303 0osC

lIBRARY IRCP0 Box 93190, 2509 AD THE HAGUE

Tel : +31 70 30 689 80Fax. +31 70 35 899 64

BARCODE / (~r(~LO:~iL ~

Uganda.

1. INTRODUCTIONThe populationin Ugandanschools, especially primaryschools, has increased from 2.5million in 1995 to 6.5 million in1999, representing an increaseof 62 percent, mainly due to therecent implementation ofUniversal Primary Educationpolicy, which entities all schoolage chikiren to free primaryeducahon. While most schoolsare already lacking in basicsanitary facilities, this suddenincrease has aggravated thesituation further, causing thenumber of students per latrinestance to exceed 700 in someschools. Efforts are thereforebeing made by the Government,UNICEF, DANIDA and otherpartners to meet the highdemands of these schools,through many school sanitationprograms across the country.

The study aimed at puttingtogether existing experiencesand lessons learned on schoolsanitation programming andimplementation in Uganda. Thestudy was based mainly on theWater and Sanitation (WES) andthe Rural Water and Sanitation(RUWASA) programs supported

by UNICEF and DANIDArespectively. The studyattempted to:• Create awareness on the

need for use of public fundsfor school sanitation,;

• Review the institutionalarrangements in place(policies, strategies,institutions and actors);

• Analyze the nature of theinterventions, which havebeen put in place, and;

• Document the experiences,lessons learned!recommendations inpromoting school sanitationand hygiene.

3c~—/(0o~7i~

Water andSanitationProgram

An international partnershipto heip the poor gain~jziained access ~aimproved water supply

and 5unitaT~onser.’lce!~

FIELD NOTESchool Sanitation andHygiene Promotion inUganda: the Challenge ~

This Field Note highlights the lessons learnt and recommendations forpromotion of school sanitation and hygiene, using Uganda as a casestudy. The study was commissioned by the Water and SanitationProgram for East and Southern Afnca (WSP-ESA) in partnership withUnicef and in collaboration with the Ministry of Health, and NETWAS in

East and Southern Africa Region

NETWAS

unicef ~:Unitcd Nations Childrcn’s Fund

ApnI 2000

k StudyMethodologyThis study focussed on the average rural primelyschool in Uganda. The study looked mainly at dassesfrom primary one to primary seven; the age rangecovered can vary between 6-16 years old. To meetthe objectives set by the study, both quantitative andqualitative data were required. The methods that wereused to collect data indudedStructured interviewswith key informants, i.e. government officials, donorand private sector representatives1 district leaders,extension staff and school management;- Focus group discussions led by children,

teachers and parents;- Field visits and observation checklists used in

Hoima, Mpigi, Mbale, Maseka and Mbararadislncts; and

- A review of secondary sources undertaken toconfirm some of the information collected by theauthors.

The man secondary sources used were surveysreports, policy document, supervision, monitoring andevaluation reports as well as written conferencepapers.

Workshopswere also organized for key stakeholdersto get an overview of school sanitation and tocorroborate Information obtalned from other sources.

B. Justification for the use of Public Fundsin School Sanitation and Hygiene

School sanitation and hygiene is a worthwhileinvestment in Uganda for many particular reasonsThey indude:Sanitation Is a basic human right The conventionof (he Rights of the Child (CRS), which has beenratified by most countries of the world, indudingUganda, states that children have a right to a safeenvironment for enhanced learning, health anddevelopment of good citizens.

Schools provide an excellent opportunity tocreate life-long changes in behavior In Uganda,the population of students (6.5 million of children,1999) spends on average 180 days in schools, eighthours a day. Other than the family environment,schools are the most important places of learning forchildren. Childhood is also the best time for childrento learn hygiene behaviors. What children learn inprimary schools is likely to be applied for the rest oftheir lives.

Targeting children as change agents. Whatchildren learn at school they can transfer to theirhomes, communities and to other children at homewho are unable to go to school for various reasons.These children will later become parents and will beduly bound to provide a safe and dean environmentfor their own children’s development. If children arebrought into the development process as activeparticipants, they can become change agents withintheir families and catalysts for communitydevelopment

Improve hygiene and sanitation is critical tohealth of school children and the community atlarge: In reality, schools are often more than justplaces for learning and behavior change. If schoolsanitation and hygiene facilities are absent, or arebadly maintalned and used, schools become a healthhazard. During the 1997-98 cholera epidemic, theUgandan government spent 4.3 billion UgandanShillings (US $3.5 million) in health care costs Theschools were rapidly becoming a place for diseasetransmission and 560 schools had to be dosed due tolack of adequate and acceptable facilities.

School dropout and low literacy rates, .especiallyamong the girl children can be attributed to poorsanitation and heafth conditions In schools: Gsts,who are already rnarginalzed in accessing educationkeep suffering because of inadequate sanitationfacilities Which allow them no privacy especiallyduring their menshualion period. The lack of privatesanitary facilities for guts discourages parents fromsending girls to school, contributes to the drop out ofgirls at puberty, and a contributing factor to fewerwomen teachers who are needed to encourage girlsto attend schools. The tow level of literacy amongwomen, as a result of girl push-out aggravatesprejudices based on inferiority and superioritycomplexes between men and women. By promotinggirls’ attendance and retention in school, thesanitation project influences sound cultural patterns ofconducL in future.

School sanitation project offers opportunities forparticipation: It has other socio-econonicadvantages such as empowerment, independence,decision-making, self-reliance, confidence building,creative development, life skills development andsustainability.

2

2. IMLEMENTATION STRATEGY ANDPROGRESS

A. Evolution of Sanitation in UgandaThe political ciimate in Uganda is now encouragingbetter sanitation as attested by:

1. The holding of the National SanitationForum: The most important achievement in theevolution of sanitation in Uganda has been thenational Sanitation Forum, which was held on 16-17 October 1997. With the theme: ~BetterSanitation, A Responsibilityfor All”, the forumbrought together the leadership of all 45 Districtsin Uganda who, together with Members ofParliament, donors, Non-governmental agenciesand concerned citizens spent two daysdiscussing the issue of sanitation. Theculmination of the forum was the signing of TheKampala Declaration on Sanitation (1997) bythe Chairmen of the District Councils.The main output of the forum was the 10-pointstrategy program of which school sanitation wasa priority in the action point number 5, whichstales (haL

Weshall ensurethateveryprimary schoolandall otherinstitutions oflearning haveadequatesanitationfacilities (lafrmnes,safedunkingwatersupplyandhand-washingfacilities; withseparatefacilities for rls) by the endof 1998’

2. The formation of a sanitation task force:The force was set up to develop new approachesand a concept paper entitled Promotion ofSanitation in Uganda’. This concept paper is themost comprehensive statement on sanitationever written in the country. It covers the globalsituation and the history of sanitation in Uganda.

3. Sanitation remaIns high on the nationalagenda. The Presidenrs 1996 eJection manifestopromised the electorate improved sanitation.Sanitation has been the subject of over 600newspaper articles in the national press since thebeginning of 1998. Home and schoolimprovement competitions are being held.Schools have build latrines and hand washingfacilities; teachers have been trained in theestablishmentof sanitation and health clubs.Private entrepreneurs are setting up businessesto recycle garbage. The visit of President B.Clinton of the United States of America led to amassive dean up Kampala campagn led

personally by the First Lady, Mrs. JanetMuseveni. Sanitation promotion also featureshigh in the manifestos of all the Kampala Citymayoral aspirants.

4. Redefinition of Sanitation: Working inclose collaboration with DANIDA, UNICEF, WHOand the Water and Sanitation Program Group inNairobi, the approach to sanitation for the entirecountry was redefined. The definition ofsanitation was broadened from the mereprovision of latrine slabs to a wider concept ofenvironmental sanitation (excreta disposal, solidwaste disposal, liquid waste disposal, hygienecontrol and vector control). Box 1 shows themain components of school sanitation definitionin Uganda.

3. INSTITUTIONAL ARRANGEMENTS

A. Public Institutions involved In SchoolSanitation

It has always been a policy in Uganda, as far aspossible, to integrate water source development,sanitation promotion and community empowermentfor sustainable community ownership, utilization andmaintenance of installed facilities/services. As a resultthere exist a number of line ministries involved insanitation. The co-ordination is done at national levelthrough the Inter-Ministerial Steering Committee(IMSC) and Project Management Teams (PMTs) toprovide an enabling environment in aspects of policydevelopment, technical assistance, quality assuranceand monitoring and evaluation. These frameworkshave greatly assisted/promoted the multi-sectoralcollaboration and lobbying needed for policy reforms.The IMSC comprises the highest ranking civilservants, i.e. Permanent Secretaries from each of theministries mentioned earlier with their technical heads

I

— ~,v

3

of department as ex-officials do. Below are outhnndthe main responsibilities of each institution

• The Environmental Health Division in theMinIstry of Health has the overall responsibilityforenvironmental sanitation improvemeni Beforethe ongoing policy reforms, the division hadoperated as a traditional centralized departmentwith environmental health officers posted in eachdistrict and urban authority. At present, the role ofthe division is being redefined with a view ofstrengthening its capacity to support localgovernments to improve environmentalsanitation. Officers who used to belong to thedivision now belong to their District LocalGovernments. Theseofficers and assistants aretrained in the Schools of Hygiene as HealthInspectors and Health Assistants and their job isto carry out mobilization and training activities atcommunity level, including mobilization for schoolsanitation and hygiene education.

• The Ministry of Gender, Labour and SocialDevelopment through the Directorate of Genderand Corwnunity Development and district staff isresponsible for social mobilization aid promotionof the role of women in sanitation improvementinitiatives. District level officers for the rural waterand sanitation sub-sector are mainly trained bythe Institute of Social Development, asCommunity Development Assistants.

• The Ministryof Education through itsInspectorate Department plays a role inenforcement of Government policy throughguidance, supervision and monitoring. It alsoplays a rote in the promotion of national syllabusthat supports and teaches sanitation andhygiene.

• The Ministryof Water, Lands andEnvironment (MWLE) is also, to date, the mostimportant institution involved in sanitationpromotion and it is represented by its Directorateof Water Development (DWD) through its twomain programs, namely

i) WESflJNICEF (1995-2000) covering 34districts with a total budget of US$27 million;and

ii) RUWASA/DANIDA (1996-2000) covering 10districts with a total budget of US$40 million.

• Other Government Projects indude SmallTowns Water and Sanitation Project (STWSP)and Eastern Centers, which are involved in

sanitation improvement programs in both ruraland urban settlements NGOs such as ActionAid, AMREF, WaterAid, AVIS and UgandaCommunity Based Health Care Association(UCBHCA) are also involved in sanitationimprovement programs, induding communitycapacity building

• At the District level, the responsibility is borneby the Department responsible for healthservices competing with other health services likeimmunization, HIV/AIDS, nutrition, and MCH. Atdistrict level, sanitation activities are coordinatedthrough respective sectoral committees of LC Ve.g. Works, Social Services, Health and districtmanagement teams with responsibility forplanning, budgeting, supervision and monitonngimplementation. The water components comeunder the Water section, WhiCh is usually housedin the Works Department

• At sub-county level, the responsiDility for waterand sanitation falls mainly on the exter.sion staff,namely health assistants and communitydevelopment assistants. There are also sectoralcommittee members for health and education aswell as local NGOs and CBOs. The sub-countychief also plays an important rote by mainlyenforcing by-laws and government policy.

• At parish and village level, water and sanitationis the responsibility of PDCs, local councilsecretaries for health, school managementcommittees arid water and sanitationcommittees.

• At schools and community levels, Parents-Teachers Associations (PTAs) form the interfacebetween the community and the schools. Thereexists institutional trust between schools andPIAs shown by the fact that in somecommunities, when given a choice of where tolocate a water source, they choose the schoolcompound or a place near the school. Somecommunities offer land for expansion of theschool and contribute labor for the expansion.Aithough the PTAs role, especially in payingteachers was redefined in 1996, they still operatealongside the School Management Committees(SMC). There are also good relations betweenthe School Management Committees and theschools. The SMC is mainly an executivecommittee in charge of the day to day running ofthe school. Problems occur betweencommunities and schools when a shared water

4

source is left to the school to repair or whencommunity members come to use the schoollatrines aid foul them.

B. Private Sector InvolvementThe private sector is both one of the main strategiesas well as being an institution that the program isusing. This is in support of the Government policy onprivatization. The use of the private sector for schoolsanitation is a very new venture, of not more than ayear old.

Initially the public sector was in Charge of constructingthe school facilities. However, some problems wereencountered. They included:- Latrine construction in most cases was very slow

and inefficient, and- Somelatrirrescollapsedduetothefactthatthey

were sited badly and because technical staff dklnot supervise construction of the latrines.

Because of these reasons, there was a need to buildcapacity for the private sector to get them involvedboth in latrine construction and latrine constructionsupervision. The private sector is also involved indevelopment, production, and dissemination ofappropriate sanitation materials as well as skills

development for sanitation service delivery andadvocacy.

Under the school sanitation program, privatecontractors undertake all latrine construction workexcept digging the pit, which is done by the schoolcommunity. The District Tender Boards advertise aridinvite tenders following the Government tendering

procedures Sub-counties are encouraged to employlocal contractors to take up construction work Therole at the national level is to support districts tostrengthen the tendering processes, assist inpreparation of tender documents for certification andpayment and supervision.

C. Implementation Arrangements for SchoolSanitation

Below is the implementation framework of theprogram. The following key issues are made sure allthroughout the process:• Continuous involvement of all stakeholders

(central and local governments, bilateral andmultilateral agencies, private sector andcommunity members) ensuring the continuity ofboth the process and benefits arising from theschool sanitation promotion.

• Ensuring that sanitation promotion remains ahighly political process. The target is that allelected officials in Uganda starting with thePresident and Cab~net,moving down throughChairmen and Secretaries at village level. Thelocal councils are recognized as vital institutionswith their main role being in planning, monitoringand resource allocation.

• Applying a demand driven and bottom upapproach. This approach is proven by the factthat the school expresses their demand by fillingin application forms and sending them to thedistrict It also ensures that all partners committhemselves to play their roles, such as diggingthe pit for example.

5

4. EXPECTED OUTPUTS OF ThE ON-GOINGAC11V111ES

The GovemmenLUNICEF, DANIDA andvariousotherpartnershasmadeefforts, to initiate schoolsanitationprograms.Belowaresomeof thedesiredoutputs with respectto thevariousacbvities

ExpectedOutput1: Betterhygienicpracticesatvariouslevelsandhigherlevel of participation

Activities undertaken ~ achieve outputPrimaryschoolteacherstrainingwithanemphasisonprovidingthemwithparticipatorytoolstoteachchildrenin amoreeffectivemanner.Teachersaretaughtwhereandhowtoapplyfor assistance,how toensurepupilspracticehygienebehaviorandhowtomobilizecommunitymembers

• Schoolsanitationmassmedlacampaignsasanattemptto inform, persuadeandmotivatesanitatonandhygienebehavioralchangeinchildren,teachersanddecision-makers.Thedevelopmentof asanitationnewspageforadvocacywasstartedin threeof theleadingdailynewspapers.

• Mobilization of political leadershipfor schoolsanitationasaprocessof passingon salientinformationto relevantstakeholdersin ordertosolicit their supportparticipationaidcommitmentto schoolsanitationactivities.

• Developmentof sanitationmaterials in supportofthe schoolsanitationactivities.Someof thematerialsdevelopedare:

SchoolsanitationguidelinesTeacherstraining facilitators guidePostersand hygieneand sanitationparticipatory tools

lmplementatl1n Framework

AdvocacyandInformationPhaseMeelin~atheld to tfrtute applicationforns to schoolsthrough

thelocal councubQ.Clll) charpersonsandsub-countychiebThemasamedaat alsoutilized in cisseminabnginfcrnahonthout

theproqan

ApplicationandVethngHeadteachers~ptyto thecsa~ntweOffl~(CAO)

Utoughthe,Sub-countycinsThecAO sitmibthelist of ~çflcationto theDlstnctVeiling

CciTvniilee (Distict TechnicalCorrntjeeandSectorSStaricingCaTvrelteeb HealthandEdeCaIIOTI) for approval

—

ApprovalandWorkplanelngA list ofwovedschoolsis thensentto theDrecbr-DWDandcopiedto thefocalpoint officersii thelie Mirastnes(Le. Health.Education,Local GoverwnentGenderandFliance).Thecfrectu

compilessubm~oIIbli~itoquaterlyrequeststo theI~risbyoffinance,Plarviing.EconomicDei’elapmentto releasefiwth to the

respectivecbfrcbascondlionalgaib

ReleaseofFundsMuu~iyof Finance,EconaTicDe#elopnentto rel~eto therespective

dsfrcb. ThecAo humstheSub-countyChsebwho advIsestheschoolauthoritiesto statdg9ngthepub

ThedslnctshatstheprivatecwSts to tattakecoiSuction.The countyHealthlnspestwandtheSub-countyICIlI Chaipersonat

alsomadeavae.

I ISoftware

Teachers’Training TheCAOflYltes friesschoolteachersfrom eachselectedschoolsfor aone-deysanitationand

— wod~.NationalMassMeda

Crpaigi

ConstructIonofHardwre,Two blocksof 5stancestabtiefor boys

HandeashingfaalheaRainwatertanks

Quality Ass4nnceWhenthepit hasbeendig, theDisbict

HealthInspectorandtheDstnctEn~neeratrespoostlefor certification

andquality assinnce

Follow-upandMonitoringNationalanddsbict teamcry Sregularspotchecks,follow-up and

monitoractivitiesfor bothhadwaeandsoftwereaspeth

Audtorsmonitorprogesson acpia’tertybasis.In acidhon,sit-countiychielsandpolitical leadersmonitorquality andthe

progessof thework

ExpectedOutput2:Developmentof a moresanitation sensitiveschoolcumculum

ActivitiesundertakentoachieveoutputSanitationmessageshavealreadybeenIncorporatedin thenational schoolsciencecurriculum.There hasalsobeenan attempt to integrate hygieneandsanitation into other subjectsarid examinations.

ExpectedOutput3: Developmentof effectivemonitoring systemsarid indicators

ActMffes undertakentoachieveoutputMonitoring indicators have been dev9loped and arebeing usedby the inspectorateof education staff.

Monitoring is being done at four levels:• Management information systems, spotchecks,

surveys, reviewsareusedat the national level• Spot checksandsupervisory visits by Distiict

Health Inspectors, District EducationOfficers,District Inspectorof Schools,District WaterOfficerat the District level

• Spotchecksandreportverificationfrom thepoliticians

• Monthly reportsdone by the extensionstaff atsub-countylevel.

ExpectedOutput4: Provisionof Sanitaryfacilities totheschools

Activities undeitakentoachieveoutputThe programsmainly supporttheprovision of latnneswhile taking into consideration the genderperspectives. In UNICEF supportedprograms, twoblocksof five stancelatrinesareprovided (withurinals for boysand no urinals for girls), alongsidewith hand-washingfacilities of two hundred litreseach. Rainwater tanksareprovided to schoolsthatare distant from other visible water sources.

The difference betweenRUWASA andUNICEFprogramsis the provision of extra stance for girls. TheUNICEF program aims for 25 per cent coverageofUPE supported schoolsfor 34 districtsand RUWASAcovers50percentfor 10districts. The dimensionsand designcriteria are mainly basedon what is

common usagearound Uganda to ensureophmumuseof the facilities. The construction is carried out bypnvatecontractorsselectedthrough acompehtivetender systemby the District Tender Board andlocalmasonsin somedistricts selectedby the SchoolManagementCommitteeChairman,the HeadTeacherand LC II Chairperson. Someschoolsprovide bathroomsfor girls on their own initiative.

ExpectedOutput5: An Integrated SoftwareandHardwareApproach

Activitiesundertakentoachieveoutput• Softwareactivitiesare plannedto precede the

hardwareonesandaredesignedto supporthardware activities. For example, mobilizationactivitieswhich entail advocacy/informationawareness,massmediacampaigns,training ofteachers.

• Hardwareactivitiesentail providing assistanceforconstructionof latrines, handwashingand watersupplyfacilities.

• The convergencebetweensoftwareandhardware takesplace at planning meetingswhere bothhardwareand softwarepersonnelsharethelr ~LiS and to try to harmonize them.Atdistrictlevel, this happensat thedistrictmanagementteam meetings.

L~T~I ~

7

5. FINANCIAL ASPECTS OF THEPROGRAMS

The main funding sources includedonors, like SIDA,DANIDA, UNICEF andtheWorld Bank, theGovernmentdistricts local governmentanddonors

pay for all materials, skilled labor, andhand washingfacilities and rainwater tanks. Belowis thebreakdownof the unit costsof the sanitation and hygienepackageused by WES-UNICEF. Thecostsarebasedupon theassumptionthat the latrines areconstructedon stablesoil formations.

Table 1: Unit Costsusedby_WES-UNICEF (February2000)

Details UgandanShillings US Dollars

6. RESULTS AND IMPACTS

Impact assessmenthasnotbeendoneyet becausethe orogramis still in theearlystage.However,internal arid external monitoring exercisesareongoing andthe results outlined belowarebasedon thestated activitiesin the study:

U The teacher-training program wasreportedto begoodin termsof content anddelivery, andveryrelevant to the schoolsanitationneeds. After thetraining, the teachersreported to have beenableto convincetheir headteachersto buy handwashing facilities. Howeverit wasobservedthattheone-dayduration of the training is notsufficientfor the teachersto internalize andsharediverseexperiencesthatexistin differentschools.The teacherstrained felt that the trainingwasbeneficialandtheyproposedthat it shouldbe extended to two daysand shouldindudemoreteachers.

• Monitoring cheddistsusedby theeducationalstaffhave revealedsomebehaviorchangein thecommunity o~eraIl.There hasbeenan increasedappreciation of the habit of hand washing, and anunderstandingof thesafewater chain. However,thehardware part of theprogramis moreappreciatedand requested.

• The study confirms high levelsof pupilknowledgeof hygieneandsanitationissueswiththemain source of information being theschools.However, translationinto behavior still remainstoo low to showsignificant results. In all the

schoolsvisited, the pupils weregenerallydean,and thoseinterviewedwereawareof theproblems associated with poor sanitationandhowto improve on the schoolenvironmentalsanitation. In addition, hygieneknowledgewasvery high, although practice isstill low.

U The teachersalsoreported somelinkagesandimpact on the surrounding community.Thesaidthat if they observepupils with problemslikebeing always dirty or with jiggersandlice, theyinvestigate further by going to the children’shome.Very often theywould link up theseresultswith povertyor a weak family structure(oldgrandparents).

• It hasalsobeenestablished thatdistrictsandsub-countiesare nowbeginning to plan andbudgetfor sanitationfrom their own resources.This showsthat theyarebeginning to appreciatetheimportanceof sanitation.

• Involvementof the politicians in the sanitationprogram hasresulted in better physical andfinancial accountability aswell asincreasedimplementation in somedistricts.

• Somedistricts havegoneaheadto recruit morestaff to fill in vacanciesof healthandcommunitydevelopmentstaffsoasto givemore to waterandsanitation development

• Latrines provided by UNICEF and RUWASAhave a life span of 5yearsandthereare nomechanismsset in place to ensurethey areeither emptiedor replaced.

Donor!Government

Community!School

Oneblodof5stanceslathnes±!andwasI~ingfacilIties

2,085,484 1,600 85%(UNICEF)91 % (RUWASA)

14%9% (RUWASA)

Rainwatertanks(10,000litres) 1,800,000 1,200 87% 13%Tr~ningfor3teachers 150000 100 100% 0%Prorkjcticnofmaterjalsfor3teach~

45,000 10 100% 0%

Nationalmassmodecerspagn 100,000 67,000 100% 0%

8

• Communitieshave beenmobilized to play theirrolesasis evidencedby the contributions thatthey maketowardsthe construction of latrines. Itmust be said however,somecommunitiescontributeunwillingly or often not all asthey haveoften thewrong understanding of theirresponsibilities in theschoolactivities.

U In general, there is insufficient monitoring andsupervision at thenational level. Monitoring andevaluation unit in theDirectorate of WaterDevelopmentdevelopeda setof surveytools forWES —Management information systemin 1998.However, it isavery comprehensivetool but itsefficient and effective useneedsto be reviewed.

U The monitoringchecklistsat theschoollevelthough effective have proven to be timeconsuming.When used,there is insufficientfeedbackfor appropriate actionsto be taken.

U Integration betweensoftw.reandhardwarecomponentsexistsalthoughpriority andresourcesare still skewedtowardshardwareactivitiessuchaslatrine constructionandboreholedrifling. Funds are for useon tangible,physical outputs whereassoftwareactivitiesrarely have physicaloutputs to claim in the shortrun.

U Integration becomesdifficult when hygienelessonson sanitation are given in class,but theschooldoesnot havethe requiredfacilities.Forexample,many lessonsemphasizewashinghands but mostschoolsdo not havewaternearby. Drinking water is not available let alonefor washinghandsbecausevery few schoolshavewater within a reasonabledistance(0.5km). Othershave water latrines that are verydangerousstructurallyandhazardoushygienically. Sosuchmessageslike ‘use thelatrine’ becomedifficult to transiate into practice.The reverse is true for hardwareinstallationswithout supportivesoftwareinputs. Forexample,many schoolshave handwashing facilitieslockedup in their storesbecausethey fall tounderstandthe valueof washing hands.

7. LESSONS LEARNED FROM THESTUDY

Lessonsare to be extracted from theweaknessesand successesof theUgandanapproach to schoolsanitation and hygiene.

• High level political commitment establishedthrough advocacyis the key to successfulimplementation of SSHinterventions.

• High level of pupils knowledgeof hygieneandsanitation issuesdoesnot ensurechangeinbehavior

• Regularsupervision,follow up andmonitoring isessentialfor proper operation and maintenance.

• Gender-sensitivity is essential whenimplementing schoolsanitation and hygieneactivities.

• Sanitation and hygienepromotion messagesdidnot focuson health benefitsalone.Theyalsopromotedvaluesof self-esteem,recognition andacceptedstatusin the society.

• Schoolshaveto be consideredin aholisticperspective,wheredasarooms,urinals, latrines,hand washing facilities andwater supply sourcesareall classifiedassanitary requirements.

• Follow up andsupervisionisnecessary for theprogressof activities,aswell asensuringthat theteachersapplied the participatory toolsthat wereusedduring the training.

• Working through existinginstitutionsratherthancreating specificstructuresensuresownership,capacity andsustainability of the activities.Institutions that exist are more legitimatebecausethey havestatutory powersandaregovernedby laws of Uganda.This makesthemmoreaccountableand reliable.

• Therearetoomany players involved in sanitationleading to weaknessin coordination andassumption of responsibility.

• There isneedfor adecentralizationof resources.Resourcesare not reachingthe intendedbeneficiariesin theamountsexpectedto makeadifference.There is needto further decentralizeresourcessothat they can move from the districtlevel to the sub-county.

• Training of teachers should include at leastonefemale teacherin eachschool,asthey areneededto encouragegirls to attendschools.

• The participation andwillingnessof the schools,schoolmanagementteams,and teachersespeciallyheadteachersto takepart in theproject arecrucial.

9

• Political interferencein the tendenngprocessresults in delaysand quality control.

• Effective participation ensuresproject activitiesrelevancy and sustainability. Communitiesshouldcontributein whichever way that they can to theacquisition of new sanitation facilities.

• Monitoring and Evaluation tools in the schoolshouldbe simple to useand should take verylittle time.

8. THE WAY FORWARD

Basedon the resultsof the study, a number ofrecommendationsweremadeto improve the currentschoolsanitation and hygienepromotion, usingUgandaasa casestudy.

1. Moreadvocacylsneededto:

- Ensure thatpolitical supportandcommitmentcontinues

- Increasesectorpartnerssupportfor schoolsanitation programsif coverageis to berealized andsustained;and

- Ensurethat communitiesare awareof theirrolesand responsibilitiesin UPEimplementationactivities.

2. More capacity buIldIng activitiesshould beundertakento:

- Increasecoverageof teachers trainedwith aspecialfocuson thefemaleteachers.

- Develop mechanismsthatensurethatstudentsare involved in schoolsanitationactivities in order for them to adopt improvedhygienebehaviorsatschools andathouseholdlevel.

- Developstrategiesthat involve beneficiariesin national-level managementto ensuresustalnabilityand local capacitybuilding

- Developa multi-sectoral approachtoenhanceimpact aseducation, nutrition and

health are linked to water supply andsanitation.

- Work on the syllabus to incorporategendersensitivity andemphasisonusing soapwhere handwashing isconcemed.

- Investmore in the private sector for cost-effective implementation and capacitybuilding

- Reinforce theLocal GovemmentAct whichprohibits political interferencein thetendering process should alsoenhanceprivate sector involvement

3. Sustainabilltyand useof hardwareshould beachievedthrough:

- Exploration of technologicaloptions thatcould be morechildren friendly aswell asgiving choicesto schools

- Provision of technologiesfor thedisabledchildren in all schools; and

- Availability of physicalfacilities for teachersto assumetheir responsibilities asrolemodels

4. SoftwareandparticipatoryapproachesshouldbeIntegrated:

- lnordertoprioritizethematalllevelssincebehavioralchangecalls for continualreinforcement of hygienemessages.

- Diversificationof approachesand targetgroupsis required to promote and sustaingooduse, operation and maintenanceoffacilities.

5. Monitoring and evaluationshouldfocuson:

The developmentof simpler monitoringcheddistsfor educationalstaffandensuring that qualitycontrolmechanismsare establishedat all levels.

The provisionof morestaffat thesub-countylevel in order to accomplishthe monitoringactivities.

This Field Notewaswritten by. Agnes Bitatureand Myriam Sidibe.Reviewedby: RoseUdondeandBrazille MusumbaDesignandLayoutby: ~1jeriGicheruProductionby: JaneWachugaDrawingsby: Timothy Kiwala