The Critical Role of WASH in Schools
Access to adequate water, sanitation and hygiene (WASH) facilities in schools is a fundamental right for students around the world. Yet, many schools in low-income countries struggle to provide these essential services. The impacts of poor WASH conditions in schools can be severe, contributing to the spread of waterborne illnesses, inhibiting student attendance and learning, and disproportionately affecting girls.
Globally, only 51% of schools have access to adequate water sources and just 45% have sufficient sanitation facilities, according to a UNICEF evaluation. This widespread lack of WASH services in schools is detrimental to student health and education. Diarrheal diseases, respiratory infections, and parasitic worms are common, leading to missed school days and long-term health consequences. Girls face additional challenges, as inadequate menstrual hygiene management (MHM) facilities can cause them to miss school during their periods.
Addressing the WASH crisis in schools is crucial for protecting the well-being and academic success of students, particularly in resource-constrained contexts. Rigorous research has demonstrated that school-based WASH interventions can yield significant health and educational benefits. By improving access to safe water, sanitation, and hygiene promotion, these programs have the potential to reduce the incidence of waterborne illness, boost student attendance, and cultivate lifelong healthy behaviors.
Evaluating the Impact of School-Based WASH Interventions
A comprehensive review of 38 peer-reviewed studies on WASH in schools in low-income countries revealed a range of positive outcomes from these interventions. The research examined several key impact areas:
Reduced Diarrheal Disease and Other Hygiene-Related Illnesses
Many studies found that WASH programs in schools led to significant reductions in diarrheal disease and other hygiene-related conditions among students. For example, a project in Kenya that provided water treatment, handwashing stations, and hygiene education resulted in a over 50% decrease in diarrhea cases. Another multi-country study in Mali observed lower odds of students reporting diarrhea or respiratory infection symptoms in schools with WASH improvements.
However, the evidence was not uniformly positive. Some interventions did not demonstrate statistically significant impacts on disease rates. Researchers noted that the effectiveness often depended on the local context, such as baseline water availability. Comprehensive, multi-component WASH programs seemed more effective than single-focus efforts like latrine construction alone.
Improved WASH Knowledge, Attitudes and Behaviors
Across 13 studies, researchers consistently found that school WASH programs led to positive changes in students’ WASH-related knowledge, attitudes and practices. Simple nudges, like painted pathways connecting latrines to handwashing stations, were effective at increasing handwashing with soap rates from 4% to over 70%. Teacher-led hygiene education and providing soap and cleaning supplies also significantly boosted handwashing behaviors.
These behavior shifts suggest that well-designed WASH interventions can cultivate lifelong hygiene habits in students. The programs empower young people to take ownership of their health and spread positive changes at home and in their communities.
Community-Level Disease Burden and Hygiene Impacts
While the primary focus of school WASH programs is on improving student outcomes, some studies examined spillover effects into households and communities. A few projects found that school WASH interventions reduced disease burden and improved hygiene practices among students’ family members. For example, a Kenyan study observed decreased diarrhea rates in the younger siblings of students in water-scarce schools that received WASH improvements.
However, achieving meaningful behavior changes at the household and community levels proved challenging in some contexts. Barriers like water scarcity and social norms can limit the diffusion of hygiene practices from students to their families.
Improved Student Attendance
Enhancing WASH conditions in schools has the potential to boost school attendance, which is crucial for learning and academic achievement. Several studies linked WASH interventions to reductions in student absenteeism, with declines ranging from 21% to 61%. Improved access to handwashing, clean and private latrines, and menstrual hygiene supplies were found to be contributing factors.
Yet, the evidence on attendance impacts was mixed. A few studies did not find significant improvements, potentially due to the complex, multi-faceted drivers of student absenteeism. Ensuring consistently high-quality WASH service delivery appears to be a key determinant of attendance outcomes.
Overcoming Implementation Challenges
While the research demonstrates the substantial benefits of WASH in schools, delivering effective, sustainable programs remains a significant challenge, especially in resource-constrained settings. Several key insights emerged from the review:
Importance of Program Fidelity: Many studies noted challenges with the consistent, high-quality implementation of WASH interventions. When programs faltered in areas like soap or water availability, their health and attendance impacts were diminished. Only one study directly linked improved intervention fidelity to reduced student diarrhea. Ensuring robust monitoring and maintenance systems is crucial.
Tailoring to Local Contexts: The effectiveness of WASH programs was highly dependent on the specific school and community context. Factors like baseline water access, sanitation infrastructure, and social norms shaped the outcomes. Programs must be carefully designed and adapted to local realities to maximize impact.
Importance of Comprehensive Approaches: Interventions that combined multiple WASH components, such as infrastructure, hygiene education, and maintenance, tended to produce better results than single-focus efforts. Addressing the interconnected WASH needs of students in a holistic manner is key.
Limitations of Self-Reported Data: Many studies relied on self-reported measures of health outcomes and behavior changes, which can be prone to bias. Incorporating more objective data sources, like fecal samples and handwash observations, can strengthen the evidence base.
Expanding the Menstrual Hygiene Management Focus
One area deserving greater attention is the intersection of WASH and menstrual hygiene management (MHM) in schools. The review found very few rigorous evaluations of MHM-focused interventions, despite qualitative research highlighting the substantial challenges girls face.
Inadequate facilities, social stigma, and lack of information can cause girls to miss school during their periods, undermining their education. Addressing these MHM barriers through private, clean toilets, disposal mechanisms, and puberty education is critical for gender equity and student wellbeing.
As the WASH in Schools field evolves, integrating robust MHM components into programming should be a priority. Innovative, participatory approaches that empower girls as agents of change hold promise for improving menstrual health and school attendance.
Conclusion: Catalyzing Lasting Change through WASH in Schools
Ensuring access to safe water, dignified sanitation, and healthy hygiene practices in schools is not only a moral imperative, but also a powerful lever for improving student health, education, and equity. The research demonstrates that well-designed, contextually-appropriate WASH interventions can yield substantial benefits, from reduced waterborne illness to increased attendance.
However, delivering sustainable, high-quality WASH services in resource-constrained school environments remains a significant challenge. Overcoming implementation barriers, such as ensuring program fidelity and adapting to local realities, is critical. Integrating menstrual hygiene management into the WASH in Schools agenda is also a key future priority.
By continuing to build the evidence base, strengthening implementation practices, and elevating WASH as a core educational and public health priority, we can make significant strides towards universal access to WASH in schools. This, in turn, will unlock tremendous benefits for student health, learning, and life outcomes. The time is now to advance water, sanitation and hygiene in schools around the world.
