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Why we have to learn about WASH in schools

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“Schools, depending on their access to and quality of water, sanitation, and hygiene (WASH) and the implementation of healthy behaviors, can be critical for the control and spread of many infectious diseases, including COVID-19”, says Dr. Carmen Anthonj, Assistant Professor of GeoHealth in the Department of Earth Observation Science. Schools provide opportunities for pupils to learn about the importance of hygiene and build healthy habits and skills. This has beneficial medium- and long-term consequences particularly in low- and middle-income countries

Water, sanitation, and hygiene (WASH) in schools

Despite the importance, according to the WHO & UNICEF Joint Monitoring Programme, in 2019, 584 million children lacked a basic drinking water service, 698 million children lacking a basic sanitation service, and basic hygiene services were not accessible to 818 million children at their schools. Coverage of basic water and sanitation services in schools ranged from 44-47% in sub-Saharan Africa to 100% in Australia and New Zealand, and coverage of basic hygiene services in schools ranged from 17% in Oceania to 100% in Australia and New Zealand, with large discrepancies in access between urban and rural areas, and between different school types globally, leaving way to go for achieving Sustainable Development Goal 6 (Ensure availability and sustainable management of water and sanitation for all).

WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. By teaching them about WASH  pupils’ absenteeism due to diseases is reduced, while their physical, mental and social health is promoted, and their learning outcomes are improved.

Learning about WASH in schools: Disconnect, integration or opportunities with health education interventions?

International organisations such as UNICEF frequently monitor WASH in schools, and roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps that have been addressed at ITC under the lead of Carmen Anthonj by analyzing Kenyan primary school science textbook content using books from class 1 through class 8, covering the age range from 6 to 13 years.


The study showed that school books comprehensively address drinking water issues; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene, and menstrual hygiene education, are all high on the international WASH agenda and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration.

COVID-19 and WASH in schools: Implications, challenges and solutions

“Despite the recognition of hand hygiene as a key aspect to preventing COVID-19, hitherto WASH interventions are rarely included in the list of structural and environmental measures carried out in the schools to reduce transmission of SARS-CoV-2. Recognizing that the COVID-19 pandemic is also a  WASH crisis is central to addressing it”, says Kasandra Poague, PhD Candidate in the Department of Earth Observation Science.

It is now well known that COVID-19 and WASH are closely related. In the 60 countries at highest risk of health and humanitarian crisis due to COVID-19, half of the children lacked basic water and sanitation services, and 75% of children lacked a basic hygiene service at their school at the start of the pandemic. As a response to COVID-19, and because the role that children play in the transmission pathways of COVID-19 remains unclear, governments around the world have temporarily been closing educational institutions in an attempt to contain the spread of the pandemic, affecting over 1.6 billion pupils, with adverse impacts also on parents and teachers. As schools are reopening, the implementation of COVID-19 prevention strategies and hygiene measures is omnipresent.

Kasandra Poague

“Despite the recognition of hand hygiene as a key aspect to preventing COVID-19, WASH interventions are rarely included in the list of measures carried out in schools”

Kasandra Poague

Building on our previous WASH in schools analyses, an ongoing PhD project by Kasandra Poague at ITC contextualizes WASH access, related knowledge, perceptions and behaviours with the COVID-19 pandemic, identifying and describing WASH conditions in Brazil before, during, and beyond the COVID-19 pandemic, as well as possible barriers, enablers and solutions related to the necessary improvement of WASH. Perceptions of the different school stakeholders, such as parents, school staff, teachers, government and pupils, are considered in a mixed qualitative and quantitative field research.

Although all the countries around the world, regardless of political and economic status are now struggling with the pandemic, responding to COVID-19 has been particularly challenging for Low- and middle-income countries (LMICs). Brazil, for instance, a global COVID-19 hotspot, has been constantly failing to implement a national response plan against SARS-CoV-2 including the safe opening of schools. Limited trust in the government, political instability,  lack of a robust federal response, extreme poverty and inequalities, frequently large populations living in overcrowded conditions and lack of access to WASH services hampers the Brazilian population to apply basic COVID-19 prevention measures, such as social distancing and hygiene. The results of this study will capture best WASH practices in schools and will be used to develop a framework that can be used for the safe reopening of schools in Brazil, with possible replication in other LMICs.

More information

If you are interested in learning more about WASH in schools, in collaborating on the project on COVID-19 and WASH in schools, e.g. by teaming up in research, offering funding opportunities, sharing relevant data, as a key informant or interviewee representing the public health, WASH or educational sector, please contact us at c.anthonj@utwente.nl (subject: WASH in schools).


Anthonj, C., Githinji, S., Hoeser, C., Stein, A., Blanford, J., Grossi, V., 2021. Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: disconnect, integration or opportunities? International Journal of Hygiene and Environmental Health 235(113756). https://www.sciencedirect.com/science/article/abs/pii/S1438463921000717?via%3Dihub

Anthonj, C., Fleming, L., Anderson, D., 2018. Solomon Islands Water, Sanitation and Hygiene in Schools Census Report. The Water Institute at UNC, Chapel Hill, NC, USA. 67 pages. (report for Ministry of Education, Solomon Islands and UNICEF Pacific)

Poague, K., 2021. COVID-19 and water, sanitation and hyigene in schools. Implications, challenges, solutions. Newsletter of Arbeitskreis für Medizinische Geographie und Geographische Gesundheitsforschung in der Deutschen Gesellschaft für Geographie [Working Group for Medical Geography and Geographical Health Research at the German Society for Geography] 1(2021), 5-6. Available at: https://med-geo.de/wp-content/uploads/2021/06/210531_NL-AK-5-2021.pdf