Up-Scaling WASH in Schools in the Philippines { Highlight and Challenges)

1. Up-
Scaling
WASH in
Schools
in the
Philippines:
- Highlights
and
Challenges
Bali
10 September

2. Outline
• Disease burden in Schools
• WASH in Schools Technical Working
Group
• Highlights and challenges of Dep Ed’s
WASH facilities program works
• Up-scaling WASH facilities
• Highlights and challenges of Dep Ed’s
Essential Health Care Program
(EHCP)
• Up-scaling EHCP
• Comparison of Approaches to WASH
in Schools
• What’s next?

3. Prioritising public health challenges
Diarrhea (10% DHS); 2nd most
common complaint for children in
schools
66% infected with intestinal worms
Dental decay & dental infection
97% of 6-yr-olds have caries with 9
decayed teeth on average
30% have Body Mass Index (BMI)
below normal

4. WASH in Schools TWG
TOR with the Aim:
Technical assistance to DepEd
Serve as a source of evidence-based
recommendations
Forum for sharing networks and knowledge
Not a program but a support group
Chaired by Dep-Ed Under Secretary for
Programs
Membership is DepEd, DoH, UN agencies
and NGOsUsing children's leadership skills
for daily activities - little extra work for
teachers
Provided advice on Design of WASH
facilities & low cost designs
WASH in School Country profile
Assisted with drafting policy/programing
(EHCP monitoring, Brigada Eskwela,
Global Hand-washing Day)

5. Planning and Targeting
YEAR TARGETS TARGETS WATER HANDWASHIN
G COUNTER
AMOUNT
FACILITIES
(NC) (REPAIR) DETACHED USD
2011 9,671 1,196 279 594 29.9 million
2012 10,694 1,345 68 13,256 33.2 million
2013 ( to be determined) 129.2 million

6. 2-Seater Toilet Hand washing Standard
3-Seater Toilet 4-Seater Toilet
WATSAN Designs

7. WATSAN Completed Projects in the
Philippines

8. Procurement and
Construction Process
• By Contract using DepEd Budget
• Community help through Brigada
Eskwela
• LGU Assistance ( Local Government Unit)
• NGO Assistance ( Non-government
Organization)
• Private donors through Adopt-a-School
Program

9. Challenges in Up-
scaling WASH facilities
• Existing data gathering tools
does not include functionality
and O&M of WASH facilities
• No specific budget for WASH
facilities O&M
• Child friendly designs
• Cost effective designs

10. Challenges in Up-
scaling WASH facilities
• The Hardware program is
not clearly linked with the
software program (Essential
Health Care Program –
EHCP and O&M)
• Targeting poor and
underserved areas; Dep Ed
priority disvisions

11. Dep Ed’s Essential Health Care Program
Daily Hand-washing Daily Tooth brushing Bi-annual Deworming
Handwashing with Toothbrushing with
soap fluoride toothpaste Supervised ingestion
of albendazole
Group activity Group activity
Supervised by
Part of daily school Part of daily school
routine teachers
routine
No piped water Parent consent
No piped water
needed needed Reduction in worm
Supervised by load by 50%
Supervised by
teachers and teachers & children
children Reduction in tooth
decay by 40-56%
Reduction of absenteeism by 27% / underweight children by 20%

12. Highlights: Clear program
management
Clear roles & responsibilities of
all involved
Using children's leadership
skills for daily activities - little
extra work for teachers
Community involvement in
construction of facilities
Detailed & simple guidance
through templates and
manuals

13. Highlights: Making it simple
and affordable
Material and costs per child per year
High quality toothbrush with
0.16 US$
cover
60 ml WHO quality tested
0.22 US$
fluoride toothpaste
50 g Soap 0.08 US$
400mg Albendazole tablet
0.05 US$
(2x)
Total ~ 0.50 US$

14. Regular process Highlight: Monitoring &
& outcome
monitoring Evaluation
Outcomes
motivate staff and
ensure sustained
government
funding
Strengthening
evidence of
program by
evaluating health
& education
impact
Vertical and
closed loop
monitoring

15. EHCP Programme coverage
& reach

16. Evidence base – 1 year
longitudinal study
Indicators Intervention Control Difference
n = 544 n = 173
Days of absence SY 3.2 ± 3.9 4.4 ± 4.8 27.3%
2009
Prevalence of 28.1% 35.3% 20.4%
Children
categorized as thin1
Prevalence of 10.4% 19.7% 47.2%
children with heavy
STH infect2
DMFS Increment 0.72 ± 1.49 0.87 ± 1.79 17.2%
PUFA Increment 0.08 ± 0.33 0.13 ± 0.40 38.5%

17. Highlight : Government
Prioritising public health challenges
Buy In
National and Provincial Advocacy
Events, WinS TWG, evidence,
cost effective, guidelines,
policies
Creation of incentives & motivation
based on analysis of interests
Competition & politics
Dep Ed investment WASH
infrastructure
Provincial Governments fund
consummerables

18. Highlight: Community
Buy in
• Materials and labour for
construction by the community
• Quality of facility is based on the
wealth of the community
• Sanitation ladders -
schools/communities see value in
infrastructure and are upgrading
• What is the driver of community
involvement:
• Creative use of incentives?
• Policies/Political pressure
• Competition within schools
and across schools

19. Challenges for EHCP
• Sanitation is not clearly linked with
the Essential Health Care Program
• Provision of water is very difficult
for some communities and needs
a multisectoral response
• Existing data gathering tools does
not include hand washing facilities
and the presence of
consummerables (eg soap,
toothpaste, cleaningn products)
• Sustaining the program with local
government funding ie No specific
national budget from Dep Ed for
consummerables.

20. Expansion of EHCP
Expansion till 2015

21. Comparison of Approaches
Traditional Approach New Approach (EHCP)
• Education/hygiene promotion • Daily skills based activities
based activities • No training of teachers required –
• Often requires large training of focus on guidelines and teacher
trainers and teachers manuals
• Many hygiene behaviours • 2 key hygiene behaviours
• Not always cost effective • Very cost effective
• Not always scalable • Scalable
• Not always evidence based • Strong evidence base
• M&E potential not fully utilised or • Key role of M&E
realised • Sanitation not included (work in
• Sanitation included progress)

22. What's next?
Sanitation &
Equity
• Schools & PTA will invest in
sanitation
• Policy support from Dep Ed and
Province – key role for WinS TWG
• Development of conditional
Support mechanisms. Eg
consummerables/toilets
contingent on construction of
water supply & hand washing
facilities
• Challenge – turning positive group
hygiene behaviour into individual
behaviour

23. Thank you!