Cover Image
close this bookPrimary School Physical Environment and Health - WHO Global School Health Initiative (SIDA - WHO, 1997, 96 p.)
View the document(introduction...)
View the documentAcknowledgements
View the documentIntroduction
View the documentChapter 1. Overview of the current situation
View the documentChapter 2. Health aspects of the school environment
View the documentChapter 3. Objectives for a healthy school environment
View the documentChapter 4. Recommendations
Open this folder and view contentsAppendix A. Case studies
View the documentAppendix B. Technology options for environmental sanitation
View the documentAppendix C. How to carry out an audit and action plan
View the documentAppendix D. References
View the documentAppendix E. Bibliography
View the documentBack cover

Chapter 1. Overview of the current situation

By the year 2000 there will be over 1400 million children between the ages of 5 and 14 years, approximately 87% of whom will be living in developing countries. Children in this age group are 14 times more likely to die between their fifth and fifteenth birthdays than their age-mates in the industrialized market-economy countries.(2)

It is widely recognized that schools can play an important role in promoting society’s health. Much effort has been invested over recent years in health education techniques for schools in low-income communities, including child-to-child methods, curriculum development, and the production of locally appropriate education materials. However, the impact of the actual fabric and management of school premises on child health has been relatively neglected. Many schools fail to provide healthy environments for their pupils. Poorly designed and maintained schools can be a source of disease and ill-health. Sick children also make poor learners.

Characteristic problems

While there is no such thing as a typical school in a developing country, certain characteristics will be familiar to many observers. These include:

· overcrowded classrooms, designed for 25 children but catering for 50 children, under one overworked teacher;

· little or no furniture, with what there is in poor repair;

· darkness due to too few windows or windows that must be kept covered with shutters to keep out the sun or wind, and no electricity;

· dilapidation due to lack of maintenance, with disintegrating floors, broken doors and windows, and holes in the roof;

· no water supply, or an intermittent or inadequate supply;

· toilets which no longer work and grounds littered with faecal material;

· toilets which may work but which are padlocked since there is no water for flushing or because the children are not trusted to use them properly;

· schools where everything that can be stolen has been taken;

· underpaid, undertrained teachers who often have to travel long distances to work;

· lack of accommodation for staff;

· an absence of blackboards, school books, writing materials for the children, and didactic materials for the teachers;

· girls kept away either permanently or every month, during their periods, because decent and private sanitation facilities for them are lacking.

It is tempting to suggest that all these problems are the products of poverty and that the answer is simply more money. Many developing countries can boast showpiece examples of good, clean, well-equipped schools - schools with in-house health services, pristine washrooms, well-tended grounds, and well-trained teachers working in classrooms equipped with computers, televisions and videos. For the lucky few these model schools are undoubtedly delivering a high quality of education in an environment conducive to physical and mental health. Where both money and focused attention is available, such things are possible. And there is no doubt that education does merit a larger share of the world’s resources. But the evidence suggests that, aside from these showpiece examples, simply throwing more money at the problem does not necessarily result in sustainable solutions. Many examples exist where well-intentioned governments and donors have made significant investments in new and improved schools but with disappointing results.

The drawbacks of standard designs

Many countries, with the assistance of international aid, have focused on developing standard school and classroom designs. Yet results have often been poor either because their authors did not recognize that conditions on the ground are not standard, or because provision for complementary aspects such as water and sanitation facilities, security, furniture and maintenance were neglected. These points are illustrated by the following brief examples.

In one South American country in the 1970s a standard design for a rural classroom was developed which used a steel frame, concrete-block walls and asbestos-cement roofing sheets. The windows were large unglazed openings running the length of the room, on both sides, under a widely overhanging roof. The design was intended to maximize cross-ventilation in hot, tropical conditions. The design worked reasonably enough in the hot lowlands, but was also used for villages in the Andean highlands, for whose extreme mountain climate it was totally unsuited. When the sun shone, the thin roofing sheets heated up excessively. When cloudy, the lightweight construction and unglazed windows soon led to extreme cold. When windy, dry dust was blown into the classrooms making conditions intolerable. Elsewhere, the overhanging roof was useful for preventing overheating - provided the room was correctly orientated. But often the builders of the schools placed the classrooms with no consideration for correct orientation, rendering this design feature useless.


A school designed for the warm and humid lowlands of Ecuador is here being used at an altitude of 4000 m in the cold, dry and windy Andean province of Cotpaxi.

In the former Soviet Union the tradition and ideology of centralized planning led to the use of standard designs in many areas of social infrastructure, including schools. Designs which were prepared for the temperate conditions of eastern Europe found their way to Siberia and central Asia. In the Pamir mountains, at the extreme south of the former Soviet Union, schools were built in communities at altitudes exceeding 4000 m using these standard technologies. In one school with 1000 pupils, all the flush toilets froze and broke down every winter. Since the break-up of the Soviet Union, resources for repairs and basic maintenance have become unavailable. None of the toilets works. The staff and students of an apparently modern, three-storey concrete school have to defecate in appalling covered compounds which serve as public toilets outside the school grounds.


In the town of Khorog, the capital of the region of Gorno-Badakshan in Tajikistan, the severe winters led to the destruction by frost of all the toilets in the school.

In a west African country the World Bank financed a programme to design and build classrooms for secondary schools across the country. A standard design was used which employed a high specification, including such items as suspended ceilings and well-equipped laboratory benches. When all the schools were visited, five years after their construction, a consistent picture emerged. In rural areas the classrooms were in good, in some cases immaculate condition, with pictures on the walls and flower-beds outside. A pristine classroom was a matter of communal pride. Yet in urban schools, built at the same time to the same design, every fixture had been stripped. Suspended ceilings were gone, window and door frames systematically removed, and every pane of glass and light fitting smashed or stolen. Elsewhere in Africa examples exist of schools built with foreign aid, with sewered WCs and washbasins but no water.


In Banjul, capital of the Gambia, well-appointed classrooms built by a World Bank-funded project were rapidly vandalized and stripped.

In Central America, as in many other areas, there is a legacy of well-built schools dating from colonial periods of the late 19th and early 20th centuries. Often these old buildings continue to form the backbone of the educational infrastructure. In one such school, the main health problem was reported to be injuries such as broken arms and twisted ankles. It emerged that these were caused by children falling through the wooden floors. The floor joists and floorboards were 60 to 70 years old and simply disintegrating. Yet while the very fabric of the school was collapsing in one area, a new air-conditioned computer room containing 20 computers was operating in another.


A well-built but now old school in the suburbs of San Jose, Costa Rica, is becoming hazardous due to rotting floorboards.

In the Indian state of Rajasthan the indoor environment of thousands of schools is effectively unusable. The schools were built for a hot, dry climate. Yet Rajasthan’s desert climate means that for most of the year mornings are extremely cold. In order to keep warm, teaching is therefore often conducted out of doors.(3)


A village school in Rajasthan, India. Students and teachers are often more comfortable outside than in a chilly classroom.

The first two examples show that, while standard designs may have their place, people must be aware of the limitations imposed by differences in climate. The west African example demonstrates that building model classrooms is not enough: the social context must also be understood and, where necessary, steps taken to protect the school fabric, both through physical protection and by building up civic responsibility. The Central American example reminds us that simply building good schools is not enough. The elements of a building have a limited life and provision must be made for repairs and replacements. The Indian example underlines the need to think of the total school environment, not just the classrooms.

For each of these examples, we do not need epidemiological evidence to conclude that a poor or deteriorating school environment is not conducive to the good health of pupils.

Looking beyond classrooms

What is a school? The answer may seem obvious - a school is a collection of one or more classrooms in which teachers teach children. The classroom is the visible manifestation of a school. But in practice this classroom-focused attitude is weak in four respects.

· Much teaching and learning can and does take place outside of classrooms. Semi-formal learning situations arise in the workplace, the kitchen, the fields and at places of worship. Informal learning takes place through play and social intercourse.


At this primary school in Petauke District, Zambia, carpentry lessons are held outdoors.
· School-based learning is not always necessarily best conducted in a classroom. In some climates, the shaded area under a tree or a grassy bank may provide a teaching environment which is healthier and more effective than a crowded, dark, cold and damp classroom.


Early morning lesson in a desert climate, Siwana Block, Rajasthan, India. Mornings are cold and children are more comfortable sitting in the sunshine.
· Many schools do more than just impart knowledge and skills. Schools often perform the important role of caring for children so that their parents can go to work. In this role, schools serve both to contain children, stopping them from “running wild”, and increasingly, to protect them from accidental or intentional harm.


A schoolgirl with malaria fever resting on the veranda of a rural primary school, Rajasthan, India, while her parents are working.
· Schools may provide a health safety net for children from disadvantaged homes. Where meals or food supplements are supplied, schools can be a vital source of nutrition. Schools can be a focal point for vaccination programmes and a means for health and social workers to identify and make contact with deprived families.


The dining-room of a primary school in Nyanza Province, Kenya.

These additional elements all have implications for the physical fabric of a school and the way in which it is used. Yet, to date, most of the work on school design has focused on classroom construction. The school compound, on the other hand, has been relatively neglected. When the school compound is dilapidated and untended, the disrepair tends to spread to the school buildings, since people come to feel that maintenance is not their responsibility. Additionally, the grounds surrounding schools are frequently open to animals to wander in and out. Any plants that exist are soon destroyed. Often school grounds are used by the local population as short cuts and sometimes even as open public toilets.

Neglected school compounds tend to accumulate waste, both from within the school itself and dumped by people from outside. When waste builds up, because of a municipal strike for example, school grounds are likely to become a natural dumping site since they probably represent one of the few accessible open spaces. If, as is quite often the case, school buildings are adjacent to health buildings, medical waste, including items such as used syringes, can frequently be found on the ground. In malarial areas, standing pools of water around a school can be a major health hazard.

External structures, such as concrete sports grounds, are often poorly built, with inadequate foundations. They are also, inevitably, exposed to the weather and so deteriorate rapidly. School grounds tend to be characterized by jagged lumps of subsiding concrete, wide cracks, broken steps and missing inspection covers. All these features are common sources of injury.

The importance of community mobilization

In contrast to the gloomy physical evidence presented by dilapidated schools, there is also plenty of proof that poor people all over the world are highly motivated to get an education. In Afghanistan, as in many conflict areas, schools were among the first targets for destruction by warring factions. Yet in Kabul, Afghanistan’s capital, among the ruins, in rooms with walls punctured by rockets, classes are still held, using desks made of ammunition boxes. The city’s university has been razed to the ground yet students still receive lectures and sit exams as dedicated professors arrange classes in basement rooms scattered about the city.


Lean-to classrooms rebuilt each year at a school in the suburbs of Banjul, the Gambia, indicate how keen parents are for their children to receive an education.

At a school in a peri-urban area in the Gambia, the two concrete classrooms are too small for the community’s needs. Every year, during the dry season, local people build ten makeshift rooms from rough poles and corrugated iron that lean against the concrete structure for support. Children attend school in two shifts to maximize the use of the classrooms. On the door of one of these crude classrooms is painted the caption “Education or death”. For the pupils in that simple iron shack, the opportunity which it offers is as precious as any offered by a pristine “model” school.

In all areas of development it has become apparent that the only hope of success lies in mobilizing local communities to accept their problems as their own responsibility. Progress is being made where there are committed individuals and groups on the ground, taking matters into their own hands and trying to make their little corner of the world a better place.

In a tiny two-room rural school in west Africa, for example, the teacher has instigated a regime whereby, every day, each pupil has to bring a plastic bag full of water. This is added to a communal tank. When the children go to the toilet they have to take water to wash themselves. The toilets, which are simple pits, have high and well-maintained bamboo-screen walls to provide privacy. A rota ensures that every morning the toilets are cleaned by one of the pupils. The result is a clean and well-tended school with a body of pupils who, by the simple expedient of carrying water to school each day, remain constantly aware of hygiene and cleanliness.

In many small communities, schooling has traditionally been a domestic affair. Certain people in the community would develop a reputation as teachers, and children would go to their houses to learn. Schoolrooms were often attached to the schoolmaster’s house. Similarly, in societies in crisis, such as in war zones and refugee camps, schools are often run in people’s houses or living quarters. And in any society it is common for mothers with young children also to look after their neighbours’ children. In Colombia, this tradition is being continued through a growing number of “community houses”, a system which has arisen partly in response to growing concerns about street violence. Women can apply for grants and loans to upgrade the sanitation and kitchens of their houses so that they can look after up to 15 children at a time. These “community mothers” form groups of up to 15 members that work under a management committee of local representatives. There are now several thousand of these groups in Colombia. While these community houses are primarily aimed at preschool children they do cater for children up to the age of seven. It is but a short step from such community-based day care to decentralized basic schooling with all the advantages of small groups and personal care.

Making the most of a valuable resource

In many communities, the school is the largest building and often the only communal space, other than perhaps the mosque or church. In such circumstances, the traditional European model of a school which is used for only a few hours each day, and only during certain times of the year, seems irrational. Many schools now operate in two or three shifts and the buildings are sometimes used in the evenings as well for adult groups. In theory, more intense use of facilities implies a more effective allocation of resources. This in turn should result in the provision of improved facilities. Creating a healthy school environment, therefore, is not just about physical design but also about developing operational procedures to make the best use of facilities and resources.

One way of increasing use of school facilities is through the practice of alternate-day schooling. In the 1940s a Norwegian study found no difference in educational achievement between pupils attending schools every day and on alternate days.(4) The strategy depends on the availability of good educational materials to support home study. It also assumes that the prime role of a school is education. Where a school is also important as a day-care centre, any schooling based on shifts or alternate days must be combined with appropriate day-care provision.

In regions vulnerable to natural disasters, schools are increasingly being recognized as an important resource for the whole community in times of emergency. In Bangladesh, schools are being built to serve as refuges in times of flood. In Viet Nam and elsewhere, typhoon-resistant construction is being encouraged for schools.(5, 6) In the earthquake-prone regions of the Karakorum mountains, in northern Kashmir, Pakistan, special reinforced-concrete designs are being used for schools, which would provide communal shelter should an earthquake strike during a severe winter.

Making use of the “hidden” curriculum

In all schools, apart from the formal taught curriculum, there is a “hidden” curriculum covering areas such as basic social values and the development of interpersonal skills. In some cases this is explicitly formulated by teachers and educationalists, but often it is unspoken and implicit. Messages about personal and communal hygiene are an important element of this teaching. Even if children come from very poor and unhygienic homes, they may develop healthier practices if they are exposed to a regime of cleanliness and hygiene at school. Equally, if the school is unkempt, if the toilets do not work, and if the teachers themselves do not practise what they preach, then poor hygiene behaviour can spread from school to home.

Lessons to be learnt from the experience so far

To sum up, a number of lessons can be drawn from this analysis of the current situation.

· Good design is not enough. Exhaustive guidelines on classroom design are not enough to improve school environments. In fact, model designs often assume an unrealistic availability of resources. More importantly, a healthy school is dependent on good management, commitment and maintenance.

· Standard designs assume standard conditions. Designs for model schools are only useful if applied intelligently and with care. If standard designs are used in circumstances for which they were not intended, the result can be counterproductive.

· Schools are more than classrooms. While much attention has been given to classroom design, many of the elements which influence child health lie outside the classroom. There is a need to think about the total school environment and the way in which schools are run. In particular, the involvement and needs of the local community should be considered.

· The greatest need is to improve existing schools. Before large amounts of resources are devoted to building new schools, better use should be made of existing schools. This can be achieved through better management and larger financial allocations for maintenance and repairs. It is also important to ensure that pupils and staff with disabilities are able to use facilities at existing schools.