Water, sanitation, and hygiene (WASH) programs in schools have been shown to improve health and reduce absence. In resource-poor settings, barriers such as inadequate budgets, lack of oversight, and competing priorities limit effective and sustained WASH service delivery in schools. We employed a cluster-randomized trial to examine if schools could improve WASH conditions within existing administrative structures. Seventy schools were divided into a control group and three intervention groups. All intervention schools received a budget for purchasing WASH-related items. One group received no further intervention. A second group received additional funding for hiring a WASH attendant and making repairs to WASH infrastructure, and a third group was given guides for student and community monitoring of conditions. Intervention schools made significant improvements in provision of soap and handwashing water, treated drinking water, and clean latrines compared with controls. Teachers reported benefits of monitoring, repairs, and a WASH attendant, but quantitative data of WASH conditions did not determine whether expanded interventions out-performed our budget-only intervention. Providing schools with budgets for WASH operational costs improved access to necessary supplies, but did not ensure consistent service delivery to students. Further work is needed to clarify how schools can provide WASH services daily.
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Research Article|
May 02 2013
Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya
Kelly T. Alexander;
Kelly T. Alexander
1Hubert Department of Global Health, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Robert Dreibelbis;
1Hubert Department of Global Health, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
E-mail: rdreibel@jhsph.edu
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Matthew C. Freeman;
Matthew C. Freeman
3Department of Environmental Health, Center for Global Safe Water, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Richard Rheingans
Richard Rheingans
5Department of Global and Environmental Health, University of Florida, Gainesville, Florida, USA
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J Water Health (2013) 11 (3): 507–519.
Article history
Received:
October 24 2012
Accepted:
March 26 2013
Citation
Kelly T. Alexander, Robert Dreibelbis, Matthew C. Freeman, Betty Ojeny, Richard Rheingans; Improving service delivery of water, sanitation, and hygiene in primary schools: a cluster-randomized trial in western Kenya. J Water Health 1 September 2013; 11 (3): 507–519. doi: https://doi.org/10.2166/wh.2013.213
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