1. SWASH+ Program A model of School WASH Date, May 8 Th 2012 Presenter: Sam Ombeki

2. 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.

3. SWS: Goal  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.

4. 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

5. SWS: Implementation stages  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

6. SWS: Expansion/Scale up  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).

7. The School Model: SWASH+ What: SWASH+ is a five-year applied research project Goal: To identify, develop, and test innovative approaches to school- based 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

8. SWASH+ Impact Assessment Schools

9. 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)

10. 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?

11. 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

12. The Three Components Of SWASH+ The 3 components - Direct implementation - Research - Advocacy/collaborative learning Direct implementation and research were started first Advocacy and collaborative learning were incorporated later Research Advocacy/Collaborative Learning Direct implementation

13. Project Timeline

14. 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

15. 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

16. 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 Impact Sustainability Diffusion of behaviors from school to home WASH knowledge, attitudes and practices Qualitative Studies Washrooms Rainwater Harvesting Soapy water Anal Cleansing Menstrual Management Girls’ Urinals Mixed Methods Latrine Maintenance KESSP Process School WASH Budget Allocation School WASH Service Delivery School WASH Accountability

17. Findings We found some answers to the three questions we started out with

18. 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

19. 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

20. 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)

21. 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

22. 111 Intervention Schools (Incomplete data on 4 schools) 111 Intervention Schools (Incomplete data on 4 schools) HW containers: 75 schools (68% of all schools) HW containers: 75 schools (68% of all schools) Water available: 61 schools (55% of all schools) Water available: 61 schools (55% of all schools) Potential Barriers: No water source? Water not put in containers? Not a priority? Potential Barriers: No water source? Water not put in containers? Not a priority? Potential Barriers: Broken containers? Broken taps? No Supply Chain? Not a priority? Potential Barriers: Broken containers? Broken taps? No Supply Chain? Not a priority? Potential Barriers: Stolen? Never purchased? No Budget? Not a priority? Potential Barriers: Stolen? Never purchased? No Budget? Not a priority? Soap Available: 9 schools (8% of all schools) Soap Available: 9 schools (8% of all schools)

23. 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

24. Infrastructure is the tip of the pyramid, not the foundation Infrastructure Supply Chains Cultural Norms and Behaviors Systems of Accountability and Support Funding and Resources Cultural Norms and Expectations

25. 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.

26. 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. Challenges and Solutions: Monitoring

27. 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

28. Thanks! Please visit www.swashplus.org for more informationwww.swashplus.org