Wash in School Manual (Final Draft)---[size:896Kb] - Ministry of Health

TABLE OF CONTENTS
CHAPTER 1: OVERVIEW OF SCHOOL HEALTH PROGRAMME ........................................................................ 2
1.1 School Health Program ...................................................................................................................... 2
1.2 School Health Services ....................................................................................................................... 3
CHAPTER 2: INTRODUCTION OF WASH IN SCHOOLS .................................................................................... 5
2.1 The WASH in Schools Concept ........................................................................................................... 5
2.2 Provision of safe water, sanitation and hand washing facilities ....................................................... 6
2.3 Faecal-Oral Transmission ................................................................................................................... 7
2.4 Five Benefits of Improved Sanitation ................................................................................................ 8
CHAPTER 3: WASH FACILITIES ...................................................................................................................... 9
3.1 Child friendly facilities ....................................................................................................................... 9
CHAPTER 4: FRAMEWORK FOR WASH IN SCHOOLS .................................................................................. 19
4.1 Planning and management of facilities ........................................................................................... 19
4.2 Operation and maintenance ........................................................................................................... 19
4.3 Collaboration ................................................................................................................................... 20
4.4 Connecting with the community ..................................................................................................... 21
4.5 Social mobilization ........................................................................................................................... 22
CHAPTER 5: HYGIENE AND BEHAVIOUR CHANGE ....................................................................................... 25
5.1 What is Hygiene? ............................................................................................................................. 25
5.2 Hygiene Education and Hygiene Promotion .................................................................................... 25
5.3 What motivates people to improve Hygiene? ................................................................................ 26
5.4 Key hygiene behaviours for school children .................................................................................... 27
CHAPTER 6: SOLID WASTE AND ENVIRONMENRAL SANITATION ............................................................... 34
6.1 Solid waste management ................................................................................................................ 34
CHAPTER 7: GUIDELINES FOR SCHOOL WASH FACILITIES ........................................................................... 36
CHAPTER 8: MONITORING AND EVALUATION ........................................................................................... 40
Annex I: Monitoring at the School Level ..................................................................................................... 43
Annex II: Monitoring at the class level ........................................................................................................ 44
Annex III: Monitoring at the individual student level .................................................................................. 45
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CHAPTER 1:
OVERVIEW OF SCHOOL HEALTH PROGRAMME
1.1 School Health Program
Globally it has been recognized that there is a critical link between health and learning, and the role of
schools in promoting life-long health and preventing health risk behaviors. The emphasis on schools is
because of its provision of a stimulating learning environment for initiating change and imbibing in children
healthy behavioural practices which they can apply for the rest of their lives. The school life is a period of
rapid growth and development that shapes the future of individuals, societies and nations. They are also
central places in the community and can influence practices throughout reach activities with students,
teachers and staff as agents of change.
As of April 2008, 166,409 children and adolescents attend school in 552 schools and institutes around the
country1. With gross primary school enrolment of 96%, school children form a significant portion of the
population and represent future citizens, parents and teachers of the country. It is therefore essential that their
health be protected and healthy practices be promoted so that everyone benefits. Recognizing this, the school
health programme in Bhutan was initiated in 1984 with financial and technical assistance of the World
Health Organization (WHO), with the main goal of improving the health status of the school children and
through them the community and the nation. The program has five objectives:
1. To formulate school health policies covering topics such as food and nutrition, water and
sanitation, substance abuse, adolescent reproductive health, counselling and provision of basic health
care.
2. To provide health services in the schools through training of teachers in rendering first aid. These
teachers are also provided with a limited list of over the counter medicines to treat minor ailments
and de-worming tablets, vitamin A and Iron folic acid tablets for mass treatment. Teachers are also
being trained to provide counselling services.
3. To encourage health promotion activities in the schools through both curricular and co-curricular
programs.
4. To facilitate the improvement of the physical environment of the schools by providing the
following basic facilities:
o Safe and adequate drinking water
o Clean and adequate urinals/toilets
o Washing and bathing facilities
o Proper and safe waste disposal
o School garden, plantation of trees and flowers around the campus
To enhance community involvement in health promotion by acting as agents of change in respect to
educating community members on health promoting behaviour. Some of the activities towards this are
organizing mass cleaning campaigns in the community, holding health rallies, enacting street drama and
imparting messages through students.
The school health unit was initially established under the umbrella of the Education Division, Ministry of
Social Services and was later merged with the Curriculum and Professional Support Section mainly to look
after the instructional part across the school curriculum and syllabi. The program is now with the Department
of Youth, Culture and Sports (DYCS). Every school and Dzongkhag are expected to establish their
1 MoE. General Statistics 2008. Policy and Planning Division, MoE, RGoB, Thimphu
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espective school health committees which in turn reports to the national school health committee
comprising of members from Ministry of Education and Ministry of health.
1.2 School Health Services
School health services are provided through appropriately trained teachers who are designated as school
health coordinators. They are the focal persons for carrying out all health related activities and in ensuring
that the school health committee remains active. The programme intends to further develop the capacity of
school health coordinators so that the following recommended health programs to be standardized and made
uniform for all schools, can be implemented by them:
a. General appraisal
• visual screening
• dental screening
• hearing screening
• growth monitoring and development
• micro-nutrient deficiency
b. First line treatment
• mass de-worming
• provision of iron supplement
• provision of iodine supplement
• minor ailments, cuts and wounds
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c. Record keeping and referral
A proper record and referral mechanism in all schools will be instituted so that individual student’s
health can be monitored and documented while at school. This will also help to generate data for the
evaluation of the programme. The school health card for individual students is being developed and
will be distributed to all schools.
d. Health Counselling Services
Provision of counselling services in schools has become very important with the increase in
adolescent-related health problems such as the rise in substance abuse, pre-marital and menstrual;
and emerging health concerns such as STD/AIDS. Considering the complexity of the nature of
adolescent problems and counselling being a specialized field, further training and development of
appropriate materials will be undertaken.
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CHAPTER 2:
INTRODUCTION OF WASH IN SCHOOLS
2.1 The WASH in Schools Concept
Water, Sanitation and Hygiene (WASH) programmes in Schools, earlier referred to as School Sanitation and
Hygiene Education (SSHE) aims to improve education and hygiene and sanitation practices of school-going
children and the quality of life of the children and their families, now and in years to come. As a result of the
International Year of Sanitation and the first ever Global Hand washing Day in 2008, countries are uniting to
find more workable and effective approaches for reducing WASH-related diseases. Providing adequate and
safe water, sanitation and hygiene education is crucial for achieving the Millennium Development Goals
(MDG) of achieving universal primary education, promoting gender equality, reducing child mortality and
most importantly in achieving the target (MDG 7) of halving the proportion of the population without access
to safe drinking water and basic sanitation.
Bhutan, like most developing countries face, a high burden of diseases related to water and sanitation,
causing increased morbidity and mortality especially among children. Diarrhoeal diseases continue to top the
list of morbidities year after year along with skin diseases, worm infestations and malnutrition2. It is
estimated that 88% of diarrhoeal diseases is caused by unsafe drinking water and inadequate sanitation and
yet many schools still lack basic facilities such as proper toilets, safe drinking water and basic information on
hygiene3.
Children’s ability to learn is also severely affected by inadequate water and sanitation facilities through
several ways. Recurrent diarrhoeal episodes and morbidity leads to increased absenteeism, helminthic
infestations leads to undernutrition which affects learning, chemical contaminants in the water such as lead
and arsenic can cause severe brain damage and impair learning, and poor school sanitary environment numbs
the learning process. Although these affect all children, girls are disadvantaged more in terms of learning
opportunities because unavailability of sanitary facilities may inhibit them from coming to school during
days of menstruation and ultimately may be a deciding factor for dropping out of school. While school health
programmes have been in existence for decades, integration of WASH in schools will ensure that schools
have decent toilets/latrines, a place to wash hands with soap, and safe water to drink. It includes the
provision of facilities that children need for sanitation, hand-washing and water supply and the support to
children to develop skills, attitudes and knowledge on effective hygiene. At the same time, children can
communicate their new behaviors and skills to their homes and communities and use it in future when they
have become parents themselves.
Therefore the main objectives of WASH in schools are to:
1. Create a healthy and safe learning environment
2. Help children develop knowledge, attitudes and life skills that support the adoption of good hygiene
behaviors and better health
3. Reach out to families and communities to stimulate safe hygiene and sanitation practices by all
community members
Besides construction of facilities, an effective WASH in Schools programme will require proper planning,
management, training and capacity building. Good coordination among institutions, participatory education
focussing on life skills and highly motivated teachers will further contribute to the success of this
programme.
2 Annual Health Bulletin 2009, Ministry of Health, Thimphu Bhutan
3 WHO (World Health Organization) (2004c). Water, sanitation and hygiene links to health. Facts and figures. WHO,
Geneva. Available at www.who.int/water_sanitation_health/publications/facts2004/en/index.html.
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2.2 Provision of safe water, sanitation and hand washing facilities
Forming consistent behaviours and attitudes is one
of the primary objectives of an effective WASH in
School programme. It is important that children
know about risks to their health and how to avoid
these risks. This means that the focus on sanitation
and water infrastructure must be combined with a
broader agenda that includes education and
consistent behaviours. Merely imparting education
and knowledge is inadequate; it must be
accompanied by an enabling environment such as
the provision of WASH facilities which are of good
quality and ensuring that they are used. If everyone
in the world had access to a regulated piped water
supply and sewage connection in their houses, 1863
million days of school attendance would be gained
due to less diarrhoeal illness. Schools with poor
water, sanitation and hygiene conditions, and
intense levels of person-to-person contact are high-risk environments for children and staff, and exacerbate
children’s particular susceptibility to environmental health hazards.
Realising the centrality of water and sanitation in the socio-economic development process of the country,
the National Drinking Water Supply Program was started jointly by the Royal Government (RGoB) and
UNICEF in 1974. The program, now known as Rural Water Supply and Sanitation (RWSS) program is with
the Public Health Engineering Section (PHE) of the Department of Public Health (DoPH), Ministry of
Health (MoH) but is consistently provided with technical and financial assistance from other international
agencies and relevant stakeholders such as Ministry of Education (MoE) and Ministry of Works and Human
Settlement (MoWHS).
In Bhutan more than 90 % of the population have access to a sanitary facility, 83 % have a safe water supply
and 73 % have a garbage disposal bin.4 The issue however is on the quality of these facilities and the
behavioural practices of the users. As stated merely providing data and statistics does not ensure good
hygiene and reduction of health risks. Similarly School sanitation has always been emphasized since the
early 80s and continues to receive high priority in all the plan periods. A baseline assessment of water and
sanitation facilities in schools was carried out in 20095. A total of 507 schools were surveyed which had
151,290 students enrolled at the time of study.
Water
% of schools with no piped water supply 6%
% of schools with water storage facility 67%
% of school with spring as water source 57.2%
% of functional taps (n = 7368) 69%
% of schools with assigned water caretaker 89%
Sanitation
% of schools with sanitation facilities 97%
% of functional toilets/latrines (n=3765) 88.4%
% of schools with assigned sweepers 9.2%
4 National Statistics Bureau. Statistical Yearbook of Bhutan, 2009. RGoB, Thimphu Oct 2009
5 UNICEF. A baseline assessment of Water and Sanitation Facilities in Schools (2009), unpublished report. MoE and
UNICEF
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There was no significant difference in water supply coverage for urban and rural schools. Of the 7368 taps
assessed for functionality, 31% were found to be non-functioning at the time of study with majority of the
schools reporting “broken tap” as the common cause for this. Water adequacy was assessed using PHE’s
guideline of 1 tap: 50 students and it was noted that majority of the schools were inadequate.
In terms of sanitation coverage, pit latrines were found to be the most common (51.7%). Sanitation adequacy
was calculated based on PHE’s guideline of 1 latrine to 25 girls and 1 latrine to 40 boys and here too the
results showed inadequacy.
Overall hygiene knowledge in schools was high but hygiene practice was limited, mainly due to the lack of
appropriate facilities.
2.3 Faecal-Oral Transmission
If pathogens from human faeces enter a person’s mouth and are swallowed, they will cause diarrhoea. If not
treated properly, it frequently leads to dehydration, which in turn can result in death for young children. The
pathogens can enter the mouth in a number of ways; these include:
Directly from person’s hands or fingers – if the hands are not washed after a person has defecated or the
hands come into contact with someone else’s faeces on the ground.
Food – pathogens are present in food, contaminated by flies which settle first on excreta then on the food.
Water – pathogens can enter body in water contaminated by faeces
Soil – if soil contains faces, pathogens can be transferred by hands not washed before eating or by crops not
cleaned or cooked properly.
Figure 1: Faecal-Oral Transmission
Preventing fecal-oral transmission of pathogens
The likelihood of diarrhoea can be greatly reduced by blocking the various faecal-oral transmission routes.
Good sanitation facilities act as the first barrier by preventing contamination of water, food and other
materials which are in contact with humans. Provision of adequate and safe drinking water along with good
hygiene practices acts as the second barrier. Good hygiene practices, particularly hand washing with soap,
serve as essential secondary barriers. For health to improve changes in hygiene behaviour are also needed to
break the cycle of disease transmission.
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2.4 Five Benefits of Improved Sanitation
In essence school health promotion is an investment in our future. The benefits of improved sanitation
include:
1. Effective learning:
Children learn and perform better in a clean and hygienic environment. Poor and unhygiene condition make
both teaching and learning difficult.
2. Greater gender equity and educational opportunity for girls and disabled children
The lack of separate private sanitation facilities for girls can discourage parents from sending girls to school
and contribute to the drop out and absence of girls. Girls and boys, including those with disabilities, are
likely to be affected in different ways by inadequate water, sanitation and hygiene conditions in schools, and
this may contribute to unequal learning opportunities. Toilets that are inaccessible often mean that a disabled
child does not eat or drink all day to avoid needing the toilet, leading to health problems and eventually to
their dropping out of school altogether.
3. Reduced risks for disease and worm infestation among children, staff and family
If school sanitation and hygiene facilities are absent, or are badly maintained and used, schools become
health hazards. Many schools serve communities that have a high prevalence of diseases related to
inadequate water supply, sanitation and hygiene (particularly lack of hand washing), and where child
malnutrition and other underlying health problems are common. By providing WASH, the disease burden
among children staff and their families can be greatly reduced.
4. Promotes Environmental cleanliness in school and community
Proper facilities will prevent pollution of the environment and limit health hazards for schools, families and
the community at large. Children who have adequate water, sanitation and hygiene conditions at school are
more able to integrate hygiene education into their daily lives, and can be effective messengers and agents
for change in their families and the wider community. Conversely, communities in which schoolchildren are
exposed to disease risk because of inadequate water supply, sanitation and hygiene at school are themselves
more at risk. Families bear the burden of their children’s illness due to bad conditions at school.
5. Children’s rights to health and education
Children have the right to be healthy and to have an education as enshrined in the constitution. Good
sanitation and hygiene practices contribute to less disease, better health and better nutrition. Children also
thorough the learning process imbibe healthy behaviour and contributes towards attaining life long positive
hygienic behaviour which can then be passed down from generation to generation.
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CHAPTER 3:
WASH FACILITIES
3.1 Child friendly facilities
The child-friendly approach to school hygiene, sanitation and
water aims to design, construct and maintain facilities that are
easy and pleasant to use by children and is part of the learning
environment. All children should be able to safely and
conveniently use toilet/urinal, wash hands with soap and water
and drink clean water in school. The facilities should be
acceptable, culturally appropriate and be sustained and
maintained by the school community.
The concept of child-friendly facilities incorporates the following:
Figure 2: Examples of special provision for children
• Facilities are interactive spaces that stimulate children’s learning and development. The information
received from the environment through visuals, smell and touch are important stimulants for
children’s learning and development. Based on the type of facilities they may develop either positive
or negative behaviors related to sanitation and hygiene. The facilities also require privacy and
sharing, which teach children about social behavior and all these are powerful tools for hygiene
education.
• Facilities have appropriate dimensions and adjustments for children. Some of the adjustments
required are weight and height of the doors, door knobs and latches, strength needed to open tap,
height of the taps, distance between the foot rest during squatting, diameter of the squatting hole, and
height of urinals. Another often ignored aspect is addressing the needs for children with physical
disabilities. When these adjustments have not been considered during the design stages, children face
obstacles in using the facility appropriately and as a result use it wrongly or worse don’t use it at all.
• Facilities encourage hygienic behavior by making facilities easily accessible, easy and convenient to
use and have enough capacity for the number of students. In addition other facilities such as
availability and access to soap and water for hand washing, and appropriate culturally accepted
materials for anal cleansing should be integrated with the other facilities.
• Facilities offer enough capacity and with minimal waiting time. The number of toilets to be
constructed will not only depend on the number of students and the ratio of boys to girls but also on
the timetable (recess to go to toilets when there is a rush), future growth of school population and
type of school (primary, middle lower or higher secondary school)
• Facilities should address the gender-related needs and roles. Since schools function as an example in
the community it is ideally located to teach gender roles through proper design and construction of
WASH facilities. The needs of males and females are different biologically and also because of the
different roles played by the two sexes, the knowledge and experience is different. Few examples of
gender specific facilities are location of the girls toilets (maintaining privacy without it being too
isolated), facilities for menstrual hygiene and consideration of urinals.
• Stimulate children’s learning and development, and ensure that education tools are designed in an
age-appropriate way. Learning should be interactive allowing children to put their new knowledge
and skills into practice.
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• Projects are designed with involvement of all. Rather than using standard designs rigidly, the users
especially the children should be properly informed and guided to be involved right from the
designing and planning stages. It has been found that by including the users throughout the different
stages, better solutions are arrived at and there is better acceptance and maintenance of the facilities.
• Look for low-cost solutions without compromising quality. Facilities should be affordable, durable,
encourage proper use, and are easy to maintain and keep clean. Building low cost facilities often
results in quality being compromised and leading to excessive maintenance and low usage.
Therefore better facilities may initially be more expensive but in the long run, it will be cheaper
because of less maintenance and there will be better acceptance and higher usage along with longer
life span for the facilities.
• Facilities do not harm the environment. Environmental sustainability should be an integral part of the
design, operation and maintenance of the facilities such as reducing risk of soil and groundwater
contamination. At the same time consideration must be given to improve traditional sanitation
facilities (drop and store latrines such as pit latrines) so that bad odour, unhygienic surroundings and
breeding grounds for insects are avoided.
• Have operation and maintenance plans indicating responsible persons/authorities and involving
parents, teachers, children and the community. By clearly delineating responsibilities for cleaning,
maintenance, provisions for materials and their costs will result in sustaining the facilities for longer
periods and also in ensuring that children imbibe these responsibilities and complimenting their
hygiene education.
• The location of the facilities are strategic and appropriate such that children feel secure to use it,
offers adequate privacy, is easily monitored and accessible during all times and every season (rain
and snow). The facilities also do not degrade the environment and is protected from indiscriminate
use and vandalism.
Figure 3: Ten strategies and
points for child friendly WSH
facility and their goals6
6 Zomerplaag J, Mooijman A. Child friendly Hygiene and Sanitation facilities in Schools: Indispensible to effective
Hygiene education. IRC & UNICEF, 2005
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When setting about participatory design,
implementation, and operation and maintenance
(O&M) processes, project implementers should take
into account the following considerations:
• It is often impossible for the entire community
to directly participate in the design,
implementation, and O&M process. When this
is the case, a hygiene committee that
represents not only teachers and students, but
also parents and possibly other stakeholders
such as the community leaders and primary
health care staff, should be created.
• Stakeholders should be informed about the sequence of the design process. Progress can be ensured
by structuring the entire process in clear phases and by informing stakeholders of the expected
outcome of each phase.
• Involvement of children is essential during the design and rehabilitation of water and sanitation
facilities in schools. Children have a different view of the world than adults and therefore experience
the use of facilities differently. Children can be frightened in situations that adults consider to be
safe.
• In most cultures, sanitation is a sensitive subject, so it is important to create an environment in which
children and adults feel free to talk about issues such as urinating, defecating, and menstruation.
Better results can be expected from an informal group session than from a traditional classroom
setup. To enable open discussion, women and girls can be separated from men and boys, and the
children can be separated by age groups.
• The technical drawings that are normally used for design and construction purposes can be confusing
to stakeholders because they do not illustrate how the facilities are going to look or function from a
user's viewpoint. To address this problem, perspective drawings and scale models should be used.
a. Design and technology for school latrines
The minimum standard for rural household latrine as set by the rural water supply and sanitation (RWSS)
sector policy is a “simple pit or drop latrine which does not allow direct contact between human waste and
the outside environment i.e. where human waste is not accessible to flies, has no objectionable odour and can
be easily kept clean”.7 For the schools the minimal acceptable standard is a VIP latrine, with one
compartment for every 50 users. In case of residential schools and monasteries, the minimum standard is one
bathing unit and one aqua privy toilet for every 50 users.
There are many types of latrines and some of the Common low-cost technologies include:
• Simple pit latrine
• VIP (ventilated improved pit) latrines
• twin VIP latrines (two alternating pits)
• Pour-flush latrine (single- or double-pit)
• Leach pits
• Septic tanks
• Urinals
7 MoH & E. RWSS Sector policy. RGoB Thimphu December 2002.
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Pit Latrine
This consists of a simple pit dug in the ground at various depths and then covered with wooden planks or
earth with a hole above the pit. People simply squat over the pit and defecate into the pit through the hole.
This is the most common type of latrine in the rural areas, and if it is well designed can serve as a good
sanitation facility with the advantages of being cheap, easily constructed, minimal maintenance and does not
require water. However poorly designed and constructed pit latrines produce unpleasant smells, breed
insects, are liable to collapse and may lead to chemical and biological contamination of groundwater.
VIP (Ventilated Improved pits)
This is an improvement over the simple pit latrine in that it is fitted with a vent pipe to take away the gases
emitted from the decomposed organic excreta and a fly screen over the pipe to prevent flies from entering the
pit. The hole over the pit can also be improved with a cover and also a pedestal or basin. Depending on the
number of pits, it can be single or double, the latter having the advantage of lasting longer and being more
eco friendly if properly managed.
Figure 4: Cross section of VIP toiltes
The VIP and twin VIP are particularly suitable for areas with water scarcity. Building the twin pit latrine is
more practical in areas where the latrines can not be rebuilt in another location when they fill up or where
there is no facility for emptying the pits. In this model, only one pit is used at a time, and when this gets
filled, its drop hole is covered and the other pit is used. After a duration of one-two years the content can be
easily removed and used as fertilizer. The important thing here is to know when to cover the drop hole and it
is usually covered when the pit is filled to 1 meter below the floor of the toilet.
Pour Flush latrine
In this type of latrine, there is usually a pan instead of a hole over the pit and requires water to flush the
excreta into the pit. The pan usually has a water seal and as shown in the diagram below which prevents flies
from the entering the pit and also prevents unpleasant odour from escaping. The pits may be simple or
ventilated. Depending on the design of the pit there are again different types such as leach pits, septic tank,
aqua privy etc, which are described briefly.
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Leach pits
The leach pit is the most important component
of pit latrines. Its structure and design allows
the liquid and gases produced from
decomposed excreta and other organic wastes
in the pit, to leach (seep) into the surrounding
soil and atmosphere. The walls of the pit/trench
are loose (gravel and sand) to enable the liquids
to escape readily into the surrounding soil as
shown in the figures below.
Figure 5: Cross section of a Leach pit
Septic tanks
Figure 6: Types of pits
The septic tank is a more expensive model and consists of a tank that receives all the waste. Inside the tank
the solids settle to the floor while grease, oils and lighter solids rise to the top forming a layer of scum. In the
middle layer lies the liquid portion where decomposition takes place through anaerobic action. However this
removes only about 40 % of the solids and as a result requires periodic removal to empty the tank.
Figure 7: Corss section of Septic tanks
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Aqua Privy
This is a type of latrine constructed over a tank containing water. Excreta falls through a pipe that is
submerged at least 75 cm into the water forming a water seal. To maintain this water seal at least a bucket of
water must be poured through the pipe to compensate for evaporation loss. Overflow pipe from the tank can
be connected to a soak away leach pit or trench or sewer. This type of latrine has low water usage but needs
to be emptied periodically (every 2-3 years) because the sludge is thick and concentrated.
Figure 8: Cross section of Aqua Privy
Figure 9: Urinal Design
Urinals
These are less expensive than latrines and are built in many schools. The social acceptability of the urinal for
older girls needs to be checked locally before construction.
Ecological sanitation: composting and dehydration
Ecological Sanitation or Eco-san is a revolutionary concept in
sanitation which is based on the implementation of reuse and
recycling of human faeces and waste water for the benefit of
agriculture. This methodology helps to reduce health risks
from improper sanitation facilities, prevents pollution of
ground water, utilizes the nutrients and water resources from
the waste in the latrines and prevents the degradation of soil
fertility.
The recommended facility is the double vault compost latrine
which is described below:
• The latrine is constructed over two water tight
chambers (vaults) which collect faeces. Urine is
collected separately through a pipe into a urine
storage chamber or drum. This is important because
the faeces collecting vaults must be relatively dry to
allow decomposition to take place naturally.
Figure 10: Cross section of Ecological Sanitation
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• The floor of the vaults are first layered with an absorbent material such as saw dust, shredded leaves
or ash and then after each use, the faeces is covered with ash or saw dust or shredded leaves or
mixture of these. A ventilation pipe can be attached to bring in fresh air into the chamber. Only one
vault is used at a time and when it is filled to about three quarters, it is filled to the brim with soft
soil, sealed and then allowed to compost over a period of one year. The second vault is then opened
and used till it is similarly filled, usually over a one –two year period. The first vault where compost
is formed is opened and its contents emptied to be used as fertilizer, after which the vault can be
reused. Similarly you can have two urine reservoirs to be used alternately (6 month periods) and
after diluting the urine with water, it too can be used as fertilizer.
This is suitable for areas with water scarcity and also where there is potential for ground water to be
contaminated. The main disadvantages are that the users must be all well educated on proper usage and
prevent the vaults from getting wet. It must also be culturally acceptable especially for using feces as
fertilizers.
b. Water supply facilities
The different types of water supply and drainage
technologies include:
• taps of different shapes and sizes
• Water stand posts as extensions of piped water
schemes
• Gravity-flow water system from a natural
spring
• Rainwater harvesting
• Connections to municipal water systems
• Soak away
• Drainage field and evaporation mound
• Water drainage to plants or trees
The water supply system should be designed in way to ensure that the source does not get contaminated.
Sometimes the school water facilities are connected to a municipal or other piped system which supplies
water irregularly or intermittently, has low pressures at peak hours of use or provides water of low quality. In
these cases, the school might want to consider the construction of storage tanks or alternative systems such
as rainwater harvesting. When no safe drinking water source is available nearby, there is a chance that water
intended for hand washing and anal cleansing will also be used for drinking. As this water is not always
clean and safe, children should be told about the risk of drinking from these sources and should have access
to a safe drinking water source.
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Water disinfection
Water disinfection is the removal, deactivation, killing of disease-causing organisms (pathogens). When
pathogens are not removed from drinking water, drinking water usage will cause people to fall ill.
Disinfection can be attained by means of physical or chemical disinfectants.
For chemical disinfection, the following disinfectants can be used:
• Chlorine
• Chlorine dioxide
• Potassium permanganate
• Hypochlorite
• Alcohols
• Bromine and iodine
• Phenols
• Bromine chloride
• Metals such as copper and silver
• Several acids and bases
• Ozone
• Hydrogen peroxide
For physical disinfection, the following are used:
• Ultraviolet (UV) - SODIS
• Electronic radiation
• Heat
• Sounds
• Gamma rays
Chemical inactivation of microbiological contamination in natural or untreated Water is usually one of the
final steps to reduce pathogenic microorganisms in drinking water. Combinations of water purification steps
(oxidation, coagulation, Settling, disinfection, and filtration) cause drinking water to be safe after production.
Water handling
Even when the water is safe at the source, it may be (re)contaminated during transportation, storage and
drawing at home. In all these cases safer handling of drinking water at the household level is of great
importance. Options for water treatment at point of use are:
The three pot system - This is an application of the principles that bacteriological contamination levels drop
over time and through settlement. Water is poured into the first pot, if available, through a piece of folded
muslin cloth. The water is allowed to settle for as many hours as feasible. Storing water for just one day can
result in the die-off of more than 50% of most bacteria. Longer periods of storage will lead to further
reduction up to 90%. This water is then poured into a second pot and this procedure is repeated for the third
pot from where the drinking water is drawn. This simple technique can be used easily, with limited resources
and is sustainable. However, some bacteria and other micro-organisms might remain in the water after
treatment.
Boiling - This is one of the best known techniques. The water must boil for at least 10 minutes in a ‘rolling’
boil which simply means that householders can actually tell that the water has reached a sufficiently high
temperature. Reaching 100°C for a few moments will kill most pathogens - most are already killed at much
lower temperatures. Pasteurization is effective when the water is heated to 70°C.
Limitations:
1. Boiling water is time and energy consuming making it difficult for poorer households to apply it.
Boiling water uses up fuel and gathering or buying firewood, kerosene, gas or other types of fuel has
an economic price.
2. Boiled water takes time to cool down and needs a safe place to cool down
3. It must be stored separately from un boiled water, so one needs separate containers
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4. There should be no risk of recontamination during storage and drawing
5. Boiling affects the taste of the water, although increasing the air content by vigorously stirring the
water, or shaking it in a bottle, after cooling will improve the taste.
Chlorination
Chlorine is greenish-yellow in its gaseous form and is 2.5 times heavier than air and is the most common
chemical used for disinfecting water. It is extremely corrosive so stored chlorine must be kept away from
organic chemicals, protected from sunlight, moisture and heat. It is a strong oxidizing agent that may be used
as liquid or gas. Chlorine mixed with water forms hypochlorous and hypochlorite ions. The hypochlorous ion
is a more effective disinfectant. It acts by destroying disease-causing bacteria, nuisance bacteria, parasites
and other organisms. Chlorination also removes soluble iron, manganese and hydrogen sulfide from water.
On the other hand, it does not remove nitrates from water and can cause bad smell and taste. To remove the
smell and bad taste due to chlorine, activated charcoal or charcoal filter may be used.
The effectiveness of disinfection using chlorine is determined by the pH of the water and takes place best
between pH 5.5 and 7.5. The effectiveness also depends on the chlorine concentration, contact time,
temperature, number and types of microorganisms and concentration of organic matter in the water. Chlorine
is highly water soluble (3L chlorine/1 L water) and to kill bacteria, the concentration of chlorine required is
0.2 – 0.4mg/L. Municipal nd health authorities should be contacted for their use.
Bio-sand/Slow sand Household Filters
It is a simple, cheap and effective means of removing disease-causing micro-organisms from contaminated
water. Slow sand filters contain very fine sand and usually function without chemical pre-treatment, such as
chlorination or flocculation. The presence of harmful bacteria, parasites and other micro-organisms is greatly
reduced through a ‘bio-film’. This is a biologically active layer in the top of the sand which creates an
environment where most pathogens (disease-causing organisms) cannot survive. The micro-organisms in the
bio-film consume pathogens as they are trapped in and on the sand surface; other filtration mechanisms
support the quality improvement. Slow sand filters are usually cleaned by scraping of the bio-film and/or the
top sand layer. In general, slow sand filters have filtration rates of up to 0.4 m/hour. However, it does not
adequately improve the quality of chemically contaminated water.
Ceramic Silver Impregnated filters
These filters are locally baked clay pots, where the inside is coated
with colloidal silver fluid. The ceramic filtering element is made
porous by mixing clay with a material burnt away during firing, such
as sawdust or rice husk. The element is impregnated with colloidal
silver which is a bacteriostatic ingredient that lodges on the pore
walls of the ceramic material and acts like a magnet on the bacteria.
The element is placed in a plastic receptacle with a faucet and
covered with a lid. "Raw" water is poured into the filtering element
that contains 8 litres, and then seeps through the pores thereby
producing potable water at a rate of 2 to 3 litres per hour. With 3
fillings per day, more than 20 litres can be produced. Cleaning is
done by scrubbing the ceramic element when the pores get clogged.
At the same time the receptacle should be cleaned to prevent bacterial
growth. Ceramic filters do not treat chemical contamination.
Figure 11: Ceramic silver Impregnated filter
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Solar disinfection (SODIS)- Clear plastic bottles filled with
contaminated but not turbid water are exposed to full sunlight for 6
hours (clear, non-coloured glass bottles also work). The technique
works through a combination of UV light and heating. In the rainy
season, the bottles may need to remain exposed for two or more
days. Householders must know this and adjust exposure to climatic
conditions and altitude. Turbid water needs pre-treatment. This
method is cheap and very effective but not suitable in all climatic
regions.
c. Hand washing facilities
Figure 12: Solar Disinfection
Handwashing with soap (or ash or clean mud) before
eating and after using sanitary facilities should be a
priority in schools. Soap or its equivalent—must be
provided and located where children can easily reach it.
Many schools may focus on avoiding water wastage,
especially in areas where clean water is scarce. For
example, schools can use a device that measures out a
fixed quantity of water. To avoid the spreading of
pathogens, water should be properly drained after each
hand washing. Without proper drainage, surroundings
become muddy, discouraging children from washing
their hands and attracting mosquitoes. Channeling
wastewater to flush urinals can help conserve water and
preserve hygiene.
Anal Cleansing
Figure 13: Hand washing methods
Social practices of anal cleansing in the community should be considered prior to establishment of the
facilities such as the anal-cleansing habits of people and designs of the sanitation facilities.
Anal-cleansing is necessary following defecation in order to remove faeces from the anal opening. Analcleansing
may be carried out using water alone (anal-washing), or dry materials used for wiping such as
paper and leaves. Poor personal hygiene by food handlers frequently contributes to outbreaks of food-borne
illnesses. Worm infections such as round worm (Ascaris lumbricoides), hook worm (Anclyostoma duodenal
and Necatar americanus), tapeworms and pinworm are also spread through poor hygiene practice. Handwashing
with hand-soap is particularly effective even when using contaminated water.
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CHAPTER 4:
FRAMEWORK FOR WASH IN SCHOOLS
4.1 Planning and management of facilities
Creating and working towards a successful WASH in Schools programme is more than just mere provision
of facilities. It is an investment in the future. It begins with planning based on the needs. Therefore it is
important to assess the situation and collect baseline data or information on the existing school structures.
The parents and the community should understand the value of the programme and be committed. Decisionmaking
and planning should be participatory. Children have a right to express themselves and to participate
in the projects that concern them. Community involvement may be achieved through participation in school
events, functions and contributions in the form of labour. If the facilities are to be accepted and used as
intended, then children, teachers and parents need to be consulted before construction to ensure that the
design of the facilities is child-friendly.
Planning of WASH facilities should involve the Ministry of Education (School Engineering unit), Ministry
of Health (Health engineering division), Ministry of Works and Housing, District engineering section, Local
municipal authorities, international agencies (UNICEF, SNV etc) and school representatives (teachers and
students). While the design and technical aspects can be planned and implemented, the management of the
facilities should be under a committee comprising of relevant stakeholders at the district and school level.
4.2 Operation and maintenance
Each school will need a plan showing how to use facilities and who will clean them, when and how. Such
issues need to be discussed with the MoE, teachers, children and parents. Where funds are available,
sweepers and janitors may be employed to clean and maintain the facilities, however where funds are
limited, schools should devise innovative means for the same. Some examples are by partnering with parents
and the local community or by entrusting responsibility to the school health club and the hygiene captains
(middle lower and higher secondary schools)
Children play a major role in the operation and maintenance of facilities and therefore need to be taught on
how to use the water and sanitation facilities in the school. This needs to be planned and supervised by the
teacher. Often older children help monitor and remind the younger children in schools.
Supervision may be taken up by health clubs or similar groups in the school to ensure proper use and
maintenance. Cleaning should be the responsibility of the janitors/paid cleaners as well as of the users.
Teachers will play a bigger role by ensuring both minor and major repair works are done on time and that
funds for operational expenses are budgeted for.
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O & M Activities
Operation
• Cleaning slab regularly with water and disinfectant
• Closing the latrine door
• Ensure drop hole is never covered
• Cleaning materials are available
• Non-biodegradable materials like stones, glass are not thrown in the
pit
Maintenance
• Check for cracks on the floor slab
• Ensure pipes and fly screens are not damaged
• Rainwater should drain away from the latrine
• Empty or cover old pit when full
• Dig new pit
4.3 Collaboration
Establishing and implementing a WASH in Schools requires active participation of a large number of groups
and institutions such as the government, NGOs, teachers and students at the school level, parents and other
community organizations.
In schools, health clubs can play a very important role in creating awareness about the importance of
sanitation and hygiene. Teachers and interested students can form a group and then develop criteria for
joining the club. They can take over the role of inspecting other students’ personal hygiene and homes for
qualification to join the club.
At the national level, relevant agencies such as the MoH, MoE and international organizations such as the
WHO and UNICEF have a major responsibility of ensuring that there is a national policy framework
supporting improved water and sanitation programs in schools. Whereas at the local level, coordination and
support is required from teachers, students and community for achieving and sustaining a health school
environment. The aim of this coordinated effort is to have in place a hygiene and sanitation policy that brings
together actions and resources at the national and local level under a single common framework.
The main stakeholders in a water and sanitation programme and their roles are outlined below:
Actor
Roles and responsibilities
School health clubs Club members can be role models for sanitation practice, use and maintenance of toilets
and urinals
Ensure participation of all students
Represent in various committees in the school related to sanitation, hygiene and health
Conduct extra curricular activities related to sanitation and hygiene with the help of
teachers
Teachers
To become role models by giving high priority to hygiene and sanitation in the school
and community
To encourage the activities carried out in accordance with the action plan through
follow up and evaluation activities.
To check whether students have been equipped with skill oriented education and have
translated the skills into their lives
To lay emphasis on constructing properly and maintaining facilities like toilets, waste
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School committee
Parents
Community
GYT
BHU
Dzongkhags
PHES, MoH
SPBD, MoE
pits, drainage and etc.
To assist groups/clubs in making annual work plan and conducting innovative activities
for promoting sanitation
Involve other stakeholders in mobilizing local resources and support activities like fund
raising, construction, maintenance and repair
Take a lead in coordinating and preparing action plan for school sanitation and hygiene
programmes
Encourage children to comply with the procedures for use and care of water and
sanitation facilities
Promote good hygiene behaviors at home
Support or actively participate in parent-teacher associations
Support maintenance of school facilities
Participate in community planning and monitoring workshops
Signing and enforcing written agreements between the community and dzongkhag
confirming commitments including labour contribution, management system,
maintenance fund contributions, and ensuring proper use of facilities
Assist in construction work and assist in collecting locally available construction
materials
Planning
Gup to act as resource person for community management committees
Mediate between two parties in case of conflicts over water use
Identify and communicating water supply and sanitation needs and problems to
dzongkhag authorities
Contribute to training community members
Provide health and hygiene messages
Support all community activities related to water supply and sanitation
Respond to geog level priorities and plans
Preparation and implementation of annual budget and plans
Monitoring of water quality
Technical and financial sanctioning
Regular progress and financial reporting
Plan and coordinate all Dzongkhag-based trainings
Formulation and implementation of appropriate strategies to support sustainable
provision of water supply and sanitation facilities
Coordination of water and sanitation programmes at the national level
Assist the Dzongkhags in design, material procurement, testing and development of
appropriate technologies
Support capacity building at central and dzongkhag level
4.4 Connecting with the community
The challenge is to make best use of the interrelationship between the school and the community for
improved sanitation and hygiene. Links with the community are important for many reasons:
• Improving school sanitation and hygiene makes no sense if most children cannot practice hygiene at
home.
• Children are in general highly motivated to improve conditions and practices at home and in their
communities and thus can be excellent catalysts for positive change.
• School events (e.g. parents’ days) and students’ assignments (e.g. simple surveys in their homes,
neighborhoods and community) are excellent opportunities to raise awareness and initiate
community projects on subjects such as environmental protection and improved water supply and
sanitation.
• Schools need the assistance of parents and local administrations (such as the Dzongkhag and Geog
authorities) and organizations to establish and sustain good facilities.
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• Other people in the community, such as the staff of water supply and sanitation programmes or
health staff, might be involved in organizing special activities and campaigns. Services which they
could deliver are:
o yearly treatment against parasitic infections,
o immunization of children in pre-school, and
o Promotion of iodized salt and foods rich in iron and carotene (vitamin A)
4.5 Social mobilization
Social mobilization is the process of bringing
together all social sectors to raise people’s awareness
of and demand for a particular development
programme, to assist in the delivery of resources and
services and to strengthen community participation
for sustainability and self-reliance.
The main objectives at the beginning of the
programme are:
• Mobilizing, group formation and training
• Awareness raising and promotion in the
community, including IEC (information,
education, communication) activities.
• building commitment to and understanding of WASH
Social mobilization can be done through:
• stimulating demand through household visits and public meetings about the need for and benefits of
water and sanitation facilities in schools
• assisting with planning exercises with local government officials and local leaders,
• assisting with training NGOs and government officials about social mobilization and management
aspects of the programme
• assisting in block coordinating committee meetings
Mobilization in a community usually begins with formation of committees, preparation of IEC materials,
planning & discussion on design and technology of the facilities and fund mobilization.
a. Committees
A working committee is usually needed for decision-making, finance and implementation. These committee
and school staffs are seen as a bridge between the school, outside organizations and the community. The
committee can be organized in many ways. It can be formed from an already existing committee or be
developed from an existing community based organization such as the DYT or set up as a new committee
that includes the head teacher, members of the DYT and parents or representatives from locally-active
groups. For the WASH programme to be successful, the committees need skills and understanding of the
major tasks at hand, therefore it is important that selection of members is done carefully.
b. Financial Management
Financial management and ensuring transparency are among the
more difficult aspects of community management. There should
be proper accountability on how allocated resources are spent.
This can be done in partnership with the school authorities,
DEO’s, MoE and international funding agencies.
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c. Training
Capacity building and training are important elements in social mobilization. A large number and wide range
of people require training on various technical aspects including management. Various methodologies may
be used for imparting such trainings such as role-playing, workshops, on-the-job learning and problemsolving
exercises. For children, life-skills based hygiene education allows them to apply the knowledge and
skills they have acquired into practice. However, schoolteachers need to be trained before they can
implement life-skills based hygiene education. In addition, training for teachers may focus on organizing the
students, using and maintaining facilities and making repairs.
d. Communication strategies
Information, education and communication (IEC) are
vital components of any programme and one that will
have the greatest impact. Therefore, IEC activities
and materials including the selection messages must
be planned and developed carefully.
Mass activities should be combined with face-to-face
contact, that is, interpersonal communication such as
for example, through home visits. It includes raising
awareness, advocacy and educational contents as
people can begin to learn about the reasons for the
WASH programme and the basic issues of hygiene
behaviour. Interpersonal communication is usually
undertaken by committee members from the school,
by local professionals and members DYT/GYT.
Finding out what the community and children
perceive and understand about the new programme
of water, sanitation and hygiene can become part of
the communication package to reach the community
and children. Finding out the reasons of different
groups of people for wanting this change can assist in
developing the messages for the different groups.
A variety of IEC activities for social mobilization
campaigns
competitions
exchange visits
wall painting/writing
street plays
folk media such as drama
interpersonal communication (house-to-house)
newspaper (depending on literacy status)
weekly market stalls displaying products/posters
poster/flip charts
songs /slogans
folk dance
cultural programs
Example:
• For fathers a reason could be that the family contribution for toilets and hygiene in schools will
improve the education and comfort of their children. It is not expensive.
• For mothers, a reason could be that their children will develop good habits and their girls will have
privacy of toilets in the school. This will bring a sense of
relief.
• For children, they will have ready access to water and
toilets. For girls especially, the hardship will be reduced
in terms of privacy availability.
These advantages can be transformed into simple, positive
messages, for example:
• Using a toilet makes the household look nice.
• When children use toilets, families enjoy good health,
respect and dignity.
Figure 14: Communication
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Delivering message to the target audience in the most effective way is very important. For example, fathers
may be more likely to attend school meetings. Mothers might be easier to reach through house-to-house
contacts or during community festivals. The PTA can also be useful in promoting health awareness among
parents, children and the community at large. This paves the way for effective two-way communication.
e. Social marketing
It involves the use of marketing approach to
match available resources with social needs. It
can be product or behavior-focused, is not based
on individual financial motivation alone but is
concerned with achieving a social objective.
The basis of social marketing is the four Ps:
• Product- such as a home toilet or school
toilet, or a change in behavior, such as
hand washing after defecation.
• Price– may refer to the price involved in
changing behavior.
• Place - the distribution channels used to
make the product, service, or concept
available to the target group.
• Promotion - range of channels through
which the campaign messages are
directed to the target group such as TV,
radio or traditional methods such as
plays.
Steps for programme communication
Some well-known steps for programme
communication borrowed from the concept
of social marketing are summarized below:
Decide on:
• The principle message
• The target audience
• The motivation (immediate
advantage and long-term goal)
• The promoter (child, teacher, health
worker)
• The tone of the communication
(e.g.: fun or serious
Applying the 'Four Ps' in your WASH programme
PRODUCT
Decide on what the product is, its form,
format, presentation, in terms of packaging
and characteristics
Product (tangible outputs): Home toilets.
Practice or behavior: Using and cleaning toilets,
washing hands after using the toilet.
Idea: Clean environment, good sanitation for
health/hygienic excreta management.
PRICE
Decide on what the consumer would be
willing to pay, both regarding direct and
indirect costs and what perception of benefits
that make the product worth getting
PLACE
Where will the product be available for the
consumers, including where it will be
displayed or demonstrated
PROMOTION
How will the consumers know the product
exists, its benefits, costs, and where and how
to get it
Monetary:
Cost of products (with or without subsidies).
Opportunity cost: Time lost from other activities,
missed opportunities, transport, and loss in production
or income.
Psychological or physical: Stress on changing
behavior, effort involved in regularly using toilet
instead of open fields, in maintaining toilet or in
obtaining additional water.
Delivery of product: Health centers, pharmacies,
households, clubs, DYTs, schools, women’s group
meeting place.
Delivery of message: Television, radio, newspapers,
posters, billboards, banners, folk singers or actors,
interpersonal/group counseling
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CHAPTER 5:
HYGIENE AND BEHAVIOUR CHANGE
5.1 What is Hygiene?
The word hygiene comes from the greek word hygieinos
which translates literally as “healthful”. In addition, a
number of definitions have been provided such as "clean,
good, safe behaviour for health", "health awareness",
"physical and mental cleanliness leading to better health
and environment", and "those who keep themselves and
their living area clean and avoid eating unclean food".
All of these answers are correct and point to a broader
definition of hygiene that is to encourage individuals to
practice most of the time, behaviours that will allow
themselves and others to live in a clean environment.
The key to good hygiene (and therefore good health) is
behaviour change. Handwashing, when done correctly, is
an important personal hygiene practice to prevent
contracting and spreading diseases. Good hygiene is not
determined by the number of toilets constructed; water
connections built or by what children know about
hygiene. Knowledge that is not applied to practices, leads
to failure. Changing risky practices to hygienic practices
is the ultimate goal of hygiene education and promotion.
5.2 Hygiene Education and Hygiene Promotion
Some Examples of Good Hygiene
• Taking drinking water from protected
sources like taps
• Keeping water pots covered when they are
not in use
• Going to the toilet at a safe distance from
water sources that are used for drinking,
cooking or other household purposes
• Ensuring animals are kept away from
houses, water sources and latrines
• Using a sanitary latrine instead of going to
the toilet in the bush
• Hand-washing with soap and water after
going to the toilet and before eating
• Making drainage channels or soak pits to
take wastewater away from water sources
and homes
• Washing fruit and vegetables before
cutting, keeping cooked food covered and
utensils off the ground
Hygiene promotion: This is the process of enabling people/children to adopt safe hygiene practices to
prevent diarrhoea and other water and sanitation related diseases. The methods of doing this are through the
provision of accurate, simple, positive, easy to understand and attractive messages, delivered through IEC
activities such as campaigns, games, story-telling, role-play, videos and home visits. Hygiene promotion
starts before water supply construction and involves collection of information on hygiene knowledge,
attitudes and practice in the community. The impact of the hygiene promotion may be evaluated after a
certain time period. 2008 being observed as the International Year of Sanitation served as an important
medium for hygiene promotion.
Hygiene education: This, on the other hand, relates to the provision of information and instruction on
hygiene, its benefits, health problems related to poor hygiene and how it can be prevented. The idea is that
when people understand and think together about their situations and practices, they can plan and act to
prevent diseases. One important actual situation for hygiene education is working with children within the
classroom wherein hygiene messages are incorporated into the standard curriculum.
Although there are overlaps between hygiene promotion and education, the latter in its narrowest meaning,
relates to giving instructions which does not lead to instilling lastingly improved conditions and practices.
Therefore hygiene promotion is preferred as it promotes good hygiene practices in a measurable and
sustainable way incorporating aspects of hygiene education in addition to other methods used to change
behaviour. Nevertheless, the purpose of both hygiene education and promotion is to bring about behaviour
change, leading to widespread adoption of safe practices related to sanitation and water so as to prevent
diseases like diarrhoea, skin and eye infections and worms (parasites). To bring about positive behavioural
change, it is important that children are convinced and believe that the healthy practices will lead to better
health, and that a larger group feels the same.
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5.3 What motivates people to improve Hygiene?
If people are to improve hygiene then they must first accept and then adopt healthy behavioural practices
related to water and sanitation. Merely providing information and repeating certain health messages will not
get the desired result. People must be motivated to change, not only as individuals but as a group and
community results in longer lasting change. There are many theories and models which have been proposed
to promote health and bring about behaviour change, two relevant and well known models are described
below.
Health belief model: This model is based on the fact that people, in general, are afraid of getting serious
illness and that certain behaviour is adopted based on the assessment of perceived threat of acquiring that
disease. In essence individuals conduct an internal assessment of the net benefits of changing their behavior,
and decide whether to act or not. The six aspects of the health belief model can be summarized as follows:
• Perceived susceptibility to disease (diarrhoea and other sanitation related disease)
• Perceived severity of the disease (dehydration, malnutrition, absenteeism, death)
• Perceived benefits of behaviour change (better health and learning in school)
• Perceived barriers to learning (availability of soap, water, latrine,)
• Cues to action (messages on good hygiene, supportive and trained teachers)
• Self efficacy (actual experience of good health and free from diarrhoeal diseases)
Hubley Model: This has some similarity to the health belief model, was originally designed for adults but
has been adapted for children. Essentially the model suggests that adults will change behaviour and practice
good hygiene:
• When he/she believes that the practice has net benefits for health and that this is an important benefit
• When the significant people around his or her environment also support and adopt the same practice
• When the enabling factors (latrines, water, soap, time) are sufficiently available
For children, the influence of key significant people around the child’s environment (parent, teachers, and
community leaders) and their support and adoption of good hygiene practices, as role models is perhaps one
of the most important factors in enabling children to practice.
It must also be recognized that there are many causes for people adopting certain bahaviors and these causes
can be categorised as predisposing factors, enabling factors and reinforcing factors. It is critical to identify
and select those factors, which on modification will bring about the desired change in hygiene behaviour.
The factors are listed below in respect to hygiene (although the same can be applied for any other health
behaviour)
• Predisposing factor: Knowledge, attitude, belief, values about good hygiene
• Enabling factors: (latrine, soap, water, ability, time)
• Reinforcing factors: teachers, family and peers practice same good hygiene, rewards for cleanliness,
good school health policies)
By doing this, interventions can be directed
towards the appropriate factor so that the desired
behaviour change can be brought about. The
introduction of life-skills based education for
school sanitation and hygiene education has
shown many advantages over the traditional
education methods. It seeks to combine the
essential teaching of hygiene principles with
children's developing experience of life at home,
at school and in the community. Through
participatory learning, the children acquire
knowledge, develop positive attitudes and,
critically, gain skills that enable them to improve
their own lives and those of their families and
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communities8. When they understand why good hygiene is to their advantage, they will act.
Improvement in hygiene behaviour alone has been shown to have a positive health impact whereas
improvement in water and sanitation facilities alone may not bring health benefits. Therefore, greater
emphasis needs to be put on improving hygiene behaviour, but the ideal situation would be one where
improvement in both behaviour and facilities can take place simultaneously.
5.4 Key hygiene behaviours for school children
a. Drinking safe water
Why is it important?
• Water from open source like streams, river, canal/channel etc., is unsafe for drinking, as it is prone to
contamination by animals and human beings.
• Drinking contaminated water causes diseases such as diarrhoea, dysentery, typhoid, cholera and
hepatitis.
• Even if water is collected from a safe source, it can get contaminated if it is not handled properly
while collecting, storing and using.
How should Drinking Water be collected, handled and stored?
• Drinking water should be collected from a safe source such as a taps and protected springs only
• The inside of a vessel should be cleaned well before collecting water.
• After filling the vessel with drinking water, it should be covered while being carried from water
source to the place where it is used
• Treating water at the point of use is an effective way of making it safe to drink. Treatment methods
include:
o
o
o
o
Point-of-use treatment using chlorine (chlorination) solution
SODIS (solar disinfection): fill clean 1.5-2 litre plastic (PET) bottles with clear water, place
on an inclined surface (roof) in the sun for 6 hours (48 hours if cloudy), water will be safe to
drink
Filtering using special ceramic filters
Boiling: heating water until a rolling boil begins. After cooling off, it is safe to drink if it has
been kept covered.
• To remain safe, water must be stored in clean containers with narrow necks, or covered with hard
covers or in jerry cans or other closed containers with spigots.
• To keep treated water safe, hands and other objects should not be put into drinking water containers.
A ladle or cup attached to the storage container or hung on the wall with a nail and only used for the
purpose of serving the water should be used.
b. Disposing off faeces safely
Why is safe disposal of human excreta important?
• Simple pit latrine spreads foul smell and is a breeding ground for insects and flies which act as agent
for spreading diseases. Pit latrines also contaminate ground water.
• Exposed excreta contaminate drinking water and are a major cause for epidemic including diarrhoea
and typhoid.
• Exposed excreta make children and family members vulnerable to deadly diseases.
8 Life skills-based education. IRC 2004
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• Safe disposal of faeces can reduce diarrhoea
• “Improved” sanitation facilities include toilets, pit latrines with washable slabs, pour-flush latrines,
and other models.
How can human excreta be safely disposed?
• The safest way of disposing human excreta is to use proper latrines for defecation, which are covered
and not open.
• Latrines must be flushed with water and cleaned regularly
• Faeces of small children and babies are full of germs and must be disposed of safely. Use potties,
dump into latrines, and wash potty and hands afterwards with soap.
• Children above two years should be taught how to use latrines.
• Households, schools, pre-schools, and other institutions, not having access to a pour flush water-seal
latrine, must be motivated to construct one.
c. Handwashing
When should we wash our hands?
• Before touching the eyes, nose and mouth
• Before eating or handling food
• After using the toilet
• When hands are contaminated by respiratory
secretions, e.g. after coughing or sneezing
• After changing diapers or handling soiled articles
when looking after young children or the sick
Steps for good handwashing
• Wet hands under running water.
• Apply soap and rub hands together to make a soapy
lather.
• Away from the running water, rub the palms, backs of hands, between fingers, backs of fingers,
thumbs, finger tips and wrists. Do this for at least 20 seconds.
• Rinse hands thoroughly under running water.
• Dry hands thoroughly with a clean cotton towel.
• Washing hands with water alone is not enough! Soap and rubbing helps remove germs.
• Ash or other cleansing materials can replace soap, if soap is not available
• In areas where water is scarce, it is still possible to practice washing hands with soap using “tippy
taps” — plastic bottles with holes in the cap and string attached to the top and the bottom that can
hang over a piece of wood or a nail and be tipped to pour water over hands and tipped back to stop
the flow.
d. Maintaining personal hygiene 9
Why is it important?
• Washing hands regularly with soap and water after defecation, before and after eating, cooking and
serving food can reduce the incidence of diarrhoeal diseases.
9 CSHP. Guidebook for Teachers (Life skills). MoE, RGoB, Thimphu Bhutan 2008.
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• Unwashed skin can result in skin diseases like scabies, eczema and ring worm.
• Not cleaning teeth regularly leads to cavities in the teeth, foul odour from mouth and tooth decay.
• Walking barefoot generally allows hookworm’s larvae to enter into the human body by piercing the
skin of the foot.
• Hair, which is not washed and combed regularly, becomes infested with lice, which suck blood from
the scalp. Lice are also very easily transferred from one person to another.
How can personal hygiene be maintained?
Bath
• Both hands should be washed with soap and water after defecation, before and after eating, cooking
and serving food
• Fingernails must be clipped regularly to keep them short.
• Both adults and children should clean their teeth daily.
• Bath should be taken daily preferably using soap, taking care to clean the eyes and ears.
• Hair should be washed regularly and combed daily.
• Clothes worn should be clean.
• While going out slippers/footwear should be worn to protect the skin of the feet from coming into
contact with parasites like hookworm.
• Hand or a handkerchief should be used to cover the mouth while sneezing or coughing.
• A good and thorough bath one or twice daily is important to maintain healthy skin and to prevent
infections of the skin.
• Use soap and water
• Important to wash off after games, exercise and work
• Dry with clean towel
• Change into clean underwear after bath
Nails
• Keep your nails short and clean
• Space in between the nail and finger can be good hiding places for germs which spread infections
Hair
• Wash your hair once a week with soap or shampoo
• Rinse well
• Brush/comb your hair daily three/four times
• Oil your scalp once a week preferably an hour before bath
Teeth
• Brush your teeth twice a day, in the morning and before going to bed
• Brush in a circular fashion ensuring that food particles stuck between the teeth and in the crevices of
the molars are removed effectively
Anal cleansing
Materials for anal cleansing are often forgotten and children use sticks, stones, leaves, etc. after defecating.
Throwing these solid materials into the sanitary system leads to unnecessary filling up of pits, decreasing
their lifetime considerably, and frequent blocking of water seals. To avoid this, appropriate cleansing
material or water should be available in each latrine. The material, if other than water, should be put on a
stand or be hung onto the wall to prevent it from being scattered on the floor and getting dirty. Used
cleansing material should be put aside in a special container. The collection and disposal of anal cleansing
materials has to be well organised to avoid unhygienic situations and contamination caused by flies, odours,
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etc. Containers have to be emptied and cleaned on a regular basis and the waste has to be disposed off
elsewhere, in a separate pit that will not allow it to come into contact with drinking water sources.
Male hygiene
Genital hygiene
A build-up of secretions called smegma can form under the foreskin of uncircumcised men. If you are
uncircumcised, gently pull back the foreskin when you have a shower and clean with water. You can use
soap if you like, but make sure you rinse it off well.
Body odour
Body smells are caused by a number of factors working in combination, including:
• Chemicals in sweat, including pheromones, which are made by the body and sexually attract (or
repel) other people.
• Wastes excreted through the skin, such as metabolized alcohol.
• The actions of bacteria that live on the skin and feed on dead skin cells and sweat.
• Unwashed clothes, such as underwear and socks.
Taking a bath once or twice daily will ensure that bad body odour does not occur. Use soap and water to
wash daily and change all inner garments daily after bath.
Female Hygiene
What is menstruation?
Menstruation is the normal shedding of tissues and blood from the lining of the womb through a woman’s
vagina. This process takes place about once a month during a woman’s reproductive years. Menstruation is
also called monthly bleeding, menses, menstrual course, menstrual period, and period.
Menstrual hygiene
A girl needs to keep her vagina and surrounding area clean at all times but especially during periods.
Otherwise she may have infection, itching, and burning and bad odor. A girl should practice the following
during this period:
• Bathe daily with warm/cold water. Washing is important. There need be no taboo about bath on
these days. Some people have the problem of odour during menstruation. Cleanliness and change of
pad/tampon as often as is necessary reduces this problem. It is not advisable to use perfumed pads or
tampons. In fact, using powder in the genital area is not recommended
• Change sanitary napkins frequently at least 3-4 times a day in order to prevent bad odor and
infection. The used napkins must be placed in a paper or a plastic bag before throwing them in a
closed dustbin.
• If using cloth, wash the cloth in hot water with detergent soap and dry it in the sunlight in order to
prevent infection.
• When blood stained pad or cloth rubs against the thigh, the skin of the thigh gets sore. It becomes
difficult to walk. Hence, applying cream, in that area is helpful. It is not advisable for girls to engage
in heavy physical activity (such as manual labor) during menstruation as there is loss of blood and
the various reproductive parts are under strain due to the process of menstruation. Moderate work is
allowed.
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ACTIVITIES
Teachers can explain to students the health benefits of good personal hygiene habit through
flash cards.
Teachers can demonstrate how hands should be washed with soap while highlighting the
need to scrub the palms, the area behind nails and the upper portion of the hands.
Teachers can demonstrate the use of a nail-cutter. She/he must ensure that every classroom
has a nail-cutter to help students with long nails to cut them in the school. The
monitor/hygiene captain of each class can be given the responsibility of checking the nails
of the students once a week.
Teacher can explain the need for cleaning teeth daily. The importance of bathing daily,
using soap should also be explained.
Teacher can explain to the students the need for protecting the feet from worm infestation,
while walking or playing outdoors. Children should not be Always wear shoes allowed to
play barefoot while playing outdoors
Students can be encouraged to put up drawings and simple messages related to hand –
washing and other hygienic habits on the sanitation corner in school.
Students of higher classes can be given the responsibility of ensuring that a soap and clean
towel are always kept handy outside the school pour flush water-seal latrine, next to the
storage tank.
Key Messages
Cut nails every week
Wash hands with soap after defecation and before eating food
Wear footwear while going to toilet
e. Disposal of garbage and animal excreta
Why is it important?
• Accumulated garbage provides a breeding ground for harmful insects including flies, insects, and
cockroaches and attracts rats, all of which spread infectious diseases.
• The micro-organisms which cause another fatal disease, “tetanus” also breed in garbage and animal
excreta.
• An unclean school with accumulated garbage is a health hazard and is not conducive to learning. It
looks and smells bad and also creates a bad impression about the students and teachers. The school
should, therefore, be kept neat and clean.
How can garbage be disposed?
• Every class should have a small basket or crate or cardboard box as a dustbin for collecting garbage
of the classroom. It is important that, this dustbin is emptied daily into a large garbage pit dug within
the school compound.
• A garbage pit can be dug in a corner in the school to throw all garbage and once it is filled it should
be covered with soil and then another pit should be dug.
• Plastic and tin wastes will have to be dealt with separately. These can either be collected for
recycling or disposed of through a municipal collection system.
• Waste bins placed in every classroom and around the school compound should be used to facilitate
collection before treatment.
• Sometimes space for garbage disposal is a problem. An option is for the older pupils to collect the
garbage and take it to the municipality if it is not collected. Older pupils can also help with the
selection of material for recycling. Another option is to ask community members for their help.
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ACTIVITIES
• Teachers can help the students of all classes to cultivate the habit of throwing waste paper,
pencil shavings, etc., into the class dustbin. The monitor/hygiene captain) of the class can be
given the responsibility of monitoring this habit.
• Group of students in each class can be made responsible, on a rotation basis, for emptying the
classroom dustbin into the school dustbin/garbage pit everyday just before the school closes.
• Students of senior classes can be given the responsibility of ensuring that young students do
not litter the school play ground with paper, leftovers of food etc.
• One lesson a week may be set aside by each class teacher for involving the students in
activities aimed at beautifying the school. These can include cleaning the classroom, putting
up charts and posters, sweeping the school compound, cleaning the drains and dusting the
chairs and tables or carpets.
• Students can be guided to motivate their parents to construct garbage pits for the disposal of
household garbage.
• The PTA meetings can be used as a forum for motivating parents to contribute towards
dustbin, dusters, brooms etc. for the school.
• Students can be encouraged to put up drawings and simple messages related to hand –
washing and other hygienic habits on the sanitation corner in school.
Key Messages:
Garbage should be thrown only in pit
Animal excreta should also be thrown in a pit, other it attract flies
f. Home sanitation and food hygiene
Why are they important?
• Homes that are damp, dark and stuffy are unhealthy to live in as they get little sunlight and fresh air.
• If they are not swept and cleaned daily, they attract disease carriers such as rats, flies and
cockroaches.
• Contaminated food cause diseases such as diarrhoea.
• Food handled by unwashed hands with long fingernails gets contaminated as disease causing
organisms are transferred from the dirt on the hands and from under the nails to the food.
• Food left uncovered can also become contaminated and unfit for eating as it attracts animals, flies
and other insects.
• Vegetables and fruits are often contaminated because of open defection in field by human beings. If
eaten raw and unwashed, they can cause diseases.
• Stale food and food that smell foul, if eaten, cause diseases.
How can Home Sanitation and Food Hygiene be maintained?
• The house should be well ventilated to allow plenty of fresh air and sunlight to come in. It should be
swept well and cleaned daily.
• Children’s and infants’ excreta should be immediately disposed in a pour flush water seal latrine or
in a pit dug in the ground and later covered with soil to prevent flies from sitting on it.
• Vegetables/fruits should be washed well before they are eaten raw/cooked.
• Food, which is stale and smells foul, should not be eaten.
• Plates/utensils used for eating/cooking should be washed immediately to keep away flies,
cockroaches and pets.
• Cooked food should always be kept covered to protect it from flies, pets and other stray animals. A
food safe can be used to store the food at home
• Hands must be washed well with soap and water before cooking food, before serving it and before
feeding children.
• Food, which has fallen on the ground, should not be eaten.
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ACTIVITIES
• Students can be guided by the teacher to motivate their parents to keep their homes clean
and well ventilated. Students can also be encouraged to assist their
• Parents in sweeping and mopping the house and in disposing off the household garbage
in the community garbage pit.
• teachers can explain to the students the need for maintaining sanitation at
• Home, to handle food with washed hands and to keep food covered.
• Vendors selling exposed food should not be allowed to sell their wares in or near the
school.
• Teachers should explain to the students why exposed food from vendors should not be
eaten.
• Students should be taught about washing raw vegetables and fruits before eating.
• Posters/drawings/sketches with messages on home sanitation and food hygiene, prepared
by the students, can be put up on the walls of the school. Simple messages can also be
written on school walls.
• The older students can be given the task of monitoring the habits of the younger students
such as not eating food, which has fallen on the ground, not buying
• Foodstuff from vendors selling exposed food etc.
Key Messages
Food fallen on ground should not be eaten
Don’t allow flies to sit on food, keep food covered
Keep home and kitchen clean
g. Community sanitation
Why is it important?
• Simple pit latrines at schools and household smell foul and look dirty. It also attracts flies, which
transfer disease- causing organisms from excreta to food, which people eat.
• Excreta thrown into community drains or in open places close to habitation, the whole village smells
foul and looks dirty. It also attracts flies, which transfer disease- causing organisms from excreta to
food, which people eat.
• Household garbage, thrown by people on the streets, attracts disease carriers such as cockroaches,
flies, and rats’ etc and other insects. It also chokes the community drains.
• Stagnant water in drains, around community water sources and on the streets provides a breeding
place for mosquitoes, which spread Malaria.
• Filth and animal excreta (such as cattle dung, ducks and hens excreta) provide a breeding ground for
the germ, which causes tetanus.
• A clean community environment is a generic indicator of the hygienic practices of the people living
in it.
How can community sanitation be promoted?
• Every household must construct a pour flush water-seal latrine and all the members of the household
must use it. Children above two years of age should be discouraged from defecating in the open and
be taught to use a pour flush water-seal latrine.
• Household garbage should be collected and thrown into community/own garbage pit.
• Platforms and drains around water sources and in community should be cleaned on periodic basis
and must be repaired, if they are damaged.
• The PTA of the local school can contribute (in cash or labour) towards construction of pour flush
water-seal latrines and other sanitary facilities in the school.
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CHAPTER 6:
SOLID WASTE AND ENVIRONMENRAL SANITATION
6.1 Solid waste management
Waste is generated by people of all ages; it
comes from homes, schools, businesses,
factories, and other places. Waste that is not
disposed off in a proper manner can become
a breeding place for vectors (diseasecarrying
organisms) and can cause an
increase in the spread of disease.
Appropriate disposal methods include waste
reduction, recycling and composting,
incineration, and land filling (burying in pits
in the ground).
Reduction - Waste reduction is one of the
most important methods and one in which
everyone can participate.
Figure 15: Solid Waste Management
What can schools do?
Schools can reduce wastes in many ways, by using paper on both sides, sharing resources when possible,
using durable items, reducing disposables and excess packaging wastes in lunches, and setting a good
example for others.
Recycling – some materials such as plastics can be recycled and re-used. This will lead to decrease of
pollution, saving of landfill space, conservation of energy and resources.
Composting - Over half of our waste are organic materials that can be composted. Compost is a valuable
resource for lawns and gardens. By composting, we save space in landfills and turn waste into a product that
can improve soil and increase its water-holding capacity.
Incineration – is the burning of waste materials at very high temperatures. This process not only destroys
pathogens but also decreases the amount of waste that needs to be buried in landfills.
Landfills - Landfills will always be needed to manage our noncombustible, non-recyclable materials, as well
as ash from incineration and residues from recycling.
There are several methods for solid waste management. Schools can make decisions on which one to adopt
based on the size of the area, student population, costs of the various options, possibilities, and available
resources.
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Reduce, Reuse, and Recycle
SUGGESTIONS FOR CHILDREN IN SCHOOLS AND AT
HOME
6.2 Reduce
• When you go shopping, take along a bag and tell the
shopkeeper that you will not need a new one.
• Avoid buying fast food unless it is served in recyclable
packages.
• Do not buy products that are over packaged. Choose items
packaged in containers that are recyclable or made of
recycled materials.
• Do not buy or use disposable products. Switch to cloth
napkins, carry drinks in refillable thermos bottles, and
carry your lunch in washable, reusable containers. Instead
of paper towels, use a cloth or sponge to clean up.
• Do not buy aerosol cans. They can not be recycled, and
they contain ingredients which cause air pollution. Instead
look for spray bottles or other alternatives.
• Try to avoid creating hazardous wastes. Many household cleaning products can be replaced with
simpler, less hazardous materials.
• Reduce your use of batteries. They contain heavy metals that are toxic. Try to use mechanical
objects, ones that plug in, or rechargeable batteries.
6.3 Reuse
• Donate outgrown toys and clothing for a worthy cause, rather than throwing them away. Even wornout
clothing can be used as rags for cleaning.
• Create a compost pile. With very little effort, compound wastes and food scraps can be made into
compost, which will help your garden or compound to grow.
• Learn to fix things rather than throwing them away. When buying new objects, look for sturdy ones
that will last for a long time.
• If you or your family has old magazines or books you want to get rid of, donate them rather than
throwing them away.
6.4 Recycle
• Find out what is recyclable in your community, and help your family to make whatever changes are
necessary to recycle everything possible.
• Ask your parents to buy drinks in glass or aluminum containers instead of plastic, since glass and
aluminum are easier to recycle.
• Whenever possible, choose products made from recycled materials. Unless people want to buy
recycled products, companies will not produce them.
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CHAPTER 7:
GUIDELINES FOR SCHOOL WASH FACILITIES10
The following guidelines are intended for all schools in Bhutan so as to provide a healthy environment in the
area of water, sanitation and hygiene for school children, teachers and other staff. The different tiers of
schools, right from community to higher secondary schools as well as day and boarding schools has been
considered. Wherever relevant the guidelines have been adapted for each special case. While it is critical for
boarding schools to have adequate WASH facilities given the increased risks of transmission of
communicable diseases, it is equally important to address the needs of the day schools where substantial
amount of time is spent by children and teachers. The types of schools also vary in terms of human resources
(cleaners, matrons), structural facilities (hostels, dining rooms) and financial provisions. Considering all
these, the following guidelines have been recommended to provide every school with basic WASH facilities
so that children can learn in a healthy environment, create greater gender equity and enable school children
to learn and practice lifelong positive hygiene practices.
Water and Sanitation has always received high priority in Bhutan as evident from His Majesty the Fourth
King’s royal edict in 1992 which proclaimed that water and sanitation was a basic right of every Bhutanese.
Similarly in Bhutan 2020, the government has committed itself to continue to provide priority “to the rapid
expansion of access to portable water and safe sanitation” such that by 2020 Bhutan would “have achieved a
situation comparable to the standards that today prevail in industrialized countries”.11 The RWSS (rural
water supply and sanitation) Sector policy also highlights the requirement of all schools to “include water
supply and sanitation facilities in their building plans, construction contracts and annual facilities
budgets”.12
Guideline 1: WATER QUALITY
Water for drinking, cooking, personal hygiene, cleaning and laundry must be safe for the purpose
intended
Notes
• The microbiological quality of drinking water must be such that no thermotolerant coliform bacteria
especially Escheria coli (which indicates fecal contamination) is detectable in any 100 ml of water
sample. All sources must be bacteriologically tested prior to the scheme construction or immediately
after major rehabilitation. The responsibility of conducting this test will be at the district hospital.
• Chemical and radiological testing will not be done routinely as results of water quality study from
across the country show that chemical components in the water are below acceptable parameters.
However the Public health Laboratory along with Public health Engineering Division can be
requested to carry out required tests where appropriate.
• The source of water will mainly be from protected spring or stream and the maximum distance from
source to the facility should be five kilometers. Where this is not available, alternate source or design
should be considered such as rain water harvesting, ground water or schemes with simple treatment
technology.
• Water at the source or at the reservoir should be disinfected with chlorine to ensure microbiogical
safety wherever feasible. The Ministry of health can assist in this and proper channel of
communication should be maintained. Other means of treating water, such as boiling, filtering,
SODIS and sedimentation may be used at a small scale and usually at the individual level.
10 Adapted from: Adams J, Bartram J, Chartier Y et al. Water, Sanitation and Hygiene standards for schools in low-cost settings. WHO, 09-14-
WASH-13-EDIT(28Jul09)accepted.doc; 2009
11 Planning Commission. Bhutan 2020. A vision for peace, prosperity and happiness. RGoB, Thimphu 1999.
12 MoHE. RWSS Sector policy. RGoB, Thimphu; Dec 2002.
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• The taste and odour of the water should be acceptable for drinking purposes
• Water for cooking, washing utensils, bathing and hand washing must be of same quality as drinking
water. Water for other purposes such as for cleaning, laundry and sanitation may not be of such high
quality.
Guideline 2: WATER QUANTITY
Sufficient water should be available at all times for drinking, food preparation, personal hygiene, laundry
and cleaning
Notes
• For day schools the amount of water available for each student per day should be 10 liters
• For boarding schools the amount of water per student per day required will be 65 liters
• For the community it is 45 liters per resident per day.
• The amount of water includes all the water requirements such as for drinking, personal hygiene,
laundry and for food preparation. This is important for planning and for designing water facilities in
schools.
• The most important point to note however is to ensure that at least adequate drinking water is
available thorough out the day for school children. In day schools children may be asked to bring
their own drinking water to school.
• Additional water requirements should be considered for sanitation depending on the type and design
of the facility. There must be water available for hand washing through out the day.
Guideline 3: Water facilities and access to water
Sufficient and adequate water use points (taps/shower) must be made available and this should be easily
accessible to school children for various purposes
Notes
• All schools should have adequate number of tap stands with soap in the toilets and in the dining
room, kitchen or areas where students eat. Where this is not feasible, low cost hand washing points
such as a reservoir (dekchi, pots) and a jug or a drum with a tap fitted to it can be installed near
toilets and dining areas.
• There should be reliable and adequate number of facilities for drinking water (taps, filters) and this
should be easily accessible to all school children and staff at school including those with disabilities.
The standard number of sets
• For bathing purposes, there should be at least one shower for every 20 students. Separate shower
facilities or showering times must be instituted for boys and girls. The source of the water should be
as close to the showering area as possible to ensure that adequate water is used for bathing.
• There should be adequate water and facility for laundry purposes in the boarding schools. Separate
facilities must be provided for boys and girls.
Guideline 4: Hygiene promotion
Hygiene promotion should be an integral component in the schools to ensure that water and sanitation
facilities are used appropriately and maintained
Notes
• Hygiene promotion should be incorporated in the life skills and health education curriculum in the
schools.
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• Teachers and staff should promote positive hygiene behavior by becoming role models. Hygiene
education should be part of teacher training and they should consistently demonstrate good hygiene
practices.
• School health clubs or houses should appoint hygiene captains who should lead the activities in
cleaning and maintaining the facilities. Schools should organize these activities regularly with a view
to promote good hygiene and not as punishment. These activities should be fun and made prestigious
instead of making it demeaning.
• Student representatives should be included in the planning and designing of WASH facilities and
their opinions and comments incorporated wherever appropriate.
• Older girls and female teachers should be provided with facilities to practice menstrual hygiene such
as privacy, waste basket to throw sanitary pads/cloth, water to wash and place to dry cloths used for
sanitary purposes.
Guideline 5: Toilets
Sufficient, accessible, private, secure, clean and appropriate toilets should be provided for school children
and staff.
Notes
• There should be sufficient toilets for girls, boys and teachers, the standard recommendation being;
one toilet per 25 girls, one toilet plus urinal per 40 boys and one toilet each for female and male
teachers.
• The toilets should be easily accessible to all users, at all times and even during the rainy season.
• Male and female toilet should be completely separated and should offer adequate privacy and
security. In boarding schools, the girl’s toilets should be housed within the hostel so that they need
not go out at night. It should be brightly lit and lamps should be functional.
• Toilets should be kept clean at all times. Towards this end, responsibility for cleaning and
maintenance as well as a rigid routine must be clearly entrusted and outlined. Materials for cleaning
such as buckets, brush and disinfection should be provided for cleaning the toilets on a daily basis.
The materials used for constructing toilets (especially the slabs and other surfaces that will be soiled)
should be made of concrete, be smooth, waterproof and resistant to cleaning products.
• The toilets should be located near class rooms and playing field so that children can access it easily.
The design should be such that all ages can conveniently use the facility without any difficulty.
Wherever appropriate, one toilet should be specially designed for children with disabilities.
• All toilets must have facility for proper hand washing. Washing materials such as water, soap or
other cleaning agent must be made available at all times.
Guideline 6: Cleaning and waste disposal
Routine cleaning and proper disposal of waste should be carried in schools
Notes
• Classrooms, hostels, dining rooms and multi purpose halls should be regularly cleaned. Daily
sweeping and regular mopping must be routinely carried out after delineating responsibility.
• Exposure to diseases and injury should be minimized by proper disposal of waste and removal of
sharp objects within the school campus. Broken glasses should be disposed and repaired quickly.
• Adequate number of waste bins should be places around the school campus for solid wastes and a
system devised to empty it in a regular fashion.
• All schools should have a proper system of waste disposal and wastes should be disposed properly
routinely. The type and method to be used should be done in consultation with the local health and
municipal authorities.
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• Cleaning campaigns around the school campus and the community should be theme based and
carried out regularly (once a month for school campus and twice in a year for the community).
Guideline 7: Promoting healthy school environment
The school environment should be kept clean, healthy and safe
Notes
• Disease spreading vectors (flies, mosquitoes, rats) should be minimized and rid off by instituting
appropriate measures such as nets, insecticide residual spraying (in malaria prone southern
dzongkhags) and screens.
• Breeding sites such as tall grasses and bushes should be cut regularly, stagnant water drained, left
over food properly disposed and prevent accumulation of other waste.
• All schools should plan, grow and maintain gardens around the campus including kitchen gardens
for boarding schools. These can be used adequately for teaching children on the proper use of
organic fertilizers. Trees and flower plantations should be included in the list of school activities in
addition to school forestry days.
• Food for school children must be stored and prepared with utmost cleanliness. Cooks and other
personnel in the kitchen must be trained and educated on basic food safety and good hygiene
behavior.
• The school health club, Hygiene captains and other school representatives should monitor food
storage and preparation. A kitchen committee should include representation from students, teachers
and other staff.
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CHAPTER 8:
MONITORING AND EVALUATION
Monitoring is an ongoing activity in school sanitation and hygiene programmes and involves checking,
analyzing and acting to improve a situation. There should be a set of measurable indicators that describe the
minimum necessary conditions for programme success. Indicators should be developed by those involved in
the project and should show a standard that you want to reach.
The key indicators for monitoring WASH in schools are:
Facilities
• Adequate safe drinking water
• Separate toilets for boys and girls
• Handwashing facilities with soap
• Drainage
• Clean classrooms and compound
Use and maintenance of facilities
• All children use the toilets/latrines
• Hands are washed before eating and after using toilet, with soap
• All children share the task of collecting water and cleaning toilets
Education and promotion
• Hygiene education is in the curriculum
• Education is participatory and life skills based
• Good hygiene behaviours are promoted among staff and children
• It involves parents and community
Training
• Teachers are trained before or during construction of facilities
• District and geog-level officers are trained
• All trainers are trained
Based on the above key indicators, a simple checklist, such as one shown below, can be developed and used.
In any particular school this can be adapted to the local situation.
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Yes/No
1. Are the latrines functioning?
2. Total number of existing latrines Numbers ………….
3. Are there separate latrines for girls? Yes or No
4. Are there separate latrines for female teachers? Yes or No
5. Is there easy access to the latrines for the boys and Yes or No ( in bad conditions,
girls?
locked implying not enough for
6. Number of girls who use one latrine.
children)
Good (less than 60 to 1
latrine):fair (60 to 130 to 1 latrine):
poor (more than 130 boys for 1
latrine)
7. Number of boys who use one latrine. Good (less than 60 to 1 latrine):fair
(60 to 130 to 1 latrine): poor (more
than 130 boys for 1 latrine)
8. Condition of doors (also hinges and frame) for Good; fair (needs repair); bad
privacy
(needs replacement)
9. Condition of roofs for protection Good; fair (needs repair); bad
(needs replacement)
10. Condition of slabs and pans Good; fair (needs repair); bad
(needs replacement)
11. Condition of vent pipes Good; fair (needs repair); bad
(needs replacement)
12. Condition of Y-junctions Good; fair (needs repair); bad
(needs replacement)
13. Condition of concrete covers Good; fair (needs repair); bad
(needs replacement)
14. Is there a bucket of water and a mug inside each
latrine?
Yes or No (no cup, no bucket, or
bucket is not 1/3 full)
Answers
15. Cleanliness: no visible garbage, no excreta on
floors. No visible excreta or dirt in pan.
16. Are there hand washing facilities near the latrine? Yes or No
17. Can these facilities be easily used by children? Yes or No
(Has water, easy to reach etc.) Does it smell? Are
there puddles or pools of water /urine?
18. Is there soap by the hand washing facility? Yes or No
19. Do children use the hand washing facilities? Yes or No
When?
20. How far is the water supply facility from the
latrines?
Good; fair (should be cleaned
better or more often); bad (children
don’t like to use the latrine)
Near (50 meters away) or far
(beyond 50 meters away)
21. Is there a concrete apron and drain in good
repair?
22. Is the area around the water point clean, free
from visible garbage and puddles?
23. Is the water from the facility safe for drinking
purposes?
Good; fair (cracks, parts fallen off,
needs repair); bad (needs
replacement
Good; fair (some garbage or
puddles); bad (standing water and
garbage make it difficult to walk
Yes or No
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Below is an example of using information to monitor school water and sanitation programmes:
Issues % of total on ……….. % change from…..to
…….…….
Use safe drinking water
Storage of water
Washing hands
Use of toilets
Use of garbage pits
Kitchen garden
Similarly monitoring and evaluation should also be done at the programme level for effective management.
Some of the key indicators include:
• Action plan is prepared
• mobilization activities are planned
• training is conducted
• construction is completed
Activity
Divide the children into groups of 3 or 4 people. Ask each group to develop a monitoring checklist on
different components of water and sanitation facilities in the school. One group can develop checklist for
handwashing, the other can do on use of toilets and so on.
Key points on Monitoring:
• indicators should be both qualitative and quantitative
• it should be participatory
• information collected should be accessible to all persons involved
• the aim should not be to show what others have done wrong
• outcome should be help people improve their behaviour
• feedback on the monitoring information can help reinforce positive behaviour change
A regular monitoring and reporting system to track the implementation of WASH in schools programmes
will make it possible to identify problems, address the issues and in the long term, ensure sustainability of a
successful programme.
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WASH in School Programme
Annex I: Monitoring at the School Level
(To be filled by the Headmaster)
Name of the School:
Location:
Name of the headmaster:
Monitoring period:
A
B
C
D
E
Activities Yes No Remarks
Environmental sanitation
1. sweeping of classrooms and school compound regularly
2. placement of waste collection basket inside classroom and
office
3. school environment maintained with no littering around the
school complex and protection of plants and trees
4. garbage pit constructed in the school compound
5. use and maintenance of garbage pit
Cleanliness of water and water point
1. cleaning of water point (tap) and its surrounding done
regularly
2. waste water properly drain out of kitchen garden/soakage pit
3. cleaning and covering of drinking water storage vessel and
glass/jug, etc.
4. protection and maintenance of sources of water in the
village, if necessary
Disposal of excreta
1. provision of latrines and urinal in the school
2. use of latrine and urinal by:
a. girls
b. boys
c. teachers/staff
3. proper maintenance of:
a. latrine
b. urinal
4. availability of broom, bucket etc. for maintaining latrine
5. maintenance of latrines by:
a. students
b. peon/other staffs
Sanitation sub-committee
a. formed
b. functioning
Personal hygiene
1. regular monitoring of the personal cleanliness of the
students by the health/class teacher
Note:
1. The feedback is to be based on the headmaster’s personal observation. He/she has to make frequent
survey. At least every week to assess the situation of the activities.
2. This form is to be forwarded to the concerned school authorities or produce it when demanded or
requested by any visiting or inspection team.
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WASH in School Programme
Annex II: Monitoring at the class level
(To be filled in weekly by health /class teacher)
Class:
Name of the students:
Name of the teacher:
Monitoring period:
A
B
Activities Yes No Remarks
Classroom sanitation
1. sweeping of the classroom regularly
2. placement of waste collection basket inside
classroom
3. spread of litters and waste paper inside the classroom
4. use and maintenance of garbage pit by the students of
the class
Personal hygiene
1. nail cutting and cleanliness of hand
2. cleanliness of the clothes worn
3. cleanliness of head and hair
4. cleanliness of face (eyes, ear, and nose)
5. cleanliness of teeth
6. wearing of shoes/slippers
7. bathing regularly
8. using latrine regularly
Note:
This form has to be filled in class wise by the concerned class/health teacher and submitted to the
headmaster. Based on this the overall situation of a particularly class can be assessed
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WASH in School Programme
Annex III: Monitoring at the individual student level
(To be filled in every month by class teacher)
Name of student:
class:
Sl.no. Activities Months
1 2 3 4 5 6 7 8 9 10 11 12
1 Taking bath regularly
2 Cleanliness of face
3 Cleanliness of teeth and mouth
4 Nail cutting and cleanliness of
hand
5 Cleanliness of personal goods
(bag, books, etc)
6 Cleanliness of clothes
7 Cleanliness of feet and wearing
shoes/slippers
8 Using latrine regularly
9 Other (specify )
Date of monitoring
Signature of the class teacher
Note:
The class teacher should fill in this form based on his own personal observation and monitor the status
regularly
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