|Primary School Physical Environment and Health - WHO Global School Health Initiative (SIDA - WHO, 1997, 96 p.)|
|Appendix A. Case studies|
In 1992, Maria Sörensson of the International Water and Sanitation Centre (IRC) in the Hague, the Netherlands, carried out a detailed study of 22 public primary schools in and around Madras in India.(12) In many respects the schools were very similar: all were co-educational, run by the local government and served similar types of population. However, water and sanitation conditions differed significantly. Three of the schools had clean functioning toilets, a well-tended compound and well-observed handwashing practices. In the other 19 schools, children were defecating in the compound, the water was contaminated and the waste area was poorly controlled.
One of the interesting observations of the study was that children and staff in all 22 schools were well aware of the links between poor hygiene and ill health. Madras has an active hygiene education programme and interviews with children confirmed that health messages were understood. However, in the majority of the schools neither staff nor pupils were putting their knowledge into practice.
Sörenssons study, based on observation and extensive dialogue, revealed four common factors which distinguished the three more hygienic schools from the other 19.
· A secure compound. Madras is short of space and water. Schools which have their own water supply find that members of the neighbouring community enter the compound to use the water. Also, people enter to defecate either in the toilets or in the compound, because both offer more privacy than the streets. Only 25% of houses have their own toilets. Schools that built compound walls and, in one case, employed a watchman, were more able to maintain clean compounds.
· A key member of staff. All teachers in the Madras area receive training in hygiene and environmental sanitation. The majority have received additional training from the Institute of Public Health. But Sörenssons study demonstrates that training is not enough. The three successful schools each had at least one member of staff who was truly motivated. He or she was committed to putting words into practice and this enthusiasm spread to pupils and other staff. Sörensson suggests that the key to future success lies in trying to understand this spark of motivation, which goes beyond mere training.
· Group involvement. An important element of the success achieved by these key individuals was that they managed to involve and stimulate those around them. In particular, they won the cooperation of lower-status cooking and cleaning staff. Additionally, children took an active part in cleaning and repairs. By working alongside the non-teaching staff, pupils developed an attitude of respect which was missing in some of the other schools. The teaching staff also involved themselves in hygiene activities, showing that they were prepared to practise what they preach. Parents were involved in special events, such as a Water Day, where children promoted hygiene to their families.
· Achievable solutions. In the 19 schools where hygiene was poor, staff complained of a lack of resources and a lack of support from the authorities. In the three successful schools, even though resources were limited, teachers found ways to make small changes. Some were cost-free organizational measures, such as involving children and staff in cleaning. Others required small purchases, such as that of a ladle for the water tank so that children were not dipping their hands into the common water supply. Another initiative involved persuading parents to supply their children with sandals.