Bali 10 September

Up-Scaling WASH in Schoolsin the Philippines:- Highlights and Challenges

Outline• Disease burden in Schools• WASH in Schools Technical Working Group

• Highlights and challenges of Dep Ed’s WASH facilities program works

• Up-scaling WASH facilities• Highlights and challenges of Dep Ed’s Essential Health Care Program (EHCP)

• Up-scaling EHCP• Comparison of Approaches to WASH in Schools

• What’s next?

Prioritising public health challenges

Diarrhea (10% DHS); 2nd most common complaint for children in schools

66% infected with intestinal worms

Dental decay & dental infection

97% of 6-yr-olds have caries with 9 decayed teeth on average30% have Body Mass Index (BMI) below normal

WASH in Schools TWGTOR with the Aim:Technical assistance to DepEd

Serve as a source of evidence-based recommendations

Forum for sharing networks and knowledge

Not a program but a support group

Chaired by Dep-Ed Under Secretary for Programs

Membership is DepEd, DoH, UN agencies and NGOsUsing children's leadership skills for daily activities - little extra work for teachers

Provided advice on Design of WASH facilities & low cost designs

WASH in School Country profile

Assisted with drafting policy/programing (EHCP monitoring, Brigada Eskwela, Global Hand-washing Day)

YEAR TARGETS (NC)

TARGETS(REPAIR)

WATER FACILITIES

HANDWASHING COUNTER DETACHED

AMOUNTUSD

2011 9,671 1,196 279 594 29.9 million

2012 10,694 1,345 68 13,256 33.2 million

2013 ( to be determined) 129.2 million

Planning and Targeting

WATSAN Designs

2-Seater Toilet

3-Seater Toilet

4-Seater Toilet

Hand washing Standard

WATSAN Completed Projects in the Philippines

Procurement and Construction Process

• By Contract using DepEd Budget• Community help through Brigada Eskwela

• LGU Assistance ( Local Government Unit)

• NGO Assistance ( Non-government Organization)

• Private donors through Adopt-a-School Program

Challenges in Up-scaling WASH facilities

• Existing data gathering tools does not include functionality and O&M of WASH facilities

• No specific budget for WASH facilities O&M

• Child friendly designs• Cost effective designs

Challenges in Up-scaling WASH facilities

• The Hardware program is not clearly linked with the software program (Essential Health Care Program – EHCP and O&M)

• Targeting poor and underserved areas; Dep Ed priority disvisions

Daily Hand-washing

Daily Tooth brushing

Bi-annual Deworming

Handwashing with soapGroup activityPart of daily school routineNo piped water neededSupervised by teachers and children

Toothbrushing with fluoride toothpasteGroup activityPart of daily school routineNo piped water neededSupervised by teachers & childrenReduction in tooth decay by 40-56%

Supervised ingestion of albendazoleSupervised by teachers Parent consentReduction in worm load by 50%

Reduction of absenteeism by 27% / underweight children by 20%

Dep Ed’s Essential Health Care Program

Highlights: Clear program management Clear roles & responsibilities of all involved

Using children's leadership skills for daily activities - little extra work for teachers

Community involvement in construction of facilities

Detailed & simple guidance through templates and manuals

Highlights: Making it simple and affordable

Material and costs per child per year

High quality toothbrush with cover

0.16 US$

60 ml WHO quality tested fluoride toothpaste

0.22 US$

50 g Soap 0.08 US$

400mg Albendazole tablet (2x)

0.05 US$

Total ~ 0.50 US$

Highlight: Monitoring & Evaluation

Regular process & outcome monitoring

Outcomes motivate staff and ensure sustained government funding

Strengthening evidence of program by evaluating health & education impact

Vertical and closed loop monitoring

EHCP Programme coverage & reach

Indicators Intervention Control Difference

  n = 544 n = 173  

Days of absence SY 2009

3.2 ± 3.9 4.4 ± 4.8 27.3%

Prevalence of Children categorized as thin1 

28.1% 35.3% 20.4%

Prevalence of children with heavy STH infect2

10.4% 19.7% 47.2%

DMFS Increment 0.72 ± 1.49 0.87 ± 1.79 17.2%

PUFA Increment 0.08 ± 0.33 0.13 ± 0.40 38.5%

Evidence base – 1 year longitudinal study

Prioritising public health challenges

National and Provincial Advocacy

Events, WinS TWG, evidence, cost effective, guidelines, policies

Creation of incentives & motivation based on analysis of interests

Competition & politics

Dep Ed investment WASH infrastructure

Provincial Governments fund consummerables

Highlight : Government Buy In

Highlight: Community Buy in• Materials and labour for construction by the community

• Quality of facility is based on the wealth of the community

• Sanitation ladders - schools/communities see value in infrastructure and are upgrading

• What is the driver of community involvement:

• Creative use of incentives?

• Policies/Political pressure

• Competition within schools and across schools

Challenges for EHCP• Sanitation is not clearly

linked with the Essential Health Care Program

• Provision of water is very difficult for some communities and needs a multisectoral response

• Existing data gathering tools does not include hand washing facilities and the presence of consummerables (eg soap, toothpaste, cleaningn products)

• Sustaining the program with local government funding ie No specific national budget from Dep Ed for consummerables.

Expansion till 2015

Expansion of EHCP

Comparison of ApproachesTraditional Approach

• Education/hygiene promotion based activities

• Often requires large training of trainers and teachers

• Many hygiene behaviours

• Not always cost effective

• Not always scalable

• Not always evidence based

• M&E potential not fully utilised or realised

• Sanitation included

New Approach (EHCP)

• Daily skills based activities

• No training of teachers required – focus on guidelines and teacher manuals

• 2 key hygiene behaviours

• Very cost effective

• Scalable

• Strong evidence base

• Key role of M&E

• Sanitation not included (work in progress)

What's next? Sanitation & Equity• Schools & PTA will invest in sanitation

• Policy support from Dep Ed and Province – key role for WinS TWG

• Development of conditional Support mechanisms. Eg consummerables/toilets contingent on construction of water supply & hand washing facilities

• Challenge – turning positive group hygiene behaviour into individual behaviour

Thank you!