Challenges

Many school children in Southeast Asia suffer from ailments such as diarrhoea, acute respiratory diseases, worms and dental caries, all of which are preventable and caused mainly by poor hygiene. These illnesses impair a child’s physical and cognitive development and have a negative impact on their ability to learn and their prospects. Although many countries in Southeast Asia have recognized the value of school health programmes and developed their own national strategies, there is still a lack of realistic, affordable approaches and required expertise to pursue them. Very few sustainable programmes run on a regional basis. Many are only carried out in a few individual schools and thus are far from reaching their full potential.

Toward a Solution

The Regional Fit for School Programme in Southeast Asia was created in 2011 to tackle this problem head-on. The programme aims to improve the health and learning outcomes of primary school children by supporting ministries of education in selected Asian countries to sustainably implement a step-by-step approach to improve water, sanitation and hygiene (known as WASH) in schools on a large scale.

Fit for School supports South-South regional exchanges, networking and capacity development for WASH in schools. It provides technical assistance to support ministries of education in partner countries to integrate the management of the programme into their existing structures. Schools are transformed to become learning environments that enable children to realize their full potential in health and education. The programme supports government partners to develop contextualized implementation models. Knowledge-sharing and regional/international learning exchanges provide platforms for collaboration and create momentum for WASH in schools beyond programme countries.

The programme approach developed in the Philippines through the Department of Education as the Essential Health Care Programme serves as a model for other countries. The programme focuses on a simple, scalable, sustainable and systematic approach that supports ministries of education to improve WASH in schools incrementally. Simple, cost- effective, evidence-based preventative measures, such as hand washing with soap and brushing teeth with fluoride toothpaste, form daily group activities in public primary schools, along with school-based deworming. Including parents and the community in the step-by-step approach is an integral programme principle that fosters ownership and responsibility. The main principles apply to implementation and management models, the aim being to integrate WASH in schools management into existing structures of the education sector on all levels without overburdening stakeholders.

Impact and process evaluations from the Philippines show positive effects on school children’s health: 20 per cent fewer underweight children, 30 per cent less absenteeism, 40 per cent fewer infections from decayed teeth, and 50 per cent fewer heavy worm infections compared to control schools. Results from Cambodia, Indonesia and the Lao People’s Democratic Republic show improved oral health and increased access to washing facilities, hygiene supplies and clean/functional toilets. A Cambodian study showed increased individual hand washing with soap after toilet use in programme schools compared to control schools.

The methodology integrates WASH in schools into existing governance structures of the education sector, as the main implementing partner, and finances it locally. The programme strengthens management and institutional capacities at the district and school levels as a driver for effective WASH in schools implementation. The focus of the second programme phase (2015- 2018) is to support government partners to develop innovative, contextualized approaches to programme scaling up following the principles of simplicity, scalability, sustainability and systemic thinking. At the individual child level, interventions focus on students’ behavioural change through skills-based daily hygiene activities.

The programme’s step-by-step, evidenced-based approach in low-resource settings builds on and strengthens existing structures and mechanisms of the education sector. It promotes regional learning and supports partners to develop their own country-specific sustainable implementation models, which takes more time and requires a solid research and development phase but increases ownership and sustainability in the long run. It also applies a multi-level approach that includes international and regional integration and learning exchange, along with strengthening national policies/implementation models and subnational education-sector structures to ensure quality implementation.

Fit for School has developed realistic, clear implementation models and capacity development materials and uses existing educational structures to facilitate replication. The simplicity and cost- effectiveness of the interventions trigger interest and creativity among stakeholders, encouraging them to apply and contextualize the approach to their context. Lessons from regional programme countries are shared with other countries in the region and beyond. Recently, the piloting of Fit for School began in the United Republic of Tanzania, situation analyses were conducted in South Sudan and Guinea, and India, in collaboration with UNICEF, has started to integrate group hand washing into the national school-feeding programme.

The regional partner SEAMEO has a clear mandate to foster South-South cooperation within Southeast Asia and collaborates with regional and international organizations, such as other SEAMEO centres and the WHO Western Pacific Regional Office, ensuring alignment of WASH in schools with the education sector. The Three Star Approach for WASH in schools developed by the German Agency for International Cooperation (GIZ) and UNICEF serves as the guiding concept. Implementing partners in the four countries include the ministries of education and other relevant ministries as well as government officials at the district and community levels, school principals, parents and local communities.