Tuesday, September 29, 2015

Case Study: WASH infrastructure, education is improving health of rural school community in Rohal village

By Margaret Fenton

Student at Rohal Primary School exiting the latrine facility that UNICEF and partner organization ESC-BORDA installation.
© UNICEFCambodia/2015/Margaret Fenton

Cambodia continues to struggle to provide access to clean water and sanitation facilities, one of the key determinants of household health. While 82 per cent of people in urban areas have access to hand washing and latrine facilities, only 25 per cent of rural Cambodians do, covering a mere 37 per cent of the total population. Access to sanitation facilities, as well as knowledge of good hygiene practices, can drastically reduce exposure to severe childhood illnesses, particularly diarrhoea. Sanitation coverage in Cambodia is poor with 66 per cent of rural families practicing open defecation.
Children at Rohal Primary School washing their hands together during a break from class.
 © UNICEFCambodia/2015/Margaret Fenton

In an effort to transform communities by empowering the next generation, Environmental Sanitation Cambodia & the Bremen Overseas Research and Development Association (ESC-BORDA), in cooperation with the Ministry of Education, Youth and Sports (MoEYS), UNICEF, and other stakeholders have implemented the School Based Sanitation (SBS) programme. This has provided water, sanitation, and hygiene installations and trainings at 10 of the primary schools in Svay Leu district, Siem Reap province. One of the 10 primary schools in the district, Rohal Primary School has experienced the positive impact of the programme, not only for the school but for Rohal village community members too.

SBS aims to improve the health, hygiene and sanitation situation in Cambodian schools by building infrastructure and by promoting education and awareness. Addressing sanitation challenges requires a holistic approach that provides both technical fixes and social behaviour changes to students, parents, and the community. The projects involve an extensive selection process, community engagement, and long-term support for each school. Continuous visits over the course of two years help to make hygiene and sanitation practices an ingrained component of the students’ daily life. School support committees, established as part of the project, serve as liaisons and principal stakeholders in its sustainability and success.

Rohal Primary School’s support committee consists of local community members. Committee members inspect and maintain the facilities daily when bringing their children to school. The inspections include checking the cleanliness of the latrines, if water is available, and ensuring that all of the water taps are working well.

Touch Loeum, a parent and co-chair of the school support committee of the Rohal village primary school.
© UNICEFCambodia/2015/ Margaret Fenton

The committee checks more than just the facilities, it educates children on the ‘how-to’, thereby promoting behaviour change. According to Touch Loeum, a parent and co-chair of the school support committee, “washing hands has many steps and the children had trouble with it in the beginning.” The group cites three trainings with ESC-BORDA as the foundation of their knowledge of safe hygiene and sanitation practices. During visits to the school and among parents in the community, the group promotes the appropriate hand washing steps at the hand washing stations and the use of latrines, rather than open defecation. The committee found that students began to change their habits dramatically within a month of the project’s start.

Rohal Primary School students washing their hands with soap and water at the hand washing installation.
© UNICEFCambodia/2015/Margaret Fenton

To date, the committee has seen a significant improvement in parental and community engagement as a result of the committee’s efforts toward transparency and accountability. Before the project, it was rare that the community and parents of students would demonstrate support for the school aside from labour for construction. Now, they are supporting the school financially as well. Annually, each family contributes 3,600 Riel (about $0.90) toward the cost of hygiene materials and potential repairs at the start of the school year.

A collection of toothbrushes and toothpastes, the result of community contributions of hygiene materials at Rohal Primary School.
© UNICEFCambodia/2015/Margaret Fenton

The most frequently cited outcome of the project has been the reduction in cases of diarrhoea among the children. In a 2012 survey by the Cambodian Ministry of Health, cases of diarrhoea accounted for 13 per cent of all hospital visits by children. Rohal village chief and committee co-chair Mao Siu says that it is now very rare to have cases of diarrhoea in the village. While five per cent fewer people reported having diarrhoea in the SBS 2014 monitoring report covering all 10 projects, the committee believes that many more people in their community are healthier as a result of the project. Mr. Mao attributes this to efforts by parents to disseminate information from hygiene and sanitation trainings.

Village chief Mao Siu, co-chair of the SBS support committee with his son Sam, 5, a student at Rohal Primary School.
    
© UNICEFCambodia/2015/Margaret Fenton

A knock-on effect of the programme is that families in Rohal village have been inspired by the toilet block at the school, and have begun to construct their own self-funded latrines. Currently, 20 families have latrines and another one or two latrines are constructed every month. Others look forward to using the facilities at the school. “I use the toilet here all the time,” says teacher Naong Sona. “It is helpful to use it here, because my home is very far away. Before, when there wasn’t a bathroom, I would have to go to the forest nearby and dig a hole.”

Narong Sona, teacher of a kindergarten class at Rohal Primary School.
 © UNICEFCambodia/2015/Margaret Fenton

Another positive result has been the economic gains of illness prevention. Loeum recalls a time when one of his sons was seriously ill with a diarrhoeal disease and faced a two hour round trip every time he had to visit the nearest hospital. The family spent around $2,000 on treatment, medication, and transport. “According to my observations, families are poor mostly due to sickness,” he says. “The community members feel like they are not losing income now. Before they spent a lot of money on medications. Now they don’t spend any.” He explains that improvements in his 8-year-old daughter’s health allowed her to attend school more often. His daughter, Loeum Sok Lim, now reads much faster and has moved from being ranked 20th in the class to 2nd. “I clean my hands every day with the other children,” she says. “I like doing it because I want to be clean, and then there is no smell to my mouth and hands.” Loeum’s situation highlights that as well as good health, good hygiene practice also impacts cognitive development.

Rohal school director San Set remarks that because of the habits the children have learned, more come regularly and their learning outcomes have improved. “Before the project started, more than 10 per cent of the children would be absent each day. Now only five to six per cent are absent daily.” Two years ago, only around 50 per cent of students passed the national exam, and last year 60 per cent did.

Loeum Sok Lim, 8 years old, recites sentences aloud with Rohal Primary School classmates.
© UNICEFCambodia/2015/Margaret Fenton

This year, at the second exam, 78 per cent of the students have met the standard. The retention rate in the upper grades also far exceeds that of nearby schools. Mr. San strongly believes that this is a direct result of the projects implemented in the school, the active involvement of the school support committee and their promotion of hygiene knowledge in the community.

Loeum Sok Lim, 8 years old, leading the in-class assignment at Rohal Primary school.
 ©UNICEFCambodia/2015/Margaret Fenton

The committee’s active outreach to develop new solutions, new partnerships, and community investment for the healthy development of their children who attend the local schools has proved that this project is both successful and sustainable.

Rohal Primary School Director San Set.
 © UNICEFCambodia/2015/Margaret Fenton

With support from MoEYS, UNICEF, and partner organizations like ESC-BORDA, engaging with, organizing, and empowering local communities plays an appreciable role in ensuring access to sanitation for all Cambodians.

Female students at Rohal Primary School taking their turn at the water pump station during a break from class.
 © UNICEFCambodia/2015/Margaret Fenton


Additional writing by Ariel Hofher

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