Can scaling up school-based water, sanitation and hygiene improve the health practices of school-age children and their communities in Haiti?
Summary:
Schools across Haiti have been negatively impacted by lack of clean, safe drinking water, lack of hygiene awareness about hand washing behaviors and unequal accessibility to sanitation facilities, especially following the 2010 earthquake. In 2016, IMA World Health worked with the Ministry of Education to provide WASH infrastructure improvement and social and behavior change interventions with school children, teachers and local communities in selected sites. Through a two-stage random sampling approach, three cross-sectional surveys measured WASH knowledge, attitudes and practices among school-age children at baseline, endline and one-year post-project follow up. While endline results were promising, one year following the end of project, results had dropped slightly in some indicators. Endline results showed that 70% of schoolchildren had knowledge of hygiene practices compared to 36% at baseline but dropped to 53% one year later. Additionally, post-project, 49% of students have access to safe drinking water in schools (baseline: 25%, endline: 52%); and 74% of children washed hands with soap after using toilet and before eating (baseline: 28%, endline: 82%). Data suggests these types of interventions can be used to inform future WASH policy and programming in Haiti. Globally, the program has made an important contribution to the well-being of children through the integration of WASH facilities and activities in schools. However, local governments must take a proactive approach to allocate resources to WASH infrastructure and school budgets. Without additional support, the success of the WASH programming in schools will likely decrease over time.
Background/Objectives:
Haiti is the most underserved country in the western hemisphere in WASH-related infrastructure. An estimated 69% of the population had access to an improved water source and 17% had access to improved sanitation facilities in 2010. In schools, students lack access to potable water and sanitation. Since the 2010 earthquake, 75% of schools lacked access to safe drinking water and 63% lacked sanitation facilities. Several waterborne diseases, including neglected tropical diseases, are endemic to Haiti. While schools can serve as a platform for scaling up WASH activities, little is known about the impact of such efforts on WASH practices.
Description of Intervention and/or Methods/Design:
In 2016, IMA World Health implemented a school-based WASH project in three regions in Haiti to improve school-childrens health by providing an essential package of WASH activities: open communication among stakeholders; alignment with existing national policies; a combination of education, infrastructure improvement and stakeholder engagement; and religious leaders engagement to promote related behavior change though prepared sermon guides. In collaboration with school authorities, IMA developed maintenance, operation and sustainability plans to ensure WASH activities were applied after the project. Data were then compared across three cross-sectional surveysbaseline in 2016, endline in 2018 and a one-year follow up-- to identify trends in WASH-related knowledge, attitudes and practices (KAP) among the student body over time. Five schools from three regions of the country were randomly selected and a total of 824 school-age children were interviewed. A two-stage random sampling approach was used during the survey.
Results/Lessons Learned:
Findings from the KAP surveys showed improvement in school-age childrens behavior and their knowledge on WASH compared to the data collected at project inception. However, a year after the project ended, some results were not as sustained although indicators were still improved than at the baseline. One year later, 49% of students have access to safe drinking water in schools (baseline: 25%, endline: 52%); and 74% of children washed hands with soap after using toilet and before eating (baseline: 28%, endline: 82%). Significant improvements between baseline, endline and follow up have been noted. On the question on students opinion of their school toilets, 61% of students responded that their schools latrines are clean and nice compared to the baseline (33%) and the end line (60%). Nearly all students (96%) disposed of their garbage in trashcans at school, a significant increase from baseline (baseline: 64%, end line: 86%).
Discussion/Implications for the Field:
Despite a decrease in some indicators post-project, the overall benefits to accessing WASH facilities and exposure to hygiene education are dramatic. Schools are a platform to scale up WASH interventions for improved health. School children are a suitable target for hygiene education as they can serve as agents of change by communicating what they learn back to their families and communities. While the KAP study did not take into account data related to sermon guides, it may have had an indirect effect on WASH practices. Ensuring sustainability once donor funding ends requires support from the community and local governments.
Abstract submitted by:
Abdel Direny - IMA World Health
Ellen Knowles - IMA World Health
Alain Javel - IMA World Health
Paul Emile Dalexis - IMA World Health
Scott Torres - IMA World Health
Mary Linehan - IMA World Health
Schools across Haiti have been negatively impacted by lack of clean, safe drinking water, lack of hygiene awareness about hand washing behaviors and unequal accessibility to sanitation facilities, especially following the 2010 earthquake. In 2016, IMA World Health worked with the Ministry of Education to provide WASH infrastructure improvement and social and behavior change interventions with school children, teachers and local communities in selected sites. Through a two-stage random sampling approach, three cross-sectional surveys measured WASH knowledge, attitudes and practices among school-age children at baseline, endline and one-year post-project follow up. While endline results were promising, one year following the end of project, results had dropped slightly in some indicators. Endline results showed that 70% of schoolchildren had knowledge of hygiene practices compared to 36% at baseline but dropped to 53% one year later. Additionally, post-project, 49% of students have access to safe drinking water in schools (baseline: 25%, endline: 52%); and 74% of children washed hands with soap after using toilet and before eating (baseline: 28%, endline: 82%). Data suggests these types of interventions can be used to inform future WASH policy and programming in Haiti. Globally, the program has made an important contribution to the well-being of children through the integration of WASH facilities and activities in schools. However, local governments must take a proactive approach to allocate resources to WASH infrastructure and school budgets. Without additional support, the success of the WASH programming in schools will likely decrease over time.
Background/Objectives:
Haiti is the most underserved country in the western hemisphere in WASH-related infrastructure. An estimated 69% of the population had access to an improved water source and 17% had access to improved sanitation facilities in 2010. In schools, students lack access to potable water and sanitation. Since the 2010 earthquake, 75% of schools lacked access to safe drinking water and 63% lacked sanitation facilities. Several waterborne diseases, including neglected tropical diseases, are endemic to Haiti. While schools can serve as a platform for scaling up WASH activities, little is known about the impact of such efforts on WASH practices.
Description of Intervention and/or Methods/Design:
In 2016, IMA World Health implemented a school-based WASH project in three regions in Haiti to improve school-childrens health by providing an essential package of WASH activities: open communication among stakeholders; alignment with existing national policies; a combination of education, infrastructure improvement and stakeholder engagement; and religious leaders engagement to promote related behavior change though prepared sermon guides. In collaboration with school authorities, IMA developed maintenance, operation and sustainability plans to ensure WASH activities were applied after the project. Data were then compared across three cross-sectional surveysbaseline in 2016, endline in 2018 and a one-year follow up-- to identify trends in WASH-related knowledge, attitudes and practices (KAP) among the student body over time. Five schools from three regions of the country were randomly selected and a total of 824 school-age children were interviewed. A two-stage random sampling approach was used during the survey.
Results/Lessons Learned:
Findings from the KAP surveys showed improvement in school-age childrens behavior and their knowledge on WASH compared to the data collected at project inception. However, a year after the project ended, some results were not as sustained although indicators were still improved than at the baseline. One year later, 49% of students have access to safe drinking water in schools (baseline: 25%, endline: 52%); and 74% of children washed hands with soap after using toilet and before eating (baseline: 28%, endline: 82%). Significant improvements between baseline, endline and follow up have been noted. On the question on students opinion of their school toilets, 61% of students responded that their schools latrines are clean and nice compared to the baseline (33%) and the end line (60%). Nearly all students (96%) disposed of their garbage in trashcans at school, a significant increase from baseline (baseline: 64%, end line: 86%).
Discussion/Implications for the Field:
Despite a decrease in some indicators post-project, the overall benefits to accessing WASH facilities and exposure to hygiene education are dramatic. Schools are a platform to scale up WASH interventions for improved health. School children are a suitable target for hygiene education as they can serve as agents of change by communicating what they learn back to their families and communities. While the KAP study did not take into account data related to sermon guides, it may have had an indirect effect on WASH practices. Ensuring sustainability once donor funding ends requires support from the community and local governments.
Abstract submitted by:
Abdel Direny - IMA World Health
Ellen Knowles - IMA World Health
Alain Javel - IMA World Health
Paul Emile Dalexis - IMA World Health
Scott Torres - IMA World Health
Mary Linehan - IMA World Health
Source
Approved abstract for the postponed 2020 SBCC Summit in Marrakech, Morocco. Provided by the International Steering Committee for the Summit. Image credit: IMA World Health