked well-structured S&H Progm

Deficient knowledge of teachers on concept of S&HDeficient knowledge of teachers on concept of S&H

Chn-Chn- High knowledge level (92.6%) of hand-High knowledge level (92.6%) of hand-washing behaviour at critical timeswashing behaviour at critical times

Findings (cont)Findings (cont)Sanitary Facilities, Usage & MaintenanceSanitary Facilities, Usage & Maintenance Latrines (67.7% usage- 5.5% x3)Latrines (67.7% usage- 5.5% x3)

Urinals (40% Nil; 99% Usage)Urinals (40% Nil; 99% Usage)

Classroom Dustbins (90% Nil;)Classroom Dustbins (90% Nil;)

Anal Cleansing(50%’T’ Roll; 30% leaves Anal Cleansing(50%’T’ Roll; 30% leaves etc) etc)

Materials and sanitary cleaning materialsMaterials and sanitary cleaning materials (20% Nil). – Various levels of maintenance(20% Nil). – Various levels of maintenance

Findings (cont)Findings (cont)Hygiene FacilitiesHygiene Facilities Safe Drinking Water(82.8% Safe Drinking Water(82.8%

access, 41.4%shortages; 21.3% -access, 41.4%shortages; 21.3% -pure Hpure H22O)O)

Hand Washing (40% Nil; 88.4%yes Hand Washing (40% Nil; 88.4%yes to HWng soap & water)to HWng soap & water)

Soap (76.3%)Soap (76.3%)

Findings (cont)Findings (cont)Good Practices Identified Good Practices Identified

Commitment and co-operationCommitment and co-operation

Chn- Involvement & active participtnChn- Involvement & active participtn

Monitoring & support supervision of Monitoring & support supervision of chn by HT &SHCchn by HT &SHC

Maintenance of sch S&H facilities.Maintenance of sch S&H facilities.

Findings (cont)Findings (cont) Poor Performers of SSHE Poor Performers of SSHE TeachersTeachers lacked ability to review, lacked ability to review,

assess, and direct programmeassess, and direct programme Heavy teaching workloadHeavy teaching workload Inadequate resources for S&H Inadequate resources for S&H

facilities & activitiesfacilities & activities Lack of co-operation & support frm Lack of co-operation & support frm

peers to S&H prefectspeers to S&H prefects Latrines are not user friendly – Latrines are not user friendly –

difficult to clean.difficult to clean.

Findings (cont.)Findings (cont.)System for SSHE AssessmentSystem for SSHE Assessment

No system for M &E No system for M &E

Lacked clearly defined indicatorsLacked clearly defined indicators

Inability to assess SSHE prog impactInability to assess SSHE prog impact

Impact on childrenImpact on children

INTERVENTION PROCESS MODELSINTERVENTION PROCESS MODELS

Way forward for Establishing Systems for Way forward for Establishing Systems for SSHE and Identifying Indicators for SSHE and Identifying Indicators for Strengthening Programme & Measuring Strengthening Programme & Measuring ImpactImpact

- - 1- 1- Sanitation and Hygiene Behaviours Sanitation and Hygiene Behaviours Acquisition Process Model Acquisition Process Model

- 2- The Child’s Sanitation and Hygiene - 2- The Child’s Sanitation and Hygiene Behaviour Impact Process Mode Behaviour Impact Process Modell

-3--3- Sanitation and Hygiene Behaviour Sustainability Model

Fig. 1 –Sanitation and Hygiene Fig. 1 –Sanitation and Hygiene Behaviours Acquisition Process Model Behaviours Acquisition Process Model

Provides - Knowledge and skills that lead to Behaviour Capacity

Home/School Environment Provides Opportunity and Facilities for Cues & Triggers for Linking Theory with Practical Action

Provides -Observational Learning through Social Interactions

Child’s Behaviour Capacity, Adoption, Change and Behaviour Setting

Reinforcements •Direct Vicarious Reinforces Child’s behaviour selection Mastering Learning through skills Acquisition

Fig. 2 - The Child’s Sanitation and Fig. 2 - The Child’s Sanitation and Hygiene Behaviour Impact Process Hygiene Behaviour Impact Process

ModelModel

CHILD AS THE KEY

RESOURCE

a) Social Networks and Social Support

To School SSHE Program Focus on training children as Future Parents

f) SUSTAINABILITY OF PROGRAM’S IMPACT

Acquisition of Behaviour Capacity and Adoption

e) Individual Coping Resources - Developed by Child

Problems Solving Abilities Child UndergoesMental Development:

Eager to learn new concepts

See Environmental Care and Their Role As Important Takes Care of own health Health of Others

d) Physical Mental & Social Health Development

Active Participant in Developmental Process

c) Health Behaviours Preventive Health Practices – Build Child’s capacity at School for its acquisition through -Developmental Socialization Process -Child → Change Agent

Within Family Stimulus To Community Development

b) Community: Resources; Empowerment, & Competences of Key Players- to Guide & Develop Child’s Primary Socialization Process – Social Order e.g.

Household Roles Cleaning Caring for younger siblings

Etc.

Fig. 3 - Sanitation and Hygiene Behaviour Sustainability Model

2) Involvement of Community leadership:

- Build Community Capacity

1) SOCIAL NETWORKS &

SOCIAL SUPPORTMultiple Levels of Influence Pool of Committee Stake Holders Influential and Supportive of School Environment

4) Advocators for Effective SSHE Interventions: To Government /District Assembly, NGO, CSO Mass CommunicationsMediaSHEP Policy Change

3) Community ownership and control of Schools Environment - Keen oversight of school Management & Environment - Ensures schools have adequate Sanitation & Hygiene facilities always- Community education to promote Sanitation and Hygiene facilities at home to conform to that of the schools’

5 Conducive School Environment Full Complement of School Structures & Sanitation & Hygiene cues /triggers Well structured Sanitation and Hygiene Educational Programme Clearly targeted specific Sanitation and Hygiene behaviour for change. Capacity development of teachersActive media involvement for sustained Advocacy for School SSHE programme Employment of Trained Sanitation and Hygiene Labourers /Workers

6) CHILDPromotion of Developmental Socialization Sustained Sanitation and Hygiene behaviour Ability & opportunity to link Sanitation & Hygiene theory with practice. Acquisition of Behaviour capacity & Adoptions

Way ForwardWay Forward The Intervention Models have The Intervention Models have

identified factors likely to determine identified factors likely to determine behaviour changebehaviour change

Provide indicators for monitoring and Provide indicators for monitoring and evaluating the SSHE impact. evaluating the SSHE impact.

Guide to determine the extent to Guide to determine the extent to which changes in behaviour are which changes in behaviour are sustained over time.sustained over time.

RECOMMENDATIONSRECOMMENDATIONS

1)1) Improving SSHE Improving SSHE ProgrammeProgramme

2)2) Guide for SHEP Policy Document Guide for SHEP Policy Document FinalizationFinalization

3)3) Further ResearchFurther Research

1) 1) Improving SSHE Improving SSHE Programme- Short Term Programme- Short Term

Short-term i.e., 1-3 yearsShort-term i.e., 1-3 years Develop concept of good S&H in Develop concept of good S&H in

schoolsschools Strategies: Strategies:

-- Broaden S&H scope of Sch Chn Broaden S&H scope of Sch Chn

-- Expose chn to S&H optionsExpose chn to S&H options, ,

-- Exchange visits, tours / Exchange visits, tours / excursionsexcursions

Improving SSHE Prog Improving SSHE Prog (cont)(cont)

-- Use proposed modelsUse proposed models- - Trng, Prog Trng, Prog Imp & M&EImp & M&E

-- Equally involve both boys and Equally involve both boys and girls girls in S&H activities in S&H activities

- - collective development of collective development of hygiene hygiene behaviour capacity, behaviour capacity, adoption, and adoption, and change.change.

Improving SSHE Prog Improving SSHE Prog (cont)(cont)

Enhance nature & methods of Enhance nature & methods of teaching hygiene behaviours in teaching hygiene behaviours in school school - 1st - Assess knowledge & skills of - 1st - Assess knowledge & skills of

teachers on SSHE. teachers on SSHE. - 2nd - Identify or design appropriate - 2nd - Identify or design appropriate & cost-effective S&H trng materials & cost-effective S&H trng materials & models & models -- Review & develop IEC materials.Review & develop IEC materials.

Improving SSHE Prog Improving SSHE Prog (cont)(cont)

3rd - Promote innovative & appropriate 3rd - Promote innovative & appropriate methods of teaching S&H methods of teaching S&H

– – Adapt & UseAdapt & Use behaviour change behaviour change

communication modelscommunication models

Reduce teaching workload by teaching S&H Reduce teaching workload by teaching S&H during the holiday period. during the holiday period.

2)2) Guide for SHEP Policy Guide for SHEP Policy Document FinalizationDocument Finalization

Need for common goal, vision, mission, and Need for common goal, vision, mission, and objectivesobjectives

Give prominence SSHE Programme; & HaveGive prominence SSHE Programme; & Have Support supervision strategiesSupport supervision strategies Indicators for implementation, M&E & impact Indicators for implementation, M&E & impact

assessment.assessment. Maintenance, supply & replacement systemsMaintenance, supply & replacement systems Incorporate hygiene promotional intervention Incorporate hygiene promotional intervention

packages of inter-related actionspackages of inter-related actions Take cognizance of recent international targets Take cognizance of recent international targets

and recommendationsand recommendations Ensure programme uniformity for all schoolsEnsure programme uniformity for all schools

3)3) Further ResearchFurther Research

What policies for construction of school What policies for construction of school buildings and their facilities?buildings and their facilities?

Who plans or designs schools &Who plans or designs schools & Who Who approves?approves?

Why are structures commissioned without Why are structures commissioned without S&H facilities?S&H facilities?

Effects of children congregating without Effects of children congregating without S&H facilities?S&H facilities?

Any standards for school S&H facilities?Any standards for school S&H facilities? Who ensures adherence to all the above?Who ensures adherence to all the above?

CONCLUSIONCONCLUSION

““We see the active participation of We see the active participation of children: children actively involved In children: children actively involved In decision-making at all levels and in decision-making at all levels and in planning, implementing, Monitoring, and planning, implementing, Monitoring, and evaluating all matters affecting the evaluating all matters affecting the

rights of the childrights of the child”.”.

[A World Fit For Children: The Children’s Statement, UN General Assembly, May, 2002][A World Fit For Children: The Children’s Statement, UN General Assembly, May, 2002]

CONCLUSIONCONCLUSION

““Schools bring little influence to Schools bring little influence to bear on a child’s achievement bear on a child’s achievement that is independent of his that is independent of his background and general social background and general social context”context”

[James Coleman, 1964][James Coleman, 1964]

CONCLUSIONCONCLUSION

Strengthen the social networks and social support Strengthen the social networks and social support (fig. 4). To become catalyst to strengthen (fig. 4). To become catalyst to strengthen community involvement in promoting healthy community involvement in promoting healthy homes and schools’ S&H environments. homes and schools’ S&H environments.

Undoubtedly, children who are socialized with the Undoubtedly, children who are socialized with the ability and opportunity to link sanitation and ability and opportunity to link sanitation and hygiene theory with practice both at school and in hygiene theory with practice both at school and in the home would be raised.the home would be raised.

Then, Links Between Sanitation at Schools and in Then, Links Between Sanitation at Schools and in Households – WOULD BE MADEHouseholds – WOULD BE MADE

FOOD FOR THOUGHTFOOD FOR THOUGHT

““The child of today carries national The child of today carries national and international responsibilitiesand international responsibilitiesfor the world of tomorrow by ensuring for the world of tomorrow by ensuring that he will do all he can to make it a that he will do all he can to make it a better place than he met it. Yet the better place than he met it. Yet the child is helpless”.child is helpless”. [[Treading a Way to the Future; First Decade of GNCC (1979-1989)]Treading a Way to the Future; First Decade of GNCC (1979-1989)]