School Sanitation and Hygiene Education (SSHE)

1. Introduction
2. About SSHE
3. Goals
4. Objectives
5. Benefits
6. Strategies
7. Key Components
8. Status of water and sanitation facilities in the schools
9. Issues related to water and sanitation in Schools in Bihar
10. Key Achievements
11. Lessons Learned
12. Key Impact
13. Challenges

1. Introduction

   The demand creation and provision of safe water and sanitation facilities is a first step towards a healthy physical learning environment. However, mere provision of the facilities doesn’t make them sustainable or produces the desired impact either. It is the use of the facilities that facilitates healthy living environment. In school, hygiene education aims to promote practices that will help to prevent water and sanitation related diseases. It will lead to healthy behaviour in the future generation of adults.
   
   Children are most vulnerable to environmental health hazards and are subsequently also the worst affected. Schools will partly determine children's health and well being by providing a healthy or unhealthy environment and by developing useful life skills on health and hygiene. Although water and sanitation facilities are being recognized as fundamental for hygiene behaviour and children's well being, in practice, many schools are confronted with extremely bad sanitary conditions. Conditions vary from inappropriate and inadequate sanitary facilities to the outright lack of toilets and safe water for drinking and sustainable hygiene practices. This even contributes to absenteeism and the dropout rates of girls.
   
   Schools can be a key factor for initiating change. Children are often eager to learn and willing to absorb new ideas. New hygiene behaviour learned at school can lead to life-long positive habits. Teachers can function as role models, not only for the children but also within the community. School children can influence the behaviours of family members - both adults and younger siblings - and thereby positively influence the community as a whole.
   
   The focus of the programme are Primary School Children because they are eager to learn at the early stages of life, they have important roles in household chores, they can become agent of change and they are ready for initiatives guided in the schools by the school teachers and their peer groups.
   
   A focus on school sanitation stems from the fact that children have a right to basic facilities such as school toilets, safe drinking water, clean surroundings, friendly environment and knowledge and information on hygiene. If these conditions are created, children come to school, enjoys learning, learn better and take back to their families, especially siblings, 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 away from all dropout of school which do not have toilet facilities.
   
   The major objectives of the project are to develop awareness of the school children about health, hygiene and sanitation, encourage school children to examine their environment critically and to act in a manner which would make it more hygiene and sanitary and to use schools as “education and information centres' for safe water, sanitation, health and hygiene which would link teacher to child, child to child, child to parent and parent to community.

2. About SSHE

   School sanitation and hygiene education is a comprehensive programme through which children learn and practice key hygiene behaviours, share it with their siblings and influence parents and the community. School children can spread important health messages and practices from school to home and are potential agents of change within their homes and communities. If they learn and practice good health knowledge and skills now and develop caring attitudes now they are likely to carry these forward to the next generation.

   Why is it important to focus on schools? After the family, schools are most important places of learning for children; they have a central place in the community. Schools are a stimulating learning environment for children and stimulate or initiate change. If sanitary facilities in schools are available, they can act as a model, and teachers can function as role models. Children are more receptive to new ideas and can more easily change their behaviour. They have important roles in the household, taking care of younger brothers and sisters.

    

   

3.  Goals

   School Sanitation and Hygiene Education is a comprehensive programme to ensure child friendly water supply, toilet and hand washing facilities in the schools and promote behavioural change through hygiene education. SSHE not only ensures child-right to have healthy and clean environment but also leads to an effective learning and enrolment, particularly girls and reduce diseases and worm infestation. The goals of SSHE are:

   • Better and healthy environment for children at schools for learning, particularly for girls
   • Increase in enrolment and retention, particularly of girls
   • Development of life skills among children
4. Objectives

   The main objectives of the School Health and Sanitation Programme are:

1. Generate hygiene awareness and demand among teachers and children in schools.

2. Create an environment, which will help to sustain the attendance of girls in school.

3. To introduce and promote behavior changes related to hygiene and health among children.

4. To promote optimum use of available resources for better health and clean environment.

5. To create an environment for attainment of child rights (Survival, protection, development, participation)

6. Reduce diseases and worm infestation among school children

7. Environmental cleanliness in and around the schools

8. Increase enrollment and retention, particularly of girl students

9. Promote quality and joyful learning

Focus on educational outcomes:

1. Contributing to increase in attendance
2. Contributing to quality education through
   •  Improved physical environment
   •  Hygiene linked to education process
   •  Strengthen school & community linkage
5. Benefits

   The main benefits of SSHE programme are:

   • Effective learning: Children perform better if surrounded by a hygienic and clean environment.
   • Enrolment of girls: The lack of private sanitary facilities for girls can discourage parents from sending girls to school and contribute to the drop out of girls, particularly at puberty.
   • Reduced disease and worm infestation: If school sanitation and hygiene facilities are absent, or are badly maintained and used, schools become health hazards.
   • Environmental cleanliness: Proper 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. Good health and sanitation contribute to a happy childhood.
6. Strategies
   • Children learn hygiene, practice and monitor
   • Capacity building and institutional strengthening
   • Inter-sectoral convergence
   • Community participation and ownership
   • Provision of sustainable water and sanitation facilities
   • Encourage innovation
   • Effective Hygiene education (classroom hygiene education by trained teachers
   • Establishing children as agent of change - changing themselves, family and the community.
   • School as resource Center and setting a model for change
   • Joyful learning methods – Child friendly

7.  Key Components

   Key components for Effective School sanitation and hygiene education in a school:

   1. Improvement in Healthy physical environment
      • Availability and Use of water and sanitation facilities
      • Availability and use of hand washing facility
      • Some kind of protection fencing around the school
   2. Improvement in learning Environment
      • Hygiene promotion activity (regular health check up, rally, painting etc) including hand washing before mid day meal
      • Teaching learning material including hygiene linked to curriculum activity in use in school
   3. Improvement in Community School linkages
      • Child cabinet trained and actively promoting hygiene practices in families
      • PTA/MTA/ VSS meets regularly and
      • Monitoring board on hygiene practices regularly updated with involvement of children and the teachers contribute s in school development

8.  Status of water and sanitation facilities in the schools

   In Bihar 8635 schools (17%) still do not have safe drinking water facilities. About 81% (excluding NPS) of the schools have toilet facilities. When it comes to separate toilet for girls the situation is even worse. When it comes to separate toilet facility for girls, around 47% schools (excluding NPS) have separate and functional girls’ toilet. Even where the facilities exist, are so poorly maintained or in state of despair or are so few in number, that most children do not use them. Growing girls have to endure this hardship; this often results in dropping out of school or absenteeism.

9.  Issues related to water and sanitation in Schools in Bihar
   • Inadequate facilities
   • Unhealthy and dirty classrooms and school compound
   • Lack of hand washing habits and practices among children
   • Quality of construction of sanitation facilities.
   • Improper use and vandalism as most of the schools lack boundary wall
   • Inadequate or no water storage arrangements for hand washing and for use in toilet/Urinals
   • Lack of community participation and contribution to School Funds
   • Inadequate maintenance arrangements leads to Facilities falling into disrepair and quickly out of use
   • Locked school toilets and urinals

   Availability of latrines / urinals and safe drinking water has been perceived as a crucial requirement for primary schools in rural areas. Lac of sanitation facilities poses serious inconvenience for students and teachers, particularly girl students and female teachers. The high drop out rate, among girls, has been attributed to absence of water and sanitation facilities in the schools. Hence provision of water and sanitation facilities has been perceived as a key element in quality education. Presently, water and sanitation facilities are provided through various programmes and schemes, such as:

   • Sarva Siksha Abhiyaan (SSA)
   • Total Sanitation Campaign (TSC)
   • Swajaldhara
   • Accelerated Rural Water Supply Programme (ARWSP)

10.  Key Achievements

    1. Water and sanitation facilities in schools – installation & maintenance School Sanitation and Hygiene Education is combination of hardware and software. Therefore under hardware component water and sanitation facilities are ensure through convergence with different department and schemes. The SSHE is being implemented through the structure of BEP/SSA, therefore decentralized process is adopted. In every school school management committee is responsible for ensuring the facilities through convergence. Therefore Vidyalaya Shiksha Samiti (School management committee) were oriented and trained under SSHE programme for Installation of the facilities in the school.

    Source of funding for Water Facilities: BEP/ SSA and PHED Source of funding for Sanitation Facilities: BEP/ SSA and Total Sanitation campaign (nodal department PHED).

    Process adopted: Funds were leveraged from Total Sanitation Campaign and Accelerated Rural Water Supply Programme for construction of separate toilet for girls and boys and for drinking water facilities to concerned School Management committee through BEP And School Management committee ensure construction/ installation of sanitation facilties. Apart from that every government school in Bihar receives funds annually for School Development schools. On an average Rs.10000.00 - 12000 is provided to each school from SSA which varies as per number of class room at the school level. Efforts are being made to ensure use of such fund for maintenance of water and sanitation facilities at school level. Till date leverage funds for 20175 School toilets to BEP from TSC fund in 28 districts. Leveraged funds for 4087 hand pumps from ARWSP and hand pumps in all NPS from SSA for Schools. The coverage of school toilet has increased from 24% in 2004 to 79% in 2009 and presently in March 2010 it is 80%. We will continue to advocate 100% coverage as funds are available with districts.

    2. Software activity- Rolling out SSHE Package:

    From the beginning of the program to till present various approached / strategies used have undergone various changes and modification. Earlier we were following cascading mode of training, at present a total shift from cascading mode of training to Two days school based training program on all stakeholders.

    Though various method are being adopted to inculcate hygiene practices amongst children, but one of the novel method being adopted is a Two days package for Sanitation and hygiene promotion. The strategic initiative is under implementation in various districts of the state. This mode of promoting hygiene and building capacity of teachers, children and community has been adopted based on the learning that cascading mode of training dilutes the message and its quite time consuming to reach to children.

    Key elements of this model are as below:

    • The Two days strategic initiatives involves the participation of the teachers, child cabinet, meena Manch, Vidyalaya Siksha Samiti at school level.
    • It is shift from the traditional way of capacity building in cascading mode to field / school based activities, of which orientation is one of the components.
    • The approach adopted is simple, yet output oriented. All key players are sensitized and oriented on SSHE and their roles and responsibility are discussed and agreed based on which a school plan of action is prepared for follow up action.
    • All facets of development pertaining to school and children are discussed such as strengthening of infrastructure, how to generate resources and manage it , behavior change towards sustainable and regular use of hygiene practices.
    • The objective of initiative, basically, is to catalyze joint action by teachers, child cabinet and VSS members to play their roles efficiently with responsibility.
    • Trained facilitators have been engaged to facilitate the whole process.
      

    3. Excellent community, school and parent participation and decision making Process School is an

    At present Two days school based activity covered in 4646 schools.

    3. Eight Star Out put Monitoring system:

    A eight star monitoring system of SSHE has been introduced, which in essence emphasizes on 8 key components to cover health physical and learning environment and improvement in school community linkages. Each star represents one indicator based on which monitoring is done.

    Cluster Resource Centre Facilitator are under process of getting orientation/ regular reporting under the program in commonly developed format based on 8 star.

    4. Information Education and Communication (IEC) Materials:

    Communication has a lot to do in changing the knowledge, attitude and practices of school teachers and school children. Communication materials have a catalytic role in promoting knowledge related to health and hygiene. As part of the School sanitation and Hygiene Education programme, lot of IEC materials were developed and provided to the schools for the use of teachers, students and community. As various strategically change came under the program strategy therefore, a change in IEC Material also came. Earlier major IEC material developed was training module of different stakeholders i.e. VSS, Teachers and Child cabinet. Now a training module of Two days school based activity was developed consisting of complete package to orientation of stakeholder, WATSAN plan preparation and follow up action in one module.

    Apart from that four types of flex was developed to be used during school hour based on sanitation. Other IEC materials which are in use are:

    • Four type of Flex set
    • Oral Faecal Chart (Laxman Rekha Chart)
    • Flip Charts and Flash cards on Seven components of Sanitation
    • Books on School Sanitation
    • Supplementary Reading materials for Grade 1 to 5
    • Posters on Sanitation
    • School Toilet Design Guidelines

    5. Celebration of Global Hand washing and School Sanitation Month:

    For promotion of hand washing behavior among the children specially at the time of midday meal and after defecation this year district celebrated Global Hand washing day on 27th of October in all Schools of Bihar through active involvement of school teachers and children. This year on the eve of Global Hand Washing Day, One Month School Sanitation mo nth was celebrated from the period 27th October to 26th November 2009. All government schools of 38 districts were covered under the School Health campaign.

    6. Convergence :

    • Convergance with SSA:
      • A- Hardware:
        • Construction of Boundary wall through SSA: Boundary wall construction is done in schools through SSA. Therefore focus schools are covered under school with boundary wall. As availability of boundary wall is one of indicator for achieving 8 star school.
        • Installation of Hand pump in NPS
        • Construction of Exclusive toilet for girls and boys in all New Primary School.
        • Construction of school toilet in urban school

        

      • B- Software:
        • Operation and maintenance is a critical issue. Under SSA every government school receives funds annually for School Development Grant (SDG) on an average Rs.10000.00 - 12000 which varies as per number of class room at the school level. Efforts were made to ensure use of such fund for maintenance of water and sanitation facilities at school level. Till date instruction are issued to use the School development grant for hygiene promotion in 28 districts. An amount of Rs. 1700 / school are decided to be spent on hygiene promotion related work.
           
    • Convergence with MDM:

    Hand washing is one of the critical component of SSHE. Efforts are made to ensure convergence with Mid Day Meal Scheme of Central government. In few district (11 districts) decisions were made to ensure hand washing before MDM. But effort is required to bring it at grass root level.

    • 
    • Convergence with DWSC:
      SSHE is an integral part of Total sanitation campaign. Looking to the overall progress of program very less effort were made of hygiene promotion in school through the program. So far as agreement is concerned, DWSC is agreed to ensure SSHE activity in more than 6000 schools of 16 districts.

    Till date around 600 schools covered under hygiene promotion activity in schools through convergence with DWSC.

    7. Informed Advocacy  :

    • Advocated and facilitated establishment of functional SSHE Cell at state level and District SSHE Cell
    • Baseline Survey of all the schools completed, data analyzed and shared with all stakeholders and motivated to take initiative for providing facilities
    • Minimum package on SSHE developed, agreed and implemented in all the districts
    • Facilitated the District Orientation programme in 14 districts
    • Global Hand washing campaign organized in all 38 districts.

    8. Partnership Building and Convergence

    • Strategic partnership with NGOs: In Vaishali Sulabh International, ACE and other local 12 NGOs have been involved to construct school toilet in 1500 Schools. Apart from that School toilet has been constructed through various NGOs in 23 districts. In around 27 districts fund has been released to BEP for school toilet construction under TSC.
    • Menstrual Hygiene Management: Adolescent girls have been oriented on Adolescent Health and Hygiene in convergence with WDC (Women Development Cooperation). In follow-up of the training program Sanitary Napkin Production unit cum training centre has been established in Bidupur Block of Vaishali District. KGBV girls are oriented and trained on menstrual hygiene Management in selected KGBV of Gaya and Muzaffarpur district.
    • Convergence with SSA & PHED to scale up SSHE : In New primary schools, toilet construction and Hand pump installation took place through Sarva Siksha Abhiyaan. Apart from that all school will be provided with facility based on Infrastructure gap (boundary wall, play material etc.) at school level through Mukhya Mantri Samagrah Vidayalay Vikaas karyakram. Agreement with DWSC to leverage fund from DWSC for SSHE activity for around five thousand schools.
    • Organized four days Foundation course programme in partnership with CEE.
    • Joint capacity building program for TSC and SSHE coordinators.

    9. Quality Control System for school toilet construction 

    • Standardized toilet design (Double unit toilet, Single unit toilet separately for girls and boys) has been developed in coordination with SWSM and UNICEF and shared with all DSEs.
    • Site selection done by technical supervisors of SSA and ensuring participation of teachers, VSS, Children and MTA/PTA. Site Selection form has been developed which are used at school level in order to select proper site.
    • Trained Masons on low cost / leach pit toilet technique are available at district level to ensure quality construction and supervision of school toilets
    • Engineers of SSA and PHED are involved in verifying and ensuring school toilet construction as per the norms and design

    10. Knowledge Management

    • Organized successful 4 days Foundation Course sharing information with the district and state stakeholders along with 25 State Resource Group.
    • Joint refresher training of SSHE and TSC coordinators
    • Conducted Exposure visit to Gaya to learn form the School Sanitation programme implemented
    • Facilitated successful visit of British Cultural Minister Ms Jowell to see SSHE in Gaya
    • Participated in Joint Review Meeting of GOI & UNICEF and disseminated the information at state and district level
    • Video documentation of SSHE programme in Vaishali Bihar (Jagriti).
    • Exposure of District level stakeholders to Chennai. 

    11. Capacity Building

    • Mainstreaming teachers training module on SSHE in existing in-service training (11 days UJJALA III teachers training )
    • Training modules developed and followed for capacity building of Teachers, VSS and Students
    • Developed State Resource Team of 25 people to support scaling up SSHE in all the districts
    • 158 Teacher Coordinators trained to provide awareness among teachers of their districts
    • Two days teachers training programme on SSHE completed for 4000 schools
    • One day orientation of VSS members completed in 4000 schools
    • 1500 schools have functional MTA
    • The Prime Minister, Sanitation Minister and other members of Bal Sansad are being been trained on Sanitation and hygiene practices at school level.

    12. Innovation

    • Involvement of Child Cabinet in hygiene promotion activities at school level.
    • Effective use of wastewater through gardening in school.
    • Training of Adolescent girls on adolescent health and established Sanitary Napkin Production unit cum training centre.
    • Provision of Water quality testing in schools and alternative drinking water source i.e. Rain water harvesting structure (RWHS)
    • Bihar Education Project Council (BEPC) initiated a survey to ensure all newly recruited teachers have toilet.
    • Demonstration of low cost household toilet at adolescent girl’s houses of disadvantage community who participated in Kishori Mahotsav 2007.
    • Conversion of Normal HP into Force and lift hand pump for ensuring water for hand washing and water inside the toilet unit

    SSHE is a combination of hardware and software. During implementation of the SSHE it was observed that use of toilet depends on various factors, but the major reason came up for that was non availability of running water inside the toilet unit. Therefore looking to the findings of the field experiences a new intervention was designed, i.e. up gradation of water facility – Conversion of normal HP into Force & Lift Hand pump. This help in ensuring running water inside the toilet unit and also hand washing facility exclusive for boys and girls. This intervention was supported by Unicef in 954 schools. Future plan is to ensure convergence with other line department i.e. SSA/ PHED.

    • Retro fitting in school toilet for CWSN: As per secondary data around 1-2% of children are CWSN. Therefore looking to scenario, innovative intervention was done. i.e. Retro fitting in school toilet. This a input through which little modification is done in the toilet unit, i.e. installation of horizontal and vertical grab bars in toilet and urinal of each boys and girls to provide handholding support while using the school toilet. This is intervention to ensure CWSN friendly toilet. This innovative intervention was done in 869 schools.
       
    • One day Sanitation based orientation of CWSN during Summer camp: During summer vacation SSA has organized special summer camp for CWSN children. SSHE has made innovative convergence with SSA to orient CWSN children on hygiene and sanitation. Hardware input was also made. i.e retro fitting in existing school toilet was done for them to make CWSN friendly sanitation facilities. Total 2254 children were covered out of 29 districts.
11.  Lessons Learned
    • The success of school sanitation programme depends on effective teachers training and involvement of children, teachers and parents.
    • Urinals are used more than the toilets.
    • Unless there is sufficient water in the toilet, it can not be kept clean.
    • The enthusiasm generated by Nirmal Gram Purashkar motivated Panchayat representatives for improvement in Education.
    • Boundary wall/Protection wall in schools provides security to school facilities.
    • Cascading mode of training is time consuming and the convergence of action between school teachers, VSS and School children requires additional effort. Joint planning of school based activities by VSS, Teachers and students is an effective tool.
    • Convergence of technical and education team crucial for success in creating ownership
    • Children’s right to participation is expressed in the form of child cabinets.
    • SSHE is proving to be gateway for broader community level sanitation.
    • Integration of hygiene promotion with school activity crucial for sustained change
    • Convergence and inter-sector coordination between different departments bring synergy.

12.  Key Impact
    • Increased attendance of children in schools.
    • Strong school-community linkages
    • Demand for toilets at the household level increased.
    • Usage of home toilets increased
    • Children’s forums are empowered
    • Clean children and clean schools

     

13.  Challenges
    • Operation & Maintenance of water and sanitation facilities
    • Need additional infrastructure as number of children increases in school
    • Orientation of Child Cabinet and institutionalization of such training needed to rooted in the school system
    • Community ownership of SSHE elements is a long drawn process.