PromotingWaterSanitationandHygiene(WASH) Practices
inRuralSchoolsofZimbabwe
Abstract
Water, sanitation and hygiene (WASH) in schools contributes to better health and educational outcomes among students. Water, sanitation and health are therefore very critical not only as a human right, but also as a step to quality education, national development and poverty reduction. The paper sought to review water use and sanitation practices in rural schools of Zimbabwe. Inadequate capital to support and maintain WASH standards in schools, and lack of monitoring systems at schools, remain key challenges. Despite support by UNICEF and other international agencies, further support is required to meet international recommendations for healthy, genderequitable schools.
Key words
Water Supply, Sanitation Practices, Hygiene.
1 Ezra Chipatiso Correspondence: echipatiso@gmail.comAccess to water, sanitation andhygiene(WASH)in schools isintegral to thewell-beingofchildren and their right to quality education. The impact of WASH in schools is multi-faceted, and has made a crosscutting contribution to achievement of the Millennium Development Goals (MDGs) through impacting universal primary education, gender equality and environmental sustainability (WHO, 2009). WASH has also been considered significant in the achievement of Sustainable Development Goals (SDGs).
Although the world has progressed in the area of water and sanitation, more than 2.3 billion people still live without access to sanitation facilities and some are unable to practice basic hygiene (UNICEF, 2006). In developing countries, there is mounting pressure from international agencies for schools to institute Water, Sanitation and Hygiene (WASH) facilities to reduce or eliminate water borne diseases. Inadequate water supply and sanitation are largely responsible for the high levels of water borne diseases in Southern Africa, where the majority of people live in rural areas and do not have appropriate sanitation systems (Hirji, 2002). Not surprisingly, infectious water borne diseases, such as dysentery, cholera, and hepatitis are almost endemic in places where water is scarce.
2. Global Overview on Water and Sanitation
Since 1990, WHO and UNICEF, through the Joint Monitoring Programme (JMP) for Water Supply, Sanitation and Hygiene, have tracked progress on global water and sanitation goals (UNICEF, 2022) Human health depends on the quality of our immediate surroundings, in which water and sanitation services, and their management have a key role. In September 2000, the United Nations General Assembly adopted a number of Millennium Development Goals (MDGs) that challenged the global community to reduce poverty and increase the health and well-being of all peoples. In September 2002, the World Summit on Sustainable Development in Johannesburg reaffirmed these goals and added specific targets on sanitation and hygiene (UN, 2003). By including sanitation and hygiene in the MDGs, the global community has acknowledged the importance of promoting sanitation and hygiene as development interventions and has set a series of goals and targets. These are to half by 2015, the proportion of people without access to basic sanitation. Additionally, MDGs also sought to improve sanitation in public institutions, as well as strengthening existing information networks (UN, 2003).
The global statistics on sanitation hide the dire situation in some developing regions. According to UNICEF (2013), developing regions have an average coverage of 50%, that is, only one out of two people has access to some sort of improved sanitation facility. The regions presenting the lowest coverage are Sub-Saharan Africa (37%), Southern Asia (38%) and Eastern Asia (45%). Western Asia (84%) has the highest coverage among developing regions. It is estimated that 272 million school days globally can be gained if the MDG for sanitation is achieved (UNICEF, 2012a). Apart from impacts on educational performance, health and social development, access to improved WASH standards in schools is about dignity and respect for the child in enabling a safe and healthy learning environment (WSP, 2011). Since the Global Joint Call to Action for WASH in Schools, “Raising Clean Hands” was published in 2010, the focus on school-based water, sanitation and hygiene has increased, but still lags behind targets for global and regional coverage, which is improving, but much too slowly (UNICEF, 2012b).
2.1 Lessons Drawn from Developed Countries
Improved sanitation practices that produce the desired results have been studied in the developed world. WHO (2009) notes that, in the developed world, only the sanitation technologies which operate in an environmentally responsible manner are chosen. This section focuses on implementation of eco-sanitation in Romania and Ukraine to manage excreta. In developed countriessuchasUkraine,lackoftheaccesstosafewaterandsanitationhasbeenthemainproblem for the rural schools. According Ukraine Country Report (2013), 20 % of rural schools in the country were not connected to centralized water supply, and 32% of drinking water samples in Ukraine do not meet sanitary and hygiene standards, while 23% of samples did not meet bacteriological standards.
Following the implementation of eco-san toilet in Romania in 2003 aimed on improving school sanitation facilities, Ukraine adapted the eco-san toilet design to Ukrainian building standards in 2004 (Ukraine Country Report, 2013). The toilet consists of three double vault urine diverting toilets, three waterless urinals and two urine tanks of 2m³ each. Plastic squatting-pans were selected for hygienic reasons. Urine and faeces are properly separated, collected and stored. After storage of the urine during six months and composting of the faeces during two years, it can be used as a fertilizer (Compost Toilets Practical Action Technical Brief, 2007).
Thisnewtechnologycan beusedasa goodalternativetothetraditionalpitlatrinesforrural schools because it does not result in groundwater contamination and produces good fertilizer. According to TsvietkovaandKovalyova(2006),thepupils hadthreelessons about eco-sanitationandhygiene per month. Additionally, the storm water gathering system was installed in spring 2006. Ecosanitation may be appreciated as sustainable and affordable water-protecting solution because it also does not require water for flushing. In 2006, repeated surveys were carried out among 160 school pupils in Gozhuli school and the results were the following: 75 % of students were happy to use school toilet and the number of students still having problems with eco-toilet use had decreased to 25 %. The survey among teachers of the school showed that 90% of them liked ecotoilet, but had complaints about bad smell during cold seasons (Tsvietkova and Kovalyova, 2006). The success of the sanitation programmes were attributed to cooperation schools and stakeholders, who were also committed to conserving the school environment and adhering to school policies.
2.2 Rural Water Supply and Sanitation Programmes in Africa
The African Ministers Council on Water (AMCOW) commissioned the production of a second round of Country Status Overviews (2nd CSO) to better understand what underpins progress in water supplyand sanitation and what theyand their governments can do to accelerate that progress across countries in Sub-Saharan Africa (SSA) (WHO, 2010). AMCOW delegated this task to the World Bank’s Water and Sanitation Program and the African Development Bank (AfDB) who are implementing it in close partnership with UNICEF and WHO in over 30 countries across SSA (UN-Water, 2011). The level of success for schools in the developing world needs to be determined, as the economic and technological settings are different. A range of sanitation practices have been designed and implemented in Africa, but this section focuses on sanitation practices in Nigeria, Rwanda, Sierra Leone, Uganda, South Africa, Lesotho, Mozambique, for which literature could be found.
2.2.1 Sierra Leone
The Rural Water Supply and Sanitation Project-RWSSP (2013 - 2018) cover five rural districts in the Northern, Southern and Central regions of Sierra Leone. The project is expected to benefit 625,000 rural Sierra Leoneans, including providing improved sanitation access for 91,000 school children (RWSSIProject Briefs, 2014). The RWSSP project contributes to Sierra Leone’s Agenda for Prosperity - the third generation Poverty Reduction Strategy (PRS III), in particular towards
achievement of the water supply, sanitation and hygiene targets set out in the Millennium Development Goals (WHO, 2014). It will also result in a better managed water sector and improved knowledge, attitudes and practices among the primary beneficiaries.
2.2.2 Nigeria
In Nigeria, the African Development Bank’s Sub-Programmes covered two states: Yobe in North East Nigeria and Osun in Western Nigeria (UK Aid, 2014). The overall project was expected to increase and sustain the provision of safe water and access to 2.56 million people in Yobe and 0.76 million in Osun, and to improve sanitation for 2.30 million people in Yobe and 0.68 million in Osun. The project includes the formation and training of Water and Sanitation Committees (WASHCOMs), who operate and manage the water and sanitation facilities installed. The impact of the sub-programmes has been felt in the two states. According to RWSSI Project Briefs (2014), rural water coverage increased from 43% in 2006 to 80% by 2010, and to 100% by 2015; rural sanitation increased from 32% in 2006 to 60% by 2010, and to 90% by 2015.
2.2.3 Rwanda
Improved access to potable water and to improved sanitation and hygiene is also a key part of Rwanda’s overall development objectives. The country’s planning tools are driven by the Vision 2020, the Economic Development and Poverty Reduction Strategy, (EDPRS I and II), the Government’s 7-year program and MDGs (Japan International Cooperation Agency, 2011). The current EDPRS (2013-2018) has prioritized water supply and sanitation as a critical service that will contribute significantly to Rwanda’s growth in the next five years (WHO, 2014). Since 1974, theAfrican Development Bankhas beenakeydevelopment partnerto Rwandaandhas contributed greatly to the development of the water and sanitation sector in the country. According to UN (2011),access tosafewaterandimprovedsanitationnotonlycontributesto betterlivingconditions and increased productivity, but it also promotes gender equality and the development of children especially girls through their increased school attendance.
2.2.4 Uganda
Rural water and sanitation component of the Uganda Water Supply and Sanitation Program provides support to the decentralized implementation of rural water supply and sanitation facilities by local authorities through Sector Budget Support and implementation of three Large Gravity
Flow Schemes (LGFS) and twenty Multi-Village Solar Powered Water Systems (MVSPS) (RWSSIProject Briefs,2014).Accordingto the Uganda Bureau ofStatistics (2005), it is estimated that 29.7 million people (83.7%) reside in rural areas. The programme supports the promotion and implementation of sanitation and hygiene development. Programme activities include the provision of software, infrastructure, construction and installation, baseline surveys, social mobilisation, community-based planning and monitoring, hygiene and sanitation education, gender awareness and capacity building at user level, for effective use and sustainable operation. According to RWSSI Project Briefs (2014), the positive impacts of the programme include: improved rural water access to 77%; improved rural sanitation coverage to 77%; improved access to hand washing at households to 50%; improved access to hand washing in schools to 50%; improved management and functionality of rural water and sanitation facilities to 90%.
2.2.5 South Africa
The Government of South Africa launched the Community Water Supply and Sanitation (CWSS) Programmewith theDepartment ofWaterAffairsandForestry(DWAF,2003)to address backlogs in the area of water supply and sanitation. The first phase of the programme that was initiated in 1994 involved the identification and immediate implementation of key water projects. However, provision of sanitation services lagged behind water, and only in 1997 was the National Sanitation Programme initiated (Statistics South Africa, 2003). During the second phase of the programme, the focus was on increasing the rate of delivery of water and sanitation services in rural schools in order to meet the government target of eliminating the backlog within 10 years. DWAF was assisted in this task by a large number of implementation agents and project teams, including NGOs and small-scale private sector support teams, who undertook the project work on the ground (DWAF, 2003). They worked to support rural schools, and committees were to assist in delivery and training in building and health, as well as hygiene promotion. Although by early 2002, excess of 7 million people had been provided access to water supply at a basic level of service, only half a million people had been positively impacted by the National Sanitation Programme (GoSA, 2008). Inappropriate regulatory framework that ensures effective, efficient, equitable and sustainable provision of basic sanitation services to both urban and rural schools in South Africa has been cited as the major barrier to service delivery (GoSA, 2010).
2.2.6 Lesotho
Lesotho has increased sanitation coverage from 20% to approximately 53% over 20 years (UN, 2003). During this time, policies have shifted away from subsidizing latrines, and much more money has been channeled towards promotion and training. Key aspects include consistent significant allocation of the regular government budget to sanitation and earmarking of these funds for promotion, training local artisans and monitoring. Recently, the Lowlands Rural Water Supply and Sanitation Project (LRWSSP) has been designed to increase coverage in the Lowlands areas by providing improved, sustainable, equitable and inclusive access to water supply and sanitation to an estimated 65,000 populations in the Maseru and Berea Districts, where major bulk water supplyinfrastructure is being developed (Africa Development Bank Group, 2013). The project has four main components: Water Supply Infrastructure; Environmental Health, Sanitation and Hygiene promotion; Institutional Support and Capacity Building; Project Management; and Engineering Services. The project contributes to the achievement of the country’s Vision 2020 objective of improved health and social wellbeing of the population, through universal access to improved water and sanitation services (RWSSI, 2014).
2.3 Water and Sanitation Programme in Rural Schools of Zimbabwe
The active phase of this programme began to build up after Zimbabwean Independence in 1980 when external donor support became available to the country (Robinson, 2002). Before that time the Ministry of Health has been involved through its Environmental Health Department in the promotion of hygiene and the improvement of shallow ground water supplies and sanitation, a programme which had been building up since the later 1940's (Morgan, 2006). In the early 1980's when peace returned to the countryside and donor support became available, a variety of lower cost options were designed, but the Ministry of Health, insistent on a longer term benefit from the programme, chose solid brick built structures which could serve a generation (Robinson, 2002). A method of offering material incentive to individual families and schools was also developed. According to Sidibe and Curtis (2002), this method of offering an incentive helped enormously to promote the uptake of improved household and school sanitation throughout rural Zimbabwe.
Pursuant to that, the 2nd CSO Report has also been produced in collaboration with the Government of Zimbabwe and other stakeholders during 2009-10. The analysis was meant to help countries assess their own service delivery pathways for turning finance into water supply and sanitation
services in each of four subsectors: rural and urban water supply, and rural and urban sanitation and hygiene. The 2nd CSO analysis has three main components: a review of past coverage; a costing model to assess the adequacy of future investments; and a scorecard which allows diagnosis of particular bottlenecks alongthe service deliverypathway. Accordingto WHO (2010), the 2nd CSO’s contribution is to answer not only whether past trends and future finance are sufficient to meet sector targets, but what specific issues need to be addressed to ensure finance is effectively turned into accelerated coverage in water supply and sanitation.
2.4 Legislation for Water and Sanitation in Schools in Zimbabwe
The 1976 Education Act, amended in 2006, made provision for WASH in schools among other requirements. It is a requirement that everyschool shall have at least two blocks of toilets, separate for girls and boys, and the number of toilets is further determined by enrolment in line with Ministry of Health and Child Welfare standards (MoHCW, 2011). Before a school is registered by the Ministry of Education, it is Government policy that officials from MoHCW inspect and certify as satisfactory sanitary conditions at that school (GoZ, 2013). The national standards require an approved toilet for schools, that is, ventilated improved pits (VIP) for rural schools without reticulated water supply; or water-borne sanitation where reticulated water system is available (usuallyin urban areas). The ratio of pupils to toilet is 25:1 for boys and 20:1 for girls as a national policy (MoHCW, 2011). National standards on WASH in schools are specified in Minimum (Functionality) School Standards designed by Ministry of Primary and Secondary Education (Appendix A), while international standards for WASH in schools are specified by UNICEF Guidelines (Appendix B).
2.5 Institutional Arrangements on Management on Water Supply and Sanitation in Zimbabwe
The country undertook significant reforms in the 1990s to create a Zimbabwe National Water Authority (ZINWA) to manage the national water resources. But the water resource sector has been badly hit by the economic downturn and the lack of investment has nullified many of the reform gains. Rivers are now unregulated, inadequate attention has been given to the maintenance of key water resource infrastructure with a high risk to public safety from the breach of dams, and significant pollution has occurred in some major water bodies (Murinda, 2011). Operations of ZINWA stem from the Water Act of 1998 and the ZINWA Act of 1998. For the purposes of
managing the nation’s water resources, Zimbabwe is divided into seven catchments that are based on the six major river basins in the country, and these are; Sanyati, Runde, Manyame, Mazoe, Mzingwane and Gwayi Catchment Council (Murinda, 2011). Each catchment is administered by an elected Catchments Council, with technical support from ZINWA. The Ministry of Water Resources Development and Management (MWRDM) provides guidance on policy matters through the Department of Water Resources (DWR) (GoZ, 2010). The main responsibility of ZINWA is to exploit, manage, and conserve water resources in order to ensure security of supply and to facilitate equitable access to water by all sectors, and its efficient utilization, while minimizing the impacts of drought, floods and other hazards (GoZ, 2010). In addition, ZINWA also work with urban councils to provide services in urban areas. ZINWA provides bulk water supply to cities and towns, and in those towns where the local authorities either cannot, or do not wish to, assume responsibility for service provision (WHO, 2009).
The key entities active in rural water and sanitation are; the National Action Committee (NAC), the Rural District Councils (RDCs), District Development Fund (DDF), and Water Environmental Sanitation Working Group (WES) (World Bank, 2012). The National Action Committee (NAC) has representatives from different ministries who are active in the programme. These include: Ministry of Local Government, Ministry of Rural Development and Water Resources, Ministry of Health and Child Welfare, and Ministry of Education (WSP, 2011). In practice however, the rural sanitation projects are always supervised by the Ministry of Health on the ground, with the Rural District Council being responsible for the procurement of resources (WHO, 2010). In 1992, the Government of Zimbabwe together with key donors, NGO’s and other resource persons prepared a “Vision 2000", a blueprint for how the decade may function in the future, with active and selforganized communities working with Rural District Councils, supported by Central Government in areas such as national planning, policy formulation, technical assistance and training, as well as research and information exchange (JMP, 2010). The increased involvement of NGO’s has been encouraged.
2.6 Millennium Development Goals (MDGs)
The Millennium Development Goals bind countries to commit themselves to finding solutions from within their nations and provide practical solutions that are relevant to their particular problems (UN, 2003). Figure 2.1 shows Zimbabwe’s progress towards MDGs. During the first
decade of independence (1980 to1990), real Gross Domestic Product (GDP) growth rate averaged 3 to 4% per annum and reached a peak of 7% in 1990 (WSP, 2011). During this period, public expenditure was geared towards the social sector and the expansion of the rural infrastructure, with the aim of reducing social and economic inequalities (World Bank, 2001). Such spending led to strong positive indicators in education and health. Since 1990, there has been little change in water and sanitation coverage in Zimbabwe.
Zimbabwe’s unprecedented economic decline saw spiraling inflation, deteriorating physical structures and, in 2008, the inability of the public sector to deliver basic social services resulting in severe cholera outbreak (World Bank, 2012). The country has been facing severe human resources capacity constraints in the public sector, the health sector in particular. According to UN (2013), progress towards water supply and sanitation has been further challenged by continuing population growth. Based on the most estimates of sanitation coverage in 2010, Zimbabwe needs to increase coverage from 52% to 77% in urban areas and from 32% to 68% in rural areas to meet the MDG targets in 2015 (JMP, 2010). In rural areas access to safe water needs to increase by17%
from 69% to 86%. In urban areas, populations have close to universal access to basic water supply, although100%has not yet beenreached(WorldBank,2012).Equityin achievingtheMDGtargets is important, not only because the poorest schools are least able to invest in their own facilities, but also because they have the most to gain due to their heightened vulnerability to adverse health outcomes (WHO, 2014). Therefore, additional efforts and resources are essential to ensure the poorest and most vulnerable rural schools are reached.
2.7 Project Funding, Promotion and Capacity Building
The Ministry of Health has supported an active promotion campaign for many years throughout the entire country and the offer of a material incentive has turned theory into practice for hundreds of schools (MoHCW, 2009). Since 1980, the government and politicians have supported the rural sanitationprogrammepossiblybecausethetechnologyis“homegrown”andpopularwiththeusers (Morgan, 2006). Latrine construction and the functions of the “Blair VIP” also form part of both the primary and secondary school curricular (Robinson, 2002). Schools and institutions build multi-compartment Blair Latrines which house up to ten cubicles in one single structure. It also became common practice to build a hand washing facility to provide hand washing facility close to school multi-compartment latrines (ZEWSP, 2006). Under this programme, models have been built and operations of the latrine taught. The campaign has resulted in the construction of around 500 000 familyBlair VIP latrines since its inception, including a few thousand multi-compartment school latrines in the national programme and many tens of thousands more in the commercial sector (MoHCW, 2011). Clearly, this has been a result of a mixture of sound technology plus practical marketing and the offer of financial support.
According to Morgan (2006), Ministry of Health has been training its Environmental Health Technicians (EHTs)toworkwithschoolteachersandstudentsindevelopingseriesofparticipatory tools (visual aids and lesson plans) on hygiene education in both primary and secondary schools, as well as upgrading of school sanitation facilities. The sanitation programme alone has led to the expansion of building skills widely throughout the country with many thousands of builders being trained annually. According to Robinson (2002), the Mvuramanzi Trust alone had trained over 1500 builders by 1997.
2.8 National standards for WASH in Schools
The 1976 Education Act, as amended in 2006 made provision for WASH in schools, among other requirements. It is required that every school shall have at least two blocks of toilets, separate for girls and boys, and the number of toilets is further determined by enrolment in line with Ministry of Primary and Secondary Education standards (25 pupils to 1 toilet/squat hole for boys and 20 pupils to 1 toilet for girls) (Minimum School Standards, 2013). Before a school is registered by the Ministry of Education, it is government policy that officials from MoHCW inspect and certify as satisfactory sanitary conditions at that school. The national standards require an improved toilet (Blair Ventilated Improved Pit) for rural schools without reticulated water supply, or water borne sanitation where reticulated water system is available (MoHCW, 2011). According to UNICEF (2013), the majority of WASH standards in schools in Eastern and Southern African region focus on acceptable ratios for the number of students per toilet, ranging from 20 to 50 students per toilet. Standards for water and hand washing are less common and none of the current standards found in the region consider the condition of facilities. Although a school may meet standards for toilet ratios on paper, the majority of them may appear to be broken down or filthy (WHO, 1996). Similarly, they may meet the official standards for hand washing basins even if water and soap and rarely provided. This research focuses on pupil-latrine ratios and the condition and adequacy of water and sanitation facilities, including availability of soap. UNICEF (2006), noted that funding for WASH, including government and civil contributions, are typically insufficient to support the realization of many government standards and are accordingly challenging to enforce.
2.9 Impact of Devotion and Decentralization on WASH
During the 1990’s, the Government of Zimbabwe was engaged in a decentralization programme in which the Rural District Councils played a much larger part in planning and financing development projects within their respective districts (World Bank, 2001). Project funding from a number of donor agencies now passes directly through the Rural District Council and these projects include latrine building and water supply (JMP, 2010). It has been accepted that some material support in the form of hardware (cement, reinforcing wire and a fly screen for the VIP latrine) be provided to schools that are willing to make considerable investments in the construction of their own latrines (Robinson, 2002: MoHCW, 2010). The value of the material assistance varied considerably, with some NGO’s offering far more than the government’s
recommendation, whilst other NGO’s offering less (World Bank, 2001). However, as the costs of labour and materials increased in the new millennium, far fewer schools were able to contribute to these costs since the value of the Zimbabwean dollar began to depreciate considerably.
Recently,developmentsinWASHsectorhavebeennecessitatedbyDevolutionProgramme, which has seen various Rural District Councils (RDCs) receiving funds for development purposes. Here, developmental projects have been cascaded from national level to districts level. These developments have seen the construction of dams, classroom blocks and toilets, as well improved water supplythrough availabilityof borehole water. The Devolution programme is founded on the principle of empowering provincial government councils to spearhead economic and social development projects in their respective area by utilizing local resources.
2.10 Global Status of WASH in Schools
TheinclusionofWASHinschoolsintheSDGs goals4a,6.1 and6.2depictsincreasingrecognition of their significance as key components of a safe and inclusive environment. The WHO/UNICEF JMP expanded its databases to include WASH in schools and published harmonized national, regional and global baseline estimates in August 2018 (UNICEF, 2022). A progress update was released in August 2020, including estimated trends from 2015 to 2019, with special focus on the implications for ensuring the safety of students and school staff during COVID-19 pandemic in 2019. In 2022, the JMP released a data update for the period 2000 to 2021, with thematic analysis on preparing schools for future pandemics and providing disability-inclusive WASH services in schools. The latest JMP report on WASH in schools showed the following findings (UNICEF, 2022);
a. Water Supply
71% of the schools had a basic drinking water service, 14% had limited service and 15% had no service. Nearly546 million children worldwide lacked basic drinking water service at their school.
b. Service
The findings revealed that 72 % of schools had a basic sanitation service, 16% had a limited service, and 15% had no service. Approximately 539 million children worldwide lacked a basic sanitation service at their school.
c. Hygiene Service
58% of schools had a basic hygiene service, 17% had a limited service and 25% had no service, Nearly 802 million children worldwide lacked a basic hygiene service at their school.
2.11 Recommendations
The following recommendations;
i. Efforts should be made by national governments, in Zimbabwe and other countries, to establish continuous monitoring systems to regularly track needs and improvements of WASH in schools.
ii. Further researches might look at water qualitytests on sources of drinking water in schools to determine whether water is contaminated or not. Escherichia coli or thermo tolerant coliform bacteria should not be detectable in any 100-ml sample. More so, water should meet WHO Guidelines for Drinking-water Quality or National Standards and acceptance levels concerning chemical and radiological parameters.
iii. Future studies might use a random sample of public schools to spot check and validate WASHconditionsreportedbyquestionnaires.Oneoptioncouldbetodeployrapidsurveys, with fewer questions and a smaller sample size, as an alternative to long-format surveys and can be used to study a specific research question in a smaller geographic area. Studies might also use mobile devices as monitoring instruments to collect geospatial data points. With geo-location, monitoring data can be linked to other data sets to provide additional covariates for analysis which will provide further value and more robust analyses.
Conclusion
Conditions are likely worse than specified in this study if schools do not improve water access and sanitation adequacy to students. For instance, not all improved water sources are necessarily free
of contamination, so access to safe water coverage may in fact be lower than reported since the results from the UNICEF/WHO Joint Programme and national WASH programme did not include water quality testing, but only access and coverage. Due to lack of a system of monitoring and surveillance, the government and donors may not have been aware of the low WASH coverage and rural disparity in the access and quality of WASH in schools.
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