AN ASSESSMENT OF SANITATION FACILITIES IN PUBLIC PRIMARY SCHOOLS

IN KAJIADO CENTRAL DISTRICT

Annette Warero Gisore

H57 / 71445 / 07

A Dissertation Submitted in Partial Fulfilment for the Award of the Degree of

Master of Public Health (MPH) of the University of Nairobi

22 0ctober 2013
DECLARATION

I, Annette Warero Gisore, do hereby declare that this dissertation research is my

original work and has not been presented to any institution for the purpose of

obtaining a degree.

Signature: ____________________________ Date: _____________________

i
APPROVAL

This proposal is to be submitted as part fulfilment for the award of the degree of Master in
Public Health of the University of Nairobi with our approval as supervisors:

Internal Supervisors:

Prof. Mutuku. A. Mwanthi, PhD; MSEH; BSc.

Associate Professor of Public Health

School of Public Health-University of Nairobi

Signature: _________________________ Date: _____________________

Ms. Mary Kinoti, MSc (Human Ecology); MSc (Epi/Biostat); BEd(Sc).

Lecturer, School of Public Health-University of Nairobi

Signature: _____________________ Date: ______________________

Approved by Director, School of Public Health, University of Nairobi

Dr. Dismas Ongore, PhD.;MPH; MB.ChB.

Director, School of Public Health-University of Nairobi

Signature: ______________________ Date: _______________________

ii
DEDICATION

I dedicate this thesis to my family; Isaac, Aimee and Bryan; your support, patience

love and encouragement continually strengthens me. My parents Joan Nasimiyu and

John Opiyo for all the unconditional support constantly given, and my sister Cecelia

Nambengele whose mentorship and generosity has been an inspiration.

iii
ACKNOWLEDGEMENT

I wish to express my sincere gratitude and appreciation to my supervisors at the

School of Public Health - Prof Mutuku. Mwanthi and Ms Mary Kinoti for their

invaluable guidance, patience, advice, input and support during the development,

review and final defense of this thesis. Appreciation is also extended to Chairman

and lecturers at the School of Public Health, the Defense Panel and the external

examiner Dr. J. Kariuki for their invaluable input and perspective in the review and

analysis of the final document.

I appreciate the assistance of the then District Education Officer Mr. Odhiambo the

District Commissioner Mr Kakimoni and the staff at the study schools in Kajiado

Central District. Particular appreciation goes to Mr Indeche of the Ministry of

Education Headquarters who availed his own copy of the Safety Standards Manual

for Schools in Kenya, and thus enabled the effective actualization of this study.

Nawashukuru sana.

iv
TABLE OF CONTENTS

DECLARATION....................................................................................................................... i

APPROVAL ..............................................................................................................................ii

DEDICATION........................................................................................................................ iii

ACKNOWLEDGEMENT ...................................................................................................... iv

TABLE OF CONTENTS ........................................................................................................ v

LIST OF FIGURES ............................................................................................................. viii

LIST OF TABLES .................................................................................................................. ix

LIST OF ABBREVIATIONS ................................................................................................. x

DEFINITION OF OPERATIONAL TERMS ..................................................................... 13

ABSTRACT ............................................................................................................................ 14

CHAPTER 1: INTRODUCTION .................................................................................... 16

1.1 Background ............................................................................................................ 16

1.2 Statement of Research Problem ......................................................................... 21

1.3 Rationale/Justification of study............................................................................ 23

1.4 Study Limitation ..................................................................................................... 25

1.5 Objectives ............................................................................................................... 25

1.6 Hypothesis .............................................................................................................. 26

CHAPTER 2: LITERATURE REVIEW ........................................................................ 27

2.1 Health in Schools .................................................................................................. 27

2.2 Challenges in Developing Countries .................................................................. 29

2.3 Intervention Impacts.............................................................................................. 31

v
CHAPTER 3: METHODOLOGY ................................................................................... 34

3.1 Study Design .......................................................................................................... 34

3.2 Variables ................................................................................................................. 34

3.3 Inclusion and Exclusion Criteria .......................................................................... 35

3.4 Confounders ........................................................................................................... 36

3.5 Study Area .............................................................................................................. 36

3.6 Study Population ................................................................................................... 39

3.7 Sampling Procedure ............................................................................................. 40

3.8 Data Collection ...................................................................................................... 42

3.9 Data Processing and Analysis ............................................................................ 45

3.10 Minimization of Errors and Biases ...................................................................... 45

3.11 Ethical Consideration ............................................................................................ 45

CHAPTER 4: RESULTS ...................................................................................................... 47

4.1 Determination of the Pupil Latrine Ratio ............................................................ 48

4.2 Availability and Main Source of Water ............................................................... 51

4.3 Availability of Hand Washing Facilities .............................................................. 53

4.4 Cleanliness Status and Maintenance of the Latrines ...................................... 55

4.5 Awareness of School Administrators on National Standards ......................... 58

4.6 Comparison of the Study Schools’ Sanitation Facilities against the Set
National Standards................................................................................................ 59

CHAPTER 5: DISCUSSION, CONCLUSION AND RECOMMENDATIONS.............. 61

5.1 Discussion .............................................................................................................. 61

5.2 Conclusion .............................................................................................................. 70

vi
 5.3 Recommendations ................................................................................................ 71

REFERENCES ....................................................................................................................... 73

Appendix 1: Map of Arid and Semi Arid Lands in Kenya ................................................... i

Appendix 2: Informed Consent Explanation Form ..............................................................ii

Appendix 3: Key Informants Interview Guide and Structured Observation Checklist . iii

Appendix 4: Budget ................................................................................................................ ix

Appendix 5: Work plan ........................................................................................................... x

Appendix 6: Approval from KNH/UoN - Ethical Review Committee ............................... xi

Appendix 7: Approval from National Council for Science and Technology ....................xii

Appendix 8: Approval from Ministry of Education - Kajiado Central District ............ xiii

Appendix 9: Approval from Office of the President – Kajiado Central District ............ xiv

vii
LIST OF FIGURES

Figure 1: Main Source of Water for Schools (n=20)............................................................. 52

Figure 2: Percentage of Schools with Handwashing Points (n=20) ..................................... 53

Figure 3: Percentage of Schools with Water Present at Handwashing Points (n=11) .......... 54

Figure 4: Presence of Urine or Faeces in and/or Around Latrines (n=228) .......................... 55

Figure 5: Cleanliness Status of Latrines (n=228) ................................................................. 56

Figure 6: Frequency in Cleaning of Latrines (n=20)............................................................. 57

Figure 7: Type of Materials Used in Cleaning Latrines (n=20) ............................................. 58

Figure 8: School Head & Health Teachers’ Awareness of Published Standards (n=40) ...... 59

viii
LIST OF TABLES

Table 1: Educational Divisions and Schools in Kajiado Central District ............................... 42

Table 2: Summary of Data Collected ................................................................................... 44

Table 3 : Gender Distribution in Study Schools ................................................................... 47

Table 4: Latrine Ratios in Study Schools ............................................................................. 50

Table 5: Comparison of National Standards and Study Schools’ Latrine Ratios .................. 60

ix
LIST OF ABBREVIATIONS

AMREF African Medical Research Foundation

ARIs Acute Respiratory Infections

CWS Church World Service

CWSA Community Water and Sanitation Association

CLTS Community Led Total Sanitation

CSO Country Status Overview

DEO District Education Officer

ECDE Early Childhood Development and Education

EFA Education for All

ESH Environment Sanitation and Hygiene

EMIS Education Management Information System

ERC Ethical Review Committee

FPE Free Primary Education

GAA German Agro Action

GCN Girl Child Network

GLAAS Global Annual Assessment of Sanitation and Drinking Water

HH Households

HGSF Home Grown School Feeding Program

x
IRC IRC International Water and Sanitation Centre

JMP World Health Organisation and United Nations International Children’s

Emergency Fund, Joint Monitoring Programme for Water Supply and

Sanitation

KDDP Kajiado District Development Plan

KDHS Kenya Demographic and Health Survey

KIHBS Kenya Integrated Household Budget Survey

KII Key Informant Interview

KNH Kenyatta National Hospital

KPHC Kenya Population and Housing Census

KPLC Kenya Power and Lighting Company

MDG’s Millennium Development Goals

MoE Ministry of Education

MoH Ministry of Health

MoPHS Ministry of Public Health and Sanitation

MoWI Ministry of Water and Irrigation

NCST National Council for Science and Technology

NESHP National Environmental Sanitation and Hygiene Policy

NGO Non Governmental Organisation

NHPRRA National Health Policy for Rural Areas

xi
NIA Neighbourhood Initiative Alliance

PHAST Participatory Hygiene and Sanitation Transformation

RMI’s Repair, Maintenance and Improvement’s

SHP School Health Programme

SMC School Management Committee

SSHE School Sanitation and Hygiene Education

STH Soil Transmitted Helminths

UN United Nations

UNICEF United Nations International Children’s Emergency Fund

UoN University of Nairobi

UPE Universal Primary Education

USD United States Dollars

VIPL Ventilated Improved Pit Latrine

WASH Water Sanitation and Hygiene

WES Water and Environmental Sanitation

WHO World Health Organisation

WSSCC Water Supply and Sanitation Collaborative Council

xii
DEFINITION OF OPERATIONAL TERMS

Basic Sanitation One that provides privacy and separates human excreta

from human contact.

Hygiene The practice of keeping oneself and the surrounding

environment clean.

Improved Sanitation The availability and use of a simple pit latrine; ventilated

improved pit latrine, pour-flush latrine, or connection to

septic tank or a public sewer.

Open Defecation The practice of defecating and/or urinating on the ground

or in the bush, and not in a latrine or toilet of any type.

Vision 2030 Strategic plan of the Government of Kenya which sets the

year 2030 as the time by which Kenya should have

become a middle income country through a series of

development plans that have to be attained by that year.

13
ABSTRACT

The Government of Kenya has a National School Health Policy (2009) and its
corresponding guidelines National School Health Guidelines (2009), through which it
aims to ensure the improved health of all school going children. The policy provides
for a comprehensive school health programme which addresses various health
needs of children through the formal schooling system. Through the Safety
Standards Manual for Schools in Kenya (2008) school administrators have well
defined parameters and process indicators to guide implementation.

The proposed study was carried out in Kajiado County, where 56% of the
households defecate in the bush and 65% have boreholes as the main source of
water (Kenya Population and Housing Census (KPHC), 2009).School going children
spend between six and eight hours in school daily. Inadequate sanitation facilities
force them to practise open defecation and prevent them from washing their hands.
This exposes them to the risk of contracting faecal-oral and other sanitation related
diseases such as diarrhoea, typhoid and soil-transmitted helminth infections.

Objective: The study aimed to assess sanitation standards in public primary schools
within Kajiado Central District in order to evaluate the extent to which they conform
to the guidelines set in the Safety Standards Manual for Schools in Kenya (2008)
Ministry of Education/Church World Services.

Methods and Analysis: This was a descriptive cross sectional study carried out in a
population sample of twenty public primary schools in Kajiado Central District in
March 2012 during a normal school term. A structured observational assessment
based on a prepared checklist was carried out as well as key informant interviews

14
with the head teachers and health teachers. The study area has a small urban centre
Kajiado town, but the majority of the schools are in the rural areas. The study
employed mixed sampling techniques to ensure proportionate representation of
schools in all divisions of the district.

Results: A total of 228 pupil latrines and 57 staff latrines were observed in the study
with 58% of mixed schools having boys’ urinals. National standards stipulate a ratio
of 25 pupils to 1 latrine but the situation in the study schools differed greatly. The
overall pupil latrine ratio was 45 girls: 1 latrine with a door; for boys in schools with
urinals was 71 boys: 1 urinal and 2 latrines, while the ratio for boys in schools
without urinals stood at 71 boys to 1 latrine with door. The main source of water
varied with 30% having water piped to the school, 20% buying from vendors, 15%
respectively from community boreholes and water pans/dams, 5% own borehole and
the rest from rain water harvesting. Fifty five percent of schools had designated hand
washing points but water was only available in half of these, in effect only 30% of
study schools had functional handwashing stations. The study found that 45% of
school administrators were not aware of any type of national sanitation guidelines or
standards, while 85% of health/environment teachers reported being unaware of any
national standards or guidelines.

Conclusion: The sanitation facilities in public primary schools Kajiado Central

District do not meet national requirements with two parameters: latrine ratios and
functional hand washing points falling extremely short. In addition the school
administrators and health teachers ought to be knowledgeable on the national
guidelines and standards.

15
CHAPTER 1: INTRODUCTION

1.1 Background

Sanitation and Health

Sanitation refers to the promotion of hygiene and prevention of disease through the

provision of, and access to, safe water and adequate sanitation facilities; and good

individual hygiene practices. There is high morbidity and mortality related to lack of

water, poor sanitation and poor hygiene globally, with the developing countries

bearing the greatest load. Sanitation related diseases debilitate and kill one million

Africans every year (Enoh, 2010).The number of people without improved sanitation

facilities globally stands at 2.6 billion, and of these 533 million are in sub-Sahara

Africa (World Health Organisation (WHO),United Nations Children’s Fund (UNICEF),

2010).

The health, academic performance and retention rates of school going children is

greatly affected by the availability, accessibility and quality of sanitation facilities.

Studies indicate that an estimated 400 million children have diminished learning

abilities due to intestinal worm infestation (Hall et al, 2008); while according to the

International Resource Centre on Water and Sanitation (IRC, 2005) 75 percent of

adolescent girls in marginalized areas drop out of school due to the lack of adequate

private sanitation facilities in school.

16
Pit latrines are utilized as an effective and convenient method of on- site human

waste disposal in areas not served by a sewerage system. They also serve to

encourage prevention of disease, better sanitation practices and to deter open

defecation. It is estimated that globally four thousand (4000) children less than five

years die daily from diarrheal diseases alone, and millions of others are made sick,

weakened or disabled by diarrhoea and other water-and-sanitation-related diseases

(WHO/UNICEF, 2008).

Sanitation is an important aspect that is poorly addressed in developing nations and

a major cause of high infant mortality and morbidity as well as morbidity in children

and the general populace. The United Nations (UN) has included it as an integral

part of the Millennium Development Goals (MDG’s) as: MDG 7, Target 7C: ‘To

halve, by 2015, the proportion of people without sustainable access to safe drinking

water and basic sanitation’; (UN, Millennium Development Goals Project, 2000).

Recent estimates indicate that 2.6 billion people (approximately 39% of the global

population), lack access to improved facilities for the disposal of human excreta,

such as a basic pit latrine, toilet connected to a septic tank or sewer system or a

composting toilet (WHO/UNICEF, 2010). In several parts of the developing world

sanitation lags behind in all infrastructure development. In sub Saharan Africa 66%

of the population had no access to basic sanitation services in 2008 (WHO/UNICEF,

2010).

17
As part of the efforts to meet the Millennium Development Goals (MDG’s), the UN

Millennium Project and the UN Secretary General identified specific provisions for

accelerated implementation to schools and health care facilities and called this

‘Vision 21’. Targets promoted by Vision 21 include: 80 percent of schoolchildren

educated on hygiene, and all schools equipped with facilities for sanitation and hand

washing by 2015(Water Supply and Sanitation Collaborative Council (WSSCC),

2000).

International Guidelines

Guidelines for international standards of sanitation facilities in school settings require

the provision of basic sanitation facilities, (separate for boys and girls); provision of

water and soap (or ash) for hand washing after using the latrines and before meals,

and the provision of safe drinking water. According to Adams et al, (2009), the

number of toilets should be:

 One per 25 for girls and one for female staff; and

 One toilet and one urinal (or 50cm of urinal wall) per 50 boys and one for male

staff. They should be hygienic to use and easy to clean as well as having

convenient handwashing facilities close by.

Statistics from the Global Annual Assessment on Sanitation & Drinking Water

(GLAAS, 2010),, indicate that over 2.6 billion people did not use improved sanitation

facilities while nearly 900 million people did not use drinking water from an improved

source (WHO/UNICEF, 2010). The same document indicates that less than half of

18
the rural population are using improved sanitation facilities as compared to 76% of

their urban counterparts.

The lack of sanitation facilities contributes directly to soil transmitted helminth (STH)

infections. Due to open defecation, helminth cysts are very easily transmitted to their

human hosts leading to chronic infestation in given areas. Children are especially

vulnerable as they walk and play bare foot in their surroundings, and their health and

cognitive functions are adversely affected by a high helminth load. Children are

estimated to represent about one third (400 million) of the global soil-transmitted

helminth burden (The Task Force on Global Health, 2010)

http://www.childrenwithoutworms.org 24/08/10.

Kenya Government Policies

a) Government Policies

The government of Kenya through the National School Health Policy and Guidelines

aims ‘to provide safe water, adequate sanitation and hygiene services to all schools

in the republic (National School Health Policy, MoPHS/MoE, 2009). The concept is to

ensure the uptake of good sanitation habits at an early age so that they are retained

for life. The children will serve as change agents in their homes and communities.

Additionally there is the National Environmental Sanitation and Hygiene Policy

(NESHP, 2007), and a National Health Policy for Rural Areas (NHPRA, 2007), aimed

at providing basic sanitation and potable water to all citizens, especially in schools

and in rural and marginalized areas. The former Ministry of Public Health and

19
Sanitation (MoPHS), the Ministry of Education (MoE), and the former Ministry of

Water and Irrigation (MOWI), all had a role in the achievement of this goal (NESHP,

2007).

The then MoPHS had made sanitation improvement a priority; in its Specific Goals

and Strategies one of its milestone indicators states; Thrust 2.5: Increase sanitation

coverage from 46% to 66% and Increase no. of households utilizing clean water by

20%, (MoPHS Strategic Plan 2008-2012). This translates to 644,000 households

with latrines and a similar number of households using treated water. This was part

of the Ministry’s plan in efforts to meet the government’s First Term Medium Plan of

Vision 2030. Implementation of a comprehensive School Health Programme is

addressed in Strategic Thrust 1 which sets the target of 1800 schools successfully

implementing the policy by 2012, (MOPHS Strategic Plan 2008-2012).

Further commitment from the government through ‘Sessional Paper No. 1, 2005’,

and the ‘National Action plan for Education for All (EFA)’ put structures and policies

in place to ensure equity in education, and elimination of gender and regional

disparities. Thus since 2003 under the FPE programme, all primary schools receive

Kshs.1, 020 (USD 13.6) for each child to cover for tuition, instructional material and

support staff (exchange rate of Kshs. 85 to 1 USD, 2012 rates). Any additional levies

have to be approved by the Ministry of Education, and have to have been ratified by

the School Management Committee (SMC) and the District Education Office

(Education Service Delivery in Kenya, MoE/UNICEF 2005).

20
b) National Guidelines

The then Ministry of Public Health and Sanitation (MoPHS) and the Ministry of

Education (MoE) developed the National School Health Policy and its accompanying

Guidelines to give general direction on a comprehensive school health program. The

School Safety Standards Manual stipulates the number of, and required provisions

for sanitary facilities, these being:

 The first 30 learners: 4 closets (holes),

 The next 270 learners: one extra closet for every 30 learners,

 Every additional learner over 270 learners: 1 closet per 50 learners, (Safety

Standards Manual for Schools in Kenya, MoE, 2008).

According to the Kenya Integrated Household Budget Survey (KIHBS) in a document

titled ‘Well being in Kenya’, water is considered safe if it is obtained from the

following sources; piped water, boreholes, protected spring and protected well. It

also defines adequate sanitation to include the use of flush toilet (to sewer/septic

tank), covered pit latrine and ventilated improved pit latrine (VIPL), (Kenya National

Bureau of Statistics, 2008).

1.2 Statement of Research Problem

During the school term school going children spend majority of the day in school, a

duration of between five to eight hours for pre-school and upper classes respectively

as per the school schedule set by the Ministry of Education. Thus the availability and

21
access of sanitation facilities which include latrines, wash basins and water for hand

washing and drinking is essential for their health and well being.

Children are the most susceptible to diarrhoeal diseases with an estimated annual

mortality of 2.2 million children due to unsafe water, inadequate sanitation and

insufficient hygiene (WHO, 2008). Open defecation creates a situation where the

children are exposed to pathogens leading to high incidences of diarrhoeal diseases,

soil-transmitted helminth infections and other faecal- orally transmitted diseases.

One of the major challenges facing schools came about due to an increase in

enrolment from the year 2003, brought about by free primary education (FPE)

implemented as a result of election pledges during the 2002 national elections.

Enrolment in public primary schools increased from 6.9 million in 2003 to 7.4 million

in 2007 (a 7.7% increase), while enrolment in private primary schools increased by

251% from 253,169 to 889,192. The net enrolment rate rose from 80.4% to 91.6% in

the same period (Education Management Information System (EMIS), MoE 2008). A

look at government policies and publications does not indicate budgetary provisions

made to match infrastructure provision including that of improved sanitation.

Accordingly the assessment on sanitation standards in public primary schools was

based on the Safety Standards Manual that has comprehensive guidelines and

minimum standards on various health and safety aspects for schools in Kenya. The

Safety Standards Manual (2008) replaces the Ministry of Education Circular (2001)

22
that was previously used to define the Health and Safety Standards in educational

institutions. The National School Health Policy (2007) and its accompanying National

School Health Guidelines (2007) both jointly MoPHS/MoE, have general guidelines

but do not have the required details for comprehensive implementation.

Research Question

Are the sanitation facilities in public primary schools in Kajiado Central District in

conformity with the stipulated standards set in the , Ministry of Education, Safety

Standards Manual for Schools in Kenya, 2008; policy document?

1.3 Rationale/Justification of study

Children spend most of their day in school, a duration of approximately 5-8 hours for

preschool and primary classes. Thus the availability and access of sanitation

facilities which include latrines/toilets and water for hand washing among others is

crucial. Studies have shown that lack of adequate sanitation facilities in schools lead

to high rates of absenteeism, poor academic performance and reduced retention

rates especially amongst girls (Redhouse 2004, Njuguna et al 2008, Freeman et al

2011).

Public primary schools were chosen as the study population as they are the schools

under the direct jurisdiction of the Government of Kenya through the MoE. They are

also the schools to which majority of pupils from the surrounding community in

23
Kajiado Central District enrol and attend. Thus their administrators would be

expected to adhere to government standards and regulations in the running of the

schools.

There are 37,954 Early Childhood Development and Education (ECDE) centres and

26,606 primary schools in Kenya with an enrolment rate of 1.72 million and

8.6 million respectively (EMIS, MoE, 2009). These 10.3 million children are the focus

of the health education programmes especially those in preschool and lower primary

(Classes 1-4).These schools receive funding from the government through the Free

Primary Education (FPE) program; and the amount disbursed per school is

dependent on the number of pupils registered in the school.

In Kajiado Central District, there are no sanitation or sewerage services provided by

the national or local authority; and there is also chronic water scarcity most of the

year. There is a relatively small urban area being Kajiado town while majority of the

area and residents are rural based. The region is classified as an arid and semi arid

land area (ASAL) Appendix 1 (ASAL Map), a marginalized area in need of special

intervention. The study aims to assess the status of the sanitation facilities in the

selected public primary schools.

Assessing the existing situation in the area will enable acquisition of relevant data

from a local perspective, and thus the necessary interventions may be initiated. The

data from the study may guide future interventions. The outcome of the study

24
informed on the current situation in the area and its findings will be shared with the

MoE and MoH to enable them evaluate the application and implementation of their

sanitation policies and safety standards.

1.4 Study Limitation

The vast area of the study region (8, 141km2) with harsh terrain, poor transport

infrastructure and many schools located deep in the hinterland posed a big challenge

in accessibility and limited the sampling of desired number of schools. The study was

time bound by the school calendar, as it had to be carried out during a normal school

term, thus it could not be carried out in April, August or December. Additionally the

study could only be conducted when there are no national or school examinations;

and other extracurricular activities such as sports events or drama festivals going on

at the school.

1.5 Objectives

The main objective was to assess the sanitation facilities in public primary schools in

Kajiado Central District.

The specific objectives were:

i. To determine the pupil : latrine ratio;

ii. To ascertain availability and source of water;

iii. To determine the availability of hand washing facilities;

25
 iv. To evaluate the state of cleanliness and maintenance of the latrines;

v. To explore awareness of national sanitation standards and guidelines

by school administrators

vi. To compare the sanitation facilities against the set national standards.

1.6 Hypothesis

Public primary schools in Kajiado Central District meet the requirement of hygiene

and sanitation guidelines as set in the Safety Standards Manual for Schools in

Kenya and the National School Health Policy and Guidelines, Ministry of Education

documents.

26
CHAPTER 2: LITERATURE REVIEW

2.1 Health in Schools

School Water, Sanitation and Hygiene Education (SWASH) refers to the

collaborative efforts of various stakeholders; government, NGO’S and international

institutions, to ensure safe and healthy schools through the provision of clean water,

latrines for both girls and boys, and appropriate hygiene education. This is put in

context as estimates indicate that 1.1 billion people worldwide lack access to

improved water supplies and 2.6 billion people lack adequate sanitation (UNICEF,

2010).

Less than two thirds of the global population, an approximate 2.6 billion people do

not use improved sanitation. The greatest numbers are found in Southern Asia

followed by large populations in Eastern Asia and Sub-Saharan Africa. Access to

water is better with 87% of the world population and 84% in developing countries

getting their drinking water from improved sources. But sub-Saharan Africa fares

poorly with only 60 % of its population using improved sources of drinking water,

(WHO/UNICEF, 2010).

The international bodies such as UNICEF, WHO, amongst others have been active

in spearheading, WASH campaigns across the world with special emphasis in

developing countries in Asia and Africa. Studies indicate that annually 272 million

school days are lost by children due to diarrhoea (Hutton et al, 2004). This has

27
obvious detrimental effects on academic performance. The availability of water and

sanitation facilities in schools has been shown to reduce diarrhoea and hygiene

related diseases amongst school children (Curtis et al 2003; Pruss-Ustun et al,

2008).

An estimated one in three school–aged children in the developing world is infested

with intestinal worms (Savioli et al, 2002). A more recent study estimates that 400

million school children and 47 percent of 5-6year olds in the developing world are

affected by worms (Hall et al, 2008). The same study indicates that 100 percent of

annual soil transmitted worm infestation cases are attributable to inadequate

sanitation and hygiene. The reduction of open defecation through adequate latrine

provision especially at schools; may definitely reduce and eventually break the cycle

of infection and re-infections.

Where sanitation is poor and water supply is inadequate and unsafe, outbreaks of

disease with severe health consequences tend to occur. Water and sanitation

related diseases include diarrhoea, cholera, typhoid, dysentery, hepatitis A,

Poliomyelitis, acute respiratory infections and soil-transmitted-helminth infections.

The global Disability Adjusted Life Years (DALY’s) for diarrhoeal diseases is

estimated to be 4.1 percent and it’s also estimated to be the cause of death for

1.8million people annually (WHO, 2010), most of them being children in developing

countries.

28
Other than providing adequate latrines, the availability of water and soap for hand

washing further enables the reduction of diarrhoeal disease and respiratory

infections. Studies indicate a 30 percent reduction in diarrhoea cases when hand

washing is practised in day care centres and primary schools (Ejemot et al, 2008).In

addition other studies also indicate washing hands with soap could reduce acute

respiratory infections including pneumonia, which is the highest cause of child

mortality, by 25 percent (WHO, 2008).

Availability of latrines and water improves school attendance and is especially

important for adolescent girls who are menstruating as they require the privacy of

separate latrines and also water. When this is lacking there is consistent

absenteeism during their monthly period and this can reach up to twenty percent of

school time (IRC, 2005). Many times such girls drop out all together from school

especially as they also face challenges accessing sanitary towels due to its cost.

2.2 Challenges in Developing Countries

Developing countries face challenges in the provision of sanitation facilities and this

is markedly more so in schools. A study in India evaluating the environment and

sanitation in a rural government school as compared to national guidelines found

that only 50% of the schools had adequate latrines for boys and 60% had adequate

latrines for girls, while only 10% had adequate handwashing points with soap (Majra

et al, 2010).

29
In Bangladesh a UNICEF study on sanitation facilities in primary schools (UNICEF,

2004) showed an average of one latrine for 152 pupils, with 25% having one latrine,

44% with two latrines, 13% with non functional latrines and 6% having none. The

same study also indicates that 19% of all schools had no water facilities, 28% having

non functional water sources and 53% with functional water sources. There are no

national guidelines on sanitation facilities in primary schools in the country (Nahar et

al 2006).

The situation of inadequate sanitation facilities in schools is replicated in Africa.

Many times those entrusted with school administration are neither adequately

informed nor knowledgeable on the policies in place. A study on Knowledge and

practice of School Health Programmes in a local government area in Nigeria

reported that 27.7% of the schools had no toilet facility, 33% had pit latrines while

40% had water closets. Only 25.6% had handwashing facilities. Additionally none of

the head teachers had adequate knowledge on the school health programme

(Ofovwe et al, 2007).

In Ghana a study carried out to determine the conditions of the existing sanitation

facilities indicated that out of 30 selected schools, 53% were without toilet facilities

while 83% were without safe water on site (Gyabaah et al, 2009). The Ghanaian

education policy requires all schools to have adequate sanitation and safe water

facilities with a required ratio of 50 persons per squatting hole set by the Community

Water and Sanitation Agency (CWSA) 2004).

30
In South Africa, twenty three percent of the population is without access to basic

sanitation while nine percent lack access to safe water. In regards to school

sanitation, the government of South Africa aims to ensure that all schools have

adequate sanitation facilities by 2014 (Global Water Challenge, 2010).

2.3 Intervention Impacts

The WASH concept incorporates the aspect of child-friendly facilities to enable pupils

easily and safely utilise the latrines and hand washing points provided. This requires

that the facilities constructed should take into consideration and be adapted, to fit

children’s smaller size and not just construct ‘standard’ latrines. Thus the latrine

squatting hole and foot rests should be customized with children in mind as well as

the height and location of the taps at hand washing points. A study in Tanzania

showed a 12 percent increase in school attendance when water is available within a

15 minute walk (Redhouse, 2004).

Availability of sanitation facilities on the other hand, leads to improved health

outcomes for children and keeps girls in school. An evaluation of WASH in schools in

Kenya showed that girls were less absent in schools where there was more hand

washing and high toilet use, and there were reduced incidences of diarrhoeal

diseases and helminth infestation (Njuguna et al, 2008).

31
Using children as agents of change not only within their schools but especially in

their communities is one of the driving points in the school WASH programme. A

study carried out in rural western Kenya showed that when children are actively

engaged in WASH they lead to community adoption of good hygiene behaviours and

adoption of sanitation technologies (Onyango-Ouma et al, 2009).This in turn leads to

improved health both at individual and community level (Bowen, 2007).

A randomized impact evaluation of a deworming programme in western Kenya

demonstrated that the worm burden in children contributed to 25% of overall school

absenteeism rates, (Poverty Action Lab, 2007) The Ministry of Public Health and

Sanitation has recognised the impact of helminth infestation and has active

deworming campaigns carried out every quarter in schools by the area public health

officers. The data is tracked and monitoring indicators in percentage for the number

of school children properly dewormed in the catchment area on an annual basis is

regularly recorded (MoPHS Strategic Plan 2008-2012, 2009).

A recent cluster randomized trial of school-based WASH on pupil absence in Nyanza

Province of three arms: water treatment and hygiene promotion, sanitation

improvement, and control; indicated a 58% reduction in absence for girls (Freeman

et al, 2011). Another analysis of a SWASH + project in the same region resulted in a

60% reduction in diarrhoea in the schools that were receiving comprehensive WASH

interventions (Brooke Keen et al, 2011). In addition it also exposed challenges in

maintenance operational budgets as well as the role of individual administrators’

initiative in the status of sanitation in schools.

32
In the school environment, teachers input and cooperation is crucial as they serve as

role models to their pupils and also to the community. Supporting and encouraging

good hygiene behaviours is an additional task outside of standard teaching duties

and thus finding ways to keep the teachers motivated to continue with this effort is

important.

33
CHAPTER 3: METHODOLOGY

3.1 Study Design

This was a descriptive, cross sectional study. The study assessed the standards,

maintenance and physical structures of the sanitation facilities in public primary

schools in Kajiado Central District. Sanitation facilities in the context of the study

refer to toilets/latrines, washstands/handwashing stations, and water for - drinking,

hand washing and cleaning the toilets/latrines. Public primary schools were chosen

because these are schools which are under the jurisdiction of the Government of

Kenya through the Ministry of Education (MoE). They are also the schools in which

the majority of pupils are found. These schools receive funding from the government

through the Free Primary Education (FPE) programme. The amount of funding is

dependent on the number of pupils registered per school. The sanitation facilities in

the study schools were assessed to establish their conformity with the Safety

Standards Manual for Schools in Kenya, MoE/CWS 2008.

3.2 Variables

The exploratory variables in the study were:

1. Availability of latrines

2. Accessibility/Usability of latrines

3. Availability of water

4. Adequacy of the sanitation facilities

5. Cleanliness of the latrines

34
6. Privacy of the latrines

7. Availability of handwashing stations

8. Type of school-rural or urban

9. Boarding or day school

10. Funding for sanitation facilities and type/extent of funding

3.3 Inclusion and Exclusion Criteria

Inclusion Criteria

Schools included in the study were;

i. Public primary schools funded and administered by the Ministry of

Education.

ii. These could also be mixed/co-ed (both boys and girls), or single sex

(only girls or only boys) in composition

iii. May be day and/or boarding schools.

Exclusion Criteria

Schools that have private ownership and exclusively privately funded were not part

of the study

35
3.4 Confounders

There are public schools that have received funding and donations for sanitation

projects. These were in the form of direct financial aid for specific sanitation

infrastructure or material donation of structures such as water tanks. They thus had

better facilities than others that did not receive such funding. Thus a section of the

questionnaires enquired about the extent and type of donor funding and addressed

the findings in the analysis.

3.5 Study Area

Administration

The study was carried out in Kajiado Central District, which is in Kajiado County in

the south-eastern area of the Rift Valley Province in Kenya, (ASAL Map Appendix 1).

Kajiado Central covers an area of 8,141.9km 2 (Kajiado District Commissioners Office

2008). Kajiado was originally one vast district covering total of 21, 902.9m2 and

situated between longitude 3605’ and 3705’east and between latitudes 100’ and 300’

south. It was divided into 3 districts Kajiado North, Kajiado Central, and Loitoktok in

the period 2009-2010 for easier administration (Kajiado District Development Plan

2009).

The district comprises of the divisions of Central, Enkorika, Bissil and Namanga

which were among 7 divisions in the former larger Kajiado district. The district

borders the Republic of Tanzania to the south west; Kajiado North district to the

36
East; Kibwezi and Nzaui districts to the southwest, and Narok North and Narok

South districts to the west. The district has two local authorities- Ol Kejuado County

Council and Kajiado Town Council (Kajiado District Development Plan (KDDP) 2008-

2012, 2009).

The Central Zonal Education Office which is in the centre of Kajiado town, houses

the Home Grown School Feeding Programme (HGSFP). The HGSFP had measured

and recorded the distance from its office to every school in the district for the

purposes of accounting for mileage when distributing food. The schools in the study

closest to, and furthest from this reference point, were 5kms and 180kms away

respectively.

General Population

During the recent census, the population in the district was found to number 162,278

(Kenya Population and Housing Census (KPHC), 2009). The percentage of

households with latrines was 30% out of which 60.0% being simple pit latrines

(KPHC, 2009). The district had 22 public primary schools with a total population of

12,345 pupils as of June 2010(District Education Office, Kajiado,2008) but at the

time the study was carried out the number of schools had risen to 85. The estimated

population of under fives was 35,163 while for school age going children (6-13) was

11,348.8(District Statistics Office Kajiado, 2008).

37
Culture

In the area under the study, communities are still largely rural and the Maasai who

are the majority live a pastoral nomadic lifestyle with deep held cultural practices and

beliefs. Fifty six percent of HH in the district deposit their human waste in the bush

(KPHC, 2009). Hygiene and sanitation education at school and community level has

been the major approach used to attempt to bring about change. Participatory

methodologies such as Community Led Total Sanitation(CLTS), Participatory

Hygiene and Sanitation Transformation(PHAST); as well as Water, Sanitation and

Hygiene Education (WASH) programmes; have been carried out in communities and

schools. This has been in an effort to drive acceptance and sustained change

through active community participation in sanitation and hygiene practices.

Climate

Kajiado district is one of the arid and semi-arid lands (ASAL) with livestock keeping

being the predominant economic activity. Most of the land is non-arable (92%) with

only 8% able to sustain subsistence farming. During the period 2003-2007 there was

a terrible drought with the district losing over 70% of its livestock population. The

government currently runs a school feeding program in the district to enable keep

children in school (KDDP, 2009).

The district is water deficient with few permanent rivers that are along the border with

other districts. The alternative water sources are pans (400) and dams (5) and many

boreholes. Currently there are 300 private, 264 institutional and 436 Government of

38
Kenya (GoK)/community boreholes, but due to low management capacity only 60%

of the community boreholes are operational. Households with access to piped water

stand at 30%, while those with access to potable water are 10%.The average

distance(km) to the nearest water point during the dry season is 10km and 5km

during the wet season (KDDP,2009).

Infrastructure

Kajiado district has 2 district hospitals, 3 nursing homes, 11 health centres, 51

dispensaries and 27 private clinics. There is low acceptance of family planning

methods at only 14%, while immunization has attained over 80% coverage.

HIV/AIDs prevalence is at 6.25 which is higher than the national rate of 6.1% (KDDP,

2009).

There are 4 tarmac roads in the district with a total of 288kms. These are Namanga-

Athi-River, Isinya-Kiserian, Magadi-Mbagathi and Kiserian-Ngong. However, most

areas are served with either gravel roads (609.7km), or earth roads (619.9km).

Railway length is 147 km with 5 airports/strips and mobile network coverage of 60%.

There are 8 post offices and 3 sub post offices (KDDP, 2009).

3.6 Study Population

The study population’s sampling frame consisted of all the public primary schools in

Kajiado Central district, registered at the District Education Office. The education

39
sector is administered from the District Education Office and is divided into 2

divisions Central and Namanga. These divisions are further divided into 5 zones,

with each being supervised by a District Zonal Officer who reports to the District

Education Officer (DEO). The DEO is the administrative head of all the public

schools in the district.

There were 85 registered public primary schools in Kajiado Central District at the

time of the study (March 2012), Seventy seven percent of the schools (n=65) were

previously community run schools and had only just joined the MoE during the period

2010-2012 since the introduction of FPE. The parameters’ under assessment were

the sanitation facilities in these schools; these included the latrines, the water

supply/main water source and hand washing facilities/stations. There were two key

informants interviews in each school for data collection, and these were the Head

teacher (or deputy or senior teacher) and the health/environment teacher.

3.7 Sampling Procedure

The Sampling Frame was drawn from the public (government run and funded)

primary schools in Kajiado Central District, duly registered at the District Education

office. There was close collaboration with the District Education Office (DEO) of

Kajiado Central district as they are the office mandated to oversee all the public

schools in the area. The DEO availed a list of the divisions, zones, and all the

schools in each zone which the Investigator utilized for sampling purposes. At the

time of data collection there were 85 schools in the district with a mixture of both

40
urban and rural schools (Table 1). Seventy seven percent of these schools (n=65)

had been community schools and only just become part of the MoE family during the

period 2010-2012 since the introduction of FPE in 2003.

Sample Size Determination

Purposive sampling was applied in selecting the number of schools to be assessed

in the study due to the vast size of the district with schools scattered up to one

hundred and eighty kilometres apart. While taking cognizance of the need for

adequate district representation into account, the sample size was also influenced by

resource limitations .The sampling unit was the public primary schools in Kajaido

Central District. The district has 2 divisions and 5 zones and on assessing the

sampling frame provided at the District Education Office (Table 1), this would

translate to approximately 3 schools sampled from each zone, with additional

schools included in zones having higher numbers of schools.

The sampling type was a simple systematic random sampling where study schools

were randomly chosen from the sampling frame with the first and every subsequent

fifth school on the list being selected (i.e. every 1st, 5th, 10th school etc). As such

zones with higher numbers of schools had a higher representation as more schools

were included in the study (Table 1) making a total of 20 schools selected for the

study. There was thus a proportional representation of each zone amongst the

sampled number of schools.

41
Table 1: Educational Divisions and Schools in Kajiado Central District

Education Educational Zones Number of Schools Schools Sampled

Divisions

Kajiado 18 4

Central
Enkorika 17 4

Elangata Wuas 11 3

Il Bissil 26 6

Namanga
Namanga 13 3

Totals

2 5 85 20

3.8 Data Collection

The researcher carried out the data collection in all the schools and this was done

during a normal school day. The investigator first introduced herself to the head

teacher, deputy head teacher, or teacher on duty, briefed him or her on the study

before requesting for permission for the study to be carried out in the school. The

respective teacher in attendance then signed two consent forms, with one copy

being left at the school. Data collection was done using interviewer administered

questionnaires and structured observation checklist. The format for the both the

structured observation checklist and the questionnaires were developed using the

42
Safety Standards Manual for Schools in Kenya, MoE (2008), as the guiding

document. Due to the large size of the district and rough terrain there were

challenges faced in reaching many of the schools but once at the schools, full

cooperation was experienced from all the school staff with a 100% response rate. All

schools consented to participate in the study. The survey instruments comprised of

Head teacher questionnaire, Health/Environment teacher questionnaires, and

structured observation checklist.

Key Informant Interviews

Key Informant Interviews (KII) were carried out to solicit information from the staff

using interviewer administered questionnaires. In each school information on the

administrative issues in regards to water and sanitation was sought from; a school

administrator (head teacher or deputy; or in their absence the senior teacher,

teacher on duty, or any other teacher delegated the task). The second KII was the

school health/hygiene teacher or environment teacher or WASH club teacher/patron.

Flexibility was given because schools have different names for the teacher in charge

of the cleanliness, hygiene and sanitation matters. Thus from each school data were

collected from two key informants (Table 2 and Appendix 3) making a total of 40

filled questionnaires from this group.

Structured Observation Checklist

A structured observational survey was carried out in each of the schools to assess

the status of sanitation facilities in place. Thus, the numbers of forms for purposes of

43
recording data on were 20, equal to the number of schools. Direct observation of the

sanitation facilities in the schools was carried out by the Investigator (Table 2 and

Appendix 3) using a defined checklist. Handwashing points were designated as any

contraption used to dispense water for the purpose of washing hands and included

but were not limited to: regular sink with taps, tank and tap, tippy taps or other.

Table 2: Summary of Data Collected

Survey Instrument Expected Response Actual Response

Head Teacher KII 20 20

Health/Hygiene/Environment or 20 20

WASH Teacher KII

Observation Checklist 20 20

Total 60 60

Quality Assurance

To ensure accurateness and completeness in data collection, back checks and

cleaning-up of study tools was done in the field to ensure all the required data were

sufficiently captured before leaving a school. In addition observation of the sanitation

facilities was carried out over the same period of time each day i.e. between 12-3pm

to ensure that pupils had had a chance to use the facilities.

44
3.9 Data Processing and Analysis

The data was entered into and analysed using Microsoft Excel®. The questionnaires

to key informants were coded and tallied for easier and comprehensive analysis.

There were 111 variables under consideration for each school, making a total of

2,220 variables for analysis. Analysis and interpretation of the results was done

using descriptive statistics – ratios, percentages frequency tables and charts.

3.10 Minimization of Errors and Biases

Prior to commencement of the study, a study pre-test was carried out at a local

public primary school in Kajiado, which was not part of the study sample. The pre-

test was carried out during a week day in the school term when all pupils and staff

were available. The pre test and its results were used to fine tune the survey

instruments and to make any necessary adjustments to address any shortcomings

and challenges prior to conducting the actual study. The schools studied were all

public primary schools both day and boarding as was the case, to ensure that the

resources, facilities, structures, staff and students were as similar as possible.

3.11 Ethical Consideration

The study was jointly approved by the Kenyatta National Hospital and; University of

Nairobi, Ethical and Research Committee (KNH/UoN-ERC)(Appendix 6).

45
Additionally, authority and permission to carry out the study was sought from the

National Council of Science and Technology (NCST), the District Education Officer

and the District Commissioner, Kajiado Central (Appendices 7, 8 and 9). Once at the

selected school, permission to carry out the study was requested from each head

teacher (or relevant representative) and once given an informed consent form was

signed, then the interviews and observations commenced. (Appendix 2).

46
CHAPTER 4: RESULTS

The results are compared to the standards set in the Safety Standards Manual for

Schools in Kenya (MoE, 2008) under the topic Sanitation Standards on pages 22-24.

Demographic Characteristics

The total pupil population in the study schools was 10,052, with 4,827 boys and

5,225 girls; amongst these preschool pupils were 1,852 (901 boys and 951 girls).The

average number of pupils per study school in the district was 503 with these being

254 boys; and 261 girls, while the range in gender population in the schools varied

from 58 – 501 boys, and 42 – 714 girls. The staff both teaching and support

numbered 304, these being 134 males and 170 females. There were 86 special

needs pupils in thirty percent (n=6) of study schools.

Table 3 : Gender Distribution in Study Schools

Parameter Boys Girls Total

Pupil population in study 4,827 5,225 10,052

schools

Number of preschool pupils in 901 951 1,852

study schools

Average number of pupils in 254 261 503

study schools

Staff - teaching and support 134 170 304

47
4.1 Determination of the Pupil Latrine Ratio

All the schools had pit latrines which were mainly ordinary and ventilated improved

pit latrines (VIP).A total of 228 pupil latrines were present in the study schools and

were subjected to an observational assessment. The National recommendations are

that latrines should be a minimum of 10 metres from tuition and boarding facilities

and these were met in all the study schools. The distance measured in the study

schools from the tuition block to the latrines, ranged from a minimum of ten metres to

a maximum of seventy five metres; while that of schools with boarding facilities was

a minimum of fifteen metres to a maximum of forty five metres from boarding block to

the latrines and ablution block. Any latrine that had been constructed and had a

hole/aperture in the ground for disposal of urine or faeces was termed ‘latrine hole’,

while a latrine with a hole in the ground and a door was classified ‘latrine with door’.

4.1.1 Preschool Latrine Facilities

Out of the schools sampled 85% (n=17) had a Preschool (nursery) section, but out of

these only 29 %(n=5) had separate latrines for the preschooler boys and girls. The

preschooler latrines all had doors with the exception of one girl’s preschool latrine. In

only one school (6% of schools) were the preschool latrines designed with the small

latrine holes in consideration of the smaller sizes of the pupils.

4.1.2 Pupil latrine ratio

The average ratio of pupils to latrines was found to be 39 girls to every latrine (hole),

and 45 girls to every latrine with a door. Forty two percent of mixed schools had no

48
urinals for boys and in these schools the pupil latrine ratio was 48 boys to every

latrine (hole) and 71 boys to every latrine with a door (Table 4). The distinguishing of

these two (latrine hole and latrine with a door) is due to practicability of use as

latrines with no doors pose challenges in regards to privacy in utilization. The

National Standards ratio is ‘25 pupils to 1 closet’ the ratios above clearly indicate an

acute inadequacy in latrine provision in the schools clearly in contravention of the

required standards In addition all mixed schools with the exception of one, had

separate latrines for boys and girls and therefore met the requirements.

4.1.3 Urinals

Fifty-eight percent of mixed schools (n=11) had urinals and all these met the

minimum wall length requirements of 42cm, with a majority actually longer. The ratio

for sanitation facilities for these schools with urinals stood at 1 urinal and 2 latrine

holes per 61 boys; and 1 urinal and 2 latrines with doors per 71 boys (Table 4). The

national standards are: “one third of the fittings for boys should be closets and the

rest urinals". Therefore these should be 1 urinal and 2 latrines per 75 boys and the

existing status though mildly in breach are encouraging in these schools with urinals

for boys.

4.1.4 Staff Latrines

There were a total of 57 staff latrines in the study schools out of which 33% were

funded by donors. Staff sanitation in the study schools in the district met the required

ratios of “at least one closet for 12 persons” set in the Safety Standards. On the

49
other hand it fails in that 65% of schools had shared staff facilities, yet the standards

require that there should be separate male and female facilities. The average ratio of

staff to latrines was 4 males per latrine, 7 females per latrine and 6 staff per shared

latrine (Table 4).The ratios of pupil and staff latrines in the study schools takes into

consideration the total number of pupils both in primary and pre-school as well as

factoring in urinals in the schools that had them (Table 4).

Table 4: Latrine Ratios in Study Schools

Study Findings

1 urinal and 2 latrine holes : 61 boys

Boys 1 urinal and 2 latrines with doors : 71 boys

(schools with urinals)

1 latrine hole : 48 boys

1 latrine with door : 71 boys

(schools with no urinals)

1 latrine hole : 39 girls

Girls
1 latrine with a door : 45 girls

1 latrine : 4 males

Staff
1 latrine : 7 females

1 shared latrine : 6 staff`

50
4.1.5 Special Needs

Thirty percent of schools had learners with special needs; and of these special

needs pupils (n=86) 44% were hearing impaired. Other special needs children

present were physically challenged and visually impaired (but not totally blind).No

school had any provision for the special needs learners contrary to set requirements.

4.2 Availability and Main Source of Water

Water Source

The provision of piped water to schools occurred in 30% of study cases. These

schools also had the most reliable water supply and visible presence of water

availability. Water was piped by the local water authority from a central borehole to

the schools. Some schools relied on rainwater as the main water source despite the

fact that the area is semi-arid and rains are usually poor. Pupils bringing water daily

to school in 20 litre jerry cans was prevalent in 15% of schools and this was a

mandatory activity.

Boreholes as the main water source was mentioned by twenty percent of the school

administrators, with these being both community and school own boreholes. In many

instances water sources was shared by the school and the surrounding community.

The main water sources in the study schools are as depicted in Figure 1.

51
 Piped to school 30%

Buy from Vendors 20%

Community Borehole
Type of water source

15%

Waterpans/dams 15%

Pupils bring from home 10%

Rainwater 5%

Own borehole 5%

0 5 10 15 20 25 30 35
Percentage of water source per type

Figure 1: Main Source of Water for Schools (n=20)

Although all schools had several water tanks only 25% of these tanks had water in

them at the time of the study, 75% of the tanks were empty. The installed capacity of

the water tanks in all the study schools was 309,200litres; out of this a capacity of

299,200litres was from tanks donated by NGOs. Water was not visibly present and

available in majority of the schools at the time of the study, but in the 20% schools

with water, it was plentiful and pupils were observed freely accessing it. All schools

had fixed gutters on the classroom roofs and installed water harvesting tanks as

additional water sources but in only one school was this (water harvesting) declared

the main source of water.

52
4.3 Availability of Hand Washing Facilities

Hand washing points

Forty five percent of schools had no designated handwashing points of any kind

(Figure 2).This is despite the fact that schools are required to have “soap and tap

water or water cans fitted with taps outside the toilets for washing hands after the

use of these facilities”(Safety Standards Manual, 2008 ). The hand washing points in

the schools that had them, consisted of a mixture of small tank and tap, tippy- tap,

large jerry can with tap as well as sink with tap connected to a main tank.

Availability of handwashing facilities in study schools

45%
Schools with h/w points
55%
Schools without h/wash
points

Figure 2: Percentage of Schools with Handwashing Points (n=20)

53
Water availability at handwashing points

In the fifty-five percent of schools with handwashing points, only half(55%) had water

available at the points (Figure 3).Twenty-seven percent of the handwashing facilities

in these schools were funded by donors other than government. The hand washing

points in these schools with water available consisted of very large tanks(<10,000l)

with a tap connected to it ,as well as sinks with taps connected by pipes to a large

central tank. A functional handwashing point/station is one where there is a sink and

tap, tank and tap or tippy tap with water available. Thus in the district only 30% of

schools had functional handwashing facilities, with 70% having either no

handwashing facilities or non functional handwashing facilities. Figure 3 depicts the

schools with functional handwashing stations. Soap or ash for handwashing was

seen in only one school while none of the existing hand washing points for girls was

behind a wall or screen as stipulated in the requirements.

Water availability at handwash point in schools

with handwashing points

45%

55% schools with water

schools with no water

Figure 3: Percentage of Schools with Water Present at Handwashing Points

(n=11)

54
4.4 Cleanliness Status and Maintenance of the Latrines

Cleanliness was defined as lack of faeces and or urine in and around the latrines.

The cleanliness of the latrines varied with majority of schools having mixed status i.e.

some latrines clean while others were dirty with faecal matter present in/or around

latrines. There were a total of 228 pupil latrines in the study schools. Eighty three

percent of all latrines had doors with this being 87% of girls latrines and 80% of boys

latrines, while all the preschool latrines had doors. Majority of the latrines were

constructed with iron sheets and there were no cracks observed in any of the walls.

When assessing the presence of urine and/or faeces in and around the latrines, it

was found that urine was present in twenty percent and faeces fifty percent of the

latrines observed during the study (Figure 4).

90% 80%
80%
Percentage of findingsf

70%
60% 50% 50%
50%
40%
30% Present
20%
20% Not present
10%
0%
Urine in and/or around Faeces in and or around
latrines latrine
Prescence of urine or faeces in and/or around latrines

Figure 4: Presence of Urine or Faeces in and/or Around Latrines (n=228)

The study assessed the general status of cleanliness of latrines and found that 50%

of schools had a mixture of clean and dirty latrines, in 20% of schools all observed

55
latrines were clean, in another 20 % of latrines were dirty and in the other ten

percent of schools the latrines were clean but had wet floors (Figure 5).

Cleanliness status of latrines

10%
Categpory of cleanliness

Clean but wet floors

All dirty 20%

All Clean 20% Status of latrines

Some clean some dirty 50%

0% 10% 20% 30% 40% 50%

Percentage of cleanliness per category
.

Figure 5: Cleanliness Status of Latrines (n=228)

The latrines in the schools were generally not very well maintained but majority were

well constructed while those on the extreme were in a very poor state. Thirty five

percent of the schools had latrines cleaned three times a week while only five

percent had latrines cleaned twice a day. Figure 6 depicts the frequency in which

school latrines were cleaned.

56
 Frequency in cleaning latrines

twice a day 5%

two times a week 5%

once a week 10%

three times a week 35%

0% 5% 10% 15% 20% 25% 30% 35%

Percentage of cleaning frequency per category

Figure 6: Frequency in Cleaning of Latrines (n=20)

Pupils were responsible for keeping the latrines clean in 90% of the schools but they

were not provided with any protective gear for this purpose. The guidelines indicate

that “when pupils are responsible for cleaning latrines protective gear should be

provided”. The cleaning of latrines was scheduled by the health/environment

teacher or the prefects and was based on a duty roster for pupils from classes 4-7,

or for the environment/WASH club. In only one school was this different and there

cleaning the latrines was a punishment for those who flouted school rules. Cleaning

of the latrines was mainly done using water and a broom or twigs in 45% of the

schools, while another 45 % used water soap/ash and twigs/broom and ten percent

used broom with twigs/ashes. The types of cleaning materials used are depicted in

(Figure 7).

57
 Type of cleaning materials

10
broom/twigs,ashes

45
water,broom/twigs

water,soap/ash,
45
twigs/broom

Figure 7: Type of Materials Used in Cleaning Latrines (n=20)

4.5 Awareness of School Administrators on National Standards

The researcher interviewed twenty head and twenty health teachers on what they

used as a guide for the sanitation in the school (Appendix 3 and 4)). The study

enquired from the key informants on their knowledge/awareness about four guideline

documents, two released by the Ministry of Education and another two published

jointly by the Ministries of Education and Public Health and Sanitation. These were:

‘Safety and Hygiene in Schools’ Circular (2001) Ministry of Education; School Health

Policy Standards (2009) Ministry of Education/Ministry of Public Health and

Sanitation; School Health Policy Guidelines (2009) Ministry of Education/Ministry of

Public Health and Sanitation; and Safety Standards Manual for Schools in Kenya

(2008) Ministry of Education.

The school administrator’s awareness of the national standards was wanting with:

45% of head teachers having no knowledge of any sort of national standards; 15%

58
were aware of all the above listed documents, 20% were aware of the Safety

Standards Manual for Schools, and 20% aware of the Ministry of Education circular

of 2001. The health teachers fared worse with 85% not aware of any sort of

government guidelines (Figure 8).

Head and Health Teacher Guidelines Awareness

90% 85%

80%

70%

60%
Percentage

50% 45%
Headteacher
40%
Health teacher
30%
20% 20%
20% 15%
10%
10% 5% 5%
0% 0%
0%
Not aware of Aware of all Aware of Aware of Aware of
any Safety Stds circular Policy
Booklet
Head and Health teachers' awareness of national standards

Figure 8: School Head & Health Teachers’ Awareness of Published Standards (n=40)

4.6 Comparison of the Study Schools’ Sanitation Facilities against the

Set National Standards

The status of sanitation facilities in Kajiado Central district was below the required

national standards as detailed in the Safety Standards Manual for Schools in Kenya

59
(2008). The standards indicate that: “In construction of sanitation facilities, the

following must be observed in relation to numbers:

 The first 30 learners : 4 closets(holes)

 The next 270 learners: one extra closet for every 30 learners

 Every additional learner over 270 learners: 1 closet per 50 learners “

 At least one third of the fittings for boys should be closets and the rest urinals.
If a urinal is a tough, then 0.6m (2ft) of the trough is equivalent to one fitting.

The study findings ratio of pupils to latrines was much higher than the “25 pupils: 1

closet” recommended and greater as well than the 1 urinal and 2 latrines: 65 boys

recommended (Table 5).

Table 5: Comparison of National Standards and Study Schools’ Latrine Ratios

Standards Study Findings

Boys 1 urinal and 2 closets for 75 1 urinal and 2 latrine holes : 61 boys
boys 1 urinal and 2 latrines with doors : 71 boys
(Schools with urinals)
1 closet :25 learners
1 latrine hole : 48 boys
1 latrine with door : 71 boys
(Schools without urinals)

Girls 1 closet : 25 learners 1 latrine hole : 39 girls

1 latrine with a door : 45 girls

Staff 1 closet to 12 persons 1 latrine : 4 males

With separate facilities for
1 latrine : 7 females
males and females

2 shared latrines : 6 staff`

60
CHAPTER 5: DISCUSSION, CONCLUSION AND
RECOMMENDATIONS

5.1 Discussion

This study is unique and exceptional as it is the first of its kind where the sanitation

facilities in schools are assessed based on standards set by the Ministry of

Education of the Government of Kenya. Other studies evaluating sanitation have

been carried out on the basis of outcomes of various interventions implemented by

interested non- government parties in study and control schools. The studies have

thus been influenced by interventions and situations based on the researchers’ own

interest and objectives. This study on the other hand, evaluates the situation in

public primary schools as they normally are, and it thus gives a realistic depiction of

the status of our schools as they truly are.

Health Impact

Sanitation is the most basic of health issues, yet in many parts of Kenya it’s greatly

disregarded and neglected. The progress of the modern society at the time of the

industrial revolution was actualized when sanitation and sewerage systems were

aggressively implemented. Prior to this hundreds of thousands perished in the many

cholera epidemics across Europe and the Americas. In Kenya we still experience

frequent cholera epidemics - a clear indicator of poor, inadequate and/or non-

existent human waste disposal systems. In addition the existing networks of

sewerage systems, even in the main cities and towns are inadequate and do not

cater for the majority of the population. Across the country, latrines and septic tank

61
connections serve the needs of majority of the population whereas in many other

areas open defecation is the norm.

Water and sanitation related diseases in school going children are mainly contracted

by the faecal-oral route. These diseases include diarrhoeas, dysentery, typhoid,

various helminth infections as well as trachoma. These diseases significantly affect

the population in the study area and children are especially vulnerable. In addition

acute respiratory infections (ARIs) are prevalent in school settings and it’s a common

expectation for mothers that once schools are in session children inevitably

experience colds and flu’s.

Studies indicate that in developing countries 272 million school days are lost

annually due to diarrhoea (Hutton et al, 2004), and 400 million school children and

47% of 5-6 year olds are affected by worms (Hall et al, 2008). These factors lead to

poor academic results in affected children as the train and flow of learning is

interrupted when lessons are missed. More importantly a helminth burden is

associated with reduced cognitive function and this may cause long term damage to

a child’s intellect and future academic prospects.

Ensuring the proper disposal of human waste is imperative to prevent faecal oral

infections and improve the quality of life for children. The availability of water and

sanitation facilities in schools reduces diarrhoea and hygiene related diseases

(Curtis et al 2003, Pruss-Ustun et al 2008, Njuguna et al 2008, Brooke Keen et al,

62
2011). The provision of these facilities is a big step in ensuring hands and mouths do

not come into contact with faeces. In addition adequate sanitation facilities create a

conducive environment for study and increases school retention rates and academic

performance, (Redhouse 2004, Njuguna et al 2008, Freeman et al 2011).

In majority of schools the Key informants expressed dissatisfaction and frustration

with Ministry of Health officials who are rarely seen in the schools and only appear

when a major adverse health event occurs. According to the National School Health

Policy the MoE and the MoH are responsible for ensuring that all schools are

provided with adequate sanitation and hygiene services. The Ministry of Water and

Irrigation has the overall responsibility for the provision of water and sewerage while

Public Health and Sanitation staff are required to carry out water quality surveillance

and monitoring twice per term in all schools to ensure water safety as well as

organize hygiene education at least once every four months. Based on the facts on

the ground and the KII views all these ministries have failed the policy stipulations.

Latrine Ratios

The total number of pupil latrines across the study schools was 228, with 41 % (93)

of these funded by nongovernmental organisations. The study schools ratio of

learners to sanitation facilities of 45 girls: 1 latrine; 47 boys: 1 latrine and for boys is

above the recommended levels of 25 pupils :1 latrine. This is further compounded by

latrines lacking doors as due to the dire situation every latrine that’s not functional

makes a bad situation worse. The inadequacy of the latrines leads to urination and

63
defecation around the latrines and this becomes a breeding ground for faecal-oral

diseases and helminth infections. The lack of latrines and water for cleaning is

particularly distressing to menstruating adolescent girls who exhibit frequent

absenteeism and end up dropping out of school (IRC, 2005; Poverty Action Lab

2007, Njuguna et al, 2008).

Some schools allocated a latrine to each class in an attempt to ensure easier

access; this creativity is laudable but still falls short of meeting pupils’ needs. In

some regions poor soil types led to the collapse of several latrines and this is a clear

indication of lack of guidance and advisory services from public health and public

works officials. The MoE directive for boys urinal and latrine ratios should be simpler

and more precise than they currently are –‘one third of all fittings for boys should be

closets and the rest urinals’ which required tedious calculations and the possibility of

errors. The MoE should in my humble opinion instead adopt the international

standards which simply states ‘one toilet plus one urinal(or 50cm of urinal wall) per

50 boys’ (Adams et al , 2009).

On the contrast availability of adequate sanitation facilities improves school

attendance and retention. There should thus be increased efforts by County

government and the community to provide potable water and adequate sanitation

facilities in schools especially in marginalized areas such as the where the study was

carried out and where children face additional challenges due to cultural practices.

The schools in the area should work closely with the parents, County government

64
and other education stakeholders to provide adequate sanitation infrastructure and

ensure constant water supply.

As part of the FPE and to ensure smooth transition to primary school, the

government directed that all primary schools should have a pre-school section.

Eighty-five percent of schools had a preschool section but only 29% of them had

separate facilities for the pre-schoolers thus creating a challenge for the young

learners when using them. An additional factor noticed when carrying out the

research but which was not one of the study objectives was the special needs

learners. There were no provisions for special needs students in any of the schools;

this is despite the fact that 30% of schools were integrated schools with 15% of all

schools having physically challenged pupils. The government recommends provision

of facilities for these pupils and should support schools to achieve this.

The situation in some sixty-five percent of schools where teachers shared latrines

contrary to the expected norm is also of concern. Teachers also require dignified

sanitation facilities to enable them carry out their duties with peace of mind. On the

brighter side though the facilities were shared they ratios were lower than the

recommended standards and staff latrines were more than sufficient.

The fact that the majority of schools (77%) were previously community schools

meant that there was a lot of interaction with the school community and the external

population in the community. This posed challenges in utilization of sanitation

65
facilities as the community members tended to access and use the sanitation

facilities at will. Majority of the schools had fences of different kinds but 25% had no

fence of any kind, 45% were securely fences with barbed wire while the remaining

30% were poorly and or partly fenced with twigs. In the schools that were securely

and properly fenced, the sanitation facilities were in a much better state and were

better maintained than those with poor fencing.

Handwashing Facilities

Hand washing facilities were completely lacking in 45% of the schools and this is of

very great concern as it creates situation where pupils are vulnerable to contracting

faecal-oral diseases. The schools with handwashing points also had challenges as

only 55% had water available at the hand washing points. Greater effort needs to be

made by the District Public Health and Water officers as well as the School Health

Department of the Ministry of Education to remedy this situation. Studies indicate

that availability of water and sanitation facilities in schools reduces diarrhoea and

hygiene related diseases amongst school children (Curtis et al 2003; Pruss-Ustun et

al 2008, Njuguna et al 2008, Brooke Keen et al 2011, Freeman et al, 2011).

Water sources and availability

Water availability in the region is a challenge with 40% of schools having a

somewhat consistent water supply. All schools were well equipped with water tanks

and in the total capacity of installed water tanks was 309,200 litres out of which a

capacity of 299,200 litres was from donors. The water sources in the schools were

66
varied with majority relying on seasonal and unsafe water sources. About twenty

percent relied on water pans and rainwater yet the region is semi arid with little and

unpredictable rainfall, another 20% relied on own or community borehole with

another 20% purchasing from vendors.

The Ministry of Water should be mandated to provide boreholes to serve schools

and this will translate to better health and better education for the school going

children( Curtis et al 2003, Pruss-Ustun et al 2008, Redhouse 2004, Njuguna et al

2008, Onyango-Ouma et al 2009, Bowen 2007, Freeman et al 2011, Brooke Keen et

al 2011).The existence of several water tanks in all schools was encouraging but this

was negated by the fact that 75% of these tanks being empty. The Ministry of Water

in conjunction with the Ministries of Education and Health should devise methods

through which water bowsers deliver water to schools on a regular basis. With the

devolution of government, the Kajiado County Governor can ensure that water

provision to schools is a priority for this area.

It may be claimed that the poor sanitation situation in the study area is due to the

semi-arid nature of the area and the pastoral nomadic culture of the majority

community. This assertion is factually incorrect because studies carried out in other

regions of Kenya such as Nyanza and Western provinces which receive plenty of

rainfall all year round, indicate poor sanitation facilities and inadequate water

availability and non functional water sources in schools there (Bowen 2007,

Onyango-Ouma et al 2009, Freeman et al, 2011, Brooke Keen et al 2011) .

Additionally in these regions the same health challenges such as diarrhoea, helminth

67
infection and adolescent girls absence from school are experienced in a similar

fashion as that in the region of the study schools.

Cleanliness

The assessment of the study school’s latrines cleanliness showed mixed results

amongst and within schools. As noted in the results pupils were responsible for

latrine cleanliness in 90% of the schools with this mainly being scheduled as a duty

roster. Only in one school was latrine cleaning a punishment and this is something

that needs to be discouraged. Making pupils clean latrines as punishment does not

encourage positive adoption of good habits as this will forever be etched in the

minds of the punished student and all other pupils in the school that latrine

cleanliness is an undesirable thing.

More encouraging were the majority of schools where it was a duty performed on

rotation by any student and thus not a cause for shame or ridicule. Also

commendable were the Health/Environment/WASH clubs where members took it as

their privileged duty to ensure all the latrines as well as the entire school compound

were kept constantly clean.

Guidelines and Standards

The role of the MoE school inspectors in regards to compliance and enforcement of

regulations is queried. There is a very clear chain of command in the MoE from

68
headquarters to the zones with a District education office in each district and a zonal

education officer overseeing all schools in a zone. The lack of awareness of national

standards by 45% of the school administrators’ and 85% of health teachers is a

cause of great concern as school administrators cannot implement and enforce

standards that they are unaware of.

This could be an indication of failure in the oversight functions of the various MoE

officers on the ground. Alternatively it is not clear whether the booklets are out of

print or just reserved for special persons as their availability and distribution appear

constrained. Studies indicate a similar situation as well as inadequate sanitation

facilities in other developing countries such as Bangladesh, India, Nigeria and Ghana

(UNICEF 2004,Nahar et al 2006, Ofovwe et al 2007, Gyabaah et al 2009)).

On the other hand getting the Standards booklet was a great challenge to the study

investigator as the department in the MoE at Jogoo House in charge of school

sanitation did not have it and the officers there claimed to have no knowledge of any

such standards. (The same response was received from officers in the then Ministry

of Public Health and Sanitation.) What was available and freely given were the

National School Health Policy and Guidelines booklets but these are general

information booklets and do not give any practical and usable details on requires

standards. Numerous fruitless and frustrating visits eventually led to the investigator

seeking for help from higher floors and by sheer luck the officer bumped to in the

corridors was well versed with the particulars required for the study and availed his

69
own copy thus enabling the finalization of the study and eventual commencement of

data collection.

Head and health teachers will be unable to champion for provision of adequate

sanitation facilities in their schools with insufficient information and knowledge on

existing standards. The Ministries of Health and Education should ensure that these

documents are available in every school and the administrators and all teachers are

knowledgeable on them.

There are many Nongovernmental organizations (NGOs) that are very active in the

area and in 85% of schools latrines, water tanks and health education initiatives

were funded and organized by them. In addition thirty percent of health and head

teachers reporting that they used guidelines given by NGOs to implement sanitation

standards in their schools The NGOs include AMREF, World Vision, German Agro

Action (GAA), Girl Child Network (GCN), Neighbourhood Initiative Alliance (NIA) as

well as UNICEF. These NGOs play a very important role in the region and their

proactive and positive impact on the community should be lauded..

5.2 Conclusion

The status of sanitation facilities in the study region based on the results obtained,

indicate that the amenities in public primary schools within Kajiado Central district do

not meet the required standards set by the Ministry of Education in the ‘Safety

70
Standards Manual for Schools in Kenya (2008)’. Awareness of the standards

amongst school administrators and the health teachers who are responsible for

sanitation and hygiene in the schools is also very low.

 Sanitation facilities in the study schools are severely strained with the average

pupil to latrine ratio exceeding the required national standards by 150 -240 %

for both boys and girls.

 Water supply to the majority of schools was inadequate made worse by the

fact that the region is semi arid.

 Functional handwashing points were present in only 30 percent of all study

schools. Handwashing points were not found in some schools with only 55%

of schools having them. In the schools that did have hand wash points only

55% of these had water available.

 In general the majority of latrines were in a poor hygienic condition with urine

and faecal matter visible.

 Awareness of the national sanitation standards as set by the Ministries of

Education and Health amongst the school administrators was low, with 45%

being completely unaware of any sort of national standards or guidelines.

5.3 Recommendations

 The Ministries of Education, Public Works and Health through their officers in

the districts and counties should ensure that as schools are built, the required

sanitation facilities should be constructed alongside the classes. Enforcement

of the set public health and health and safety standards and guidelines should

71
 be made part of the performance contracts of the officers to ensure vigilance

and enable adherence. Provision should be made for special needs pupils

and staff to ensure their needs are catered for.

 The Safety Standards Manual for Schools being a Ministry of Education

publication should be availed to all school heads. This can be easily done

during the annual school heads meetings and in addition the Education

Officers in the counties should ensure those unable to attend get copies.

 Water availability is a great challenge for schools in the region, thus the

Ministry of Water should ensure water is availed just in the same way as the

Ministry of Energy through KPLC has plans to ensure all schools have

electricity.

 The Ministry of Education in collaboration with the MoH, MoWI and other

partners should ensure there is a specific vote for water and sanitation so that

this important aspect is properly catered for. The County government and the

local community should also increase their support for school infrastructure

especially sanitation facilities.

 Further in depth studies should be carried out in this and other parts of the

country to inform the status of sanitation facilities in schools in Kenya. This will

enable the country know where we stand in regards to the Millennium

Development Goals as well as Vision 2030.

72
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79
Appendix 1: Map of Arid and Semi Arid Lands in Kenya

Source: Ministry of Lands

i
Appendix 2: Informed Consent Explanation Form

Study Title: An Assessment of Sanitation Facilities in Public Primary Schools Kajiado Central

District.

My name is Annette W .Gisore, a postgraduate student in the School of Public Health,

University of Nairobi. I would like you to participate in a research study whose aim is to

assess the sanitation facilities in public primary schools, Kajiado Central District. Schools

were randomly selected for the study from the register at the District Education office. You

will be required to respond to questions related to the status of sanitation facilities in the

school, to help us understand the situation of the sanitation facilities in public primary

schools in the district.

Participation through the filling in of a questionnaire is entirely voluntary. Your confidentiality

will be safeguarded: your identity and records relating to your participation will remain

confidential; no names of participating schools will appear in the final reports or publications

resulting from this study. Giving accurate information will enable us derive correct

conclusions and help us in accurate interpretation of the research findings. You do not need

to provide your name as the Key Informant in this study.

If there is any part of this consent explanation that is not clear, you are free to ask the

investigator before signing below. In case of any problem or concern, you may either

conduct my supervisors in the School of Public Health, University of Nairobi on the following

number 020-2724639/2723251 or the KNH Ethics and Research Committee at P.O. Box

20723; Tel 020-7293000 Nairobi Kenya. I can be reached on 0733944591 for any queries.

PARTICIPANT: I have fully understood the objectives of the research and hereby sign as an

indication of consent for the school to participate in this study.

Signature............................................................... Date...............................................

ii
Appendix 3: Key Informants Interview Guide and Structured

Observation Checklist

Section A: Key Informant Interview 1 - Head teacher

Head Teacher Questionnaire Yes ..No ..Code

School:
Registration Number:
1. Is this a public primary school solely funded by the government
of Kenya?
Has the school been funded by donors to improve the sanitation
facilities?
Can this be quantified – indicate the facilities provided by this
funding
Is the school urban or rural?

2. What is the current enrolment figure of pupils in the school?

Total enrolment primary:

Primary Boys :

Primary Girls:

Preschool total enrolment:

Pre-school boys:

Pre-school girls:

3. What is the total number of staff in the school?

Teaching staff:

Support staff:

Male staff:

Female staff:

4. What are the designated school break times?

5. At what times are students allowed to use latrines.

iii
Section B: Key Informant Interview 2 – Health Teacher

Health Teacher Questionnaire

Name of School:
Registration no.

Yes No Code
1. Is sanitation and hygiene part of the school curriculum?

2. Does the school have an active health club?

3. Who cleans the latrines in the school?

Students:
Staff:
4. How many times are they cleaned? Tick answer.
Once a day:
Twice a day:
Every other day:
Once a week:

Other (state):

5. If pupils clean the latrines how is the cleanup organised?

According to class?
If above, which classes?
Is it a punishment?
State other:

6. Is protective gear provided for cleaning?

7.

iv
Section C: Structured Direct Observation

Direct Observation Checklist Yes No Code Comment

Type of sanitation facilities

a) Ordinary pit latrine’

b) Ventilated Improved Pit (VIP)

c) Water closets

d) Other(specify(

Are the latrines at least 10

1. metres away from

a) Tuition and

b) Boarding facilities?

2. Are the latrines on the

windward side

Are the latrines at least

3. 15metres (50ft) away from a
borehole or well or water
supply point
In mixed schools are the girls
4. sanitation areas separate from
the boys?

Do they offer complete

privacy?

How many latrine doors are

5. No. of
present for
doors

a) Girls
b) Boys
c) Female staff
d) Male staff
e) Shared staff

6. Is there a urinal present for

boys?

v
 Direct Observation Checklist Yes No Code Comment

7. Is there a provision for learners

with special needs?

8. Is there provision for very

young learners in pre-unit and
lower primary?

9. Are the latrines clean? ( i.e.

free from visible faeces on floor
and walls?

10. Are they well ventilated? i.e. do

they have a vent pipe?

11. Are they well maintained? i.e.

How many have doors?

a) Girls latrines
b) Boys latrines
c) Female staff latrines’
d) Male staff latrines’
e) Shared staff latrine

12. How many lack doors?

a) Girls latrines
b) Boys latrines
c) Female staff latrines’
d) Male staff latrines
e) Shared staff latrine

13. What is the condition of the

latrine floors?

a) Wet
b) Dry
c) Have faecal matter
d) Clean

14. W
What is the condition of the
walls?

a) In good condition
b) Have cracks

vi
 Direct Observation Checklist Yes No Code Comment

15. Who cleans the latrines?

a) Pupils
b) Staff

Do they have protective gear

for cleaning?

16. Is there a handwashing point?

If yes, what type is it?

a) Tippy tap?
b) Tank and tap?
c) Piped to tap?

If yes, how many are available

a) Near latrines
b) Near feeding area
c) Near classrooms
d) Other area

17. Is water available at the

handwashing points?

Is access restricted?

18. Is there soap or ash for

handwashing?

19. Is there a separate wash point

for girls?
If yes, is it behind a screen or
wall?

Is the area around the latrines

20. bushy?

vii
 Direct Observation Checklist Yes No Code Comment

Is there evidence in the area

21. around the latrine of

a) Urination?

b) Defecation?

22. Are there health messages

(talking walls) in the school?

23. Is the school environment well

kept i.e. clean, neat and free
from litter

24. Is there a school feeding

programme?

25. Is there a handwashing facility

next to the feeding area?

viii
Appendix 4: Budget

ITEM Rate Days Amount

Fieldwork Stationery(Printing/Photocopy) 50,000

Data Collection - travel and accommodation 9500 9 85,500

Communication 300 9 2,700

Review (printing and binding ) 35,000

Miscellaneous 5,000

Total 178,200

ix
Appendix 5: Work plan

Month 1 Month 2 Month 3 Month 4 Month 5 - n

Data Collection

Data Entry and Analysis

Review and defence

x
Appendix 6: Approval from KNH/UoN - Ethical Review Committee

xi
Appendix 7: Approval from National Council for Science and

Technology

xii
Appendix 8: Approval from Ministry of Education - Kajiado Central

District

xiii
Appendix 9: Approval from Office of the President – Kajiado Central

District

xiv
15