Field Guide: The Three Star Approach for WASH in Schools

Simple • Scalable • Sustainable Acknowledgements The Three Star Approach for WASH in Schools is designed to improve the effectiveness of behaviour change programmes for children and complements UNICEF’s broader child-friendly schools initiative and GIZ’s ‘Fit for School’ approach, which promote safe, healthy and protective learning environments.

UNICEF and GIZ are grateful to the many people who contributed their expertise to developing the Three Star Approach for WASH in Schools concept and who supported the production of this Field Guide.

The following people provided inputs and advice: Zhenbo Yang (China), Mamita Bora Thakkar (), Bishnu Pokhrel (Mongolia), Anu Pudyal Gautam (Nepal), Emily Bamford, Therese Dooley, Greg Keast, Bob Linney, Catherine Rutgers, Murat Sahin, Yodit Sheido, Peter van Maanen, Carlos Vasquez and Sanjay Wijesekera (New York), Kazumi Inden (Sierra Leone) and Abdulai Kaikai (Sri Lanka), UNICEF; and Bella Monse (Philippines), Habib Benzian (Consultant) and Alexander Schratz (Germany), GIZ.

UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments.

GIZ implements programmes and projects for sustainable development on behalf of the Federal Ministry for Economic Cooperation and Development (BMZ).

August 2013

UNICEF Programme Division/WASH 3 United Nations Plaza New York, NY 10017 USA www.unicef.org/wash/schools

Commentaries represent the personal views of the authors and do not necessarily reflect the positions of the United Nations Children’s Fund (UNICEF) or Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH. The designations employed in this publication and the presentation of the material do not imply on the part of UNICEF the expression of any opinion whatsoever concerning the legal status of any country or territory, or of its authorities or the delimitations of its frontiers.

For more information on the Three Star Approach for building WASH in Schools programmes, contact Murat Sahin, [email protected], or Bella Monse, [email protected]. Field Guide: The Three Star Approach for WASH in Schools

Contents

Acknowledgements...... Inside Front Cover

Summary...... 2

1.0 Overview...... 3

2.0 The Three Star Approach for WASH in Schools ...... 5

2.1 One Star Schools...... 6 Hygiene...... 7 ...... 8 Drinking water ...... 8 Active schools ...... 10 Community support ...... 11

2.2 Two Star Schools ...... 12 ...... 13 Toilets and menstrual hygiene management ...... 13 Safe drinking water ...... 14

2.3 Three Star Schools...... 15

3.0 Managing the Three Star Approach ...... 17

3.1 The role of government and external support partners...... 17

3.2 Monitoring and certification of schools...... 18 Recognizing and rewarding achievements ...... 18

3.3 Flexibility and variations...... 19

4.0 Conclusion...... 21

Annex I. Evidence linking WASH in Schools to and educational performance ...... 22

Annex II. WASH in Schools global coverage ...... 23

Annex III. WASH in Schools bottleneck analysis...... 24

Endnotes...... 26 Summary

The Three Star Approach for WASH in Schools is promotion activities and improving infrastructure, designed to improve the effectiveness of hygiene especially for girls, and will ultimately achieve the behaviour change programmes. The approach national standards for WASH in Schools.1 ensures that healthy habits are taught, practised and integrated into daily school routines. The Three Star The Three Star Approach involves changing the Approach helps schools meet the essential criteria way WASH in Schools programming is perceived for a healthy and protective learning environment for by schools, communities, and decision makers in children as part of the broader child-friendly schools government and support agencies. By prioritizing initiative. It aims to address the bottlenecks that the most essential actions for achieving goals, the block the effectiveness and expansion of current Three Star Approach helps schools focus on meeting WASH in Schools programmes. children’s needs through key interventions. At the same time, it provides a clear pathway for all schools In the Three Star Approach, schools are encouraged throughout a country to meet national standards, to take simple, inexpensive steps outlined in this and for all children to have hygiene-promoting and Field Guide. These steps are designed to ensure that healthy schools. It encourages local action and all students their hands with soap, have access support from communities and does not depend to drinking water, and are provided with clean, on expensive hardware inputs from the education gender-segregated toilets at school every day. Group system or external support agencies. ‘Keep it simple, activities drive this incremental approach, beginning scalable and sustainable’ is the guiding concept for with daily, supervised group hand-washing sessions. interventions at all stages, so that the approach can Once minimum standards are achieved, schools can be sustainably expanded countrywide at low cost. move from one to three stars by expanding hygiene

Field Guide: The Three Star Approach for WASH in Schools 2 1.0 Overview

Children have the right to water and sanitation, activities on a daily basis. For sanitation, the and to health. This right needs to be fulfilled in focus is on keeping existing toilets clean through schools, where children spend much of their day. a daily routine. For water, teachers set up an Adequate water and sanitation as part of a healthy arrangement in which children have their own school environment significantly improve a child’s drinking-water bottles, or containers, filled with prospects to develop and thrive. The promotion water from home and brought to school, or filled of good hygiene behaviour at school can initiate from a safe source at school. behaviour changes that last a lifetime. A fundamental principle behind the approach The Three Star Approach for WASH in Schools is that expensive water, sanitation and hygiene is designed to advance the effectiveness of (WASH) infrastructure in schools is not necessary hygiene behaviour change programmes, while to meet health goals. In the many schools ensuring that schools meet the essential criteria that already have basic facilities, hardware for providing a healthy environment for children. improvements will require minimal investments The approach was developed in response to and consist mainly of constructing low-cost recent bottleneck analyses of WASH in Schools group hand-washing stations. In some schools, programmes worldwide and is modelled on additional but still modest investments will be successful programmes such as the Fit for School made for construction or rehabilitation of low-cost programme supported by GIZ. toilets. In all cases, investments in hardware will be limited to those facilities and supplies, such In the Three Star Approach, schools are as soap, that are necessary to encourage and encouraged to take simple steps to make sure reinforce behaviour change. that all students wash their hands with soap, have access to drinking water, and are provided with Once minimum standards are achieved, schools clean, gender-segregated and child-friendly toilets can move from one to three stars by expanding at school every day. hygiene promotion activities and improving infrastructure, especially for girls, ultimately Daily supervised hand-washing sessions are meeting national standards for WASH in Schools.2 a fundamental component of the Three Star Approach. During these sessions, all students as ‘Keep it simple, scalable and sustainable’ is the a group wash their hands with soap once a day, guiding concept for interventions at all stages of before meals or snack time. This group activity in the process, so the approach can be inexpensively school is designed to reinforce the habit of good expanded countrywide. By focusing on the most hygiene behaviour, and uses the positive power essential actions for achieving goals, the Three Star of social norms and peer encouragement to Approach will help schools become more effective strengthen healthy actions. at providing a healthy environment for all children and promoting positive hygiene behaviour. The sanitation and water components of the Three Star Approach are also centred on group

1.0 Overview 3 Key characteristics of the Three Star Approach

One Star School Two Star School Three Star School

Daily routines Incremental Meeting national to promote improvements standards healthy habits • Hygiene education and • School facilities and • Daily supervised group facilities to promote systems upgraded hand washing with hand washing with to meet national soap, normally before soap after toilet use standards the school meal • Improved sanitation • Daily supervised facilities, plus facilities cleaning of toilets, and and education for provision of soap and menstrual hygiene water (at least one management functional toilet for • Low-cost point-of- girls and one for boys); use water treatment no introduced in schools • Daily supervised use of drinking-water bottles by all children

‘No Star School’

The existing situation for many schools • Limited or no hygiene promotion • May or may not have WASH infrastructure

Field Guide: The Three Star Approach for WASH in Schools 4 2.0 The Three Star Approach for WASH in Schools

There are two main stages in the Three Star Reaching the other levels could require some Approach: The first and most important stage is external support and greater commitment from when a school commits to the overall approach communities and the education sector. and begins to make the necessary changes to progress from being a ‘no star school’ to a One Schools achieve Two Star status by making Star School that meets key minimum standards for incremental changes in their hygiene education a healthy, hygiene-promoting school. programmes and modest upgrades to WASH facilities. These changes are designed to facilitate A ‘no star school’ is a way of describing many the practice of hand washing with soap after toilet schools in developing countries, especially the use, in addition to before meals, and to improve a schools that have no water, sanitation and hygiene school’s ability to meet girls’ needs by increasing (WASH) facilities or regular hygiene programming. the number of toilets and/or improving privacy This category includes schools that have some and usability. infrastructure, perhaps even high-cost water and sanitation systems, but do not have effective Two Star Schools will also introduce provisions programmes for improving hygiene behaviour or for menstrual hygiene management. These maintaining existing infrastructure. These schools enhancements may include specific education may also have little or no support from their host sessions; keeping supplies of sanitary pads on communities in the area of WASH. hand for girls to use in emergencies; and improved toilet designs that ensure privacy, allow girls to Moving from the ‘no star’ level to a One Star wash their reusable cloths or stained clothing, and School is designed to require minimal financial provide proper disposal facilities for sanitary pads. investments. Yet, the move is a big step because it involves changing the way WASH in Schools move to Three Star status by making the Schools programming is perceived by schools, necessary upgrades to meet all national standards communities, and decision makers in government for WASH in Schools, which helps to ensure and support agencies. countrywide equity of access. This incremental approach for improving WASH in Schools is After schools embrace the approach and achieve consistent with current development practices One Star status, there is scope for moving on the progressive realization of rights.3 It also up to Three Star status. Many schools will be follows the global guidelines established in ‘Water able to achieve One Star status with their own Sanitation and Hygiene Standards for Schools in resources and the support of their communities. Low-Cost Settings’.4

2.0 The Three Star Approach for WASH in Schools 5 2.1 One Star Schools

A One Star School meets three criteria, one each How these milestones are achieved may vary from for hygiene, sanitation and drinking water: school to school, depending on existing facilities and the exact method taken for implementing the 1. All children participate in daily supervised approach. In all cases, the key to becoming a One group hand-washing with soap sessions Star School – and the essence of the Three Star ideally before the school meal. Approach – is the institution of daily supervised group activities for hygiene, sanitation and drinking 2. The school has basic gender-segregated toilets water. By taking part in these daily activities, that are functional, clean and used by all children become true participants in the process children (no open defecation). while developing positive lifelong habits. By 3. Every child has, and correctly uses, a personal hosting these activities, schools can significantly drinking-water bottle. improve the learning environment without relying on resources from outside the community.

One Star Schools Daily routines to promote healthy habits

Interventions Results

• Hand washing with soap becomes a habit. • The need to wash hands with soap before eating is reinforced. Daily supervised group hand washing with soap, ideally • Children like the daily activity and learn proper hand-washing before the school meal techniques. • Group hand-washing sessions provide a set time to deliver hygiene messages.

• Toilets are used because they are clean. Daily supervised cleaning • Water and soap are available in toilets. and provisioning (with soap • Open defecation in and near the school is eliminated. and water) of toilets • Children learn the importance of sanitation through active participation.

Daily supervised use of • All children have drinking water whether or not a safe source is drinking-water bottles by available at school. all children

Field Guide: The Three Star Approach for WASH in Schools 6 Hygiene Group hand-washing with soap sessions are there should be enough space for at least 10–15 conducted once a day and are supervised by children to wash their hands together, and the teachers, who emphasize good hand-washing facility should provide good drainage. techniques. Older students or school WASH club members could also help run the activity. Water for hand washing will be from existing water sources in or near the school. If potable A simple purpose-built hand-washing station – water sources are not available, any nearby source in most cases an inexpensive perforated pipe can be used because water for hand washing does system like the one used in the Philippines – is not need to meet the same standards as water installed in the schoolyard for this purpose (see the for drinking.5 illustration below and the ‘Fit for School’ box on page 16 ). Schools can adapt the design to make The daily hand-washing sessions can be carried use of locally available materials that meet criteria out during any suitable break in the school day, but for durability, functionality and low cost. In cases the best time is just before lunch or snack time to where funds are very tight, schools may choose to help reinforce the importance of washing hands install even less expensive technologies such as with soap before eating. tippy taps or buckets and ladles. The hand-washing sessions are used as an The group hand-washing station can be located in opportunity for delivering hygiene messages, the central school courtyard, near toilets or near especially the message that hands should be the water supply. Wherever the station is located, washed at two critical times: before eating and after

2.0 The Three Star Approach for WASH in Schools 7 using the toilet. The sessions can also be used to deliver messages on sanitation, drinking-water UNICEF experience with group hand safety and other health messages and activities, washing in schools such as . However, hygiene education should always be the central message. UNICEF has promoted group hand washing in schools for several years, starting with initiatives linked to Sanitation (GHD). As part of GHD activities, tens of millions of children wash their hands The sanitation component of a One Star School also with soap at school in countries around the world. In centres on daily activities, in this case, daily toilet 2012, more than 70 million children in half a million cleaning by students, supervised by their teachers. schools participated in group hand-washing activities. This activity ensures that toilets are kept clean, while involving students in the process. All but the In keeping with the GHD slogan “more than just a youngest students take part in toilet cleaning, with day,” the emphasis has been extended from once- fairness and gender equality built into the cleaning a-year exercises to more permanent and continuous rosters. Schools should also ensure that toilet programmes. In some countries, GHD activities last cleaning is never used as a punishment. for weeks or months. In other countries, the emphasis is on promoting daily, routine hand-washing initiatives, similar to Fit for School programmes in various Toilet surroundings are also kept clean, a countries and in line with the Three Star Approach. practice that discourages open defecation and is supported with messages on eliminating In Nepal, for example, daily group hand washing has open defecation delivered during the daily hand- been initiated in 300 schools. In Sri Lanka, hand washing washing sessions. During the daily cleaning, is being incorporated into the government school meals toilets will also be provided with soap for hand programme, with support from UNICEF. In Sierra Leone, washing and with water, in cases where water UNICEF works to set up peer monitoring mechanisms must be carried by hand. to monitor group hand-washing sessions before school meals. And in India, UNICEF engagement and technical Repairs, upgrades and (sometimes) new support to government has resulted in a decision to construction will need to be carried out in schools establish mass hand washing before school meals in without functioning toilets. In all cases, the focus 300,000 schools. will be on the use of local resources with the Source: UNICEF country offices. goal of having at least one functioning toilet for girls and one for boys in each school. Once this is achieved, the focus will be on maintaining and cleaning the existing toilets rather than building new toilets. This emphasis on toilet cleanliness is supported by experience and evidence showing that even when many toilets exist, children tend to use only the clean ones.6

In schools that have a janitor on staff, children can still be involved by taking on some of the cleaning tasks, under supervision of teachers.

Field Guide: The Three Star Approach for WASH in Schools 8 Drinking water A safe source of drinking water at school is not a requirement for a school to attain One Star Drinking-water bottle use in China status. Instead, students can bring their own water bottles or containers to school each day, In remote areas of China covered by the UNICEF- filled with the drinking water used at home. supported WASH in Schools Plus project, some Parents will be informed that children should schools do not have a safe water source. In these carry water to school, and teachers will schools, each child has a drinking-water bottle for his supervise this activity during assembly. Bottles or her personal use. or containers may also be used in schools that have safe water sources as a way to reduce Under the supervision of teachers, children use the bottles to bring drinking water from home every day. congestion at water sources and to ensure that The bottles are currently provided by the project at a children always have drinking water at hand. cost of $1 each, but may be sourced and purchased locally in the future. In some cases, schools may decide to provide water bottles or containers for students, but this In communities where safe water supplies are scarce, will generally not be necessary because water the project provides electric water boilers for schools. bottles are common and inexpensive in many These are used in conjunction with the drinking-water regions of the world. At the One Star stage, if bottles to ensure that all children have drinking water access to safe drinking water at home is a major throughout the school day. problem in the school catchment area, some schools may choose to install and use simple water Source: UNICEF China. treatment systems, filters or water boilers.

2.0 The Three Star Approach for WASH in Schools 9 Active schools The entire school community takes the lead for In the longer term, it will be beneficial to integrate meeting the One Star requirements. Under the relevant aspects of the Three Star Approach into Three Star Approach, both community support the education system. This could include making and support from the national education system Three Star monitoring a formal part of school and other government bodies are important, but inspectors’ duties and including it in regular training schools themselves must be actively engaged for programmes for teachers. the approach to be successful. Students’ involvement is also very important. In Active engagement means that teachers and many countries, WASH-related school clubs already headmasters* must be willing and able to take on exist, including hygiene, health or environmental the extra-curricular responsibilities necessary for clubs. These clubs, or new ones, can become a reaching and maintaining One Star status. This will central part of school efforts to achieve One Star require preliminary engagement and regular follow- status. Club members can help teachers supervise up with schools through the education system and group hand washing and toilet cleaning; be involved other government institutions. Additional support for in hygiene education for younger students; and teachers and headmasters may also be needed, such participate in forming links between the school and as manuals or templates, and training. Incentives to the community. help motivate teachers and headmasters could be tied to the certification process see( section 3.2 for more information on certification).

* In this guide, ‘headmaster’ refers to the woman or man who manages the school; this person may also be called the headmistress, head teacher, school director or principal.

Field Guide: The Three Star Approach for WASH in Schools 10 Community support Schools must have strong support from their soap or soap making, and labour and materials communities in order to and maintain One for repairing or building toilets and hand-washing Star status. Therefore, a precondition for becoming stations. The committees will usually find these a One Star School is a mechanism that enables resources locally, and they will act as advocates community members, teachers, headmasters and to request support through the education or local local government officials to work together. Many government systems as needed. For example, they schools already have parent-teacher associations might decide to contact local education officials or community-school coordination committees to advocate for including a budget line for soap that can fulfil this role; in other schools, new in the annual school budget, or for the release of groups will need to be established. dedicated funds that have not reached the school.

Community-school coordination committees Some external support from the education provide support for teachers in their daily activities system and partner agencies or non-governmental and serve as liaisons between schools and organizations may also be necessary, especially in parents, who are often the strongest stakeholders the initial stages of the programme. This support, in advocating for school improvements. Most however, will generally not include funding for importantly, they can raise funds and other hardware or supplies (see section 3.1 for additional resources to achieve goals, including funds for information on the role of external support partners).

2.0 The Three Star Approach for WASH in Schools 11 2.2 Two Star Schools In a Two Star School, all of the One Star daily The technologies used to upgrade facilities in Two group activities will continue to be emphasized. Star Schools will, as much as possible, be low- In addition, greater focus will be placed on hand cost, locally sourced and appropriate for use in washing after using the toilet, improved toilet households. This ensures that the programme will facilities and menstrual hygiene management, and be scalable countrywide. It also allows schools safe drinking water. The Two Star School will take to demonstrate good practices to community steps to meet three new incremental milestones members, a role that can be enhanced by for hygiene, sanitation and water: encouraging and supporting students to promote good hand-washing practices at home. 1. Children wash their hands with soap after using the toilet. All WASH facility upgrades will primarily be the responsibility of the school and the community, with 2. Improved sanitation and menstrual hygiene some support from the education system and from facilities are available. external support structures as appropriate. Funds for 3. Drinking water is available at school. upgrades may also come from a ‘rewards’ fund tied to the certification process see( ‘Recognizing and rewarding achievements’, section 3.2).

Two Star Schools Incremental improvements

Interventions Results

Hygiene education expanded to stress hand washing after • Children learn to wash their hands with soap at both critical times: before toilet use; hand-washing meals (during daily group hand-washing sessions) and after defecation. stations installed as needed; • Hand-washing stations are demonstrated to the community. menstrual hygiene education • Girls gain knowledge and support on menstrual hygiene management. delivered in schools

Additional and/or improved • Additional toilets are available at school for boys and girls toilets, plus facilities for menstrual hygiene • Girls are further encouraged to attend classes because there management, constructed are additional private sanitation and/or menstrual hygiene management where needed facilities.

Low-cost point-of-use • Children have access to safe drinking water at school. water treatment introduced in schools • Low-cost water treatment is demonstrated to the community.

Field Guide: The Three Star Approach for WASH in Schools 12 Hand washing Toilets and menstrual hygiene Two Star Schools ensure that students wash their management hands with soap after using the toilet as well as Two Star Schools will incrementally increase the during group hand-washing sessions. This step may usability and availability of toilets, especially for involve upgrading and increasing the number of girls. The number of new toilets will be based on an hand-washing stations near toilets in some schools, interim standard defined in each country, which will but the focus will continue to be on intensive be somewhere between the existing situation in hygiene education for behaviour change. the country and the national standard. If there is no national standard, the international standard of one Hygiene education sessions will continue to be toilet for 25 girls, one toilet and one urinal for 50 part of the daily group hand-washing sessions, and boys, and two toilets for teachers will be applied.7 may also be supplemented at other points during the school day. If the school constructs new hand- Two Star Schools will also take steps to encourage washing stations, the costs – including the cost and support girls during menstruation so they do of soap – will continue to be borne mainly by the not miss school. This involves menstrual hygiene school and the community. Each country will define education sessions at school, along with steps to its own hardware requirements (see section 3.3). ensure that girls have a private place to wash and

2.0 The Three Star Approach for WASH in Schools 13 change their clothes. Existing facilities will be used home, but a safe water source at school will allow in some cases; in other situations, a new facility them to refill their bottles during the school day. It will need to be constructed. Other steps that will also provide a safe source for students who do can be taken to support girls include stockpiling not have one at home. extra sanitary pads and clothes (such as school uniforms) for emergencies, along with enhanced In most cases, schools will use existing water training programmes for teachers. sources at or near the schools but will treat the water through the use of low-cost on-site technologies such as ceramic filters, slow sand Safe drinking water filters, solar disinfection or chlorination. Schools Finally, Two Star Schools will ensure a safe supply could also choose to raise funds locally or advocate of drinking water for students at school. Generally, for the upgrade of an existing school water source. students will continue to bring water bottles from

Field Guide: The Three Star Approach for WASH in Schools 14 2.3 Three Star Schools Three Star Schools will meet national standards Many schools and communities will need support for WASH in Schools, which are important for from the education system to upgrade facilities ensuring that the needs of all children are met and and systems to meet national standards. Some that any national inequities of access to WASH in schools will also require support from external Schools are progressively eliminated. partners. In countries without comprehensive national standards, the global guidelines Standards contain national norms for WASH established by UNICEF and the World Health facilities, including requirements for design, the Organization in ‘Water Sanitation and Hygiene number of facilities by school size and accessibility Standards for Schools in Low-Cost Settings’ can for children with disabilities. Standards can also be used as a reference for defining the criteria institutionalize hygiene education in schools, and for Three Star Schools. However, this should they address issues related to the responsibility for only be an interim solution: All countries should maintenance and repair of facilities. develop national standards, and external support programmes can assist in this process.

Three Star Schools Meeting national standards

Interventions Results

• Social norms on good hygiene behaviour are institutionalized. School facilities and • The school is able to offer full accessibility to WASH for all students, systems upgraded to meet including children with disabilities. national standards • National inequities are eliminated by ensuring all schools in the country have the same standards for WASH in Schools.

2.0 The Three Star Approach for WASH in Schools 15 The Fit for School programme in action

One good example of at-scale implementation to promote children’s health and education is the Essential Health Care Program implemented by the Philippine Department of Education. This programme is supported by international organizations, such as UNICEF, AusAID and BMZ, through GIZ, among others, as well as local actors such as the Philippine non-governmental organization Fit for School Inc.8 Three group activities – washing hands daily with soap, brushing teeth daily with and deworming twice a year – are the core of this national programme. The purpose is to lower rates of diarrhoea, respiratory infections, worm infections and severe . The Essential Health Care Program embraces simplicity and sustainability, which has allowed it to scale up rapidly, reaching about 2 million children in 2011, using existing human resources and funds from local government. The daily group hand washing with soap is supervised by teachers and normally takes place before eating, at lunch Indicator Reduction or snack time. In most schools, a simple hand-washing stand is installed, consisting of an inclined perforated pipe that provides sufficient running water for a group of Days of absence, 2009 27.3% up to 20 children to wash their hands (the punched pipe system). The hand-washing stand costs less than US$40 to build and can be installed in schools with piped water Below normal body 20.4% infrastructure and in schools without them, in which case mass index water is carried to a reservoir that is part of the facility. Fit for School programme hygiene supplies consist of soap, toothpaste and a , and cost less than Heavy worm infection 47.2% 60 US cents per child, per year. The low cost ensures that long-term public commitment goes far beyond a Opportunities for traditional approach based on donations and corporate 38.5% sponsorship. Deworming drugs are provided by the tooth decay Philippine Department of Health. Source: Monse, Bella, et al., ‘The Fit for School The Essential Health Care Program has generated clear Health Outcome Study: A longitudinal survey to evidence of impact: One evaluation found that absenteeism, assess health impacts of an integrated school malnutrition, worm infections and tooth decay were all health programme in the Philippines’, BMC , vol. 13, no. 256, 2013, pp. 1–10. significantly reduced among children in intervention schools.

Source: Joint Call to Action for WASH in Schools, ‘Raising Even More Clean Hands: Advancing health, learning and equity through WASH in Schools’, United Nations Children’s Fund, New York, 2012, pp. 14–15.

Field Guide: The Three Star Approach for WASH in Schools 16 3.0 Managing the Three Star Approach 3.1 The role of government and external support partners

The fundamental idea behind the Three bodies and support agencies resist the temptation Star Approach is that schools and their host to overly subsidize the Three Star Approach, communities can and should create the minimum especially during the initial stages. Government conditions for healthy, hygiene-promoting schools responsibility in supporting the approach lies using local resources. The One Star stage is less in funding hardware and more in creating a specifically designed to be so low-cost that even supportive policy environment, programme design the poorest communities should be able to and institutionalization of daily hygiene activities achieve its three milestones for hygiene, sanitation – which involves training for teachers in hygiene and water using their own resources. Lessons promotion, standards setting, monitoring and from the broader WASH sector – especially certification. In some of these areas, government experiences based on the Community Approaches may benefit from the assistance of external to Total Sanitation (CATS) initiatives to eliminate support agencies such as UNICEF and GIZ. open defecation – show that when communities assume responsibility for improving conditions in Each country will define the roles and this way they are more likely to maintain progress responsibilities of different government bodies, over time. spearheaded by the Ministry of Education and supported by the ministries responsible for water, While recognizing the government responsibility sanitation and hygiene, rural development or to ensure that minimum WASH standards are met decentralization, and other government agencies. in public schools, it is important that government

3.0 Managing the Three Star Approach 17 3.2 Monitoring and certification of schools

As part of the Three Star Approach, programme managers may design a certification scheme for Options for monitoring and certification WASH in Schools that recognizes and rewards appropriate efforts by schools and communities. After establishing specific criteria for One, Two and This idea is borrowed from the success of CATS Three Star Schools, based on the recommendations initiatives, in which new social norms for sanitation in this Field Guide, countries and school districts will are developed in communities through a specific develop a monitoring and certification process that set of interventions. Inspections are carried out includes checklists and other tools. to certify communities as open defecation free, Options for certification include: reinforcing and recognizing the collective behaviour change that has taken place. • School inspectors or education outreach workers can conduct monitoring as part of routine visits and/or third-party inspectors can conduct Each country and/or school district will define its monitoring through approaches similar to those own certification process and monitoring methods used to certify open defecation free communities for the Three Star Approach. In all cases, the in CATS programmes. monitoring process will increase accountability and • Participatory monitoring is key to achieving inspectors will rely on transparent country-specific ownership and sustainability. Students, parents, checklists of indicators derived from the general school staff and community members should all be approach criteria and based on WASH in Schools involved in monitoring behaviour and facilities. standards. In some situations, external support • Planners can incorporate sustainability into the certification process through time-limited agencies will also have a role in providing capacity certificates or by certifying a school only after it building or other support for the certification teams. has maintained its status for a certain period, for example, six months or a year. The inspection and certification process will • Certification ceremonies can take place on Global use a simplified and limited set of monitoring Handwashing Day for maximum visibility, and indicators that best measure progress in priority school names can be published in the media. areas, with a strong focus on behaviour change. Rewards, flags, signs and certificates can be given. Schools will be certified first for achieving One Star status and may be publicly recognized or visibility for all stakeholders and provide incentives even rewarded for doing so. Public certification for further improvement. For example, a system also has the effect of acknowledging the efforts of flags, signboards or other means may be of the community to achieve the milestone, thus used to mark school achievements, along with encouraging local participation and ownership of the special sessions involving children and community process. Moreover, certification promotes healthy representatives to publicize the milestones. competition among schools and districts. Competitions and launch events can also be part of the certification process. Recognizing and rewarding achievements In addition, the certification process could be the basis for WASH-related financial rewards or The Three Star certification process offers plenty access to special support for further improvements. of opportunities to recognize achievement, create Schools that reach One Star status, for example,

Field Guide: The Three Star Approach for WASH in Schools 18 could obtain funding to help them progress towards Two Star status. The reward structure could also Awards in India spur competition and focus on motivating teachers and student groups, achievements who are key to the success of the programme, by offering courses or similar incentives when Several states in India use competitions to recognize milestones are met and sustained. and reward schools that attain child-friendly standards, including WASH-related milestones. Winning schools receive cash awards, trophies 3.3 Flexibility and variations and certificates. Programming contexts vary widely from country In the state of West Bengal – where the education to country, and even within countries. Therefore, department adopted WASH in Schools interventions the Three Star Approach is designed to be adapted as a tool for complying with the national Right to for local needs. The definition and structure of a Education Act – annual awards are given to primary One Star School will be roughly the same across schools that maintain WASH facilities and promote countries: The three group activities for hygiene, improved hygiene practices. The competition is so popular that it has recently been expanded to sanitation and water are central to the Three Star include secondary schools, and cash prizes have Approach and should be a part of all programmes. been increased. However, countries may want to make changes to suit local needs, such as introducing water Observers note that the competition has led to treatment at the One Star stage. improved conditions in schools, an increase in hand washing and greater participation by children in The most flexibility is in how the Two Star and maintaining a healthy school environment. It has also Three Star levels are defined because the goals prompted an informal mentoring system between will depend on national standards and the situation schools, with award-winning schools providing on the ground, and will vary from country to advice to neighbouring schools on strategies and country. At the Two Star stage, for example, practices to increase their chances of winning the some countries might make hand-washing stations award next year. outside of every toilet block a requirement, Source: UNICEF India, ‘School Awards for whereas other countries might rely on existing Child Friendly Norms & Standards’, West Bengal, 2012. infrastructure but put a greater emphasis on hygiene education. Some countries may want to use the Three Star Approach to promote other health-related Countries could also choose to skip the Two Star interventions in schools, such as deworming or and Three Star stages and prioritize establishing oral hygiene initiatives, as in the Fit for School as many One Star Schools as possible in order to programme. Decisions on what else to include emphasize the three essential changes to promote will be taken at the country level and should be hygiene and make schools healthy places for based on need and evidence. If, for example, soil- children. In that case, the approach could simply transmitted helminths are a major problem in a be called ‘The Star Approach for WASH country or region, it makes sense to incorporate in Schools’. deworming interventions into the local design of the approach.

3.0 Managing the Three Star Approach 19 In all cases, additions to the Three Star Approach and the school environment. Simplicity, scalability should be made with care: Too many components and sustainability are the heart of the Three Star could overwhelm the approach and dilute the Approach. central objective of improving hygiene practices

Field Guide: The Three Star Approach for WASH in Schools 20 4.0 Conclusion

Applying the Three Star Approach for WASH while tapping into the enthusiasm and energy in Schools will help improve the effectiveness of children through group activities for hygiene, of hygiene behaviour change programmes, sanitation and water. These daily group activities while ensuring that schools meet key criteria help children build good hygiene habits that will for establishing and maintaining a healthy last a lifetime. environment for children. By addressing the bottlenecks that impede current WASH in Schools By prioritizing the most essential actions for programmes and applying lessons learned from achieving goals, the Three Star Approach helps successful field programming, countries can schools focus on meeting children’s needs help ensure that every child’s right to water and through key interventions. At the same time, sanitation, health and education is fulfilled. it provides a clear pathway for all schools throughout a country to meet national standards, The Three Star Approach draws on the capacities and for all children to have hygiene-promoting and local resources of schools and communities and healthy schools.

4.0 Conclusion 21 Annex I. Evidence linking WASH in Schools to health and educational performance

Every child has the right to adequate water and 20 per cent and 54 per cent (see the table below). sanitation, including in school. This is reason enough Drinking water at school is also important: Studies to prioritize, fund and improve WASH in Schools show that children who do not drink enough water at programmes everywhere. The case is made even school can become dehydrated, which affects their stronger by the growing body of evidence linking cognitive abilities.15 water, sanitation and hygiene education in schools to children’s health and educational achievement. Hand washing and school absenteeism: By the numbers WASH in Schools leads to healthier children Children spend a large portion of their day at school. Examples of reductions in absenteeism in studies They are less likely to get sick from diarrhoea and other hygiene-related if their school has an effective and projects around the world include: hand-washing programme, adequate sanitation and Reduction by expanding hand-washing safe drinking water.9 Their families are also less likely to 54% promotion and providing soap in target get sick when children are healthy: Studies show that schools in China16 diseases contracted at school can lead to infections in 10 up to half of household members. Reduction through twice-daily hand 40% washing in 30 primary schools in Egypt17 The most important way schools can have an impact on health is by promoting children’s good hygiene Reduction in absenteeism through behaviour through hygiene education and by making 35% hand-washing and safe water hand washing with soap a daily part of the school interventions in Kenya18 routine. When children become accustomed to these healthy habits at school, the behaviour is ingrained and Reduction through daily hand washing, can last a lifetime.11 Children can also act as agents 27% deworming and oral hygiene in the of change, influencing their siblings and parents to Philippines19 change their own hygiene practices,12 and even serving as catalysts for the adoption of improved sanitation Reduction among children reporting proper 20% 20 facilities in their communities.13 hand-washing practices in Colombia

WASH in Schools leads to better educational Girls miss the most school because they usually performance, especially for girls shoulder the greatest burden for household chores, In many developing countries, the degree of a such as hauling water21 or taking care of younger child’s exposure to hygiene-related diseases is a children who are sick, often with diarrhoea or other key determinant of her or his chances of success in WASH-related diseases. Adolescent girls frequently school and in later life. School-aged children affected stay home during menstruation due to social and by hygiene-related diseases are much more likely to cultural beliefs and practices, a lack of sanitary pads, experience extended absences from school. The World or because there are no gender-segregated toilets or Health Organization estimates that 272 million school private washing facilities at school. In some areas, days are lost annually due to diarrhoea alone.14 Studies poorly planned and located sanitation facilities may also show that hand washing with soap in primary contribute to high levels of sexual abuse and violence schools can reduce absenteeism rates by between in schools.

Field Guide: The Three Star Approach for WASH in Schools 22 Annex II. WASH in Schools global coverage

The importance of WASH in Schools is increasingly these numbers suggest. The global data set does not recognized by WASH, education and health include information on whether sanitation facilities stakeholders within governments and external support meet minimum standards, e.g., the ratio of students agencies. Governments and development partners to toilets, gender segregation of facilities and privacy; have strengthened their focus on WASH in Schools if there are hand-washing stations and soap; if hygiene and expanded their programmes, and these efforts education is delivered in schools; or whether the water are producing results. WASH in Schools initiatives and sanitation facilities are actually functional. are reaching tens of thousands of schools through UNICEF-supported programmes. The data that are available indicate that even where facilities exist, they are in poor condition. Recent data Despite these efforts, many schools in developing from South Asia, for example, show that between countries do not have even basic water and sanitation one quarter and one third of school WASH facilities facilities. Data gathered by UNICEF show that less are non-functional.23 Overall, there is a clear need to than half of all schools in least-developed and other improve WASH in Schools coverage, with solutions low-income countries have adequate water and that go beyond increased funding to encompass a sanitation facilities, and some have no facilities at more effective use of existing resources. all.22 And the challenge is actually much greater than

School water coverage, School sanitation coverage, global average global average

100% 100%

80% 80% 70% 71% 71% 67% 68% 68% 63% 65% 64% 59% 60% 60% 52% 53% 51% 50% 47% 45% 44% 45% 41% 40% 40% 35%

KEY KEY All reporting UNICEF All reporting UNICEF 20% programme countries 20% programme countries Least developed and other Least developed and other low-income countries low-income countries

0% 0% 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012

% of schools with adequate water facilities, average data % of schools with adequate sanitation facilities, average data from 130 programme countries, including 53 least developed from 126 programme countries, including 52 least developed countries and other low-income countries countries and other low-income countries

Annexes 23 Annex III. WASH in Schools bottleneck analysis

UNICEF uses bottleneck analysis to assess the of schoolchildren are not available, but individual effectiveness of its support to national WASH in studies confirm that rates for hand-washing with Schools programmes. The process helps identify key soap can be very low, in some cases even lower constraints (bottlenecks) that are impeding efforts to than 5 per cent.24 scale up WASH in Schools programmes. The bottleneck analyses also show that programmes As part of the framework for bottleneck analysis, are generally off track in cleaning and maintenance there are four broad programming categories: of existing school toilet facilities. This is important (1) enabling environment (policy, legislation and because poor maintenance leads to breakdowns finance); (2) supply (human and physical resources in and because evidence shows that children are much schools, including facilities and training for teachers); more likely to use school toilets when they are (3) demand (demonstrated motivation of the school clean.25 This is a demand-related issue: Maintenance community to finance and manage WASH in Schools and cleaning are local responsibilities, which are only resources); and (4) quality (effectiveness of the properly carried out when WASH facilities are valued inputs for changing hygiene behaviour). (demanded) by school authorities, teachers and host communities. Soap supply falls into the same Along with identifying the bottlenecks, the purpose category: National education systems often fail to of the analysis is to identify programming areas supply soap for schools. But with community and/or in which progress has been relatively good. This local government support, schools can assure that a allows government and support agency managers to continuous supply of locally sourced soap is available redirect existing resources and target new resources for hand washing. to reach areas where progress is lagging. National budgets for WASH in Schools are also Although the situation in each country is unique – identified as an area of concern within the bottleneck and, ideally, each country should carry out its own analyses. However, this is a reflection of the way analysis – a synthesis of the rapid results gathered many national WASH in Schools programmes are by UNICEF in the countries that have conducted designed with a focus on expensive hardware a bottleneck analysis highlights the primary inputs. School-level analyses show that hardware is areas of concern for scaling up WASH in Schools not identified as the biggest need. programmes, as shown in the table on page 25. To scale up national programmes, the focus should The bottleneck analyses show that the most critical shift from hardware towards an approach that builds concern is the ability of existing WASH in Schools local demand for WASH in the education system – programmes to promote hand-washing behaviour with an emphasis on making schools more effective change among students. Hygiene education is not at providing a healthy environment for children and consistently provided in most schools, and when promoting positive hygiene behaviour. programmes do exist, they are often of limited effectiveness. Global data on the hygiene practices

Field Guide: The Three Star Approach for WASH in Schools 24 Synthesis results of UNICEF WASH in Schools bottleneck analyses

Example Indicator (varies Category Determinant Global synthesis estimate from country to country)

Legal/policy Existence of appropriate policies framework and legislation 80%

Enabling environment

Budget/ National budget allocation as expenditure proportion of requirement 20%

Proportion of schools with access to Facilities water and sanitation facilities 60%

Proportion of schools with access Supply Facilities to adequate sanitation and hand- 40% washing facilities

Human Proportion of schools with teachers resources trained in hand-washing promotion 30%

Proportion of schools with clean, Sociocultural well-maintained toilets and hand- barriers 15% washing facilities

Demand

Proportion of schools with a budget Local financial for maintenance of WASH facilities barriers 20% and purchase of soap

Proportion of children washing Hygiene Quality their hands with soap after use of practices 5% sanitation facilities and before eating

Annexes 25 Endnotes

1 In countries where there are limited or no national standards, the global standards set by WHO and UNICEF should be applied. See: United Nations Children’s Fund and World Health Organization, ‘Water Sanitation and Hygiene Standards for Schools in Low-Cost Settings’, WHO, Geneva, 2009.

2 Ibid.

3 De Albuquerque, Catarina, and Virginia Roaf, ‘On the Right Track: Good practices in realising the rights to water and sanitation’, Office of the High Commissioner for Human Rights, United Nations, March 2012, pp. 23–24.

4 United Nations Children’s Fund and World Health Organization, ‘Water Sanitation and Hygiene Standards for Schools in Low-Cost Settings’, WHO, Geneva, 2009, p. 12.

5 World Health Organization, WHO Guidelines on Hand Hygiene in Health Care: First Global Challenge – Clean care is safer care, WHO, Geneva, 2009, p. 31; and Shordt, Kathleen, ‘Review of Hand Washing Programs’, IRC International Water and Sanitation Centre, Delft, Netherlands, 2006, p. 6.

6 Freeman, Matthew C., et al., ‘Assessing the Impact of a School-Based Water Treatment, Hygiene and Sanitation Programme on Pupil Absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine and International Health, vol. 17, no. 3, March 2012, pp. 380–391.

7 United Nations Children’s Fund and World Health Organization, ‘Water Sanitation and Hygiene Standards for Schools in Low-Cost Settings’, WHO, Geneva, 2009, p. 30.

8 For more information on the Fit for School framework, see: Benzian, Habib, et al., ‘Public Health in Action: Effective school health needs renewed international attention’, Action, vol. 5, 2012, pp. 1–3.

9 Jasper, Christian, Thanh-Tam Le and Jamie Bartram, ‘Water and Sanitation in Schools: A systematic review of the health and educational outcomes’, International Journal of Environmental Research and Public Health, vol. 9, no. 8, 3 August 2012, pp. 2772–2787; and Ejemot, Regina I., et al., ‘Hand Washing for Preventing Diarrhoea’, Cochrane Database of Systematic Reviews, no. 3, article no. CD004265, 2009, pp. 1–44.

10 Aiello, Allison E., Elaine L. Larson and Richard Sedlak, ‘Personal Health: Bringing good hygiene home’, American Journal of Infection Control, vol. 36, no. 10, Supplement, December 2008, pp. S152–S165.

11 Bolt, Eveline, and Sandy Cairncross, ‘Sustainability of Hygiene Behaviour and the Effectiveness of Change Interventions: Lessons learned on research methodologies and research implementation from a multi-country research study, Booklet 2’, IRC International Water and Sanitation Centre, Delft, Netherlands, March 2004, pp. 50–52; and Curtis, Valerie A., Lisa O. Danquah and Robert V. Aunger, ‘Planned, Motivated and Habitual Hygiene Behaviour: An eleven country review’, Research, vol. 24, 2009, pp. 655–673.

12 Mathew, Kochurani, et al., ‘The Sustainability and Impact of School Sanitation, Water and Hygiene Education in Kerala, Southern India’, IRC International Water and Sanitation Centre, Delft, Netherlands, 2009, p. 21.

13 Njuguna, Vincent, et al., ‘The Sustainability and Impact of School Sanitation, Water and Hygiene Education in Kenya’, IRC International Water and Sanitation Centre, Delft, the Netherlands, 2009, p. 24.

Field Guide: The Three Star Approach for WASH in Schools 26 14 Hutton, Guy, and Laurence Haller, ‘Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level’, World Health Organization, Geneva, 2004, p. 29.

15 Edmonds, Caroline J., and Denise Burford, ‘Should Children Drink More Water? The effects of drinking water on cognition in children’, Appetite, vol. 52, no. 3, June 2009, pp. 776–779; and Fadda, R., et al., ‘Effects of Drinking Supplementary Water at School on Cognitive Performance in Children’, Appetite, vol. 59, no. 3, December 2012, pp. 730–737.

16 Bowen, Anna, et al., ‘A Cluster-Randomized Controlled Trial Evaluating the Effect of a Handwashing-Promotion Program in Chinese Primary Schools’, American Journal of Tropical Medicine and Hygiene, vol. 76, no. 6, 2007, pp. 1166–1173.

17 Talaat, Maha, et al., ‘Effects of Hand Hygiene Campaigns on Incidence of Laboratory-Confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt’, Emerging Infectious Diseases, vol. 17, no. 4, April 2011, pp. 1–16.

18 O’Reilly, C. E., et al., ‘The Impact of a School-Based Safe Water and Hygiene Programme on Knowledge and Practices of Students and Their Parents: Nyanza Province, western Kenya, 2006’, & Infection, vol. 136, no. 1, January 2008, pp. 80–91.

19 Monse, Bella, et al., ‘The Fit for School Health Outcome Study: A longitudinal survey to assess health impacts of an integrated school health programme in the Philippines’, BMC Public Health, vol. 13, no. 256, 2013, pp. 1–10.

20 Lopez-Quintero, Catalina, Paul Freeman and Yehuda Neumark, ‘Hand Washing among School Children in Bogotá, Colombia’, American Journal of Public Health, vol. 99, no. 1, January 2009, pp. 94–101.

21 See, for example: Nauges, Céline, and Jon Strand, ‘Water Hauling and Girls’ School Attendance: Some new evidence from Ghana’, Policy Research Working Paper, no. 6443, World Bank, Washington, D.C., May 2013.

22 United Nations Children’s Fund, ‘Water, Sanitation and Hygiene Annual Report 2012’, UNICEF, New York, 2013, p. 24.

23 United Nations Children’s Fund, Regional Office for South Asia, ‘WASH for School Children: State-of-the-art in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka’, Provisional Draft, UNICEF ROSA, Kathmandu, 2012, pp. 9–42.

24 Republic of Kenya, United Nations Children’s Fund, and Water and Sanitation Program, ‘Are Your Hands Clean Enough? Study findings on handwashing with soap behaviour in Kenya’, WSP-Africa Region Office, Nairobi, 2009, p. 46.

25 Freeman, Matthew C., et al., ‘Assessing the Impact of a School-Based Water Treatment, Hygiene and Sanitation Programme on Pupil Absence in Nyanza Province, Kenya: A cluster-randomized trial’, Tropical Medicine and International Health, vol. 17, no. 3, March 2012, pp. 380–391.

Endnotes 27 Notes

Field Guide: The Three Star Approach for WASH in Schools 28 Simple • Scalable • Sustainable UNICEF is the largest single agency working in the WASH in Schools sector today. At the global level, UNICEF leads the WASH in Schools network, which has been joined by an increasing number of stakeholders since its establishment in 2010. Raising Even More Clean Hands, the network’s flagship publication, was launched in 2012 with the endorsement of 70 international organizations.

Due to advocacy by the WASH in Schools network, the WHO/ UNICEF Joint Monitoring Programme working group for the post- MDG agenda defined a clear goal and recommendation on “universal access to WASH in Schools by 2030.” This goal has been shared with international partners and will reach the broader community that is discussing and shaping the future for water and sanitation.

UNICEF supports WASH in Schools activities through its offices in 95 countries. In 2012, UNICEF initiatives reached 19,000 schools, benefiting more than 4 million students. Activities range from small interventions to comprehensive programmes of support. Smaller interventions that aim to influence national programmes and strategies tend to be used in middle-income countries. Comprehensive programmes are more common in low-income countries, where UNICEF is supporting standards development, training for teachers, hygiene promotion, construction of WASH facilities in schools and other activities.

The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH is implementing programmes and projects for sustainable development on behalf of the German Government in more than 130 countries.

GIZ supports the water, education and health sectors in about 100 countries. In 2012, its inter-sectoral Fit for School Approach is being implemented by partner governments in Cambodia, Indonesia, the Lao People’s Democratic Republic and the Philippines, benefiting more than 2.5 million children.

This Field Guide describes the Three Star Approach for WASH in Schools, which: • Emphasizes daily group activities to improve the effectiveness of hygiene promotion while ensuring that children have access to clean sanitation facilities and drinking water at school. • Encourages support from host communities and does not depend on expensive hardware inputs. • Continues our goal to build capacities for bringing drinking water, improved sanitation and hygiene education to schoolchildren across the globe.

For more information on the Three Star Approach for building WASH in Schools programmes, contact Murat Sahin, [email protected], or Bella Monse, [email protected].