Workshop on Water Supply, Sanitation and Health at Schools and Local Communities in West Africa

Workshop on Water Supply, Sanitation and Health at Schools and Local Communities in West Africa

Report from Workshop organized by School Health Education Programme (SHEP), Danish Water Forum (DWF) and The Danish Research Network for International Health; supported by Danida.

Executive Summary:

Initiated be the Danish Water Forum (DWF) and The Danish Research Network for International Health and organised by School Health Education Programme (SHEP) and supported by Danida, this workshop on Water Supply, Sanitation and Health at Schools and Local Communities in West Africawas held in Ghana, September 18-20th at Hotel Cisneros, Sogakofe. Most participants were researchers and water practitioners from Ghana, and others were Danish researchers andrepresentatives from the other West African countries with Danish supported Water Sector Programmes (Burkina Faso, Benin, Mali and Niger) The aim of the workshop was to identify problems and solutions, look for knowledge gaps and need for increased research and to develop joint research projects to be carried out by the researchers from all participating countries.

A large number of research projects were identified under two headings:

1. Attitudes, hygiene and links to communities:
2. Perceptions and Socio/cultural Values and Practices with a focus on those who are under five
3. Areas where things have changed
4. Cross/cultural study between Benin, Burkina Faso and Vietnam
5. Community/led total sanitation in Ghana
6. Impact study with focus on children who have been involved in cleaningof
7. Documentation of best practices
8. The Development of Indicators for progress in water, sanitation and hygiene
9. The Helminth
10. Gender mainstreaming in Water and Sanitation

1. Technical solutions, operations, maintenance and finance:
2. Improvement of designs
3. Value of Waste
4. Supervision of works
5. Rain water harvesting

The participants were interested in continuing with this cooperation and the research projects jointly and responsible persons and institutions were selected for all topics.

At a meeting at the Danish Embassy in Accra on the 21st of September it was decided that:

• The projects must be merged into 4-5 proposals.
• The networks will develop a standard format for applications to fit all areas.
• The projects must be anchored with CWSA, SHEP or Coniwas, but they can include and be led byresearchers who can be acknowledged accordingly.
• The embassy will be able to support 4-5 research projects, but applications have to pass ordinary procedures and go through the steering committee.
• The embassy and networks will investigate some outstanding issues related to funding projects.
• Deadline for applications must be December the 1st in order to finalize projects within this programme.

Workshop Report:

Background:

The two Danish research networks are given support by Danida to enhance cooperation on knowledge sharing, research and capacity building within the fields of water and health. The aim of our activities is to create possibilities for sharing knowledge, increasing cooperation and research and to ensure inclusion of research and knowledge in Danish development aid. With this purpose the two networks cooperated with SHEP on organising a common workshop on water, sanitation and health especially related to children and schools. The theme has been identified by Danish researchers, who also proposed to have the workshop in West Africa as a region with much cooperation between the countries in the region and Denmark and a region with many problems regarding water and sanitation related to education and children. Further, Danida is presently running several projects with focus on sanitation and health in the region.

First step in the planning of the workshop was an identification mission between 15-19 January 2007, where representatives of Danish Water Forum and Health Research Network met partners in Burkina Faso and Ghana and discussed the initial concept note, workshop themes, speakers, participants and timing, implementation and ways to continue cooperation after the workshop to ensure long-term sustainability of the activity.

Both researchers and institutional representatives expressed interest in the workshop, both themes and identification of research collaboration topics and partnerships. It was decided to organise the workshop by SHEP with support from Danida and in close cooperation with the two Danish research networks and K.N.U.S.T, CREPA and CWSA as well as a number of individual researchers.

A large number of workshop themes were identified at the reparatory mission. The workshop will be organised in order to present problems, discuss experiences, research themes and collaboration opportunities and funding of research projects. The themes were later groped in two themes:

1. Attitudes, Hygiene and links between schools and local communities
2. Technical aspects, operations and maintenance and financing of projects

The workshop also included a field trip to local schools to get an idea of the problems and discuss the issues with children and teachers.

The workshop was held in Ghana, September 18-20th at Hotel Cisneros, Sogakofe. Participants were mainly researchers and water practitioners from Ghana, but representatives from the other West African countries with Danish supported Water Sector Programmes (Burkina Faso, Benin, Mali and Niger) were invited to attend and contribute to the workshop, and only Mali was not represented at all. The workshop language was English, but with simultaneous translation to French.

The workshop was be financed partly by the Danish Embassy in Ghana, who paid for local activities and travels and partly by DWF and Health Research Network, who covered international travel and other expenses related to international participants. The Danish embassies in Benin, Niger and Burkina Faso funded participants from their countries expect for the hotel expenses in at Hotel Cisneros, which was funded by DWF.

The final program for the workshop was the following, but it was amended several times during the workshop in order to adapt to changes in participants’ participation, need for group discussions etc.

Day 1 – 18th September
09.00 / Opening of Workshop / Cynthia Bosum-twi Sam, School Health Education Programme, practicalities
09.05 / Overview of Problems I / Joan Awunyo-Akaba, University of Legon.
Mathilda Pappoe, University of Ghana.
10.00 – 11.00 / Official Opening Ceremony / Detailed programme was distributed to participants
11.00 / Coffee break
11.20 / Overview of Problems
II / Patrick Apoya, Coniwas
11.40 / Country Presentations / Benin
12.00 / Burkina Faso
12.20 / Q&A
12.30 / Lunch break
13.30 / Country Presentations / Mali
13.50 / Niger
14.10 / Solutions – presentation from organisations / SHEP: Cynthia Bosum-twi Sam
14.30 / CREPA, Burkina Faso: Leocadie Bouda
14.50 / CWSA (Community, Water and Sanitation Agency): Theodora Adomako Adjei and E.T Nyavor
15.10 / Q&A
15.30 / Karsten Nellemann Kryger, Denmark / The Institute for Veterinarian Pathology approach to water, health and development
16.00 / Coffee Break
16.15 – 18.00 / Break-out groups: / Round of presentations: Research activities, work of organizations, ideas for future research projects.

1. Attitudes, Hygiene and Links to communities

/

1. Technical solutions, operations, maintenance and financial strategies

18.30 / Dinner
Day 2 – 19th September
08.00 – 12.00 / Field Trip to local school, discussion of problems
12.00 / Lunch Break
13.00 / Break-out groups: Presentation of research projects and ideas for future research:
1: Attitudes and Communities: / 2: Technical solutions and finances:
15.40 / Coffee Break
16.00 – 17.00 / Report back from break-out groups / Intervention by rapporteurs:
Areas with need for research and knowledge sharing between countries
17.00 – 18.00 / Cross-cutting issues / Esi Awuah: Environmental enhancement through hygiene and sanitation education in Ghana.
Andrew Owusu: Global School based School Health Survey: Monitoring student hygiene/sanitation behaviour in Ghana
Michael Forsom: UNICEF interventions in the water and sanitation
18.00 – 18.30 / Q&A, Discussion
19.00 / Dinner
Day 3 – 20th of September
09.00 / International Research Networks / Presentation of activities:
Danish Water Forum
Danish Health Research Network
09.30 / Break-out groups: The Way Forward: Identification of projects, future research activities, knowledge sharing, building of networks, research funding
1: Attitudes and Communities: / 2: Technical solutions and finances:
11.30 / Report back from Break-out Groups
Discussion of future activities / Interventions from Rapporteurs: Identification of projects, future research activities, knowledge sharing, building of networks, research funding
13.00 / Wrap-up and Evaluation of work shop / Future research projects and networks, how to continue from here
13.30 / Official closing of the workshop
13.45 / Lunch
14.30 / Departure

All presentations from the workshop are now available at the webpage of DWF: following notes from the discussion will give an insight into the discussions about the presentations.

Name / Objective
Joan Awunyo-Akaba, University of Ghana / Poor hygiene behaviour among school children. Anthropological reasons for this. Children are responsible for toilet cleaning, water and other, Gender skewed towards girls doing the job.
Teachers with low or no education and understanding.
Cleaning utilities and soap for HW brought by the children.
Another problem is the lack of systems for solid waste disposal => Decreasing the understanding of environmental issues.
Need for advocates that can provide information and support for a better and healthier environment.
Way forward: Intervention models to be used for identifying problems and then put action on changing the condition.
Training of teachers during the school holidays.
Emmanuel Nyavor, CWSA / School health committee gets support from SHEP, Food vendors’ sell food with high hygiene levels after training (fly-net). Severe problems with low technical quality of the latrine construction. Some schools have been built recently WITHOUT hygiene facilities. Other problems are safe potable water in the schools. Need for more inspection from authorities.
Discussions: how to clean your butt! By paper or by water (the latter mostly by the muslims).
Gervais Atahouet, TA Sanitation, Benin / Similar problems in Benin, as outlined for Ghana. Building on the children, but promotion must also be on the whole family level, especially the elderly generation. Vandalizing of latrines, bad odour, hand-washing facilities destroyed. School sanitation integrated in the curriculum for teachers. But the teachers lack guidelines for carrying the topic into the classes. A guideline has been developed for the teachers.
Discussions: the attitude towards toilets/latrines MUST be changed to solve the problem of misuse of the facilities, and to improve maintenance.
Teachers should also take part of the maintenance so it does not look like a punishment of the children. Make it a collective task.
David Nunoo, Catholic Relief Service / Working with programme for supporting the northern region in Ghana. Covering 800 schools, including food programmes. The project works very much with behaviour change. Use interviews to find out what successful families are doing and then use the lessons learned to help the less successful families. There is a clear linkage to the traditional female behaviour towards sick children (checking the faeces from the sick child, using it to identify the cause of the illness). Intensive use of outreach systems, based on facilitators travelling on motor bikes to the remote areas.
Lessons learned: Continued forcing the boys to take part in the maintenance: Need to understand that maintenance is also a way to a better and healthier life. Inspections of hands and nails part of the programme.
Afternoon session
Cynthia Bosum-twi Sam, SHEP / NationalSchool Health Education Programme:
Introduction to the background of SHEP, has existed since 1964 initiated by Ghana Education Service. Joint programme from Ministry of Health and Ministry of science, sports and education.
2 policy goals for education in Ghana:Good health and AIDS/HIV
The vision is to provide: Skills-based health education. Hygiene not topic in Ghana, is integrated into all topics.
New education reform, more hygiene issues taken care of.
Also work with disease control, food and nutrition, drugs, road safety and security, first aid etc.
Development partners: UNICEF, WHO, DANIDA, JICA.
Collaboration widespread, also NGO´s
Government provide water
SHEP advocate that all schools should have latrines and hand-washing facilities.
Training of food vendors in basic hygiene and methods to prevent mosquitoes and flies infecting the food.
Capacity building of Health coordinators and committees, produce teaching materials, manuals and guidelines on school health.
Challenges: vandalism, construction defects towards disabled people and girls, NGO’s work in districts but with no report nationally meaning duplication and less SHEP overview of activities, inadequate funding and donor driven activities such as on the choice of regions to work in, lack of support by some communities and lack of sanitation facilities in some schools.
Andrew Owusu, WHO / Global School-based student health survey: Monitoring Students between 13-15 years old. Hygiene/Sanitation behaviours in Ghana:
Start 2001 from WHO, data collection September 2007 in Ghana, provide data on health behaviour to help countries develop priorities, establish trends and allow for countries to compare over regions.
75 schools from North, Central and South Ghana. Asked questions on: drugs, dietary behaviour, hygiene, mental health, physical activities, sexual behaviour, tobacco use, violence and unintentional injury. Added country specific on i.e. malaria and worms.
Hygiene components: behaviour in general, access to hygiene, knowledge, and environment.
Good instruments for youth health risk behaviour, make possible assessment of capacity building needs, use of data will drive program and help focus resources.
Future issues: sustainability, expand to all youth, interventions and programs targeted, promote hygiene and school health through sports.
Questions available at
Dissemination and use of data vital and will be distributed widely.
Karsten Kryger, University of Copenhagen / DBL approach to water & health research and development:
To generate and disseminate new knowledge, tools and methods for disease control, and to build research capacity. Focus on research into practice and practice into research.
Present case studies on:

• Risk factors for intestinal helminth infections in Western Kenya
• School based control of billharzia in Eastern Tanzania
• Billharzia Control Programme in LakeShore Communities of Lake Malawi

Francis Anto / Impact of Water Resources development on health in Ghana. NavrongoHealthResearchCenter:
Irrigated areas in Northern Ghana. Programmes of water resources development have worsened health issues. Tono irrigation system largest in Ghana, many small dams etc. Schistosomiasis has worsened over the years. Children are infected from swimming and washing items in the irrigation canals, working on tomato fields and rice farms make people more infected. Malaria also increases with irrigation, but awareness means that children in these areas are using mosquito nets more frequently, meaning not immense increase of malaria.
Case: Bui Dam to supply electricity to city of Bui. Ecological impacts due to slower flow of the river, most diseases and insects will increase, but will be less river blindness and more food production. This is also general experience from other tropical countries. Recommend measures to mitigate the impacts and increased medical treatment, and socio-economic measures such as increase community surveillance.
Introduction to break-out sessions: / Henrik Bregnhoj:
Presenting problem tree to use for discussion of items.
Differentiation of groups:
-Hygiene/Social – Institutional
-Technical, Financial, O&M/inst/socio-economic
Mr. Oumarou Hamani, UNICEF,Niger / Sahel experience: Action aid international organisation, Promotion of hygiene in the school. 48 % in project region have access to water, but low access to proper sanitation. Only 11% of schools have sanitation. Objective of project is to improve the general health among the population.
Activities taken: construction of latrines; one for boys one for girls plus hand-washing systems. Also introduction of latrines in the community. Hygiene clubs with 2 boys, 2 girls plus adults. Separate latrine buildings for boys and girls.
Hygiene is a question for the whole community; however, the women are mainly active players.
Hawa Diariwassou Mamane, Projet 3- Aide et Action, Niger, / Summary: Gender specific approach: Hygiene is everybody’s problem. Training of women at community level for capacity building. A social issue is the segregation of the boys and girls on the latrine distribution. If only one block, then the girls would not use it.
Election of the community health club: all have been through hygiene training. Knowledge on how to make soap on local material: understanding the need to avoid fecal piles around the village due to the infection rate.
Including the religious leaders provides better results.
Questions: Different types for girls and boys?
Question: cleaning? Joint team for cleaning
Siaka Banon, Joséphine Ouedraogo, Burkina Faso / Same approach as the other countries. Types a bit different, but still latrine type KVIP. Community latrines were also built in the same areas as the school latrines. Many local people have built the latrines based on blue-prints for standard latrines. The school training in hygiene is going on and teachers are trained in using the national guide. The health training was based on 8 key statements on safe health and 6 statements on the latrine construction and maintenance.
Another benefit from the systems has been the understanding of how to protect and secure water for the family household. The main problem is to find means to have the excreta moved away and utilised. This calls for direct payment to the entrepreneurs.
Question: Is hygiene a part of the school curriculum?
Answer: No, but the curriculum is being assessed. The present level is not adequate and it is the hope that it will be included in the future.
Esi Awuah, K.N.U.S.T / Environmental enhancement through hygiene and sanitation education in Ghana.
Environment quality in the schools is not at a sufficient level. Schools should be designed to enhance environmental issues. Trees should be planted in the school compounds to reduce both local and road air pollution. A school room should also be good with chairs fitted to the body and not the upper sit. Library is also necessary for the schools to provide the children with possibilities to gain more knowledge by themselves, but a library will not completely cover all, so computers with internet should also be available.
Sporting activities, tied with shower facilities and towels should be a standard part of a school.
Politicians are lacking the understanding to see promotion and new things in the western world and to bring it back and implement it in their own countries.
Hygiene must also be an integrated part of the school and we are all depending on a high level to keep us healthy and to make sure that we are capable of absorbing the knowledge provided by the school.
You can have all the policies, but if you don’t have a strategy for the implementing nothing will happen.
We need to share our knowledge and data in order to perform better and make sure that we do not waste budgets to reach points, where others have already been.
Peter Kjær Jensen, University of Copenhagen / When things do not work, they may have been made by men!! This assumption goes e.g. for the design of modern toilets, designed to look good but very difficult to clean!!
The key topic was on the use of composted excreta. In many African countries ash is added to the pit to reduce smell and to increase the value of the sludge. In Vietnam the value of composted excreta has a value of at least 200 mill. USD/year, counted as the fertilizer value.
Stephen Ntow, Water aid, Ghana / Water aid deals with the poorest population, participatory approach.
Sector experiences: poor funding and mainly funded by donors, slow pace of decentralisation, widening gap of access to sanitation, urban reform not pro-poor, weak sector capacity.
MDG target is 85%, lack behind, need much more funds.
Sanitation is not prioritised, draining is not a matter. Need to put government resources in this sector.
64% of urban population in Accra rely in water vendors, portable water supply.
Quick wins – easy design for sanitation can also be usable, not only KVIP’s can do. Promote low-cost technologies.
Work with awareness, hygiene education and advocacy on water policy.
Discussion about role of private water vendors and storage of this water in the households is it possible to this in a safe manner.
Abednego Chigumbu
UNICEF, Ghana / Programme implementation through government, agencies, ministries,
The programme runs together with SHEP.
Child-to-child approach is used to spread the lessons learned. Since the children are also responsible for behaviour changes. The programme also includes safe water supply, besides the KVIP.

In the two break-out groups discussion were on: