The sustainability and impact of school sanitation, water and hygiene education in Kerala, Southern India

This study investigated sustainability and impact of school interventions for water, sanitation and hygiene education, four years after the end of the interventions. The study was carried out in 300 upper primary schools (for children aged 6 to 13) in the southern Indian state of Kerala. Half of these schools had a time-bound intervention which combined software inputs (training, supervision, joint planning, orientation, parent mobilization...) with hardware (construction of water, handwashing  and sanitation facilities).  This research shows that four years after the conclusion of the interventions, intervention schools had cleaner and better maintained facilities.  Compared with the non-intervention schools, children in project districts had more consistent hygiene practices (specifically handwashing), more accurate hygiene knowledge, and expressed greater satisfaction with the facilities. For the girl pupil, the programme appears to help those who are beginning to menstruate, which can be a difficult time for girls in school.   There is some indication of impact in terms of continuing institutional inputs, information flow into the home and better handwashing practices in the home. 

An area of particular concern is the use of soap.  At most two percent of the children used soap when washing hands, meaning that children lose most of the health advantage of handwashing.  Only one out of twelve children reported using a school toilet over the week preceding the study; compared to more than four out of five children who used urinals, perhaps reflecting the practice in much of India is to defecate in the early morning before leaving the home.  Nonetheless the degree of toilet use is not fixed or pre-determined; it does vary and there is evidence that boys in schools in all districts may still practice open air defecation.  In comparing the threehundred schools, there was no evidence that having a janitor is related to cleaner toilets and urinals.  However, schools with active health clubs had cleaner facilities, the more a likely direction of cause and effect. In the 569 small group interviews, children repeatedly said that they need well-maintained doors and latches for the toilets and inside the toilets they need a bucket, mug and soap. Further, urinals should have a roof protecting against rain and water that can easily run inside to wash out the urinary channels.  Teachers and NGO staff from the time of the intervention stated that supervisory and support visits to the school during and after the intervention improve the outcomes of the project. [authors abstract]

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