Search

To address water and hygiene infrastructure deficiencies in health-care facilities (HCFs) in Siaya County, Kenya, portable water stations, soap, and water treatment products were provided to 109 HCFs in 2005. In 2011 and again in 2016, we interviewed staff in 26 randomly selected HCFs, observed water sources, water stations, and tested source and stored water for chlorine residual and Escherichia coli. Of 26 HCFs, 22 (85%) had improved water supplies, and 22 (85%) had functioning handwashing and drinking water stations, but < 50% provided soap or water treatment. Thirteen (50%) of 26 source water samples yielded E. coli; 24 (92%) of 26 stored water samples yielded no E. coli, including nine with residual chlorine and nine untreated samples from sources yielding no E. coli. Eleven years after implementation, 85% of HCFs continued to use water stations that protected water from recontamination. Sustainable provision of soap and water treatment products could optimize intervention use.

Water, Sanitation and Hygiene (WASH) programs in schools can increase the health, dignity and comfort of students and teachers. Understanding the costs of WASH facilities and services in schools is one essential piece for policy makers to utilize when budgeting for schools and helping to make WASH programs more sustainable. In this study we collected data from NGO and government offices, local hardware shops and 89 rural primary schools across three Kenyan counties. Current expenditures on WASH, from school and external (NGO, government, parent) sources, averaged 1.83 USD per student per year. After reviewing current expenditures, estimated costs of operations and maintenance for bringing schools up to basic WASH standards, were calculated to be 3.03 USD per student per year. This includes recurrent costs, but not the cost of installing or setting up WASH infrastructure, which was 18,916 USD per school, for a school of 400 students (4.92 USD per student, per year). These findings demonstrate the need for increases in allocations to schools in Kenya, and stricter guidance on how money should be spent on WASH inputs to enable all schools to provide basic WASH for all students.

In Nyanza Province, Kenya, a sustainability evaluation of 55 pilot primary schools 2.5 years after the implementation of the Safe Water System (SWS) intervention revealed that programme activities were not successfully sustained in any of the schools visited. The most common criterion met was drinking water provision. We identified six enabling environment domains: financial capacity; accountability; technical feasibility and availability; community support; school leadership and management; and student engagement. While these domains pertain to the sustaining of the SWS activities in schools, they are likely to be applicable in creating an enabling environment and serve as proxy indicators for other school water, sanitation, and hygiene initiatives as well.

Despite the known health benefits of washing hands with soap, global handwashing rates are low. In Nyanza Province, Kenya, a follow-up of 55 pilot primary schools three years after the implementation of a safe water and hygiene intervention revealed that only 2 per cent (one school) provided soap for handwashing on the day of the assessment. After identifying barriers to soap provision, SWASH+ partners piloted a handwashing intervention using powdered soap mixed with water to create soapy water in place of bar soap in 11 schools. The first six months of unannounced visits showed high uptake (10 schools). A one-year follow-up visit revealed a decrease of soapy water use (four schools). This paper discusses the soapy water intervention, initial and follow-up monitoring findings, potential sustainability drivers of handwashing programmes in rural primary schools and next steps.

1A major contributing factor to this burden of disease is inadequate access to safe water and sanitation infrastructure. Universal access to water and sanitation facilities will take many years and billions of dollars to achieve. There is a need, in the short to medium term, to reduce the risk of disease in vulnerable populations that will not soon benefit from infrastructure interventions. To address this need, Cooperative for Assistance and Relief Everywhere, Inc. (CARE) Kenya has been involved since 2000 in a series of projects to implement household-based water treatment interventions in Nyanza Province, where the diarrheal disease burden is high and access to improved water supplies is poor. 2 Most of these projects used the Safe Water System (SWS), an intervention that consists of water treatment with dilute sodium hypochlorite solution, safe water storage, and behavior change techniques. Evaluations of these programs in Kenya have shown that use of the SWS was feasible, acceptable, and reduced diarrheal disease risk. 3– 5 In 2003, Population Services International (PSI), a social marketing non-governmental organization , initiated a campaign to promote and sell the SWS solution, which was given the brand name WaterGuard; each bottle costs approximately $U.S. 0.26 and treats 1000 L of water. The social marketing program for WaterGuard, which has been continuous since 2003, consisted of mass media advertisements (predominantly by means of radio), wall paintings, and presentations at local markets where WaterGuard was being sold. In 2008, PSI sold nearly 1.7 million bottles of WaterGuard in Kenya. Easy and widespread access to WaterGuard facilitated efforts to implement two school-based safe water and hygiene interventions in Nyanza Province. In 2003, a pilot project was implemented in a rural boarding school, providing clay pots modified with narrow mouths, ceramic lids, and taps for drinking water, plastic tanks with taps for hand washing, WaterGuard for drinking water, and soap for hand washing. An evaluation of this project in 2004 showed that diarrhea rates among the students had decreased by more than half. 6 In 2005, the schoolbased safe water and hygiene intervention was expanded to an additional 70 public primary schools in southern Nyanza Province. An evaluation of this program in 2006 suggested that the use of water treatment and hand-washing promotion in schools resulted in a decrease in absenteeism of 35% compared with neighboring schools, and increased utilization of WaterGuard in students’ households. 7 The outcomes of these two projects have resulted in further expansion of the school programs in Nyanza Province. 8 ® ®