WASH in Schools - a holistic approach for school sanitation and hygiene education in Kerala (India)

WASH in Schools - a holistic approach for school sanitation and hygiene education in Kerala (India)

Dr.Roy Kunjappy
Executive Director
Centre for Community Health Research
Sadanathil bungalow, Vettikavala, Kottarakara, Kerala, India.
E-mail:roycchr@satyam.net.in

Introduction

Kerala is a narrow strip of land located at the southern tip of Indian sub-continent, situated between the Arabian sea and Western Ghats. The total area of the state is barely 38,863 sq. km with 580 km of coastline. Kerala State has the second highest density of population (727 persons per sq. km ) among all Indian States. In per capita income, it ranks as one of the poorest in India. The State is generally classified as backward in terms of its poor industrial development and faltering production of foodgrains.

The remarkable achievements of Kerala in the field of health in reducing mortality and fertility and improving life expectancy have attracted the attention of health experts and social scientists world over. The population has rapidly declining rate of growth, a advanced literacy and education, a slowly reducing mortality rate and a high degree of population mobility. Low birth and death rates along with higher female sex ration and higher female life expectancy in population of Kerala is a unique phenomenon in developing countries like India. But on the other hand, the levels of rate of morbidity and nutritional deficiencies present a different picture. The low mortality-high morbidity syndrome in Kerala's health situation has got serious implications.

The co-existence of the diseases of poverty with diseases of affluence is the picture characterising the morbidity profile of the State. The dominant disease group comprises diarrhoeal diseases, gastroenteritis, dysentery, cholera, infectious hepatitis, malaria, worm diseases, typhoid, polio, rotavirus infections, E-coli infections, japanese encephalitis, dengue fever, conjunctivitis, weils disease and skin ulcers were identified as the common water-borne and water-related diseases in the area. In addition to this, emerging trends of HIV/AIDS positive cases have been a major threat to the health sector of Kerala.

In 1991 a study was conducted by Kerala Pollution Control Board in association with the SEU on the bacteriological quality of dug wells in Kerala. It was observed that "water in none of the open dug wells investigated is of drinking water quality standards" as prescribed by Bureau of India Standard. Since Kerala is the only place in the world having highest density of open dug well (250 per sq.km) and 50% of population used this as the only source of water for drinking.

Recently, Centre for Community Health Research ( CCHR), Kerala in association with the Govt. of The Netherlands ( DGIS) conducted an in-depth investigation on the causes of drinking water contamination and its possible impact and implications on the health status of the people in Kerala. It was observed that all drinking water sources in the areas including open dug wells, tube wells, municipal piped water supply (KWA) and public and private small tap water supplies to be found not safe for drinking and reported highly contaminated due to high percentage of fecal and total coliforms. Non-sanitary latrines, dumping of domestic wastes, lack of drainage facilities, proximity of dug wells and water sources, water logging environment, open defecation, lapses in drinking water disinfection and source protection were found to be the main causes of large scale contamination of drinking water sources.

It was observed diarrhoea (33%), gastroenteritis (30%), worm diseases (23%), typhoid (8%), cholera (2%), polio (2%), amoebic dysentery (1%) were identified as the main water-borne and water-related diseases in the area.The noted significance of the study was observed a "wide gap" in the awareness on safe drinking water, sanitation and hygiene promotion in the mindset of the people. Provision of safe and clean drinking water, decent sanitation facilities along with best hygiene practices will create a change in the attitude/behavior of the people. That will accelerate a reduction in the present morbidity pattern and to improve the quality of life of the people in the area to a great extent.

WASH in School -International, National and Local context:

Globally,1099 millions people lack access to safe water while in India, 125 million people lack access to safe water. Globally, 2600 million people defecate in the open where as in India, 700 million people lack access to sanitation facilities & resort to defecate in the open. Diarrhoea claims the lives of 2 million children around the world every year while one million children in India die of diarrhoeal diseases each year directly as a result of drinking unsafe water and living in unhygienic conditions India is one among the developing countries facing serious drinking water problems. It was reported that a major freshwater crisis is gradually unfolding in India as a result of inadequate water management and environmental degradation by human action. The objective of the programme is to raise consciousness about sanitation and hygiene, gain the commitment of political, social and opinion leaders around the world and, ultimately, bring about the structural and behavioural changes that will provide a permanent solution to this preventable international crisis.

WASH in schools continues to be a major problem in many countries contributing to high disease prevalence, poor learning environments and impacting on girls' education. Children should be seen as agents of change for WASH within their schools, communities and homes. While the need for effective policies and strategies and a solid planning, monitoring and evaluation framework were also highlighted during the session.While coordination among all the sectors involved is important cooperation is also critical to the success of school WASH programmes. There is a need to combine top-down with bottom-up approaches which can be translated into demand and promotes accountability with everyone concerned. In the mean time,scaling up is not only or primarily about construction. It focuses on behavioural change, personal hygiene, hygiene and sanitation in the school and in the home. The challenge we face is not just expanding SSHE in numbers or quantity, but in quality. Scaling up with quality means that every child - each girl and boy - will develop and continue to practice behaviours for safe sanitation, hand washing and personal cleanliness. It implies that each child develops life skills that will be sustained, as they become the next generation of adults.

In this context, Centre for Community health Research (CCHR), Kerala in India along with other stakeholders of the WASH- India is being undertaking this programme in selected schools in Kerala State called "WASH in Schools - a holistic approach for school sanitation and hygiene education in Kerala (India)" for a better hygiene behavior and healthy environment in schools.

Over all Objective:

*Schools are the ideal places of learning for children and they have a crucial role in the process of community development. Schools can be able to stimulate children for a behavior change. If there is adequate facilities on enough safe drinking water, sanitation and hygiene facilities in schools, children as well as teachers can act as role models of the society. This will definitely influence the communities for a better change in their attitude and approach.

*Involve Children as agents of change and not just beneficiaries. Targeting children benefits schools, families and communities and the can actively participate in social change movements.

*Political commitment, policies, strategies and planning frameworks are a prerequisite for scaling up school water, sanitation and hygiene education.

*Coordination alone is not enough, there is a need for cooperation and the establishment of effective partnerships for school water, sanitation and hygiene education.

* Building the capacity of local stakeholders considered as one of the most important element for the successful implementation of the programme.
* To provide better hygiene behavior and healthy environment in schools in order to improve the quality of life of the future generation.
* Conception and production of Information, Education and Communication (IEC) tools.
* Dissemination of knowledge at grass-root level is important for a change in the attitude of the people. So schools are the best place for a start.

Activities:
* Awareness will be given to school children on water-borne diseases like cholera, amoebic dysentery, gastroenteritis, diarrohoeal diseases, typhoid, hepatitis, polio, viral infections, ascariasis and schistosomiasis. Further, intensive awareness will be provided to children on the causes and prevention on water-related diseases like malaria, filariasis, japanese encephalitis, dengue fever, yellow fever, trachoma, scabies, conjunctivitis, skin ulcers and allergy.
* Awareness camps, symposia, seminars, children congress, water quiz, competitions, rallies, will be conducted in all selected schools as part of this programme. Selected children will be sent to State and National level competitions and incentives will be given to those selected.
* To constitute "WASH school committees" and "Eco-clubs" with the co-operation and participation of pupils, teachers, parent-teachers association (PTA) and school directors.
* Parent-teachers associations (PTAs), school directors, panchayats (PRIs) and other local stakeholders will be responsible for the construction of water supply and sanitary facilities in the respective schoolsalong with local stakeholder participation (Local self-governments (Panchayats),CBOs, NGOs, self-help groups and other grass-root organisations).
* Children's project/models based on safe drinking water, sanitation, hygiene promotion will be invited in children congress. Innovative projects will be selected for further studies.
* Try to implement environmental awareness/school sanitation/hygiene in school syllabus for a healthy school environment.
* Monitoring and evaluation of drinking water status, health status, sanitary status and hygiene behavior of children as well as the local communities through an epidemiological survey. Thus to understand the actual position of drinking water, health status, sanitary status, hygiene behavior of the children and the local communities in the respective areas.
* Evaluation on the impact of WASH Campaign in schools to be monitored periodically.
* Immunisation of children will be conducted against prevalent water-borne and water-related diseases.
* Simple disinfection methods of dug wells and available water for drinking will be demonstrated to children in order to reduce water-borne morbidity.
*Intense awareness will be given to mosquito eradication.
*Exhibition on models of sanitary latrines/sanitary wells/compost latrine/safety distance of dug well and water body will be conducted.
* During rainy season, medical camps will be conducted in rural and semi-urban schools as part of WASH Campaign in association with PHCs, CBOs, NGOs, Local Self-Governments (PRIs), civil organisations and other grass-root bodies in order to detect and prevent water-borne and water-related diseases. * Translate all the 9 WASH Posters of WSSCC- India Chapter in to the regional language (malayalam) for intensive campaign in schools.
* To design and produce a Handbook and a Resource book for schoolteachers for the safe use of drinking water, school sanitation and hygiene education. This provides practical guidance to safe use of drinking water, school sanitation and hygiene education practices.

Following are few other programme Modules of WASH in Schools:

(a) Sanitation - ways within our means: This illustrates various aspects of a "clean village" and a "unclean village". The clean village is depicted as the "heaven on the earth" whereas the unclean village as the "hell on the earth". In an unclean village, there is illustration of open defecation, water stagnation, waste accumulation, various sources of drinking water contamination in wells, ponds and other drinking water sources. While in a clean village, there is Water and Sanitation Committee (WASAN)/ Village Development Committee (VDC) for making decisions and for empowering the local communities. Further to depicts on sanitary latrines, compost pit, wastewater for kitchen garden, good hand pumps/ sanitary wells etc.

(b) Simple practices for a healthy life: This poster illustrates various means of hygiene promotion for a health life. Depiction of key hygiene behaviours include water handling, personal hygiene, safe disposal of human faeces, food hygiene, safe disposal of animal and solid waste, safe disposal of liquid waste and village sanitation. In water handling, pictures to explain the use of a safe water source for drinking water collection, keeping of water containers in home and the necessity of a ladle/tap/tilt to pour drinking water in order to avoid dipping hands in water. There are three pictures in personal hygiene to explain the benefit of hand washing. In safe disposal of human faeces, there are illustrations on sanitary latrine for defecation, disposal of child faeces and safe disposal of faeces if a latrine is yet to be built. Pictures on food hygiene depict keeping up of food in kitchen, cleaning of vegetables before cooking and how to cook pork meat etc. Illustrations on safe disposal of animal and solid wastes explained how to dispose animal waste away from a water body and a dwelling area, disposal of animal and other bio-degradable wastes in compost pit and safe disposal of non-degradable waste in the household environment. Safe disposal of liquid waste depicts how to raise a kitchen garden with wastewater from household, use of a soak pit to dispose wastewater and regular maintenance of drainage canal in order to ensure free flow of wastewater. There are three pictures to explain the various aspects of village sanitation, which include protection of water sources by avoiding open defecation and washing of animals near the source. Promotion of Village Committees, maintenance of village sanitation and regular cleaning are some of the main components of this section.

(c) The Facts and the Solutions: In this section, there is a comparison of Global and Indian scenario on safe drinking water, sanitation, hygiene and health. It was noted that globally, 1099 million people lack access to safe drinking water whereas in India it was 125 million. In terms of open defecation, 2403 million people in the world as a whole resort to open defecation while in India alone 700 million people lack access to sanitation facilities and defecate in the open. Diarrhoea claims the lives of 2 million children around the world every year but in India it was noted that 1 million children lose their lives to diarrhoea every year. Pictures to illustrate the solutions for the above said problems are safe drinking water, sanitary latrines and hand washing with soap.

(d) Timely Action Saves Lives - Treat Dehydration With ORS/SSS: Various pictures of this poster to explain how to prepare ORS and Sugar Salt Solution (SSS). Some of the very important points mentioned during the preparation ORS/SSS that before preparing ORS/SSS, hands, utensils and spoons should be washed by using any cleaning agent. The vessels containing the ORS/SSS should be covered and do not use the prepared ORS solution for more than 24 hours and SSS for more than 8 hours. Directions are given to those affected with diarrhoea should have a diet supplemented with fruit juice, butter milk, black tea with lemon, tender coconut water, rice or dhal porridge. Further, lactating mothers should continue to breast feed children affected with diarrhoea.

(e) Hand Washing -Washing away germs, preventing diseases: Hands are the body's feeders and cleaners and helping to eat and keep the bodies clean, including defecation. If hands do not wash at critical times, particularly after handling human faeces, fecal germs can be transmitted, leading to diarrhoeal diseases. There are pictures to depict what are the "Critical times" when hand washing should be practices. The pictures to explain the critical times mainly after disposing of child faeces, after defecation and anal cleaning, after washing children's bottoms, after agriculture work, after any cleaning activity, after children's play, before cooking serving food, before eating and before feeding children. Practicing hand washing can prevent diseases like diarrhoea, cholera, jaundice, typhoid, amoebiasis and skin diseases. Soap, ash, soap nut powder and soil can be used as cleaning agents for washing hands.

(f) Faecal - oral Transmission Route: Depictions on faecal-oral transmission route are faeces, flies/pet animals, fields, fluids (water), fingers and food. Illustrations are given to block the faecal-oral transmission route include using of toilet, proper hand washing, using safe water source and good handling practices, and adopting good food hygiene practices. Diarrhoea, dysentry, cholera, typhoid, polio, jaundice, gastroenteritis and intestinal worms are common diseases cause due to slight contact and transfer of germs from faeces.

(g) Kitchen Gardens: This session demonstrates uses of waste water from households and other sources for generating nutritious food. Pools of stagnant wastewater are the breeding grounds for mosquitoes that are the carries of many lives threatening diseases. Wastewater can be channeled to raise a kitchen garden where abundant nutritious vegetables and greens can be grown. Kitchen gardens can be raised near the sources of wastewater disposal. The ideal places include bathrooms, hand pumps, tap stands, sanitary wells etc. The benefits of kitchen gardens include the prevention of mosquito breeding, safe disposal of waste water, vegetables and greens add nutritious value to food by preventing malnutrition and promoting health, income can be generated from the sale of vegetables, vector-borne diseases like malaria and elephantiasis are prevented, and clean and green surroundings with better quality of life.

(h) Our Children are the future. Can we afford to exclude them: This is a message to the society and all stakeholders of the sector that children are the future and it is the responsibility to all to prevent the death of 2 million children every year due to water-borne diseases. Further to recall that it is the duty and responsibility of every body to provide access to water and sanitation facilities in all schools and enabling children to learn and practice their proper use and management. We can make a difference through education and awareness on the practice of hygiene behaviours to children and through them, to the community. Further, by making children active partners in all water and sanitation programmes at schools.

(i) Who is responsible? - "We" : Finally, the depiction on who is responsible for the pitiful situation on water, sanitation and health illustrates that nobody other than "we" are responsible to manage, maintain and operate the system. Capacity building by providing proper training will create an ideal situation for the problems.

Expected outcome of the project:

* 90% improvement in the hygiene behavior of school children and 80% improvement in the sanitary and drinking water facilities, resulted a noticeable change in the quality of life of the future generation.
* Best practices and experiences will be replicated and propagate in other areas.
* It would be a model of dissemination of knowledge at grass-root for a behaviour change.
* Resource Book and WASH posters in malayalam (regional language) would be valuable materials for future programmes in other schools in the State of Kerala.
* Environmental awareness in the minds of the children will create a sense of responsibility for a healthy environment not only in schools but also in households and finally in the society as a whole.
* Building the capacity of all stakeholders may create a momentum in the society as a whole on safe drinking water, improved sanitation and hygiene behaviour.
* Advocacy at local level may lead to a policy change at the State and National level with strong stakeholder participation.
* Information utilization would be a good tool for further course of action. Web-site information on various activities will be able to use for future activities and follow-ups.
* A considerable reduction in the morbidity pattern would be noticed and this will lead to the improvement of the quality of life of the local people as part of the global target of Millennium Developmental Goals(MDG)