Summary

A schoolchild educated to the benefits of sanitation and good hygiene behaviour is a conduit for carrying those messages far beyond the school walls, bringing lasting improvement not only to his or her health and wellbeing, but also to that of the family and the wider community. It is difficult therefore to over-emphasise the importance of school health and hygiene education (SSHE), the subject of this TOP.

Despite the potential for such far-reaching benefits and the apparent popularity of the issue with politicians because the practical outcomes attract voters, SSHE has not yet achieved widespread prominence in national water, environment and sanitation (WES) programmes. The authors say there is evidence of change, with many governments now adopting strategies that support SSHE, and several international agencies playing an important part in encouraging appropriate developments. Amongst several initiatives cited are those of UNICEF and the more recent 'life skills approach' being promoted by that agency in conjunction with IRC.

Perhaps the most important lesson from past experience is that SSHE is an 'approach to life' rather than an academic subject that can be taught with a focus on theory and written examinations. With that in mind classroom teaching has to go hand in hand with practice and that in turn demands that schools have adequate, clean and well maintained water and sanitation facilities.

Shortcomings in all these areas have been, and still are, frequently evident, and are the inevitable prelude to poor project outcomes. Such basic difficulties have therefore to be overcome but the authors make clear that success depends on instituting systems in which political support from the highest level permeates through all levels of administration and is allied to demand and active participation in the communities.

Teachers have to be motivated and well informed - including on the basic workings and maintenance needs of installed facilities - and should be kept abreast of SSHE advances by means of short courses after their initial training.

Programme monitoring is of extreme importance and should be seen as an avenue to 'assessment and adjustment' rather than merely an exercise in data gathering. It should be applied not only to classroom activities but also to the 'hardware' of SSHE - the school sanitation facilities - and to the programme outcomes in terms of disease control and, not least, the enrolment of girls into schooling.

In the shorter term, positive impacts on student health and on attendance of girls will be the most tangible evidence of success. Many references within the TOP, for example chapter 3, make it clear that children burdened by diarrhoea or parasitic infection develop more slowly, both physically and in their education. It is evident too that parents are less likely to enrol girls and that drop-out rates are higher at puberty when schools lack facilities or have poorly maintained, dirty latrines; privacy is also an important factor here.

For maximum impact an SSHE project has to be sustainable. Collaboration in several areas is an important element in meeting that objective - collaboration between government departments (health, water and sanitation, education etc), between professional disciplines and between the school management and the community. Those are the foundations for providing schools with clean drinking water and well-designed and maintained sanitation facilities; a healthy school environment and a platform for competent teaching to implant the hygiene habits that can bring lasting benefits to entire communities.