A Model to Facilitate the Management of Sanitation and Hygiene

A MODEL TO FACILITATE THE MANAGEMENT OF SANITATION AND HYGIENE PRACTICES AMONGST PRIMARY SCHOOLS IN OHANGWENA REGION, NAMIBIA A RESEARCH DISSERTATION SUBMITTED IN FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN PUBLIC HEALTH OF THE UNIVERSITY OF NAMIBIA BY ANNA PANDULENI KAUKO SHILUNGA STUDENT NUMBER: 9115749 Date: April 2018 MAIN SUPERVISOR: Dr. Kabwebwe Honoré Mitonga CO-SUPERVISOR: Dr. Hans Justus Amukugo DECLARATION I, Anna Panduleni Kauko Shilunga, hereby declare that this study is a true reflection of my own work, and that all the sources used have been acknowledged in the text and in the references. The version of this work is an original work, and has not previously been submitted in its entirety or in part for a degree at any other institution of higher learning. This dissertation may not be reproduced, stored in any retrieval system, or transmitted in any form or by any means, whether mechanical, electronic, photocopying, recording or otherwise, without the express permission from the author, or the University of Namibia acting on her behalf. I, Anna Panduleni Kauko Shilunga, hereby grant the University of Namibia the right to reproduce this dissertation in its entirety or parts thereof, in any format, which the University of Namibia may deem fit, for any person who or institution requires it for study and research, providing that the University of Namibia shall waive this right if the whole thesis has been or is being published in a manner that is not approved by the University of Namibia. Signature ________________________ Date: __________________ Anna Panduleni Kauko Shilunga ii ABSTRACT Schools are great platforms where children can learn hygiene skills, behaviours and practices, and when these become part of children’ daily lives, this may lead to a positive impact in families and communities at large. However, effective hygiene promotion in school can be severely affected if sanitation facilities are not adequately managed. UNICEF indicated that, despite the provision of water to schools in Ohangwena region, there are still a high proportion of schools without sanitation facilities. This study thus purposively focused on Ohangwena region in view of the above discussed challenges. The purpose of this study was to develop and describe a model to facilitate the management of sanitation and hygiene practices among primary schools in Ohangwena region. A mixed method design of quantitative, observational, descriptive, cross-sectional study, as well as a qualitative, exploratory, descriptive, as well as a theory generating design were used in the study. The study was based on four phases. Phase 1: Concept analysis was done by assessing the conditions of sanitation facilities, describing the knowledge, attitudes and practices of schools learners on hygiene practices, and exploring and describing the teachers’ perceptions of hygiene promotion in schools. A three-staged stratified sampling was used to select ten primary schools in five circuits, using a proportionate sampling method. A checklist and a questionnaire were used to collect quantitative data from sanitation facilities and (n=450) school learners in 10 primary schools. Simple random sampling was used to select learners in grades 5, 6 and 7 learners who were seven (7) years and older. Learners gave assent to participate in the study, while parents and teachers, gave permission as ’loco parentis’. Quantitative data were analysed with the Statistical Package for Social Sciences (SPSS) version 23, while Tesch's method of open-coding was used to analyse qualitative data. Teachers were purposively sampled and signed a consent form to participate in the study. Five focus group discussions (FGDs) conducted with teachers to collect were audiotaped and transcribed verbatim. The findings proved that a combination of challenges implicate the management and promotion of sanitation and hygiene practices stemmed from poor collaboration between the schools and parents and inefficient management of resources and facilities in schools, poor knowledge, bad attitudes and practices of learners toward hygiene. The three main concepts of management, collaboration and environment, were identified and analysed. iii Phase 2 involved the construction of the relationship statements of the model. The conceptual framework based on the three main concepts of analysis and the practice oriented theory by Dickoff et al (1968), was developed. Phase 3, a management of the collaborative environment model, to facilitate the management of sanitation and hygiene practices among primary schools in Ohangwena region, was developed and described. The model was described in terms of its purpose, concepts, definitions, structure, relationships and assumptions. Evaluation was done by expert researchers to validate whether the model brought about the desired outcome necessary to meet the study’s objectives. Phase 4 involved the development of the guidelines to operationalise the model. The guidelines were formulated in terms of objectives, strategies and activities based on the four objectives of the model. Recommendations, in terms of their application to the Ministry of Education, public health and nursing practice, as well as future research, were made. iv DEDICATION This study is dedicated to the living memories of my beloved mother Selma Taleni Mwashindange, who has long prophesising me becoming a doctor. No words are adequate to describe my late mom’s influence on my educational life. May her soul continue to rest in peace. I would like to thank my grandmother Johanna Nikanor (GwaNikanor) for raising me into a woman I am today. No words are sufficient to pronounce her contribution to my life. I owe every bit of my being to her. v ACKNOWLEDGEMENTS I would like to thank the Almighty God for his grace, wisdom and guidance throughout my study. My deepest appreciation goes to my supervisors Dr. Kabwebwe Honoré Mitonga and Dr. Hans Justus Amukugo for their expert guidance, support and encouragement throughout my study. The University of Namibia, for making my dream a reality by providing financial assistance to undertake this study. Namibia Students Financial Assistance Fund (NSFAF), for financial assistance. The Ministry of Education in general and the Ohangwena regional directorate of education for granted me permission to conduct my study in primary schools in Ohangwena region. A special thanks to the principals, the teaching staff and the learners at the ten studied primary schools in Ohangwena region for their support, understanding and willingness to take part in the study. Without them, this study would not have taken off. To my friends Penny, Loide, Sara, thank you for your caring attitude, words of encouragement and for your interest in me as a person. To Esther Mulenga, thank you for being my study mate and for encouragement throughout this educational journey. To my friend Lucas Musa Jele thanks for the encouragement and for statistical assistance. Menete Shatona, a librarian at the University of Namibia, for always being helpful to provide me with resources, articles and relevant literatures timely. You made it easy for my study. My sister Tashiya, thank you for helping with the technicality of the computer and for giving the kids much needed attention and love when I was busy with my thesis. To my husband and children; Betty, Anna, Espy and Popila, thank you for understanding, patience and support throughout my study journey. vi LIST OF ACRONYMS AIDS - Acquired immunodeficiency syndrome CFS - Child Friendly School DHS - Demographic Health Survey ESAR - Eastern and Southern Africa Region EPA - American Environmental Protection Agency FGDs - Focus Group Discussions HIV - Human immunodeficiency virus HO & WT - Hygiene Promotion & Water Treatment HWWS - Handwashing With Water and Soap KAP - Knowledge, Attitudes and ractices KM - Knowledge management MAWF - Ministry of Agriculture, Water and Forestry MDGs - Millennium Development Goals MoE - Ministry of Education MoHSS - Ministry of Health and Social Services NNSP - Namibian National Sanitation Policy NNSS - Namibia National Sanitation Strategy NGOs - Non-governmental Organisations SDGs - Sustainable development goals UNAM - University of Namibia UNICEF - United Nations Children's Emergency Fund WASH - Water, sanitation and hygiene WHO - World Health Organisation vii TABLE OF CONTENTS DECLARATION ................................................................................................................................................ ii ABSTRACT ....................................................................................................................................................... iii DEDICATION .................................................................................................................................................... v ACKNOWLEDGEMENTS ............................................................................................................................... vi LIST OF ACRONYMS .................................................................................................................................... vii TABLE OF CONTENTS ................................................................................................................................. viii LIST OF TABLES ............................................................................................................................................ xv LIST OF FIGURE..........................................................................................................................................

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