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GoU/UNICEF SANITATION PROGRAM

PRIMARY SCHOOL SANITATION RESEARCH

A CONSULTANCY REPORT

By

Narathius Asingwire & Denis MuhangiDept. of SWSAMakerere UniversityFaculty of Social SciencesP. O. Box 7062Kampala, Uganda.E.mail s\vmifa'uol.cn.im

December 2000

TABLE OF CONTENTS

Acronyms..Acknowledgment..Table of Contents..List of Tables..List of PicturesExecutive Summary..

1.0 INTRODUCTION1.1 In t roduct ion. . .. .. .. 11.2 Nature of GoU/UNICEF School Sanitat ion Program .. 11.3 Study Objectives.. .. .. .. 21.4 Methodology .. .. .. .. 21.5 Data Collect ion. . .. .. .. 41.6 Problems Experienced .. .. .. 41.7 Organiza t ion of the Report. . .. .. 5

2.0 SAMPLE CHARACTERISTICS AND PROGRAMOVERVIEW2.1 Introduct ion. . .. .. .. 62.2 Background Informat ion on Sampled Schools.. .. 62.3 Sample of P u p i l s .. .. .. 82.4 The School Sani ta t ion Program Procedures

and Strategies.. .. .. .. 8

3.0 SCHOOL SANITATION SITUATION ANALYSIS3.1 Introduct ion. . . . . . . . 1 13.2 Presence of School Latrines.. .. .. 1 13.3 P u p i l : Stance Ratio.. .. .. .. 123.4 Separate Stances for Boys and Gi r l s .. .. 123.5 Separate Stances for Teachers.. .. .. 133.6 Latrine Condi t ions .. .. .. 133." Anal C leans ing Mater ials . . .. .. .. 163.8 Hand-Washing Fac i l i t i es . . .. .. .. 183.9 Presence of Ur ina l s . . .. .. .. .. 183 .10 Reported Presence of Latrines in P u p i l s ' Homes.. .. 20

4.0 SAFE WATER SUPPLY AND H Y G I E N E IN SCHOOLS4.1 In t roduct ion. . .. .. .. 214.2 Safe Water Faci l i t ies in Schools.. .. .. 214.3 Hygiene Practices, Condit ions and Faci l i t ies . . .. 234.4 Personal Hygiene.. .. .. .. 244.5 Presence of Cleaning Room for Adolescent

Girls Near the Latrine.. .. .. 264.6 Refuse Disposal .. .. .. .. 27

5.0 IEC CAMPAIGNS AND WATSAN RELATED DISEASESIN SCHOOLS5.1 Introduction.. .. .. .. 285.2 Sources of Sanitat ion and Hygiene Information. . .. 285.3 Health Messages in Strategic Places/Locations.. .. 295.4 Training of Teachers.. .. .. .. 29

EXECUTIVE SUMMARY

Over the last 3-4 years, the Government of Uganda (GoU) wi th support from U N I C E F has beeni m p l e m e n t i n g a School Sani ta t ion Program in 34 districts. The programme was in i t ia ted in thecontext of increased primary school en ro l lmen t . Enro lment has increased from 2.6 m i l l i o n in 1995before UPE to almost 6.5 m i l l i o n p u p i l s at present. The intervent ions under the Program haveinc luded support for construction of two 5-stance latrines per selected school, provision of ra inwater harvesting tanks, t r a i n i n g of teachers in WATSAN and hygiene , promotion of drama onsani tat ion and school competi t ions, media campaigns, and formation of school health or sciencec lubs . This study was therefore commissioned to assess the san i t a t ion , water and hyg iene s i tua t ionin primary schools in the context of UPE and. in l i g h t of the intervent ions. The study further soughtto ident i fy the factors fac i l i t a t ing and/or cons t r a in ing the imp lemen ta t i on and success of theprogramme.

The study was conducted in a sample of 16 d i s t r i c t s , covering a total of 235 schools; 162in te rvent ion and 73 non- in te rven t ion . A sample of 2323 p u p i l s (52% male. 48% female) was alsocovered. Other study participants i nc luded school a u t h o r i t i e s , d i s t r i c t o f f i c i a l s , sub-county of f i c ia l s ,and in-charges of h e a l t h u n i t s . Data was c o l l e c t e d u s i n g a c o m b i n a t i o n of formal in t e rv iews , ke\ -in formant interviews, observation and review of documentary sources.

The Major Study Findings

The f ind ings indicate that all schools, except one. had some form of a l a t r i ne . Almost all schools(97.2%) had slab/sanplat latrines, a l though these were s imul t aneous ly used together wi th t radi t ionallatr ines (93.8%). The number of p u p i l s u s i n g a s i n g l e stance was very h i g h in all sampled distr icts:96: 1 for sanplat/slab latrines alone, and 84: 1 for sanplat/slab and t rad i t iona l la t r ines combined.Thus, the current p u p i l : stance ratio of 96: 1 f a l l s below the recommended ratio of 40: 1.However,the current p u p i l : stance ratio represents an improvement from the pre-intervention t ime when theratio was estimated to range from 100 - 700: I . The big numbers of p u p i l s us ing a s ing le stancemakes c l e a n i n g and maintenance of la t r ines very d i f f i c u l t , and hence most latr ines were foundu n h y g i e n i c wi th some posing a hea l th hazard . Also, g iven the fact tha t most schools had anenro lment of 500-1000. wi th a few exceeding 2000 p u p i l s , l a t r i ne s w i l l q u i c k l y f i l l up. Indeed, closeto 10% of all l a t r ines were already f u l l at the t ime of t h i s study amids t lack of any replacement orsus t a inab i l i t y p lans . Part of th is cons t ra in t also lies in the type of la t r ine technology being used( u n l i n e d l a t r i n e p i t ) wh ich does not lend i tse l f to emptying .

Whereas some progress is being made to put phys i ca l s t ructures , ma in tenance and c l e a n l i n e s s ofl a t r ines remains a daun t ing challenge tor majonts schools. A big proportion of observed la t r ines fellshort of appropr ia te hyg ien ic condi t ions . F o u l i n g was one of the major problems; 42.6% of theboy's latrines. 36% of the g i r l ' s la t r ines and 13% of the teacher's la t r ines were found fouled.Between 16-30% of a l l the latrines ei ther lacked doors and/or did not provide adequate privacy.Only 36.6% of the p u p i l s ' latrines and 50.7% of the teachers" la tr ines had some form of analc l eans ing mater ia ls . These largely consisted of p lan t leaves.

Majority of the latrines (60.6%) had hand-v(vashing faci l i t ies . However. 61.7% of all HWFscontained water, 39.3% had soap, and only 59.8% had wet soil beneath them. This impl ies that evenwhere HWFs exist, they may not be under use. Up to 81.7% of the schools had ur ina l places,a l though their hygienic conditions left much to be desired. On the other hand, a few schools (16.5%)had a separate c leaning room for adolescent gir ls near the latrines. The difference betweenintervent ion and non-intervent ion schools were noticeable, with a quarter (25.8%) of the formerhaving such rooms compared to less than a tenth (7.2%) in the latter. Majority schools (79.5%) hadrefuse disposal.

V I I I

With respect to safe water f a c i l i t i e s , major i ty of the schools (85.2%) depended on protected sources.About a third of the schools (33 -1%) had received rainwater tanks. Majority of all rainwater tankswere complete and func t i ona l (66.3%). The tanks that were non - func t iona l lacked certain mater ia lssuch as sutters and fac ia l boards that were supposed to be con t r ibu ted by the communi t ies / schools .In some instances, some of the tanks had broken taps and schools could not replace them. Almosthal f (47.6%) of the schools drew the i r water from a distance of less than 100 meters. However,problems such as overcrowding at the source and drying up of water in the tanks were reported.

Regarding personal h y g i e n e , a b ig n u m b e r of p u p i l s ( 8 5 . : % ) reported unprompted that they washedthei r hands after la t r ine use. Hand-washine after l a t r ine use could have been over-reported sinceon ly 60.6% of the schools had hand-wash ing f a c i l i t i e s , and of those o n l y 61.7% contained water.The over-reporting, however, indicate h i g h levels of knowledge about appropriate and socialacceptability of the behavior. Assessment of personal hygiene amongst pupils indicated that femalep u p i l s tended to observe better personal hygiene standards compared to t he i r male counterparts.

With regard to IEC campaigns, science lessons and school teachers were the major reported sourcesof WATSAN and hyg iene related informat ion reported by 65.7% and 5 1 . 1 % respectively, ind ica t ingthe possible c o n t r i b u t i o n of t r a i n i n g of teachers under the school s an i t a t i on program. A few p u p i l s(4 .9%) ci ted sc ience or h e a l t h c l u b s as t h e i r source o t i n f o r m a t i o n , w h i c h is e x p l a i n e d bs the factthat formation of these c l u b s has not been effected in major i ty of the schools. Other softwarecomponents of the programme such as media campaigns, school competit ions, and drama activitieshad not taken off w e l l .

In respect to knowledge and awareness of WAT SAN and hygiene related diseases, majority of thep u p i l s (92.8%) reported some of the diseases caused by poor hyg iene and san i ta t ion , especiallydiarrhea. On personal experience. 26.6% of the females and 28.6% of the males reported that theyhad suffered from WATS AN related diseases over the p reced ing 3 months to th i s s tudy .

As much as the Program effects are beins realized amidst bin numbers of pupi ls , the Program hasi nhe ren t constraints and threats tha t can po t en t i a l l y i m p i n g e on sus tamabi l i ty . There are. forinstance, c r i t i c a l issues regarding i n s t i t u t i o n a l and managemen t aspects of the Program. A l t h o u g h i tis appreciated that the Program has attempted to i n v o k e a l l possible stakeholders, in absence ofef fec t ive co-ordinat ion and clear d e m a r c a t i o n / d e f i n i t i o n of roles and respons ib i l i t i es , th i s has tendedto create tension and confus ion . There is e v i d e n t "fight" for ownership and control of the Programbetween Dis t r i c t E d u c a t i o n Deaartments and D i s t r i c t H e a l t h Directora tes . In terms ofimplementa t ion in some d i s t r i c t s , of f ic ia ls are d e a l i n g d i rec t ly wi th schools by-passing Sub-counties, wh i l e others have no clear systems for selection of beneficiary schools. It was also pointedout that in some of the d i s t r i c t s . Tender Boards tend to be under enormous po l i t i ca l inf luence inawarding tenders. Another c r i t i c a l problem is tha t of raising" Focal cont r ibut ions for r a i n w a t e r tanksand latr ine construct ion. The contradictory messages from the MoES and District EducationDepartments r ega rd ing the role of parents and c o m m u n i t y in the context of U P E do not promotemass i n v o l v e m e n t and sus tamab i l i ty mechanisms.

Recommendations

Several recommendations are i m p l i c i t in the SWOT analysis presented in the text. Specificrecommendations inc lude :

• Different technology options should be explored w i t h a view of : a) ident i fy ing a technologysuited to col lapsing soils, b) i d e n t i f y i n g a technology that promises more sustainabi l i ty , such asone that allows emptying.

• There is need to improve the i m p l e m e n t a t i o n procedures especially the selection of schools andallocation of assistance lo make these processes more transparent and more accessible to neediulschools.

There is need to improve the partnership and working relationship between the district educationdepartment and health. More importantly, there is need to bring the education department onboard, and ensure their full participation in the programme.The fact that many schools pick tanks and fail to install them also requires a pre-condition thatschools to allocated tanks should first have the platform and the gutters ready before they pickthe tank, beyond a period of which their allocation is forfeited to another applicant.There is need to think and work out sustainability mechanisms especially with respect tolatrines.There is need to involve the sub-counties more. A more bottom -up approach would make theprogramme more demand driven, locally owned, sustamable and more effective and rational.There is need to rethink the accompanying strategies oi health/science clubs and drama activit iessince they seem not to be working.There is need for well-planned and authentic information to parents about their roles andresponsibilities in the context of UPE. This would help to overcome the apparent contradictionsin policy.Proper information management is also key to programme success. This may requirereport/monitoring formats that are filled from time to time.As an alternative to pinning posters on wal ls against the associated risk of removal, schoolsshould be encouraged and faci l i tated to put w a l l paintings, wood curving, and clay portraits thatdepict hygiene and sanitation messages. These alternatives could be installed in such a mannerthat they are not easily removable.There is need to target teachers with tailor-made sanitation and hygiene training while they arestill in the Teacher Training colleges. This will ensure that by the time they come out. they arealready acquainted with sanitation and hygiene issues, strategies for their promotion, and theroles they have to play.

1.0 INTRODUCTION

1.1 Introduction

In October 2000, the Department of Social Work and Social Adminis t ra t ion signed a Contract withGoU/UNICEF to earn.' out a study on "Primary School Sanitation Research in Uganda". The studywas commissioned against a background of increased enrolment of p u p i l s in primary schools as aresul t of i m p l e m e n t i n g the Un ive r sa l Primary Educa t ion Policy. Enrolment has increased from 2.6m i l l i o n in 1995 before UPE to almost 6.5 m i l l i o n p u p i l s at present due to imp lemen ta t i on of UPEpol icy . These big numbers are exerting tremendous pressure on the available schools'infras t ructure such as classroom space, safe water supplies and sanitation fac i l i t ies . For instance,in 1995, it was estimated that 44% of the primary schools had access to safe water supply, and apup i l : stance ratio of 328:1 which is estimated to have increased to about 700:1 in some schools asopposed to the recommended ratio of 40 :1 .

This study was commissioned at a t ime when the p u p i l : stance ratio in the country was not exactlyknown, but o n l \ estimates provided by several s tud ies . I n one of the recent s tudies by Vv'aterkeyn( A u g u s t 2000: 5). i t uas pointed out thai:

Most schools have increased in size so rapidly that they have a pupil to stance ratio thatranges from anything between 100-700 pupils per stance rather than the requiredniiiximum of 40!

Thus, as much as there is general u n d e r s t a n d i n g and appreciation thai there has been increase ofp u p i l s per stance, the exact p u p i l : stance ratio has remained unknown, w h i c h th i s study, amonuothers, sought to determine. Nevertheless, the b ig number of p u p i l s per stance, in turn impacts onthe condi t ions of the exis t i im latr ines (See Section 3.0). Besides, some of the rural schools arebeing reported to have no usable la t r ines , w h i l e some of those that have, do not have separatestances for g i r l s and boys. Due to these problems. G o U / U N I C E F Sani ta t ion Program has beensupport ing p r imary schools in the 34 d i s t r i c t s of Uganda to improve t h e i r hyg iene and sani tat ions i t u a t i o n . The Rura l Water and Sani ta t ion Program. East Uganda Project ( R U W A S A ) . support theschools in the rest of the d i s t r i c t s not supported by G o U / U N I C E F .

U n d e r the G o U ' U N I C E F School S a n i t a t i o n Program. Government released UG. Shs 2.11= b i l l i o nfor the year 1998/99 and 2.8/= b i l l i o n for the year 1999/2000 to UPE schools. Under the Program,various water, sanitat ion and hygiene ac t iv i t i e s were earmarked for support as elaborated in 1 . 2 .

1.2 Nature of GoU/UNICEF School San i ta t ion Program

The program has been of fer ing a wide range of in te rvent ions to promote hygiene and sanitat ion,and provide safer water in UPE supported schools. These interventions have included thef o l l o w i n g ;

• Latrine Support: Assistance is offered to UPE schools to construct latrines. At first, suchsupport was in form of slabs and money. Later on. assistance was in form of funds to coverthe costs of two 5-stance latr ines: 1 for boys and I for girls for every supported primaryschool.

• Rain Water Tanks: This in te rvent ion has involved supply of crest tanks, as well as support tob u i l d Felo-cement tanks.

Mobilization of local leaders: This is support offered for mobil izat ion meetings to informlocal leaders of the programme and enlist their participation and support for the program.

Training of Teachers: This involves t r a i n i n g of Head-teachers. Senior Women Teachers andScience Teachers. The t r a i n i n g covers sani ta t ion and hygiene issues, as well as their expectedroles in the programme.

Drama on Sanitation: Assistance is offered to schools in support of pupils to perform dramaon hygiene and sanitation .

Media Campaigns: Messages on hygiene and sanitat ion are broadcast on various media suchas radio and newspapers.

Formation of Health Clubs: Trained teachers are expected to assist pupils form health orscience clubs in schools. Such clubs are responsible for promoting hygiene and sanitationwithin the schools.

All the above activit ies/interventions are geared towards improving sanitation and hygiene inUniversal Primary Education schools. However, ever since the support was channeled to UPEschools, no in-depth review had been undertaken to assess hou the safe water supply, sani tat ionand hygiene si tuat ion has changed. It is against th i s background that t h i s study v%as commissioned.

1.3 Study Objectives

The overall objective of this study was to establish the current si tuation of primary school watersupply, sanitation and hygiene in the context of UPE. and the interventions that have beenimplemented. It is envisaged that the findings of th i s stud\ w i l l provide critical input intoreviewing GoU/UNlCEF strategies for school sanitat ion promotion.

The specific objectives:

1. To carry out an analysis of the present school s a n i t a t i o n s i t u a t i o n , as we l l as hygiene and safewater supply.

2. To analyze the na tu re of i n t e r v e n t i o n s tha t h a v e been i m p l e m e n t e d

3. To review rhe i n s t i t u t i o n a l arrangements in place, i n c l u d i n g pol ic ies , strategies, i n s t i t u t i o n sand actors

4. To assess the strengths, weaknesses, threats, and opportunit ies of the current school san i ta t ionprogram with the aim of using the information to improve the program

1.4 Methodology

Overall Research MethodologyA research design combining quantitative and qualitative methodologies was adopted in carryingout this study. The research covered various categories of respondents/informants who arestakeholders in the program.

Study RespondentsRespondents included School Pupils, School Head-teachers. Science Teachers and Senior WomenTeachers, Members of School Management Bodies. District Officials (DHL DWO, DIS. ACAO.Secretary Social Services Committee). Sub-county Officials (Sub-county Chief, HAs. CDAs.LCIII Chairpersons) and In-Charge of Health Units. With the exception of pupils who wereselected using random procedures, the rest of the informants were purposively identified andincluded in the study.

Selection of DistrictsTo generate representative data of all the 34 districts where the interventions had beenimplemented, the research targeted 50% of the dis tr icts (i.e., I 7 1 ) . Given the wide coverage, timeconstraints and resources, a half of 17 districts (9) were targeted for in-depth research, whi le theremaining 8 were targeted for non-in-depth research. In the districts where in-depth research wascarried out, data were collected from various categories of respondents, i n c l u d i n g pupi l s , wh i l e innon-in-depth research districts, the data collection exercise was limited to the Head-teachers aswell as observation of the facilities. In the latter case, the aim was to cover a wider sample ofschools to generate representative stat is t ical informat ion and to a l low stat is t ical analysis of presentschool sanitation situation such as latr ine coverage and pupi l : stance ratio.

Selection of SchoolsThe research covered both intervention and non-intervention schools with emphasis on the former.Intervention schools refer to those schools that had benefited from the GoU/UNICEF SchoolSanitat ion Program, w h i l e n o n - i n t e r v e n t i o n schools had not benefited. The aim of studying the rwocategories of schools was to enable comparison of any changes as a result of the intervention. Thenumber of schools covered in the sample of in te rven t ion and n o n - i n t e r v e n t i o n was 162 and 73respect ive!) , m a k i n g a total of 235 schools .

Sample of Pupi lsA total of 2323 pupi l s were interviewed in in-depth research districts. The m i n i m u m sample ofp u p i l s per school was estimated at 20. See Table I for sample of pup i l s per school, districtscovered aiid number of schools bv cateuorv.

Table 1: Number of Sample Schools and Pupils by District

DISTRICT

AruaBushenviHoimaKabaroleKasese*Kotido*K u m iLiraLuweroMasakaMbararaMoroto*NakasonuolaNebbi*N t u n u a m o *SorotiTotal

Total Schools

14201018208129

201844569814

235

Interventionschools

I 1 .15S1214586141328341410

162

Non Interventionschools

Ji

^

66-,j4365162i24473

Pupils interviewed

149276138227

, , .. ... - .5"

1541 1 73162 1 5550

73

1032,323

I\loii-In-Deptli Districts, no pupils were interviewed.

The 17" sampled district, Githi >vti.\ nut covered tine to tlie outbreak of Ehola. Titus, the analysisis bused tin I (> districts.This was n iiiin-in-i/efit/i district. /VV; interviews were expected for pupils.

1.5 Data Collection

Quantitative and qualitative methods were applied to collect information in in-depth and non-in-depth research districts.

Data Collection in "In-depth Research" DistrictsIn-depth research involved selection of a sample of pupi ls on whom a short interview schedulecovering aspects of knowledge and practice re°arding hygiene and sanitation issues, as well aspersonal experience of hygiene and sanitation related diseases was administered. Data collectionin this set of districts also involved appl icat ion of all the data collection procedures and covered allthe categories of respondents.

Data Collection in non-In-depth Research DistrictsThe major purpose of covering selected schools in "non-in-depth districts was to enable generationof more quantitative data that would allow' for representative generalization of pupil: stance ratioand conditions of sanitation fac i l i t ies in 34 districts. Observation of facilities and documentaryreview were the main methods of data collection, wh i l e interviews were restricted to head-teachersand district officials.

Specific Data Collection Methods

Observation: - This method was used to assess all observable aspects such as the stage ofconstruction, the n u m b e r of latr ine stances, the quality of construct ion work, the quality ofmaintenance , as well as the hygienic cond i t ions of the faci l i t ies . A semi-structured observationcheckl is t was used for th i s method.

*

Personal Interviews: - Personal in terviews uere used to collect quant i f i ab le information frompupils as well as the head teachers. Semi-structured questionnaires were designed for each ofthese categories of informants. For the pupils, interviews were used to collect information abouttheir knowledge of hygiene and sanitation issues and experience of sanitation related diseases. Forthe head teachers, interviews were used to collect data on the t \ pe and amount of assistancereceived, how it was ut i l ized , problems encountered, the i n s t i t u t i ona l arrangements in place, aswell as the numbers of pupils enrolled.

Key Informant Interviews: - Members of school administrat ion bodies, district officials and Sub-county officials were interviewed as key informants . These Interviews were used to generateinformation on the key aspects of the intervention, their u t i l i t y as wel l as constraining andfac i l i t a t i ng factors. Schedules of guide questions ( In terv iew Guides) were uti l ized for key-informant interviews.

Document Review: - Relevant documents at different levels (schools, districts, sub-counties) wereconsulted and reviewed.

1.6 Problems Experienced

The study took longer than expected due to the fact that data collection in schools could only takeplace dur ing the working days and only dur ing school hours. This had not been anticipated, butended up impacting on the study t ime and finances.

As indicated earlier, G u l u district could not be covered due to the outbreak of Ebola that led to thesubsequent closure of schools. It had been hoped that the Ebola outbreak would last a short periodso that selected schools in that district would be covered. This was not possible, and hence Guluhad to be omitted in the analysis. This, nonetheless, had no effect on the representative nature ofthe data, since in the first instance. Gulu was a non-in-depth research district, and second, districtshad been over-sampled in the preparation of this stuclv.

1.7 Organisation o f t n e Report

The rest of tincharacteristics orGoU/UNICEF Scappreciating theFocus is on la t rcleansing materivariables to anaiwater supply anchygiene are pre:campaigns as si;related diseases,institutional Arr:Seven is a SY\conclusion and rt

s repor. is organized under Seven Sections. Section Two examines thethe se lec ted schools and sample of pupils. It also presents an overview of the

;hool Sar;:ation Program. This is meant to provide a context of understanding andstudy f indings. Section Three presents findings on school sanitation situation.•me co'.--•••age. latrine conditions, pupil: stance ratio, hand-washing facilities,a!s. unn-L-. and their conditions. The data are cross tabulated with relevant;. ze po5- ' ;-• causal-effect relationships. Section Four examines aspects of safe: hygiene conditions in schools. Findings on environmental and pupils persona!rented, section Five focuses on information, education and communicationnported "•• the programme, as well as issues of water, sanitation and hygienein this section, aspects of pupils' drop-out are also examined. Section Six is onn.gemeni.-. and Actors involved in sanitation and hygiene in schools. SectionI'T ana 1 - ! S of the School Sanitation Program. Section Eight presents thecommendat ions arisma from the stuch findings.

2.0 SAMPLE CHARACTERISTICS AND PROGRAM OVERVIEW

2.1 Introduction

This section presents the background findings. It focuses on characteristics of studied schools andsocio-demographic characteristics of sampled pupils. The School Sanitation Program proceduresare also outlined as they impact on implementation and sustainability issues.

•> i Background Information on Sampled Schools.

The study covered primary schools of various categories: schools located both in rural and urbanareas and schools of different types/grades. See Table 2 for details.

Table 2: Characteristics of Sampled SchoolsVariableCategory of SchoolInterventionNon-intervention

LocationRuralUrban

TypeMixed dayMixed boardingSingle Sex dayBoarding BoysBoarding GirlsMixed day and Boarding

Enrollment<500

1 500-9991000-14991500-19992000-24993000-

Teuching Staff<5

5-910-1415-19

%

67.8•>-,- ,j _ ._

71.228.8

85.21.30.40.00.412.8

25.051.317.53.90.91.3

0.923.8

•36.139.2

N

16076

16868

20!

101

30

•> ~

11 -409-,j>

2548289

Table 2 presents the findings on various characteristics of sampled schools. The study reachedmajority intervention schools (67.8%), compared to non-intervention schools (32.2%). The bimzestpercentage of schools reached were located in rural areas as opposed to urban areas. Majorityschools had big numbers of pupils ranging from 500 and above. As a consequence, the pupil:teacher ratio as well as pupil: classroom ratio was very hitzh.

Pupil to teacher ratio was on average 59:1, clearly greater than the GoU recommended ratio of45:1. As shown in Table 3. only I district. Masaka. was found to be meeting the required

standard. Moroto distr ict on the other hand reflected an extreme shortage of teachers with a ratioof 140:1. See Table 3.

Table 3: Pupil: Teacher Ratio

DistrictAruaBushenviHoimaKabaroieKaseseKotidoKumiLiraLuweroMasakaMbararaMorotoNakasoneoraNebbi JN tun gam o

.. Soroti

Pupil: Teacher Ratio67: 156: 160: 160: 179: 158: 160: 160: 151: 143: 149: 1140: 166: 170: 156: 152: 1

Average 59: 1

The inadequacy of teachers may have implicat ions for effective teaching, i n c l u d i n g transmissionof hygiene and sanitation messages. Related with the pupil: teacher ratio, the study alsoinvestigated the pupil : classroom ratio. In assessment of classrooms, what was considered is thephysical presence of a room used for class purposes. The findings revealed an average of 82:1,with the ratio in 5 out of the 16 districts exceeding 100:1 as shown in Table 4. Congestion inclassrooms obviously makes classroom hygiene more diff icul t . Schools with high pupil : classroomratio were also conduct ing some classes in the open air or under trees, which makes hygiene moredi f f i cu l t to observe.

Table 4: Pupil: Classroom Ratio

District Pupil: Classroom RatioArua

i BushenviI Hoima 66:! Kabaroie 85: I

KaseseKotido 89:KumiLiraLuweroMasakaMbararaMorotoNakasongoraNebbiNtungamoSorotiAverage

101:176: 173 :170: 153: 1110: 173: 1113: 179: 190: 182: 1

2.3. Sample of pupils

Table 5 shows that the study reached almost equa l n u m b e r of female and male pupils: 48% and52% respectively.

Table 5: Basic Data on Sample of PupilsVariable PercentageSexMale 52.0Female | 48.0Age<10 1 9 . 1

Number

1208 i1 1 1 4

'443 ;

1 1 - 1 2 ! 28.6 ! 662 i13-14 35.115+ j 17.2Class jP3-P4 j 35 .1P5-P7 ' 64.9Distance from Home to School<0.5Kms 1 32.0

814 '399 !

814150-

- 730 :r 0 . 5 - l K m s j 25.8 | 590 :

l - l . 5 K . m s I 1 5 . 11.5-2Kms 1 9.4>2Kms 17.6

346 ;214403

Majority of interviewed p u p i l s were between 1 1 - 1 4 years o ld . but also a sizeable proportion ofadolescents who would be affected in t h e i r school attendance by the exis t ing sani ta t ion f a c i l i t i e s ofthe school. From the s tud> f ind ings , i t is clear that majority p u p i l s came from a dis tance of w i t h i n1 k i lometer radius of t he i r respective schools.

2.4 The School Sanitation Program Procedures and Strategies

2.4.1 GeneralAs has already been indicated in Section 1.0, under the program, each targeted pr imary schoolreceives or is supposed to receive support to put up 2 l a t r i n e s of 5 stances for male and femalep u p i l s respectively. However , in most d i s t r i c t s p r o v i s i o n of 2 blocks each wi th 5 stances wasfound to have been relaxed instead one block per school is provided, so as to reach a biggern u m b e r of schools. Besides the la t r ines , selected schools, depending on such considerations asexis t ing water faci l i t ies , receives or is supposed to receive support in form of a 200 l i ter water tankfor rain/water harvesting.

2.4.2 Selection of Beneficiary SchoolsTargeted schools are supposed to be informed about the available assistance, and they then applythrouah the Sub-county or to the Sub-county d i rec t ly . The Sub-county then screens and forwardsthe applications to the distr ict .

In most districts, the cri ter ia reported to be followed in a l locat ion of facil i t ies included:

equal d i s t r i b u t i o n to Sub-counties: an attempt is made to ensure that at least each Sub-countyis reached,

school enrol lment : pr ior i ty is given to schools w i t h the highest levels of enrollment.

ex i s t ing f a c i l i t i e s : schools, w h i c h already have a reasonable level of f ac i l i t i e s , are lessp r i o r i t i z e d . S i m i l a r l y those that cou ld have already benefited from support of otherprogrammes to put up san i t a t i on and water f a c i l i t i e s are not given priori ty,

response to demand: assistance is given on the basis of appl ica t ions from schools, and in thecase of latr ines, that the school has a ready pit, dug using the school's communi ty ' s owncont r ibut ion .

In most districts, issues of political influence, lack of information about the program amongstpoten t ia l benef ic iar ies , and inadequate i n v o l v e m e n t of Sub-count) off ic ia ls were reported to be themajor constraints to enforc ing these d i s t r i b u t i o n cr i ter ia .

In some cases, the dis t r ic ts were dea l ing di rect ly wi th the schools, but also in a manner that wasnot clearly known to all re levant stakeholders. For instance there were cases where schoolsapplied directly to the District, or even to the politicians, without any clearly spelt out procedurefor app l i ca t ion . In other cases, p o l i t i c i a n s or other dis t r ic t officials were reported to have on the i rown ident i f ied or short-l isted schools to benef i t . It was also common to f ind that schools that hadnot benefi ted were not aware of the procedures for a p p l y i n g or accessing the assistance. Forins tance , in K u m i d is t r ic t . Sub-counties and the Town C o u n c i l were not involved in the keyd e c i s i o n s of the program but were on ly cal led upon to "assist" in. mon i to r ing construction work. Assuch, the Sub-county and Town C o u n c i l o f f i c i a l s t a lked to, did not know w h i c h schools hadbenef i ted . .what assistance they had received and how they had been selected. Overall, it wouldappear that in some of the d is t r ic t s , the program was marred by po l i t i ca l inf luence and lack oft ransparency especial ly in a l loca t ion of assistance. In s i tuat ions where, for instance. Sub-countieswere not invo lved , this was found to have the danger of u n d e r m i n i n g the i r support to the programas we l l as the spi r i t of ownership and s u s t a i n a b i l i t y .

2.4.3 Construct ion of FacilitiesConstruction work is contracted out to the private sector. The tendering process is handled b> theDistrict Tender Boards. There uas concern at Sub-county and school levels that tenderme atdistr ict l e v e l makes projects more expensive; tha t they would use lower costs if they handled thecontracts themselves. Po l i t i ca l in f luence in the award of tenders was also cited as a commonproblem, w h i c h often leads to poor contractors being hired.

It uas reported that p re fe ren t ia l t reatment accorded to local firms as opposed to external ones.This is in l i n e w i t h government policy of poverty a l l ev ia t ion under the PAF ini t ia t ive . However,t h i s has its own shortcomings in a sense that the local private firms u s u a l l y lack sufficient capacityin terms of cap i t a l and expertise. The problem of lack of capital is made worse by the fact thatunder the cont rac t terms, the contractors can only be paid for work completed. A few dis t r ic t sh a \ e short-cut th i s problem by ex tending advances to the contractors, but this in turn breeds itsown risks, such as the possibili ty of the contractor abdicating work.

2.4.4 Mon i to r ing ad Supervis ionMonitor ing is supposed to be carried out by the relevant district officials, such as DEO. DHLD\\0. as well as their subordinates. The pol i t ical leaders responsible for social services andtechn ica l services both at District and Sub-county levels are also part of the monitoring group.Supervision is t echnica l ly under the responsibi l i ty of the District Engineer, and his staff such as theInspector of Works or Buildings. Health Inspectorate staff and water department staff also havesome technical supervision roles.

Monitoring and supervision have been facilitated by the avai labi l i ty of some funds under PAF.However, the process is laced by a number of const ra in ts . There are obvious problems related tos u p e r v i s i o n roles by D i l l and DI-X). There seems to be no collaboration between DFX) and

10

DDHS/DHI, with the latter not involved in he implementation of the proszram. Apart fromstructural/institution problems, these are logistical and supplies problem. For instance, there areinadequate vehicles, lack of fuel, and in some cases, shortage of staff. With respect to the latter forinstance, Kabarole district was found to have only 13 out of the required 35 Health Assistants,while Kasese and Kabarole did not have District Water Officers.

An issue of concern from some of the sub-counties v is i ted which could be a constraint tomonitoring was the tendency of keeping them out of the tendering process, yet they are expected tosupervise the private contractors undertaking the construct ion work. They claimed that sometimesthey did not know the terms of the contract. A genuine problem, however, could be thatcontractors who have got their tenders from the district may owe their allegiance to the Districtpeople and Sub-county officials will simply find it hard to deal with them.

2.4.5 Counter-part Contribution ArrangementsThe programme has been implemented using the strategy of local contribution to project costs.

This strategy has been employed, both as an aspect of the demand responsiveness approach as w e l las a means of ensuring ownership. For latr ines, schools are required to dm the pit. Parents aresupposed to be mobilized to provide labor for digging the pit of at least 30 ft. In some cases, thedepth of the pit is constrained by rocky and unstable (sandy or water logging) soils. Labor fordigging the pit has not been easily forthcoming as indicated later as "threats" to the program.

For water tanks, the schools are expected to build a brick/concrete platform for the tank, providetransport to deliver the tank to the school, and put facial boards for buildings and gutters. Schoolsare also expected to meet the costs or labor for buildinu the platform. However, findings revealedthat most schools are failing to raise the required money or mobilize the labor. In districts such asLuwero and Kumi. water tanks that had been delivered months back by the program had not beeninstalled at the time of this study. There seems to be variations in the local contributionrequirements over time. In some districts, it was reported that the program had started sivins pre-fabricated gutters.

There are also district variations in the success of the iocai contributions strategy. In Arua districtfor instance, it was reported that most of the problems experienced in other districts relating tomobilizing community participation were not outstanding. This was partly attributed to the uok ofthe«SNV supported Community Action Programme fC:AP). which had instilled a strong sense ofownership and participation amongst the people by use of PRA methodologies.

3.0 SCHOOL SANITATION SITUATION ANALYSIS

3.1 Introduction

One of the major objectives of th i s study was to analyze the si tuat ion of school sani ta t ion in thecontext of UPE and the program intervent ions that have been implemented. This study thereforeinvestigated the existence of sanitation facil i t ies, their quality, quantity, as well as maintenance.The f a c i l i t i e s assessed i n c l u d e d l a t r i n e s , h a n d - w a s h i n g fac i l i t i e s , garbage pits, and ciass-roomsamong others.

3.2 Presence of School Latrines

All schools visited (except Rupa Primary School in Moroto District, Matheniko County) had somesort of latrine in place. Overal l . 97.2% (n=228) of the schools vis i ted had slab latrines, a l thoughthese were s imul taneous ly being used wi th t r ad i t iona l latrines. Indeed, majority of schools vis i ted(93.8%; n=221) had t radi t ional iatrines as wel l , clearly i l lus t ra t ing the fact that almost all schoolshad both sanplat/ 'slab and t r a d i t i o n a l l a t r i ne? . Table 6 below shows l a t r i ne presence in schools b>type and by d i s t r i c t .

Table 6: Latr ine Presence at Schools by District and by Type of LatrineDistrict

-Arua -BushenviHoimaKabaroleKaseseKotidoKumiLiraLuweroMasakaMbararaMorotoNakasonsoraNebbiNtunuamoSorotiAverage

1 Sanplat/Slab (%)100.0

! 94.4i 100.0I 94.1! 100.01 100.0[ 100.0i 100.0i 95.0i 100.0 i; 100.0! 80.0, 100.0! 100.0! 100.0i 92.3' 97 "> ii " '— i

Although having in place adequate la t r ines is a challenge for most schools, with support from theGoU/UNICEF Primary School Sanitation Program, reasonable progress had taken place. Theinterventions supported by the program are further supplemented by setting of m i n i m u m standardsin some districts (e.g. in Kasese) which demand that each school should at least have 2 stancesbefore it can be allowed to operate. A key informant succinctly summarized the prevai l ingsanitation situation in Kasese.

Through the District Inspectorate of Schools, we ensure that at least every primaryschool Inis a pit latrine of some sort...,but the (/utility in general remains poor [KeyInformant, Kasexcj.

The study findings in all districts covered corroborate the above assertion as all sampled schoolsexcept one were found to have some sort of a latrine. The major problem, however, are bignumbers of pupi ls using a single stance which in turn impacts on the hygiene maintenance andcondi t ions of latrines.

V

V\SK

JO Pupil: Stance Ratio

In aeneral. increased pupi l s ' enrolment since the introduction of UPE has exerted tremendouspressure on the sanitation facilities. P u p i l : stance ratio in all schools sampled, stil l fa l ls short ofthe recommended ratio of 40: 1. The overall p u p i l , stance ratio i.e. both sanplat and traditional puttogether was 84:1 for all the 16 d i s t r i c t s . However, if sanplat /s lab latr ines are taken as therecommended fac i l i t i es for improved s a n i t a t i o n for primary schools, then the pupil :stance ratio is96:1. See Table 7 below:

Table 7: Pupil: Stance Ratio

DistrictAruaBushenviHoima

i Pupil:Overall

i 143 : 1I 54 : 1

1 1 0 : 1

Stance Ratioj Sanplat/Slab! 140 : 1! 68 : 1i iH : l

Kabarole ; 55 : 1 i 7 1 : 1KaseseKotidoKumiLira

"LuweroMasakaMbaraWMorotoNakasonuolaNebbiNtunaamoSorotiAverage

136 : 1i 6 1 : 1

68 : 1i 8 9 : 1! 76 : 1i 68 : 1i 45 : 1i 65 : 1i 72 :1i 133 : 1i 8 1 : 1

1 1 1 : 184 :1

i 1 - 8 : 1 |i 76 : 1 |I 8 1 : 1 !j 145 : 1 |! 76: 1j 70: 1! 53: 1i 7 1 : 1i 84:1! 139:1! 172:1i 124:1! 96: 1 i

As the figures in the Table i l lustrate, the pupil-stance ratio was more than 100:1 in the districts ofArua, Kasese. Hoima, Soroti and Nebb i . I t was lowest in Mbarara where it was at 45:1.Thedifference in pupils-stance ratio between in te rven t ion and no- in te rvent ion schools was notsignif icant , but intervention schools s l igh t ly had a higher pupi l :s tance ration than non-interventionschools; 97:1 and 93:1 respectively. The differences can be attributed to the fact that the programi m p l e m e n t e r s target and p r io r i t i ze schools u i t h a h i g h e n r o l l m e n t and poor l a t r ine faci l i t ies . Alsomost n o n - i n t e r v e n t i o n schools that vsere sampled were e i ther private or religious founded withbetter faci l i t ies compared to UPE schools. In a l l . the cur ren t pupihs tance ratio at 96.1 represents animprovement from around 120:1 estimated before program implementation for WES districts

||Persohal communication with UNICEF staff), and 1 1 7 : 1 in RUWASA II districts at baselineIRUWASA 1997).

3.4 Separate Stances for Girls and Boys

All schools had separate stances for boys and gir ls except one in Moroto (Naitakwae, in NaduneetSub-county. Matheniko County) where stances were shared, in a number of schools, however,stances for boys and girls were on the same latr ine block, sometimes only loosely separated, e.a.with dry banana leaves, or u banana fiber carpet. It can therefore be asserted that under theGoU/UNlCEF Primary School Sanitation Programme, efforts to provide separate stances forfemale and male pupils are paying off.

3.5 Separate Latrines for TeachersAl though , all schools v i s i ted (except Rupa pr imary) had latr ine provis ions for teachers, a goodnumber of schools had no latr ine blocks for teachers in the school compound, instead, teacherswere using latrines in the staff quarters.

3.6 Latrine ConditionsThe latrine condit ions investigated inc luded location of latrines, the physical or superstructure andthe levels of maintenance.

3.6.1 Distance of Latrine from the Nearest Class BlockMajority of the exis t ing la t r ines (81.6%) \vere located approximately 10 metres and above from thenearest classroom block as opposed to 18.4% which were within an approximate distance of 10metres and below, f a i l i n g to meet the recommended la t r ine location. Table 8 shows the latrinelocation by district.

Table 8: Distance of Latrine from Nearest Class Block bv District! Distance

Distr ic t

AruaBusheny i

" Hoi maKabaroleKaseseKotidoKumiLiraLuweroMasakaMbararaMorotoNakasonsolaNebbiNtungamoSorotiAverage

< 10 Meters: %

42.9- ~i- -J

i 20.0i 17.6i 45.0! 12.5! 8.3i 0.0! 35.0i 20.0

9.80.0

i 20.0i 12.5; 0.0i 14.3! 18.4

> 10 Metres%

57.194.180.082.455.087.591.7100.065.080.090.2100.080.087.5100.085.781.6

One of the problems regarding location of la tr ines in appropriate distance was found to be lack ofadequate land especially in the case of urban schools. In other cases, however, the highproportion of latrines inappropriately located in districts such as Arua, Kasese and Luwerohighl ights the need for support and supervision to schools dur ing the s i t ing of latrines.

3.6.2 Latrine Hygiene Conditions and MaintenanceThe physical presence of a latrine alone may not be a sufficient guarantee for proper sanitation andhygiene. Addit ional latr ine qual i t ies such as cleanliness and maintenance, privacy and protectionfrom rain s ignif icant ly contr ibute to hygiene and proper sanitation. These factors are alsoimportant in determining whether intended latr ine users w i l l find it comfortable to visi t and use thelatrine. The findings about latrine hvuiene and maintenance are tabulated in Table 9.

14

'able 9: Observed ILniirfnm; CondsiioDis and iVnsi i iUcKJisa te

Ljitrint Comditsoiis !OITers Privacy jHas shutter/Door jAdequate size of square/rectangle hole ;Adequate stance spaceOilers protection From rain 'F u l lFouled

Bovs LiHrhie77.469.000.889.09x78 . 1

42.6

Girlis Latrine | Teneliers' Lalrinc82.8 86.777.1 | 83.589.6 ! 94.387.0 ! 94.396.5 95.97.2 8.6

36.0 ~| 13.0

Although majority latrines offered privacy, had shutters/doors and offered protection from rain, itis important to note that a sizeable proportion of latrines were fouled. Thus, fou l ing featured outas a big problem in the observed latrines. Cont inued f o u l i n g of latrines has the potential ofgenerating smell , attracting Hies, and Ihus cons t i tu t ing a heal th hazard. The prevalence of fou l ingh igh l igh t s the need for more education on la t r ine use. However, t h i s might nol be enough given thebig number s of p u p i l s us ing few a v a i l a b l e stances. On the o i l i e r hand , f o u l i n g observed in morethan a tenth of teachers' latrines (13.0%) also leads to ques t ioning the role of teachers as rolemodels and hygiene promoters to the pupils.

Maintenance and cleaning of latrines is a challenge for both non-intervention and in tervent ionschools, but more of ii great challenge in the former. This is attributed to big numbers of pupilsusing few stances. Nonetheless, this reason cannot explain the almost total neglect of m a i n t a i n i n gand cleaning latrines observed in some schools. In some schools, the poor conditions of latrinesinc lud ing fouling, repugnant smell, high presence of flies and in some cases, presence of maggotson the l a t r ine door were observed to be cons t i tu t ing a hea l th hazard to the users. The picturebelow shows the door of latrine in one of Ihe schools in Nnkasongola district, which shows anexample of an extremely poorly cleaned and maintained latr ine.

Picture !: An Example of a Poorly Maintained School Latrine

'I he presence ol maggots on she iloo- oi" S ine h i i r i n c is a clear ind ica t ion that the i a t r i n e had notbeen cleaned for some t ime. When iatnsnes UK ibuied, and the human waste mixes w i t h dry leavesused by piipiis and or, teachers ibr ami cleansing, as shown in Picture 3, the r e s u l t i n g rottenmaterial subsequently leads into a s i tuat ion as shown in Picture 1.

Lack of shutters or doors anci the consequent lack of privacy were also among the commonproblems observed in some o l ' the v is i ted tatrines, recorded in about 15-30% of the la t r ines . Lackof these may also have a negat ive el!ec;: on hiir ine use, lo the extent that some poten t ia l users mayopt to use bushes or defecate behind the la t r ine block where more privacy could be offered. Theprimary purpose of h a v i n g a l a t r i ne in such a case would not have been achieved. The discomfortof using such latrines may be fell most by the older pupils , and more by gir ls .

However, the contr ibut ion of the program in enabl ing schools to at least have la tr ines with beltersuperstructures needs to be recognised. This does not mean that n i l have been achieved, but at leastsome achievements have been realised, in picture 2, the old structure represents the s i tua t ionbefore the Program implementa t ion . I t shows a structure tha t would not provide privacy asopposed to the new latrine constructed wi th program support .

icturc 2: JLatrinc Stnicturi; Beibrc and Al ter Program intervention

16

3.6.3 Latrine Cleaning Arrangements

Latr ine cond i t ions were la rge ly related to the ar rangements in place for la t r ine c l e a n i n g . In mostschools, latrine cleaning was undertaken by pupi l s themselves. Up to 85.2% of the schoolteachers/head-teachers in terviewed reported that c l e a n i n g of l a t r ines was usua l ly undertaken byp u p i l s , often with the supervision of prefects and teachers. In the rest of the cases, there was use ofhired porters or regular labourers employed by the school. In a few cases (6.8%). no clearlyknown arrangements were in place for the c l e a n i n g of l a t r i ne s . Due to the h igh user-load, schoollatr ines would require that they be cleaned several t imes in a day. But s ince th is is a responsibil i tyof the pupils who are in class most of the t ime, most schools can only afford to clean them once aday and usua l ly in the morn ing , w h i c h partly exp la ins the h igh levels of fou l ing observed.

The point that need to be emphasized is that even in schools where a lot of efforts are being put into maintain and clean the latrines, the number of users is so big that la t r ines get dirty very quick ly .Thus, mf're interventions should be focus-sing on provid ing more stances to primary schools w i t hbig numbers instead of adopting a general provision of 2 latrines of 5 stances each for every schoolirrespective of the pupi l enrol lment of the school.

3.7 Anal Cleansing Materials

S l i s h t l y over a th i rd of p u p i l s " l a t r ines and about a h a l f of the teachers ' l a t r i n e s had a n a l c l e a n s i n smater ia ls . This implies , as Table 10 shows that major i ty of the p u p i l ' s latrines and a ha l f of thosefor teachers lacked any form of ana l c l e a n s i n g m a t e r i a l s .

Table 10: Presence of Anal Cleansing Materials in School Latrines

Presence

Available

Not Ava i l ab l e

Total

Category of UsersBoys Latrines Girls latrines I

"A, % !36.6 | 36.6 |

I |1

63.4 63.41

100.0 | 100.0 i

Teachers Latrines%

50.7

49.3

100.0

Comparison by district shows that schools in Arua were least found with cleansing materials,w h i l e all latrines in Nttmgamo had c leansing mater ia ls (See Table I 1 ) .

T.u-ibiiie l i : Po'essi-uniT: o; / v i n i j u l l Qerjuiim/w IVUsiicrhiSs by Distract

IDistrJcf

AruaBusbenyiHoimaKabaroleKaseseKotidoIviimiLiraL 11 were)MasakaMbtiruraIvloroloNakasongolaNebmNl. i ! imanu>Somti

CBoys%7.!

50.040.038.945.050.041 .7

5.047.!43.250.0

12.5100.042. 9

sufejjorvj/f Users~Gids

'X,7.1

45.040.029.445.062.541 .7

5.041.25050

I I . 1100.042.9

Tcsnr limit'so// (»

30.852.666.743.868.4100.040.0

26.766.757.9

25.01 1 . 1

100.053.8

Of the pupils' latrines thai had anal demising materials, majority had plant leaves, some o!" which \^'were rotting on the latrine door, contributing to poor hygienic conditions and hence posing a "̂health hazard as shown in Picture 3.

aicturc 3: Anal Cleansing,!Viatcrials un the Lutrinc Floor7;:>»gsj JHBJMUl.1, "•\~i-~: '•:*".-f&&^"

':-.•;•--"• ~.'-'&3£t̂e^ps^..'-.-.'•."- •••'-_;?••$*

The essence of having anal cleansing materials in latrines is yet to be inculcated among teachersand pupils alike. Such materials need to be placed in such a way that they do not mix up with urineand human waste as this makes cleaning of latrine very difficult.

3.8 Hand-Washing Facilities

Installed hand-washing facili t ies next to latrines are necessary for the practice of hand washingafter latrine use to take root. This study investigated the presence, funct ional i ty and use of hand-washing f ac i l i t i e s . Overall , hand-washing f a c i l i t i e s next to latr ine were observed in 60.6% of.schools. Indicators of actual practice of hand washing after latr ine use revealed that in someschools, the practice is not yet noted. For instance, only 61.7% of the observed HWFs had water.39.3% had soap near the hand washing facili ty- and 59.?% had wet soil beneath.

As the f indings ind ica te , close to two t h i r d s of the observed schools had hand-washing facilitiesnext to the latr ines. However, only over two th i rds of all existing handwashing faci l i t ies containedwater, i m p l y i n g the poss ib i l i ty that HWFs may not be used even when they exist. Lack of water inHWFs could partly be related to lack of easy access to water by schools. But it is also related toreluctance and lack of commitment to keep the f a c i l i t i e s in use.

Table 12: Hand-Washing Facilities and Associated Indicators by District

Dis t r ic t ' HW'F

%Arua 85.7Bushenvi " ! 60.0Hoima 80.0Kabarole 64.7Kasese | 80.0Kotido i 25.0K u m i 83.3

i,4p«' --•-i'fewefo | 65.0

Masaka 55.6i Mbarara 72.7i Moroto i 100.0

Nakasongola 16.7I Nebbi 55.6i Ntungamo. j 25.0I Soroti 78.6! Average 60.6

HWF ancWate r in the

! HWF()/

I u

i 7 1 . 4i 66.7; 87.5i 69.2i 68.4| 28.6

58.3i 100.0! 40.0

54.5: 58.6

> "5.0! 25.0

50.0I 66.7

66.761.7

Other AspectsAsh/Soap Wet Soil

near HWF Beneath HWF% %

1

2 1 . 4 i 84.646.7 64.322.2 [ 50.021.4 | 69.231.6 ! 89.528.6 j 28.64 1 . 7 i 50.0100.0 ! 100.06.3 40.0

50.0 ! 4 1 . 754.4 ! 88.275.0 75.025.0 j 25.037.5 50.00.0 | 66.7

66.7 33.339.3 j 59.8

A n a l y s i s by dis t r ic t shows that h a n d w a s h i n g f a c i l i t i e s were least found in Nakasonsora,Ntunaamo. Lira and Kotido.

3.9 Presence of UrinalsMajority (81.7%) of the schools had male u r i n a l s ( n = ! 8 8 ) as compared to 18.3% (n=42) which didnot have. By district, Kotido had the least number of schools with urinals (12.5%) (See Table 13).

19

Table 13: Presence of Urinals bv District

Districtj Arua! Bushenvi

Hoirna> Kabarole: Kasese: Kotido

K u m i1 Lirai Luwero

Masaka! Vlbarara! Vloroto: Nakasonsola

NebbiNtunaamo

; SorotiAverage

Urinal presentYes % |

71 .4 i90.0 !66.7 i88.2 I89.5 !12.5 IO ^ -IOJ.J i

77.8 168.4 i94.4 j88.6 i75.0 I83.3 i77.8100.0 i85.7 !81.7 !

No %28.610.033.31 1 . 8 !10.587.516.7

2"> ~>31.65.611.425.016.7 j22.2 j0.0 j14.318.3 i

Although most schools had ur ina l s , almost all of them (98.1%) did notaffer privacy (See Table

——~— / o~^~~—~-^Table 14: Cleanliness of Urinals bv District

Cleanliness of Urinals

District

AruaBushenviHoirnaKabaroieKaseseK u m iLiraLuvveroMasakaMbararaVlorotoNakasonizolaNebbiNtunsiamoSorotiAverage

Smelly with aswarm of (lies

%30.036.842.937.566.727.362.540.035.329.333.333.342.912.521.439.8

Clean and Wellmaintained

%50.036.842.93 1 . 527.836.425.026.74 1 . 231.766.633.328.650.050.036.2

PoorlyDrained

%20.026.314.325.00.0

36.412.5

L 33.323.534.10.0

•> -> ->jj.j14.337.528.621.2

Offer noPrivacy '"

%0.00.00.0 ,6.3 ,5.6 10.00.00.0 |0.04.90.00.014.30.00.01.9

7,-/;

All indicators of wel l m a i n t a i n e d ur ina ls point to the fact that a big proportion of ur inals were nothygienic for use. For instance, majori ty (63.8%) were poorly cleaned and maintained.

20

3.10 Reported Presence of Latrine in Pupi ls Homes

School pupils are brought up in two environments consisting of the school and tne home. Theu l t i m a t e hygiene and health status of p u p i l s is therefore a product of a combina t ion of theconditions in both environments. In addition, the behaviors promoted in one of theseenv i ronmen t s , in f luences the behaviors practiced in the other. This study therefore investigatedthe presence of latrines in pup i l s ' homes. However, th is was through pupils ' reporting, rather thanvis i t s to the i r homes and. hence the f i n d i n g s m i s h t not represent the exact s i tuat ion.

Table 15: Reported Presence of Latrine in Pupi l s Homes by District and by Type ofLatrine

j

District"i Arua1 Bushenv i

HoimaKabaroleK.UITU

j LiraLuweroMasaka

! Vlbararaj Nakasongorai Soroti

Sanplat/Slab25.526.841 .341.237.919.760.546.740.732.933.0

Tvpe of Latrine*Trad i t iona l Fl^^hing Toilet

73.2 I 0.0 j^2.8 ! 0.4 !5 5 . 1 i 3.6 [55.3 3.544.480.337.64 8 . 156.058.9

INo Latrine :

i -30.0 :0.0 |0.0 \

o.o ! r.6 :o.o :0.9 !1 .9

0.0i.O iJ J •

2.2 ; 1 . 1

0.0 !53.4 ! 0.0 ;

8.2 I13 .6

* Figures only obtained for in-depth research District where pupils were interviewed

Sanplat /s lab la t r ine coverage was remarkably h i i zh in Luwero dis t r ic t , partly due to the presence ofmany slab casting groups, and the promotion work by NGOs. Flashing toi lets were reported bypup i l s from urban areas.

4.0 SAFE WATER SUPPLY AND HYGIENE IN SCHOOLS

4.1 Introduction

To realize benefits of improved sani ta t ion in schools, provision of water is inev i tab le . To th is end,GoU'lTNlCEF School San i t a t ion Programme inc luded a support component for water and hygienepromotion in pr imary schools. As indicated in the earl ier sections, the proaramme supportinc luded assistance for the i n s t a l l a t i o n of ra inwater harvesting tanks. In the area of hygiene, therange of ac t iv i t i e s i n c l u d e d t r a i n i n g of teachers, and promotion of better hygiene practices throuahformation ot science/health clubs, drama activi t ies, media campaigns and school competitionsThis section discusses the f ind ings about water and hygiene faci l i t ies as wel l as the associatedbehaviors amongst p u p i l s . Detai ls about the 1EC campaigns are discussed in Section 5.

4.2 Safe Water Facilities in Schools

The schools covered by t ins s tudy depended on vary ing types of water sources, protected and un-protected to meet thei r water needs. The findings about the type of water source used as well asother associated c o n d i t i o n s are shown in Table 16.

Table 16: School Water Facilit ies

Tvpe of Water Source for the School* %ra inwate r t a n k -i -t ij j . lBorehole/handpump 1 42.8Protected Sor ingTapUnorotected Source

1 3 . 113.614.8

Estimated Distance to the Water source 1<100 meters

Number69 _^1013!-^ "1

35

47.6 | 1 1 1100-200 meters • | 18.9>200-300 meters j 6.9>300-400 meters 7.7>400 meters j 18.9Problems w i t h the Wate r Source**NoneOvercrowdedPoor ouali tv water

36.630.5

44161 O—————— L§ —————44

8472

16.5 \ 39Low Yie ld ! 22.5 i 53Broken Down -Others ! 24.2

?57

* Some schools hud more than I source** Multiple problems repented

As the f indings indicate, hand-pumps were the most common type of water sources used byschools, followed by rainwater tanks. The presence of, and reliance on rainwater tanks by schoolsin a th i rd of the schools (33 .1%) points to the c o n t r i b u t i o n of the program in providing safe waterto schools, in a few cases, however, such as in Luwero district, there were rainwater tanksprovided under the auspices of other organizations.

An issue of concern is that up to 14.8% of the visited schools relied on unprotected sources. Thesecontinue to have t h e i r p u p i l s and staff exposed to the risks of water related diseases. Important tonote is that such schools include those that have protected sources, such as rainwater tanks, but for

one reason or the other, such protected sources are not func t iona l . In the case of ra inwater tanks,the i r functionality also partly depends on the rainy season.

Table 17: Status and Funct ional i ty of Ra inwa te r TanksStatusComplete and FunctionalIncomplete/N'on-FunctionalTotal

I Percentagei 66.3

33.6I 100.0

I Number 1j 69 |i 35 !i 104 I

The findings in Table 17 sho\\ the funct ional i ty of observed rainwater tanks, with one-third of thet anks either incomple te or n o n - f u n c t i o n a l . It was found that a fairy big number of schools that hadreceived water tanks had not f u l l \ i n s t a l l ed them. For instance, some were miss ing taps, roofsm i s s i n g gutters, whi le some schools that had received plastic tanks; the tanks were s imply l y i n g inthe compound. Such tanks were therefore non-functional. The most dominant reason was failureof schools to raise thei r con t r ibu t ions towards the ins t a l l a t ion of the tanks, namely, local materialsfor the construct ion of a platform, purchase of gutters and facial-boards for the classrooms.

However, th i s f a i lu re was also partly at tr ibuted to the strategy emploxed in the d i s t r i b u t i o n oft anks . In many d i s t r i c t s , th is uas not demand-dr iven . Dis t r ic t water officers, other d i s t r i c t staffand p o l i t i c i a n s iden t i f ied sdliddfs that were to benef i t and went ahead to allocate them tanks . Insuch cases, the schools collected them in exci tement , but had no well thought-out plan of ra i s ingthe contributions.- Possibly, they also did not really need them in the first place, or if they did. theywere not consulted on what they would c o n t r i b u t e in order to i n s t a l l them.

As regards to distance to water source, majority of the schools had their water sources wi th in adis tance of less than 400 meters (See Table 18). However, most of the sources were reported to beassociated wi th varying problems i n c l u d i n g overcrowding of users and poor y i e l d .

Table 18: Estimated Distance to the Nearest Water Source bv District

DistrictEst imated Distance in Meters to Water Source

< 100 100-200 200 - 300 300 - 400 >400Aru aBushenvi :

Hoi ma :Kabarole |Kasese 'Kotido ;Kumi iLira '•Luvvero 1Masaka jMbarara !Moroto jNakasongora |Nebbi INtungamo iSorotiAverage

46.: : 15.440.0 i 20.050.0 i 0.066.7 : 1 1 . 170.0 i 5.062.5 i 0.016.7 i 16.766.7 : 22.255.0 | 25.029.4 ! 23.547.7 | 15.920.0 i 60.050.0 i 33.344.4 j 44.425.0 ; 25.042.9 28.647.6 ! 18.9

7.75.0

20.00.05.012.525.00.05.05.96.8

20.00.01 1 . 10.00.06.9

0.05.0

20.0I I . I5.00.016.70.010.05.96.80.00.00.0

25.014.37.7

30. S30.010.01 1 . 115.025.025.0

"•' i5.0

35.3-1-1 -

0.016.70.0

25.014.318.9

4.3 Hygiene Practices, Condi t ions and Facilit ies

The hygiene practices and conditions discussed in this section include hand washing, hygienecondi t ions of classrooms, issues of personal hygiene and waste disposal.

4.3.1 Hand-washing PracticesWashing of hands after visi t ing the latrine is one of the recommended hygiene practices. We havealready indicated that the coverage of hand-washing f a c i l i t i e s in schools was 60.1%. Pupi l s in thesample were asked to report w h e n they u s u a l l y washed the i r hands. The responses are shown inTable 19.

Table 19: Reported Times when Hands are washed at SchoolReported TimesDon't washAfter Latrine UseBefore a MealAfter a MealWhen hands are DirrvOthers

! Percentage! 4.1! 85.1! 50.9j 39.3

Number95

19S61 183912

2 1 . 3 j 494i 1.7 | 40

When data were segregated by sex. no major differences were observed as shown in Table 20.

Table 20: Reported Occasions when Hands are washed at School by Sex of Pupi lSex

Situation hands are washed at school

Don' t washAfter latrine useBefore a mealAfter a mealWhen lands are v i s i b l v dimOthers

Male%4.086.448.637.821.3

1.3

Femaleo/ L-/" i.2 |

84.5 [

53.5 ;

40.8-n -,

-1 -1 :

Majorin. of p u p i l s (86.4 males and 84.5 females] reported unprompted that they washed handsafter vis i t ing -he latrine. If this represents accurate reporting, then hand washing after latrine useas a practice has taken root. However, socially approved behaviour has a tendency for being over-reported, w h i c h raises a poss ib i l i ty that most p u p i l s may not be regular ly washing hands afterv i s i t i n a l a t r ine , but since the\ know th i s as a recommended practice, they were bound to report thatthey practice it. This is inoreso given that the coveraye of hand-washing facilities was only 60.!°/e.yet more than 80% of the p u p i l s c la imed that they washed hands after la t r ine use. Nonetheless, theover-reporting would in such a case also ind ica te a posi t ive s i tuat ion, namely, that pup i l s have theknowledge that they should wash their hands after la t r ine use. The challenge would then remainthat of t rans la t ing the knowledge into practice and sus ta in ing it once adopted. This would also cal lfor ensuring that the associated enab l ing condit ions are in place, such as funct ional hand-washingfac i l i t i es instal led next to latrines, avai labi l i ty of water in HWF and soap at all times.

Important to note is that more than one f i f th of the pup i l s reported that they washed hands whenthey were v is ib ly dirty. This could mean that such pup i l s never recognized the need to wash handsunless they were visibly dirty. This calls for dissemination of more accurate information to f i l l theexist ing knowledge gap.

24

4.3.2 Conditions of Classrooms

The f ind ings about classroom c o n d i t i o n s i n d i c a t e tha t a big proportion of the exist ing schoolclassrooms had unplastered walls and floors. Such classrooms are obviously harder to keep clean.As a result, they also affect the cleanliness and general personal hygiene of the pupils. See Table2 1 .

Table 21: Classroom Condit ions

Observed Class-room ConditionsDirty /UnsweptDirty, Poorly SweptUnoiastered wallsUncemented FloorClean and Well SweptSeats and Desks Avai lable

%9.7

20.339.040.351.745.8

Number23489295122108

Of m u c h more concern was the c o m p l e t e lack of seats and desks in many schools (45.8%). Asituation where pupi l s sit on bare floor/under a tree and write whi le placing books on their laps, itbecomes rather idea l i s t i c to ta lk of proper h y g i e n e among p u p i l s .

4.4 Personal Hvgiene

As part of th i s study, observations were made on the hygiene condi t ions of the p u p i l s with respectto the d i f ferent body parts i n c l u d i n g the head. eyes, ears, teeth, chest, legs and feet. Given theclassroom environment and in some instances, complete lack of classrooms, hygiene conditionssuch as bodi ly c leanl iness were not s t r ic t ly observed as th i s could offer a distorted picture.

Table 22 Hygiene Indicators amongst Pupils

Bodv Hvoiene ObservationsEyesEve DischarseRed Eye/Conjunctivi t isSigns of TrachomaNormal AppearanceOthersTeethCleanDirtyEarsCleanDirtySkinDirtv/UnvvashedFresh Skin WoundsSeptic Skin Woundsr

Fungal Infec t ionsSk in RashScabiesBodv LiceNormal AppearanceOthers

Legs and FeetDirtv/UnvvashedFresh Skin woundsSeptic Skin WoundsFunsal InfectionsSkin RashJissersNormal AppearanceOthers

Percentage

14

1910

8019

>04.6

.4

.6

84.215

9011 .30

.8

^

>

,°,

~*

50.2

83.80.4

.42.63 1

1i . O0.763

4.80

Number

369°~i 'ij j

2129"

1854452

1919359

i1

221 |1 12444 ;79 i12 |5 ;

1947 ;9 |

404 I61 i742624 :10 i

1 784 i69

Although, majority of the pup i l s were observed to be of normal appearance for most body parts,there were big proportions observed to be dirty and unwashed for most of the parts. As alreadyindicated, the classroom condi t ions con t r ibu te to the poor personal hygiene. Other reasons such aswalking barefooted, lack of desks and chairs, lack of water at school also contributed to poorpersonal hygiene amongst pupils. The possibility of poor hygiene practice itself cannot be ruledout in the case of the observed dirty teeth, ears, and head. This possibility is strengthened by thefact that analysis by sex shows that female pupils scored higher on normal appearance for mostobserved aspects compared to the male counterparts (see Table 23). The only reason that canexplain this difference is that females are keener to keep their personal hygiene compared to males.Thus improving hygiene calls for both improving the classroom and school conditions as well asimproving personal hygiene practice.

As wi l l be discussed later, most schools reported that they conduct health parades where theyinspect and check pupils for personal hygiene. Strengthening the health parades and making themmore regular could contribute to more vigilance being put in personal hygiene by pupils.

Table 23: Observed Body Hygiene by Sex of Pupil

Observed aspect

EyesEye DischargeRed Eye/ConjunctivitisSigns of TrachomaNormal AppearanceOthersTeethCleanDirtyEarsCleanDirty

Sex of PupilMale

%

1.44.71.5

9 1 . 10.7

.

75.124.9

80.519.5

Female»//<>

1.7"* ij. I1.3

92.30.7

86.213.8

88.217.8

Skin ! jDirty/Unwashed 14.2Fresh Skin Wounds j 0.7Septic Skin WoundsFungal InfectionsSkin RashScabiesBody LiceNormal AppearanceOthers

Legs and FeetDirty/UnwashedFresh Skin woundsSeptic Skin WoundsFungal InfectionsSkin RashJiggersNormal Appearance

1 . 12.04.2O.7

8.7

4.40.21.01.82.50.30.3

7.8 | 89.30.4 | 0.4

1i

22.0 | 12.342 j 0.946 i 1.61.41.00.670.6

Others J 2 ~

0.71.00.283.53.2

4.5 Presence of Cleaning Room for Adolescent Girls Near the Latrine

Only 16.5% of the schools observed were found to have some sort of a separate cleaning room foradolescent girls near the latrine as opposed to majority (83.5%). Three districts (Luwero,Nakasongola and N'ebbi) did not have such rooms. In the rest of the districts, a few schools had.with Kasese registering majority schools (30.0%) closely followed by Masaka (29.4%). Table 24shows the presence of separate cleaning room for adolescent girls by intervention and non-intervention schools

Table 24: Presence of Cleaning Room for Adolescent Girls bv Category of School

Presence of Cleaning Rooms

Present

Not Present

Category of SchoolIn tervent ion

o//o

25.8

74.2

Non-intervention%7.2

92.8Total 100.0 100.0

According to the Table above, due to Primary School Sanitation Programme, slightly over aquarter of all in tervent ion schools had a separate c leaning room compared to less than a tenth ofnon- in ten t ion schools.

4.6 Refuse Disposal

Majority of the schools sampled had a refuse disposal pit (79.5%; n=186). By district, as Table 25shows, Soroti had the least n u m b e r of schools u i t h a refuse disposal pit (57.1%). However, evenin schools that had refuse p i t s , in some cases they were poorly managed, wi th some h a v i n g f i l ledup.

Table 25: Presence of Refuse Disposal Pit by District

District

AruaBushenviHoimaKabaroleKaseseKotidoKumiLiraLuwero

i Presence of Refuse Disposal Piti Present

<»/'• /()

1 78.6i 70.0i 100.0i 77.81 70.0; 62.: 100

87.i 70.

5.050

Not Present°//o

2 1 . 430.00.0

22.230.037.50.012.530.0

Masaka 88.9MbararaMorotoNakasonuoraNebbiNtun«amoSorotiAverage

i 81 .8 18.2! 100.0 i 0.0! 50.0 1 50.0i 100.01 100.0i 57.1! 79.5

0.00.0

42.921.5

5.0 IEC CAMPAIGNS AND WATSAN RELATED DISEASES IN SCHOOLS

5.1 Introduction

The school sanitation programme includes IEC ( informat ion , education and Communicat ion)software components, which consisted of hygiene and san i t a t ion education and campaigns. Thesespec i f i ca l ly i n c l u d e d t r a i n i n g of teachers , fo rma t ion of science/health c lubs , p romot ion of dramaon san i ta t ion , media campaigns to broadcast and d i s semina t e hygiene and sani ta t ion messages.school compet i t ions , and heal th parades among o thers . All these ac t iv i t i e s were aimed atincreas ing awareness about hygiene and san i t a t i on , changing attitudes, and ins t i l l i ng appropriatebehaviors. The f indings about these different aspects are presented in this section.

5.2 Sources of Sanitation and Hygiene Information

The data reveal tha t majoriry p u p i l s reported h a v i n g ever received i n f o r m a t i o n about hygiene,s a n i t a t i o n and water re la ted i ssues w h i l e at school . Tab le 26 ind ica tes the means of i n f o r m a t i o n asreported bv p u p i l s in I I out of 16 d i s t r i c t s .

Table 26: Pupils Reported Sources of Hygiene and WATSAN Informat ion by DistrictDistr ict

AruaBushenviHoimaKabaroleKasese*KotidoK u m iLiraLuweroMasakaMbararaVloroto*NakasongoraNebbi*Ntuns jamo*SorotiAverage

ScienceLessons

%82.670.768.183.7

--

52.039.352. S68.4"3.8

-53.4

--

37.962.0

ScienceTeachers i

%43.049.6 :46.440.5 i

i- '

76.6 !67.55 4 . 142.8 :

52 2-

46.6-

;

43.7 :51.1 i

FellowPupils

%16.14.J

6.50.9

--

19.56.8--, 7- • :

3.76.7

13.7

-16.59.1

Health/ScienceClub

%13.46.22.97.5

-

0.61.70.64.710.5

-0.0

--

6.84.9

Posters/Fliers

%15.44.36.59.3

"-

16.98.57.610.7 J1 1 . 5 !

-6.8

4.99.3

* Son-in-depth Research Disincl. nu pupils interviewed.

The d o m i n a n t means of i n f o r m a t i o n a v a i l a b l e to p u p i l s were through science lessons and teachers.This partly impl ies that the t r a in ing offered to teachers in selected schools supported under theprogram was del iver ing posi t ive results. This was also reflected by pupi ls ' possession of correctknowledge regarding water, hygiene and sani tat ion related diseases. Pupils in different schoolsacross all districts indicated that the knowledge acquired was helping them to practice properpersonal hygiene and mainta in a healthy school and home environment.

Apart from science lessons and teachers, only 4.9% reported health or science clubs as a source ofhyg iene and sani ta t ion i n f o r m a t i o n . This, as w i l l be discussed later is due to the fact that very fewschools ac tua l ly have such clubs.

5.3 Health Message in Strategic Places/Locations

Pinning of health messages (such as carried on posters) on strategic locations around the school.e.2. on classroom walls, is an effective means of ensuring constant delivery of such messages toschool pupi ls . This study found that about one quarter of the schools visited (25.6%) had healtnmessages p inned at strategic places around the school. Al though the rest of the schools had thenecessary posters for such a purpose, they were often pinned in the staff room, or in the Heacteachers' offices, where p u p i l s may not easily access them. This was also partly attributed to theneed to keep them safely, since most of the classrooms often lack window's and shutters.

To overcome this problem, schools need to be encouraged or facilitated to try out other alternativeways of e x h i b i t i n g the re levant messages, such as through paintings on classroom walls , wooccurving and clay portraits planted into the ground. These may not be liable to removal by passers-by.

5.4 Training of TeachersThis activity involved the t r a i n i n g in sani ta t ion and hygiene issues. The strategy involved t r a i n i n gof three teachers per target school (usual ly the head-teacher, the senior woman teacher, and ascience teacher). It can be noticed that this selection targeted those that were deemed to be mostconcerned wi th issues of hygiene and sanitation in schools. Teachers to be trained are drawn fromthe schools ident i f ied for latrine and water tank assistance. The training of teachers is aimed atinformiim them about the programme, their roles, as wel l as to equ ip them to pass on the messagesto p u p i l s . As part of their roles, the trained teachers are also expected to initiate science/healthclubs, drama act ivi t ies , school competitions, and health parades. In most districts, several roundsof teacher t r a i n i n g had been conducted. The t r a i n i n g s usually lasted one to two days. The trainerswere reported to be the district officials such as the DHI, DCDO, and DHE, in some cases with afacil i tator from the center.

Overall, the t r a i n i n g of teachers was assessed to be creating the desired impact . There isappreciation that the teachers' knowledge and s k i l l s in issues of hygiene and sanitation have beenupdated and rep len ished . Indeed, one of the e m e r u i n g recommendations from some of thestakeholders is that such t ra ining should target teachers right at the Teacher Training Colleges,such that by the t ime they come out, they are already acquainted with sanitation and h y g i e n eissues, and their attendant roles.

A few l imi ta t ions with respect to the training of teachers were, however, also found out. In somecases, t ra ined teachers for par t icular schools have dropped out due to different reasons, ortransferred thus leaving a gap. In other cases, it was found that some schools have receivedassistance for la t r ines and w a t e r tanks , when none of the teachers had been trained. Teacher inmost cases have also not been able to form health clubs as discussed in the next sub-section.

5.5 Science/Health Clubs, Drama Activities, Media Campaigns and School Competitions

It was found that majority of the schools had no heal th or science clubs. Only 28.6% of the pup i l sreported the existence of a Health or Science Club in their school. This contrasts sharply with theproportion of school heacl-teachers/teachers reporting the existence of such clubs, which was55.2/b. Thus the reporting by teachers is more l ikely to be an over-estimation due to the tendencyto over-report about the tasks they should have performed, in th is case formation of such clubs. Insome cases, teachers and pupils also mixed up science/health clubs with other clubs such asw i l d l i f e , scouting, and others, which also contr ibuted to over-reporting. Even where these clubshad been formed, their status and their functionality were still weak. For instance, in many cases,teachers and pupi ls a l ike could not point out who the members or even leaders of the c lubs were.

30

S i m i l a r l y , no concrete ac t i v i t i e s had been performed by the ex i s t ing c lubs , w i th the exception ofsome drama on a very l imi ted scale.

Drama performances and school competi t ions remain largely non-existent. Health parades seem tobe regular , and th i s is partly attr ibutable to the fact that these have existed in schools for a longt ime . In schools wi th big numbers of pupi l s , i t was reportedly d i f f i c u l t to conduct regular heal thparades due to much time consuming which is not provided in school timetable. Amidst this,media campaigns were found to be l imi ted to a few districts but also to a few channels, mainlyradio. Only a few districts had tried to use local newspapers. As such it appears that much of theattention has been put on the hardware ( l a t r i n e s and u a t e r tanks) rather than the software.

5.6 Sanitation, Water and Hygiene related DiseasesDiseases associated with poor hygiene, bad water and poor san i t a t ion are often some of thecommon heal th problems affecting school p u p i l s . These are expected to reduce as schoolsimprove their hygiene and sanitation facilities, and as the> gam access to safe water. At the samet ime, possession of accurate knowledge about the causation, nature and prevention of suchdiseases is essential to t h e i r r educ t ion .

5.6.1 Pupils Knowledge and Awareness of WATS.AN Related DiseasesI n all districts.^ majority p u p i l s (92.8%: n=2134) reported that they were aware of the variousdiseases caused by poor hygiene, sani ta t ion and unsafe water. Table 21 shows what p u p i l s reportedas WATSAN related diseases.

Table 27: WATSAN Related Diseases Known by Pupils by DistrictDistrict

AruaBushenvi

Reported WATSAN Related Diseases jSkin Rush

%Scabies

%Diarrhoea

%Eye Diseases

%I S . 8 i 38.9 i 5 1 . 7 i 2.0".2 i 8.3 ! 38. 8 -1 "1

J J

Hoima i 2:9 j 3.6 | 45.7 \ 0.0Kabarole 9.3Kumi i 22.1LiraLuweroMasakaMbararaNakasoimoraSorotiAverage

5 . 1

12.3 1 35.2 0.9

Others i!

43.0 :76.! ;71.7 !ST2

26.6 | 54.5 i 7.1 | 30.5 ;16.2 61.5

19.6 i 5.7 j 50.94.212.019.2i~ i

13.4

T O j .1-10— . O [ -T _ . 0

10.4 46.513.7 i 54.818.4 j 46.6

6.8 | 1S.S i5.4 j 50.0 ;0.5 ! 74,02.7 \ 12.-! I5.5 i 32.9 |1.9 | 16.5 !

14.2 j 4S.O i 3.2 52.1 j

Specific knowledge and awareness of WATSAN related diseases were rather low in the districts. Itwas only diarrhoea that was specifically mentioned by close to a half of the pup i l s interviewed(48.0%). Several unrelated diseases, categorised as various pupi l s s i m i l a r l y mentioned "others" asWATSAN related.

5.6.2 Prevalence of WATSAN Related Diseases

I n d i v i d u a l experiences of sani ta t ion , water and hygiene related diseases in schools was high wi thalmost a third (30.1%) if all interviewed pupils having suffered from WATSAN related diseasesin the 3 months preceding this study. Prevalent diseases in order of frequency included skin

diseases, internal worms and diarrhoeal diseases. Slightly more males reported episode; ofVv'ATSAN related diseases as shown in Table 28.

Table 28: Ever Suffered from WATSA.N Related Diseases by Sex in the Last 3Months

•

Ever Suffered

Yes

No

SexFemale

%29.1

70.9Total 1 100.0

Male%

3 1 . 1

68.9100.0

By district, pupils in Kumi . Lira, Nakasongola and Kabarole reported more episodes of WATS ANrelated diseases than in other districts. See Table 29.

Table 29: Ever suffered from WATSAN Related Diseases in Last 3 Months by DistrictEver Suffered in Last 3 Months

District Ever Never

Arua 17.6 82.4BushenviHoimaKabaroleK u m i

'. LiraLuweroMasaka

! Mbarara: Nakasonaora: Soroti

Average

! 24.Q! 25.4! 33.0I 53.6i 48.71 19.6i 20.8! 23.9

- -! -!: J / . /

26.4! 30.1

74.073.967.046.45 1 .380.478.870.663.073.669.9

i 'VT

i When the f indings in the above Table are compared wi th san i ta t ion condi t ion , a r e l a t i o n s h i p. emerges. For instance. Nakasongola which had deplorable la t r ine conditions as shown in Picture 1,

v ^ least number of H WF together with Lira, reported high incidence of WATSAN related diseases.

School authorities views were sought on what common diseases affected pupils. Majority (~S.4%)reported malnutrition. But as Table 30 shows, a big percentage (43.6%) reported skin diseases, anindicator of poor hygiene and bad water.

Table 30: Common Diseases Affecting Pupils at School as Reported by SchoolAuthorities

DiseaseSkin DiseasesEye infectionintestinal wormsMalaria feverDiarrhoeaMalnu t r i t ion /S tun ted growthOther

%43.66.8

25.878.418.62.5

46.6

N1031661

185446

1 10

Almost a fifth of al l schools, school authorities reported diarrhoeal diseases. This situation is madeworse by absence of school nurse in most schools.

Only 12.S% (n=30) of the schools had schools nurses or health workers. It was reported bymajority that pup i l s who manifes t san i ta t ion and hygiene related diseases are taken to the c l i n i c sand other nearby health uni ts , given first aid treatment, or sent home to the attention of theirparents.

D. / School Attendance

A^'

The quali ty of sanitation and hygiene in schools can affect p u p i l s ' regularity of school attendancein varied ways. Sickness due to sanitation and hygiene related diseases could cause pupils to missa number of school days. In some cases, adolescent girls may miss school during the time of theirmon th ly periods due to lack of adequate or c o n v e n i e n t san i t a t ion f a c i l i t i e s at school. This studyfound that more than one fifth of all the surveyed pup i l s had missed some classes since theb e g i n n i n g of te rm. Tiie m i s s i n g of c lasses was reported h ighe r among female p u p i l s than the i rmale counterparts as shown in Table 3 1 .

Table 31: Sex of Pupi ls bv Class At tendance since the Term BeganSex of pupils

Males

FemalesAverage

i Attended All Classes Since Beginning of Termi

! Yes "/» i No %: 78.1

! 75.0| 76.51

21.9

25.023.5

As Table 32 indicates, water and sanitation related disease were reported by over a ha l f of thepup i l s that had missed school, as one of the reasons for not at tendmu school.

Table 32: Reasons for not at tending classes bv Sex

Reasons for not attending

Illnesses, sanitation and water relatedIllnesses, non-sanitation and water relatedLack of sanitation facilitiesLack of money/scholastic materials

i

s

Male">//l)

50.638.250.0

p •• 4iJZ__- 47,4

?x

Female»//o

49.461.850.0

, _____ 44.352.6

5.8 Drop-out Rates

Pre-mature terminat ion of schooling remains one of the major problems of primary schooleducation in Uganda. Although there are many factors inf luencing this, the contribution of poorsani ta t ion and hygiene fac i l i t i es at school cannot be under-estimated. For instance, adolescentgirls who begin by missing u few days of school due to inadequate sanitation facilities at schoolmay eventually come to hate school and end up stopping completely.

Figures at national level show that the drop out rates dur ing 1997 and 199S were between 4-6w i t h an increas ing trend over the two vears (see Table 33).

Table 33: Rate prDropout at National Level between 1997-1998 by Sex

Class

P IP2P3P4P5P6P7Average

Drop out inFemale [

%4.8•1 7

4.24.65. 16.06.44.8 i

1997Male

o//o5.03.14.24.44.85.28.84.5

Drop out inFemale

o//o

5.74.8 ;5.05.4 ;6.17.58.45.6

1998Male

%6.05.05 ->5 -i5.55.87.05.6 1

The schools visited dur ing t h i s study could not give precise figures about drop out rates. However,specific districts such as Rondo and Moroto reported high levels of school drop out. In this study,the reasons for school drop out as reported by school authorit ies pointed to early marriages as oneof the major factors. In the districts of Kotido and Moroto. it was reported that parents get theirdaughters ojJt of school in order to marry them off so as to get resources that they can use to buyguns, necessary for cattle rus t l ing. Other common causes were reported to include lack ofscholast ic mater ials , lack of parental guidance, and the need to involve in business.

Table 34: Reasons for Dropping out as Reported by School Authorit ies

Reasons*LacJ£_gf_Sciialasii£. Materials/FeeLack of Interest in EducationEarlv Marriaizes {£)Lack of Parental Care/GuidancePoor Facilities at School

s (32% j N

pO.5 i 7216.5 i 39

i 4U> i 102Q} Ji6 j 58

3.8 j 9Involvement in Busmess/IGAs by Pupils 23.3MigrationInstabilitv/lnsecuritvDon't KnowOthers

i 9.31.33.412.7

,-s•*22

3S

30

Multiple Answers Allowed

5.9 Assessment of GoLVUNICEF School Sanitation Program

Head-Teachers and Teachers interviewed were asked to mention what they considered to be thepositive changes resulting from the GoU/UNICEF Primary School Sanitation Programme. Theresponses are tabulated in Table 35.

Table 35: Reported Changes in Schools as a Result of the Sanitation Program bySchool Authorities

Reported ChangesReduct ion WATSAN Related DiseasesProvis ion of Safe WaterImprovement in Envi ronmenta l Sani tat ionImprovement in Personal HygieneIncreased Awareness of WATSAN IssuesReduct ion in Costs for Sani ta t ionNoneDon't KnowOthers

%18.215.747.915.722.021 .02.50.48.9

n4337

1 13^525611

Key respondents and p u p i l s a l ike in schools that have benefited from the program recognized thetremendous improvement regarding awareness, f ac i l i t i e s and practices, in relation to hysiene andsan i t a t ion in schools.

6.0 INSTITUTIONAL ARRANGEMENTS AND ACTORS

6.1 Introduct ion

There are several ins t i tu t ions and actors involved in the school sani ta t ion programme at dif ferentl e x e i s . Al though this renders impetus to the mul t i - sec tora l implementa t ion of the Programme, itcan also be a source of confusion and tens ion , as some actors feel s ide l ined , w h i l e others assumethe d o m i n a n t role. Nonetheless, the var ious l eve l s ma\ be d i s t i n g u i s h e d in to Distr ict . Sub-countyand School /Community leve l .

Structures and Actors at District LevelAt dis t r ic t level , the CAO's office th rough one of the ACAOs co-ordinates the entire WESprogram. The dis t r ic t makes a work p lan , wh ich has to be approved by the WES ManagementCommittee and. in turn forwarded to Kampala ( b u t WES plans are pu l l ed out of the District annua lp l a n ) . Funds are then sent to the d i s t r i c t WES Account. At the distr ict , relevant/concerneddepartments r e q u i s i t i o n for the money to carry out p lanned ac t iv i t i e s . Specif ical ly , the variousactors at district level inc lude the fo l lowinu :

• District WES Management Team/Commi t t ee ( A C A O , DHL DWO. D^EO. DCDO, DPO):These are responsible for approving p lans , m a k i n g key decis ions , r ev iewing and a d v i s i n g theprosram and moni tor ing . The WES Managemen t Committee plays roles tha t shou ld havebeen played by the Dis t r ic t Techn ica l P l a n n i n u Commit tee i f i t were f u l l y f u n c t i o n i n g . Thecommit tee helps to br ing the d i f ferent sectors together.

• Dis t r ic t Departments/Directorates: The r e l evan t departments m a i n l y i n c l u d e DDHS, DWO( s p e c i f i c a l l y Health Inspectorate and H e a l t h E d u c a t i o n ) . Water , and Educa t ion . These have theroles of sanitation promotion and hygiene education, technical water supply, mobi l izat ion, andinspect ion and management of school affairs respect ively. Some tension, however, exists atdis t r ic t l eve l between some of these departments . The most outs tanding; ones were foundbetween the District Department of Educa t ion and H e a l t h Inspectorate . There was f e e l i n gamonsi offices in DEO that the School S a n i t a t i o n Program s h o u l d be a mat ter for educa t iondepar tment instead of the current a r rangement u h e r e b \ i t i s u n d e r hea l t h ( D I S ) . This f e e l i n gis affect ing the par t ic ipat ion of educa t ion staff i n the programme, to the extent that in mostdistricts, their role is marginal .

• Support Dis t r ic t Departments/Directorates: These are departments that also i n d i r e c t l ycon t r i bu t e to the success of the programme. They i n c l u d e , for ins t ance . C o m m u n i t yDevelopment . Finance. Audi t . E n g i n e e r i n g and I n f o r m a t i o n . The Communi ty DevelopmentDepartment is u s u a l l y responsible for c o m m u n i t y mob i l i z a t i on . The f inance and aud i tpersonnel handle the accounts of the d i s t r i c t . The a u d i t has an add i t iona l role of mon i to r ingand checking the use of district resources. The District Engineer oversees all constructionwork in the district, wh i l e the In fo rma t ion Officer may be involved in mass media campaigns.

• Pol i t ica l Leaders: These include the Secretaries and members of the District Counc i l SectoralCommittees in charge of Social Services ( i n c l u d i n g Heal th) . Educat ion, and Works andTechnica l Services ( i nc ludes Water). These are responsible for mak ing d i s t r i c t sectoralpolicies, approving budgets and plans , and m o n i t o r i n g of i m p l e m e n t a t i o n in the respectivesectors.

• Dis t r i c t Tender Boards: Tender Boards are responsible for g i v i n g out all tenders forprocurement and construction work in the district, including Sub-counties and schools. Anissue »f major concern to other s takeholders is the leng thy and slow procedures of the tenderboard. There was also concerns about the leve l of po l i t i ca l i n l luence that goes in to theaward ing ol tenders.

Structures and Actors at Sub-county LevelAt Sub-county level , the Sub-county chief is the overa l l coordinator of the programme. Otheractors at this level inc lude ;

• Sub-county extension staff in charge of Heal th and Communi ty Development, such as HealthAssistants (HAs) and Communi ty Development Assistants (CDAs). CDAs are m a i n l vrespons ib le for m o b i l i z a t i o n and to some extent m o n i t o r i n g , w h i l e HAs are responsible forhyg iene education, inspect ion and enforcement of hyg iene standards, h e l p i n g contractors ins i t i n g of f a c i l i t i e s , and supe rv i s i on .

• Sub-county Water and Sani ta t ion Committees w h i c h are supposed to oversee matters of water,hveiene and san i ta t ion . To a bis extent, these committees were found non-funct ional .

School/Community Level

• Head-Teachers and Teachers: The head- teachers are r e spons ib l e for the day to day r u n n i n g ofthe affairs of schools. The teachers, unde r the s u p e r v i s i o n of the head-teacher are respons ib lefor t each ing and passing on knowledge and s k i l l s to p u p i l s . They also enforce d i s c i p l i n e andappropr ia te behaviours .

• Parents Teachers Associat ions and school management Committees (PTAs/SMCs): These arethe local school governing bodies. They make dec i s ions af fec t ing the schools, i n c l u d i n gf i n a n c i a l decisions. They are also i n v o l v e d in the m o b i l i s a t i o n of parents and local c o m m u n i t ymembers. The SV1C plays a key role in the m a n a g e m e n t of the school in all respects.

• Senior Women Teachers: 96.1% of the schools reported the existence of senior womenteachers. Their roles i n c l u d e among others, c o u n s e l i n g and guidance of adolescent femalepupi l s , promotion of personal hygiene amongst female pup i l s , promotion of d i s c i p l i n e and co-o rd ina t i on of female teachers.

Other Actors• Private Sector: Pr ivate sector firms are responsible for t ak ing contracts and implement ing

activit ies for the district. Sub-county and schools at a fee. Activit ies implemented by theprivate sector cover all construction work, inc lud ing ; digging pits (contract got from school),b u i l d i n g latrine super-structures, ins t a l l ing water tanks, b u i l d i n g water tank platforms.

• NGOs; Information about the work of NGOs is not readily available at the district. Althoughdistrict staff know some of the NGOs involved in school sanitation, they do not know all . andat times they cannot state with certainty which NGOs are there and what their activities are.This is partly due to lack of institutionalized mechanisms for co-ordination between districtsand NGOs. In Table 37, we tabulate some of the NGOs/actors operational in some of thedistricts where data were obtained.

Table 36: NGOs/Actors Involved in School Sanitation and Water Provision in Schools

Other AgenciesDistrict involved in

School S a n i t a t i o nMbarara ACORD

: Red Cross

EOF

Luwero . . P l anI n t e r n a t i o n a l

;

AMREF

Busoaa DioceseNakasongora : World Vis ion

Ainref

B u s h e n y i CARE.

: c.o.uNtunsamo AfricareMasaka : LVEMP

Hoima i World V i s ionSoroto SOCADIDO,

Red Barnet

K i i m i ' Red Barnet.; KDDF

KotidoMorotoArua | GUAM

Lutheran WorldFederationCAP West Ni le

Nebb i EDF/DHSPWorld Vis ionACAVSNVGUAM

Lira ATABUCPARRed CrossCCFADRAWorld Vision

Activities

Water TanksSprings, WaterTanks

Latrines, Watertanks, classroomsLatrines, classroomsWater SourcesLatr inecons t ruc t ion ,classroom, waterprovis ion.Lat r ineConstruct ionLatr ineConstructionSpring protectionLatrineConstruction

Latr ineconstruction,Class room,water tanksConstruct ion ofl a t r i n e , classroom, watertanks

R e h a b i l i t a t i o n ofboreholes

B u i l d i n gClassrooms

GeographicalCoverage

2 Counties

/•"

/̂//

1

\\

\

\

}I

I

\

\

(

Remarks

Not necessarilyin schools, putsat Sub-counrvHeadquarter

— _ .—— __ _ _ _ _ _

38

6.2 Funding for Sanitation and Hygiene Activities

Majority (72.4%) of the schools reported that they had a vote for sani ta t ion and hygiene in theschool budget. Such funds were, however u s u a l l y meagre and were used for buy ing a fewconsumable items such as detergents, brooms, rather than for capital development of facilities. Insome cases, however, such budgeted funds were never released for use on sani ta t ion and hygieneexpenses.

Financial support from Local governments towards school sanitation and hygiene is l imited.Although most Sub-counties and districts had plans and budgets was found for school sanitation,insuff ic iency of funds usua l ly made it d i f f i c u l t for them to realise their plans. As can be seen fromthe Table 37. only 10.7% of the schools had got assistance from LC1, 9.8% from LC2. and 44.0%claimed to had received assistance from the district. It must be cautioned that xvhat was largelyperceived, as support from the distr ict was ac tua l l y funds from the GoU/UNICEF, channel ledt h r o u g h the districts. Interviews with distr ict off icials confirmed that dis tr icts ' direct f inancia lcon t r ibu t ions were very l i m i t e d .

Table 37: Financial Support for Sani ta t ion and Hygiene

Receive Financial Support-Yes LC1Yes LC2Distr ictNo financial support

% I N10.79.8

44.035.5

252310383

W i t h respect to Sub-counties, in some districts such as Arua. it was found that some sub-count ieshad 3 Year Investment Plans which clearly s t ipulated the assistance to be given to primary schoolsand they had gone ahead to give such assistance. For instance. Aroi Sub-county in Arua districthad an Investment Plan for 2000-2003, which seeks to put up 9 VIP latrines in 9 primary schools,being i m p l e m e n t e d between October and December 2000. /According to the Sub-county- chief, theSub-count} seeks to improve the s i t u a t i o n espec ia l ly for g i r l s and disabled c h i l d r e n , a focus, whichties properly wi th the GoU/UNICEF focus.

6.3 Parents and Local Communi ty Involvement in School Sanitation and Hygiene. ts

Parents and local communi ty members are invo lved in school sanitat ion and hygiene act iv i t ies in anumber of ways. They contribute local bu i ld ing materials, unsk i l l ed labour for carrying materialsand cons t ruc t ion , carrying out main tenance tasks of water f a c i l i t i e s such as s lashing and openingdrams, f i n a n c i a l c o n t r i b u t i o n , e n s u r i n g proper hygiene amongst the i r ch i ld ren , and in some cases,provision of some materials such as soap. However, community contributions are, however,d i f f i c u l t to mobil ise in some cases as already discussed in section 1 . This is further exacerbated bythe statements that originate from the Min i s t ry of Educat ion regarding parents role under UPE.This is further examined in the next Section.

7.0 SWOT ANALYSIS OF THE SCHOOL SANITATION PROGRAMME

7.1 Introduction

A SWOT analysis is attempted i n t h i s Section to provide some input into p lanned strategies toimprove the GoU/LTNICEF School Sani tat ion Program. I m p l i c i t l y , this Section under "weaknessesand threats'" provides possible measures, suggestions and recommendations that are tailoredtowards mains t reaming the School Sanitat ion Program. To unrave l the strengths, weaknesses,opportunities and threats, a qua l i t a t i ve approach was adopted. It is for t h i s reason, that the fmdinashere below are presented in more of an ou t l ine form.

7.2 Strengths

• The mul t i -sec tora l nature of the program ensures that re levant key stakeholders are involved,although wi thou t effective co-ordinat ion and d e f i n i t i o n of roles, th is is t u rn ing out as a threatto the survival of the program. S i g n i f i c a n t l y , m o b i l i z a t i o n of local c o n t r i b u t i o n andi n v o l v e m e n t of parents is gradual ly p i c k i n g up in some distr icts .

• Integrated package for promoting s an i t a t i on and hygiene by not only support ing constructionof latrine facilities, but also provision of safe water to schools especially in dry districts.

• Re-or ientat ion or u p d a t i n u teachers w i t h knowledge and s k i l l s in san i t a t ion and hvsiene/ . ~ ^ * ~promotion.

• Us in2 the private sector ensures real izat ion of q u i c k output . If it were parents to do the job itwould be d i f f i cu l t to give them deadl ines .

• Clear technical specifications for construction work such that even the non- techn ica l staff cansupervise.

• Existence of guidebooks en t i t l ed " What Teachers Need to Know and Do" and "Guidel ines forSchool Sanitat ion"

• Posting of Inspectors of Schools to Count ies w i l l f ac i l i t a t e m o n i t o r i n g and supervis ion.

• Program in te rven t ions have had posit ive benefi ts to the g i r l c h i l d .

7.3 Weaknesses

• Poor record keeping and data management i.e.. it is d i f f i cu l t to obtain data at district levelregarding the number of f a c i l i t i e s that have been supported and t h e i r status: incomplete orcomplete.

• Multi-sectoral nature of the program at times leads to lack of ownership. There are differentparties involved, some of whom might not necessarily be competent e.g. to ably superviseconstruction work. There are also tendencies to fight for ownership of the proizram betweenthe DEOs and the DHls.

• Inadequate fund ing at some stages and delays from WES. By the t ime the money is received,dis t r ic t staff may have other commitments . Districts are then given a very short t ime toaccount for the funds. Coun t ing of the accountab i l i ty days begins when the voucher isprepared, yet the cheque may take 2 months to reach the dis t r ic t .

40

• Making flat or un i form costing for la t r ines in d i f f e r en t soil types is inappropriate . The cost ofa la t r ine cannot be the same irrespective of the soi l type.

• The private sector tends to move at a faster pace than c i v i l servants are used to. In some cases,they go on with the work wi thou t adequate supervis ion, wh ich m i g h t result, into poor quali tywork and other problems.

• Compla in ts by the pr iva te sector that the funds paid to them are insuf f ic ien t to do a good job.

• Some schools are not easily accessible to a l low d e l i v e r i n g of a tank on a big truck.

• Insuf f ic ien t funds for m o n i t o r i n g construct ion

• Rainwater water tanks are used only seasonally. Besides, water in the tank may not be safe asit collects dust and other d in from roofs. In some cases, the provided tanks are tal ler thanexis t ing b u i l d i n g s . In other cases there are grass schools thatched u here tanks cannot be used.

• There seems to be inadequa te coordinat ion between the m u n i c i p a l i t i e s and the district. As aresul t , schools in the m u n i c i p a l i t y are u s u a l l y m a r g i n a l i s e d , not offered suff ic ient informationand sometimes left out comple te ly . I n some distr icts , Suo-counties are not invo lved indecision making and programming. Instead the\ are only called upon to help in supervision.

• Science clubs, drama activit ies and other accompanying activities seem not to have taken offw e l l . In some d i s t r i c t , d i s t r ic t o f f ic ia l s s i m p l y have no informat ion as to whether they are inplace or not.

• Poor fac i l i ta t ion of the implementers , e.a. B u s h e n y i Dis t r i c t Water office has no s ingle vehicle ,hence cannot do supervision and monitoring.

• Where WES sends money directly to schools/headteachers and then expects the Districts andSub-count ies to do the supervision and m o n i t o r i n g . The d i s t r i c t may lack resources to monitor.The Sub-counties c la imed they mi izh t not even know w h i c h schools have received the money.

• In some cases, pr iva te contractors pay the i r a l l e g i a n c e to the Tender Board, which gives themcontracts and may not cooperate with the supervisors, e.g. mav disregard advice from technicalstaff at Sub-count) level .

• In some Sub-counties, lack of extension staff (CDAs and HAs) is a major problem.

• I n urban schools, gett ing land for latr ines in reasonable distance away from classrooms is aproblem

• P o l i t i c a l in f luence in the awarding of tenders w h i c h results into contracting poorfirms/individuals, resulting into poor quality work

7.4 Opportunities

• Po l i t i ca l commi tment and support at na t iona l and other levels

• Increased fund ing per l a t r i n e overtime

• E n a b l i n g policies such as pr ivate sector invo lvemen t and decentralization

7.5 Threats

• M o b i l i z i n g parents con t r ibu t ions in the context of UPE program is a big problem. Districtsencourage schools to mobi l ize community contr ibut ions but there is no authority to enforcethis . One respondent cited a recent press release from the Minister in charge of PrimaryEducation warn ing against school authori t ies who charge fees from parents, it is argued thatschool author i t ies should not victimize/chase p u p i l s away from school for failure to pay certaincharges because it is not the responsibi l i ty of the c h i l d but of the parent. Yet sanctions onpupi ls seem the only effective way for school authorities to command the compliance ofparents. There was also a view that the Sub-county authorities should help schools to enforcemobil izat ion and parents' contr ibutions, a role they are currently not doing. It was alsosuggested that there should be an a l te rna t ive ava i lab le to parents who cannot afford tocontribute labor (e.g. those who are busy). Otherwise UPE policy has a problem of tying itselfto labor.

• "Messages from government have been negative. Instead of informing parents of their role,they put announcements threa tening school au thor i t i es that if you chase a p u p i l from schoolyou go to prison ' ' This leads to parents to be re luc tan t to contribute because they know youcannot do any t h i n g (Chairperson, School Management Committee, St.Marys P/School, Katete- Mbarara M u n i c i p a l i t y )

• Related to the above, m o b i l i z i n g c o m m u n i t y con t r i bu t i on takes a lot of t ime, which delays thework.

• Because of the above, some latr ines are not properly completed e.g. wi thout HWFs. This iscommon amongst schools that received assistance in the first phase.

• I t was assumed that distr icts would contribute to the program. But district "have no money".Distr ict revenues also depend on taxes, w h i c h are seasonal. These assumptions were madewi thou t consu l t ing and seeking the consent of the distr icts .

Some teachers are not good examples. T r a i n i n g of teachers in sani ta t ion issues should startTTCs so that by the t ime they come out they are already aware.

in

I t seems there are no mechanisms for sus t a inab i l i t y . No body knows what wi l l happen to thelatr ines when they get f i l l ed up or how the schools w i l l replace them! Only that the slabs arerngyahle_and can be used elsewhere. There also seems to be no funds for sanitation under theUPE fundsTYriie suggestions point to more sensit ization of parents, SMCs and PTAs.\^^}

There is a problem in us ing local materials from the c o m m u n i t y . If the qual i ty of work endsup poor e.g. if a wa l l cracks, the contractor can easily claim that it is because of the poorqual i ty materials provided by the communi ty , in which case you may not hold himresponsible.

In some places, what is budgeted is not enough, for what are considered local materials mayac tua l ly not be local. In Buhweju County of Bushenyi district, for instance, white sand isobtained from several ki lometers away in Sheema County. This mul t ip l ies the cost severalfold, w h i c h may not have been budgeted for.

Local contractors lack the necessary s k i l l s , finances, equ ipment and capacity in general - butdistricts are forced to use them on grounds that this is a poverty eradication program for whichthe gains should remain in the communi ty . This sometimes results into delays, and poorqua l i ty .

Problems of in t r igue and vested interests in awarding contracts. Part ly , an opt ion has been toask Sub-counties to iden t i fy contractors and then the Tender Board approves/ legal izes them.However, the tendering process is lengthy, bureaucratic and slow which delays work.

The procedures requ i re that when paying the private sector. VV'ES pays for a f in i shed product .Yet most local contractors are small and lack capital. In some districts such as Mbarara theyhave been advanc ing funds, but t h i s also has risks, e.g. one may f a i l to complete the workwhen he took the advance payment. One of the suggested options is to break the work intosmall sub-contracts for which the private sector can raise little money and then be paid uponcomplet ion of each stage.

8.0 CONCLUSION AND RECOMMENDATIONS

8.1 Introduction

This section presents the conclus ion of the s tudy and emerging recommendations. Therecommendations are meant for the improvement of the Program.

8.2 Conclusion

Provision of adequate and appropriate san i t a t ion and safe water to L'PE Schools under the variousprograms such as \VES and RUWASA s t i l l poses serious and d a u n t i n g chal lenges to thegovernment and donors. The big numbers of p u p i l s that have enrol led for primary education as aresul t of UPE since 1996 has meant that t remendous pressure has been exerted on the ava i l ab lefacilities. Although almost all schools, even those not supported under the Program, have got someform of latrine, the recommended ratio of 40 p u p i l s per stance is not any where near to be realized.At present, the ratio for recommended sanplat l a t r ines in districts supported under GoU/UNICEFPrimary School Sanitation Program stands at 96:1. This i m p l i e s that a s i n g l e stance is avai lable forsuch a big number of p u p i l s , a l t h o u g h t h i s is an i m p r o v e m e n t from what the s i t u a t i o n was beforeProaram support. The big numbers of p u p i l s u s ing a s i n g l e stance make it d i f f i cu l t to clean andmaintain the existing faci l i t ies where p u p i l s do only c l e a n i n g in the morn ing themselves. Besides.bis numbers u s i n u a v a i l a b l e f ew f a c i l i t i e s i m p l y t h a t t he la t r ines w i l l f i l l up q u i c k l y i n l i g h t o f t hed o m i n a n t - latr ine -technology. Thus, l a t r i n e a c t i v i t i e s are also s t i l l hampered 'by lack of a l t e r n a t i v etechnologies.•'o'

I t has been noted that most schools have a p o p u l a t i o n of over 500 p u p i l s with a few h a v i n g apopulat ion exceeding 2000. Thus, provis ion of 10 stances per school regardless of the popula t ionf a l l s too short of the recommended rat io. At a m i n i m u m , a school wi th 500 p u p i l s requi res about13 stances, whi le that wi th 2000 p u p i l s w i l l r equ i re 50 stances! But where can the 50 stances beconstructed even if resources were to be a v a i l a b l e e spec i a l l y in towns where land tends to bescarce. It has already been observed that l a t r ines in u rban centers tend to be located less than 10meters from the nearest class b lock due to lack of l and .

Despite the above s i t u a t i o n , the ac t i v i t i e s supported by the program are takirm root. Support forla t r ine construction is i m p r o v i n g the sani ta t ion of schools, for wi thou t t h i s support, the san i t a t i ons i tua t ion especially for ru ra l schools would have been deplorable. The school and dis t r ic tauthori t ies appreciate the increased f u n d i n g per l a t r i n e , w h i c h has enabled construction of betterq u a l i t y latrines. A major problem remains lack of m e c h a n i s m s for ensur ing sus t amab i l i t y after theset of latr ines provided under the program are f u l l .

However, many of the software aspects r e q u i r e a lot of effort to strengthen them. Cur r en t ly .ac t iv i t i e s tiiat would be carried out by Science/Heal th C lubs seem not to be emphasized. At thesame time, school competit ions, drama shows and media campaigns have been in i t ia ted in a fewschools, but also not f u l l y func t iona l .

This Program can be commended for its in tegra t ion na ture of p rov id ing not on ly sani tat ionfac i l i t ies and hygiene campaigns, but also provision of safe water through ra inwater tanks.Sanitation and hygiene behaviors and practices cannot be observed in the absence of water. Forinstance, handwashing behavior after la tr ine use cannot be commonly practiced in most schoolsdue to lack of water. However, provision of water is s t i l l hampered by fa i lure of schools to raisetheir local contr ibutions, which has rendered many of the tanks remaining non-funct ional . Second,there is apparent feel ing among some local leaders that rainwater tanks do not offer safe water topupils . Despite the l imi ta t ions , water is a cr i t ica l ingredien t in promoting hygiene among pupi l sand teachers al ike. Even w i t h water, observance of proper hygiene al school is very muchhampered by the big pup i l : classroom ratio, absence of seats and desks in most classrooms.

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The Program also seems to be faced wi th uncer ta in t ies regarding ownership and sustainabi l i ry .Although the multi-sectoral approach has been adopted of invo lv ing various stakeholders, thisseems to have created un ique problems that potentially undermine the sustainabiliry of theProgram. This is more v i s ib l e and clear between the two c r i t i ca l Departments of Health andEducat ion at the Dis t r i c t level , as wel l as between the Ministry of Educat ion and Sports, andHealth at the Na t iona l l e v e l . Whereas the Dist r ic t Heal th Inspectorate cu r ren t ly plays the majorrole in the i m p l e m e n t a t i o n of the Program, there are overt i l l fee l ings on the pan of the DEOs thatthey ought to have been the main implemented of the Program. This creates a structural confl ic t inre la t ionships that does not augur well for sus ta inabi l i ty of the Program. The other area that canpotent ia l ly unde rmine the sus ta inabi l i ty of th i s Program is f a i lu re to fu l ly work through Sub-counties in most districts. Schools dealing directly with District authorities, thereby, bypassing theSub-counties u n d e r m i n e s the c r i t i ca l role that would otherwise have been played by Sub-counties.Under the Decentra l iza t ion Pol icy . Sub-count ies retain most of the funds , wh ich they can as we l luse for promot ing school sani ta t ion and hyg iene .

F i n a l l y , the Program which would benefit very greatly from parents and communi ty cont r ibut ion ,the s ignals and communica t ions from the Center as well as the District that no parent is supposedto pay any money under UPE appear to have been mis in te rp re ted . These have been misinterpretedto the extent tiiat parents is some districts cannot contr ibute anything. After a l l . no p u p i l can bechased by school a u t h o r i t i e s on grounds tha t the parent or the guard ian d id not meet certain schoolo b l i g a t i o n s .

8.3 Recommendat ions

in Section 7.0 under "weaknesses and threats" certain areas that need to be attended in order tostreamline the Program have been il lustrated. However, other pertinent recommendations that canhelp in strengthening the Program ar is ing from the study f indings have been derived.

S t ruc tura l Relat ionships:- It has been observed that there is i n su f f i c i en t co l l abora t ion in theimp lemen ta t ion of the Program between the two c r i t i c a l Distr ict Departments of Health andEduca t ion . The Department of Educat ion bel ieves that the Program ought to have been di rect lyput u n d e r i ts care, u h i l e the DDHS through the DHI i m p l e m e n t s the Program on the strengthsof the fact that technical ly sanitation fal ls under the domain of health. Another layer ofAssistant District Water Officer in Charge of Sanitat ion was recently introduced, and hencew i l l have a role to play in the Program. Apart from all this creating confusion of roles, itcreates tension among d i f f e r e n t Departments. For ownership and sus t amab i i i ry of the Program,clear roles and r e s p o n s i b i l i t i e s need to be c la r i f i ed or defined. A mechanism of a l locat ingresources commensurate to one's roles and r e spons ib i l i t i e s need to be worked out. For th is tohappen, at the Center , the MoH and MoES need to set the whole momentum by also redef in ingand c l a r i fy ing ; their respective roles in Program i m p l e m e n t a t i o n and mon i to r ing .

Latrine Technology:- Key informants from several districts pointed to the limitationsimposed by re l iance on the t r a d i t i o n a l pit l a t r i ne as the technology. There were suggestionsthat d i f fe ren t technology opt ions should be explored wi th a view of: i) i den t i fy ing atechnology suited to col laps ing soils, i i ) i den t i fy ing a technology that promises moresusta inabi l i ty , such as one that allows emptying. It is therefore recommended that otheroptions be tried out.

Implementation Proccdures:-There is need to improve the implementation proceduresespecially the selection of schools and allocation of assistance to make these processes moretransparent and more accessible to needful schools. It has been pointed out how some schoolauthor i t i es did not know how to apply or be e l i g i b l e for assistance, or even how those whobent;filed were q u a l i f i e d . I f the process is to be genu ine ly demand-driven, there is need to giveout all in fo rmat ion 10 schools so tha t they can access assistance.

Pre-condition for Water tank:- The fact that many schools pick tanks and fa i l to i n s t a l l themalso requires a pre-condition that schools to allocated tanks should first have the platform andthe gutters ready before they p ick the tank, beyond a period of which the i r allocation isforfeited to another app l i can t .

Sustainability Issues:- There is need to t h i n k and work out sustainability mechanismsespeciallv with respect to latr ines. As of now no body knows what wi l l happen when thelat r ines get f u l l . A l though many stakeholders feel that th i s should be a responsibil i ty of theschools and the Sub-count) governments , no mechanisms are being worked out to ensure thatthey w i l l attend to this issue. This is especial ly so given that in many cases the sub-countiesare involved at the last minute, to help with the monitoring.

Involvement of Sub-counties:- The f ind ings indicate that the sub-counties have to a larseextent not been i n v o l v e d in the p l a n n i n g and design of the programmes and in key decisionssuch as selection of schools. They are only asked or directed to monitor construction work.To a bis extent the programme seems to work top-down which needs to be reversed. A morebottom -up approach w o u l d m a k e the p rogramme more demand dr iven , loca l !> owned,sus tamable and more effec t ive and r a t i ona l .

Health Clubs:- There is need to re th ink the accompanying strategies of health/science clubsand drama ac t iv i t i e s s ince they seem not to be working .

Roles and Responsibilities of Parents:- There is need for wel l -p lanned and authenticinformation to parents about their roles and responsibilities in the context of UPE. This wouldhe lp to overcome the apparent con t rad ic t ions in po l i cy .

Proper informat ion management is also key to programme success. Lack of knowledge e.g.about the schools that have received assistance constrains monitoring, and evaluation. Districtand Sub-county implementers shou ld therefore be facili tated or assisted to keep track of theprogress. Th is may requi re report, m o n i t o r i n g fo rma t s that are f i l led from t ime to t ime .

Alternatives to Posters/Fliers:- As an alternative to p inn ing posters on walls against theassociated risk of removal, schools should be encouraged and facilitated to put wall paintings. f, ,uood c u r v i n g , and clay portraits tha t depict hygiene and sani ta t ion messages. These ^-^oralternat ives could be i n s t a l l e d in such a manner that they are not easily removable .

Targeting of Trainee Teachers at TTCs:- There is need to target teachers with tailor-madesan i t a t ion and hygiene t r a i n i n g w h i l e the> are s t i l l in the Teacher Tra in ing colleges. This w i l lensure that by the t ime they come out . they are already acquainted with sani ta t ion and hygieneissues, strategies for the i r promotion, and the roles they have to play. Such a strategy wi l l savea lot on the amount of resources required to reach teachers already deployed in schools.