Group Handwashing in Schools - WASH stories from Philippines, Indonesia, Cambodia and Lao PDR

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Countries: Philippines, Indonesia, Cambodia, Lao PDR

Strengthening the evidence of Group handwashing in schools

Access to WASH in Schools (WinS) is a critical factor to promote school attendance, learning and health of children. The Fit for School (FIT) approach is an example of a WinS initiative, which aims to turn the school environment into a healthy setting by establishing a culture of cleanliness, hygiene and good maintenance. The approach stimulates healthy hygiene habits through the institutionalization of handwashing with soap and tooth brushing with fluoride toothpaste as daily school-based group activities. This requires effective collaboration between schools, local communities, Ministries of Education (MoEs) and other partners based on clear and transparent agreements.

The FIT approach originated in the Philippines where it has been implemented by the Department of Education as the Essential Health Care Programme. GIZ and SEAMEO INNOTECH are collaborating to expand the FIT approach to Cambodia, Indonesia and Lao PDR. The introduction of the approach during the ‘Research and Development phase’ (2012-2015) included a comprehensive programme assessment study comprising different elements. The focus of research was to evaluate the effectiveness of the programme interventions in creating a healthier school environment and changing hygiene habits of children. Moreover, implementation templates were developed to enable and support a programme scale-up through the national governments and other WinS partners.

A WASH survey was part of the research components, consisting of baseline assessments in 41 FIT model schools and the same number of control schools in Cambodia, Indonesia and Lao PDR. A modified version of the UNICEF WASH in School Monitoring Tool was used to collect follow-up data two years later (2014).

The survey revealed that before the programme started, all schools had limited access to handwashing facilities. And that the FIT programme brought significant improvements in access to water and soap in all three countries. All FIT model schools had on average 5 group handwashing stations with water and soap available, while 74% of control schools had no group handwashing stations. As a result, the average number of children sharing a water slot could be reduced to 4, 7 and 2 in the FIT model schools in Cambodia, Indonesia and Lao PDR, respectively; as compared to 68, 216 and 67 children sharing one water slot in the respective control schools. It was positively noted that FIT model schools even went beyond the intended programme activities and also built more handwashing facilities for individual use. As a basic principle, none of these improvements were implemented by third-parties, but rather by the schools and the school communities themselves.

To complement the WASH survey, a behavioural survey was conducted in Cambodia aiming to investigate possible changes in norms and practices for independent handwashing with soap (HWWS) after using the latrine. Observations in the schools showed that the practice of HWWS was generally better in FIT model schools: 28% of children washed their hands with soap when leaving the latrine, compared to only 3% of children in control schools – the main reason being a lack of soap in control schools. These findings highlight the importance of ensuring both, adequate access to hygiene facilities and availability of soap/water in schools so that positive hygiene behaviour becomes possible.

The research also looked into the status and usability of toilets, which was used as a proxy indicator to assess school cleanliness and maintenance in general. Toilets in FIT model schools had slightly better conditions in terms of functionality and cleanliness compared to control schools. The mean percentage of fully functional and clean toilets was 8%, 62% and 43% in FIT model schools, compared to 1%, 36% and 16% in control schools in Cambodia, Indonesia and Lao PDR, respectively. These findings indicate that the FIT programme improved the capacity of school principals, teachers and students in creating a healthy and clean school environment. However, there is still room for further improvement.

The programme will be joining forces with UNICEF and other agencies during the next programme phase in order to support the scale-up process in the respective countries. The development of government strategies, including the definition of minimum standards, will be guided by these and many other implementation experiences. The GIZ/UNICEF 3-Star Approach and the Fit for School Action Framework provide a concept for stepwise improvements of WinS infrastructure and programming; with the ultimate goal of reaching national standards.

Starting the WinS journey and experiencing that school communities can make a difference is most important: WASH in Schools is everyone’s business.

Key lessons of the story: WinS improvements are possible if simple, step-wise approaches are used and all stakeholders work together effectively.

Contribution to the SuSanA sustainability criteria

Promote Health and Hygiene Effectively: Daily group hygiene activities improve the broader culture of cleanliness

Technically appropriate including operations and maintenance: Parents and community members have an important role in advocating for WinS and keeping schools clean

Green Box / Summary: The Southeast Asian Ministers of Education Organization Regional Center for Educational Innovation and Technology (SEAMEO INNOTECH) and the German Organization for International Cooperation (Deutsche Gesellschaft für Internationale Zusammenarbeit; GIZ) have partnered to implement a school health programme in Southeast Asia based on the awarded Fit for School Approach. The approach aims to improve school environments and to integrate simple interventions, such as daily group hand washing, tooth brushing and bi-annual deworming into the school routine. The Fit for School Approach is implemented in elementary schools and in some countries also in day-care centres.

Project details

Type of project: School-based programme

Project period: November 2011 to November 2018

Start of operation: November 2011


Southeast Asian Ministers of Education Organization Regional Center for Educational Innovation and Technology (SEAMEO INNOTECH)

Bella Monse