School sanitation and hygiene promotion in Uganda : the challenge

August 2000 as (gd-uhmA iaago This Field Note highlights lessons learned and recommendations for promotion of school sanitation and hygiene, using Uganda as a case. This case study was ~~~~~~ ~~~~commisioned by the Wager and Sanitaion Program for East and Southern Africa The opuon n Unda scool, scifwil at (WSP-ESA) in partnership with UNICEF. It was conducted in collaboration with the The ppuIa X Ug anschots,specifIall a Ministy of Health, and NETWAS in Uganda. primary level, has increased from 2.5 million in 1995 to 6.5 million in 1999, representing a 62 percent increase. This is mainly due to the recent implemeantation of Universal Primary Educaition *UPE) policy, which entiles ol school age children to tre primnary education. While most schools are aldy lacng in basic sanitary facilitNes, this sudden increase has aggravated the situatisn further, causing thm numban ou sudents - a per latrine stance to exceed 700 in same schools. The Government, UNICEF, DAUIDA and other pariners are making all efforts to meet this high denmnd thromgh schoa sanitalion The study aimed at puiting together existing experiences and lessans learned on school sanitation programming and implementation Uganda. The study was based mainly on the Water and Enviromental Sanitation (WES) and the Rural Water and S anitauion (RUWASA) ____ programs supported by UNICEF and DANIDA respectively. The study attempted to: o Create awareness on the need far use af public funds for school sanitation; a " A ; o Review the institutional arrangements in place (policies, strategies, institutions . > - 4 and actors); - ohAnalyze the nature of the interventions, l , which have been put in place, and; oDocument the experiences, lessons learned and recommendations in promoting school sanitation and hygiene. United Nations Children's Fund NIE1FWAS  A. Study Methodology This study focussed on the average rural primary school in * Field visits and observation checklists used in Hoima, Uganda. The study looked mainly at classes from primary one Mpigi, Mbale, Maseka and Mbarara districts; and to primary seven; the age range covered can vary between * A review of secondary sources undertaken to confirm some 6-16 years old. To meet the objectives set by the study, both of the information collected by the authors. quantitative and qualitative data were required. Secondary sources used included surveys reports, policy The methods that were used to collect data included structured documents, supervision and monitoring and evaluation interviews with key informants, i.e. government officials, reports as well as written conference papers. donor and private sector representatives, district leaders, extension staff and school management. Other methods Workshops were also organized for key stakeholders to get included: an overview of school sanitation and to corroborate information Focus group discussions led by children, teachers and parents; obtained from other sources. B. Justification for the use of Public Funds in School Sanitation and Hygiene School sanitation and hygiene is a worthwhile investment in absent, or are badly maintained and used, schools become a Uganda for many particular reasons. They include: health hazard. During the 1997-98 cholera epidemic, the Sanitation is a basic human right. convention of the Ugandan government spent 4.3 billion Ugandan Shillings (US Rights of the Child (CRS), which has been ratified by most $3.5 million) in health care costs. The schools were rapidly countries of the world, including Uganda, states that children becoming a place for disease transmission and 560 schools have a right to a safe environment for enhanced leaming, heakh had to be closed due to lack of adequate and acceptable and development of good cifizens. facilities. Schools provide an excellent opportunity to create School dropout and low literacy rates, especially life-long changes in behavior. In Uganda, the among the girl children can be attributed to poor population of students (6.5 million of children, 1999) spends sanitation and health conditions in schools. Girls, on average 180 days in schools, eight hours a day. Other than who are already marginalized in accessing education keep the family environment, schools are the most important places suffering because of inadequate sanitation facilities which of learning for children. Childhood is also the best time for allow them no privacy especially during their menstruation children to learn hygiene behaviors. What children learn in period. The lack of private sanitary facilities for girls primary schools is likely to be applied for the rest of their lives. discourages parents from sending girls to school, contributes to the drop out of girls at puberty, and a contributing factor to Children are effective change agents. What children fewer women teachers who are needed to encourage girls to learn at school they can transfer to their homes, communities attend schools. The low level of literacy among women, as a and to other children at home who are unable to go to school result of girl push-out aggravates prejudices based on for various reasons. These children will later become parents inferiority and superiority complexes between men and women. and will be duty bound to provide a safe and clean By promoting girls' attendance and retention in school, the environment for their own children's development. If children sanitation project influences sound cultural patterns of conduct are brought into the development process as active in future. participants, they can become change agents within their families and catalysts for community development. School sanitation prgrams offer opportunities for participation. It has other socio-economic advantages such Improved hygiene and sanitation is critical to health as empowerment, independence, decision-making, of school children and the community at large. In self-reliance, confidence building, creative development, life reality, schools are often more than just places for learning and skills development and sustainability. behavior change. If school sanitation and hygiene facilities are 2. IMPLEMENTATION STRATEGY AND PROGRESS The political climate in Uganda is now held on 16-17 October 1997. With discussing the issue of sanitation. The encouraging better sanitation as the theme: "Better Sanitation, A culmination of the forum was the attested by: Responsibility for All", the forum signing of The-- Kampala 1.The holding of the National brought together the leadership of all Declaration on Sanitation Sanitation Forum: The most 45 Districts in Uganda who, together (1997) by the Chairmen of the important achievement in the evolution with Members of Parliament, donors, District Councils. of sanitation in Uganda has been the Non-governmental agencies and national Sanitation Forum, which was concerned citizens spent two days The main output of the fonum was the 2  Safe drinking water Washing hands been the subject of over 600 newspaper articles in the national press since the beginning of 1998. \ h W.J)>,,,,,,,,d Home and school improvement. competitions are being held. Schools have build latrines and hand washing facilities; teachers have been trained in t the establishment of sanitation and health clubs. Private entrepreneurs are a isposal of efuse setting up businesses to recycle 5 Disposal of refuse /g285\g garbage. The visit of President Bill Clinton of the United States of America led to a massive clean up Kampala campaign led personally by the First Lady, Mrs. Janet Museveni. Sanitation promotion also features high in the manifestos of all the Kampala City Pit latrine with hand washing facility mayoral aspirants. Box 1 4. Redefinition of Sanitation: 10-point strategy program of which develop new approaches and a Working in close collaboration with school sanitation was a priority in the concept paper entitled "Promotion of DANIDA, UNICEF, WHO and the action point number 5, which states that: Sanitation in Uganda". This concept Water and Sanitation Program Group paper is the most comprehensive in Nairobi, the approach to sanitation "We shall ensure that every primary statement on sanitation ever written in for the entire country was redefined. school and all other institutions of the country. It covers the global The definition of sanitation was learning have adequate sanitation situation and the history of sanitation in broadened from the mere provision of facilities (latrines, safe drinking water Uganda. latrine slabs to a wider concept of supply and hand-washing facilities; environmental sanitation (excreta with separate facilities for girls) by the 3. Sanitation remains high on disposal, solid waste disposal, liquid end of 1998" the national agenda. waste disposal, hygiene control and The President's 1996-election vector control). Box 1 above shows the 2.The formation of a sanitation manifesto promised the electorate main components of school sanitation task force: The force was set up to improved sanitation. Sanitation has definition in Uganda. 3. INSTITUTIONAL ARRANGEMENTS A. Public Institutions involved in School Sanitation: centralized department with environmental health officers It has always been a policy in Uganda, as far as possible, to posted in each district and urban authority. At present, integrate water source development, sanitation promotion and the role of the division is being redefined with a view of community empowerment for sustainable community ownership, strengthening its capacity to support local governments to ufilizafion and maintenance of installed facilifies/services. As a result improve environmental sanitation. Officers who used to there exist a number of line ministries involved in sanitation. The belong to the division now belong to their District co-ordination is done at national level through the Inter- LocalGovernments. These officers and assistants are trained Ministerial Steering Committee (IMSC) and Project in the Schools of Hygiene as Health Inspectors and Management Teams (PMTs) to provide an enabling HealthAssistants and their job is to carry out mobilization environment in aspects of policy devel-opment, technical assis- and training activities at community level, including mobilizafion tance, quality assurance and monitoring and evaluation. These for school sanitafion and hygiene education. frameworks have greatly assisted/promoted the multi-sectoral collaboration and lobbying needed for policy reforms. The * The Ministry of Gender, labour and Social IMSC comprises the highest-ranking civil servants, i.e. Development through the Directorate of Gender and Permanent Secretaries from each of the ministries mentioned Community Development and district staff is responsible for social earlier with their technical heads of department as ex-officials mobilization and promotion of the role of women in sanitation do. Below are outlined the main responsibilities of each institu- improvement inifiatives. District level officers for the rural water tion: and sanitafion sub-sector are mainly traine by the Institute of Social Development, as Community Development The Environmental Health Division in the Assistants. Ministry of Health has the overall responsibility for environmental sanitation improvement. Before the ongoing * The Ministry of Education through its Inspectorote policy reforms, the division had operated as a traditional Department plays a role in enforcement of Government policy 3  through guidance, supervision and monitoring. It also plays is mainly an executive committee in charge of the day to day a role in the promotion of national syllabus that supports and running of the school. Problems occur between communities teaches sanitation and hygiene. and schools when a shared water source is left to the school to repair or when community members come to use * The Ministry of Water, Lands and Environment the school latrines and foul them. (MWLE) is also, to date, is the main institution involved in sanitation promotion and it is represented by its Directorate B. Private Sector Involvement of Water Development (DWD) through its two main programs The private sector is both one of the main strategies as well namely, as being an institution that the program is using. This is insupport of the Government policy on privatization.The use i) WES/UNICEF (1995-2000) covering 34 districts with a total of the private sector for school sanitation is a very new venture, budget of US$ 27 million; and of not more than a year old. ii) RUWASA/DANIDA (1996-2000) covering 10 districts with Initially the public sector was in charge of constructing the a total budget of US$ 40 million. school facilities. However, some problems were encountered. They included latrine construction in most cases was very slow * Other Government Projects include Small Town Water and inefficient and some latrines collapsed due to the fact that and Sanitation Project (STWSP) and Eastern Centers,which they were sited badly and because technical staff did not are involved in sanitation improvement programs in both supervise construction of the latrines. rural and urban settlements. NGOs such as ActionAid, AMREF, WaterAid, AVIS and Uganda Community Because of these reasons, there was a need to build capacity for BaseHealth Care Association (UCBHCA) are also the private sector to get them involved both in latrine construction involved insanitation improvement programs, including and latrine construction supervision. The private sector is community capacity building. also involved in development, production, and dissemination of appropriate sanitation materials as well as skills development for * At the District level ,the responsibility is borne by the sanitation service delivery and advocacy. Department responsible for health services competing with Under the school sanitation program, private contractors under- other health services like immunization, HIV/AIDS, take all latrine construction work except digging the pit, which nutrition,andMCH. At district level, sanitation activities are is done by the school community. The District Tender Boards coordinated through respective sectoral committees of LCV e.g. advertise and invite tenders following the Government Works, Social Services, Health and district management tendering procedures. Sub-counties are encouraged to employ teams with responsibility far planning, budgeting, supervision and local contractors to take up construction work. The role at the nation- monitoring implementation. The water components come uondeoring themterSection, whiheis usually hopousedn te al level is to support districts to strengthen the tendering processes, Woerk DhepWartmr Sent. on, which is usually housed in the assist in preparation of tender documents for certification and Works Department. payment and supervision. * At sub-county level, the responsibility for water and C. Implementation Arrangements for School sanitation falls mainly on the extension staff, namely health Sanitation assistantsand community development assistants. There are Below is the implementation frame work of the program. also sectoral committee members for health and education as well~ aslclNO nC . Thru-onycifas The following key issues are made sure all throughout the as well as local NGOs andCBOs. The sub-county chief also poes plays an important role by mainly enforcing by-laws and government policy. * Continuous involvement of all stakeholders (central and local * At parish and Village level, woter and sanitation is the governments, bilateral and multilateral agencies, private sec- responsibility of PDCs, local council secretariesfor tor and community members) ensuring the confinuity of both the health,school management committees and water and sanita- process and benefits arising from the school sanitation promotion. teionsho mngmn committees.adwtran aia tion committees. * Ensuring that sanitation promotion remains a highly political