WASH in Schools: Our Corporate Commitment for Children Rotary WASH in Schools Target Challenge, June 2015 Lizette Burgers, UNICEF

Overview Protection of the rights of children Brief on UNICEF and WASH in Schools Scaling up WinS worldwide Rotary International partnership

UNICEF and Rights of Children UNICEF’s Mission mandated by the United Nations General Assembly to advocate for the protection of children's rights, to help meet their basic needs and to expand their opportunities to reach their full potential

UNICEF WASH Programme (2014) Annual WASH budget of USD 700+ million 107 WASH and 95 WinS Countries 13.8 million people with improved drinking water 11.3 million people with sanitation facilities More than 500 WASH professionals Global leadership in humanitarian support and development 68 Countries with WASH Emergency response 18.0 million people with emergency water 4.4 million people with appropriate sanitation Achieving RESULTS at scale 10.596 schools have access to WASH facilities 67.000 schools started to practice daily group hand washing UNICEF WASH Programme (2014) In 2014, UNICEF engaged in WASH programming in 107 countries, with a direct expenditure on WASH of US$727 million (which includes organization-wide prorated expenditure). In keeping with the UNICEF focus on equity, two thirds of this expenditure was in least developed countries, and within countries, it targeted unserved and marginalized populations.   Almost half of the total direct WASH expenditure, US$350 million, was used for emergency response and coordination, the most ever. While UNICEF responded to emergencies with WASH inputs in 68 countries, the focus was on the unprecedented six Level 3 emergencies: in the Central African Republic, Iraq, the Philippines, South Sudan, the Syrian Arab Republic and the Ebola-affected countries. The following box summarizes the direct results in terms of beneficiary numbers. However, the total beneficiary numbers will be higher given UNICEF’s role in contributing to improved policies and strengthening the enabling environment. WASH Beneficiaries from UNICEF Direct Support, 2014 Development Programme Emergency Response 13.8 million people with improved drinking water 11.3 million people with sanitation facilities 19,097 communities certified open defecation free 10,596 schools equipped with WASH facilities 1,203 health centres equipped with WASH facilities 18.0 million people with emergency water 4.4 million people with appropriate sanitation 13.0 million people with handwashing facilities 3.1 million children with WASH facilities in their schools and temporary learning environment 1.7 million women and girls provided with menstrual hygiene management supplies UNICEF provides direct support to WASH in Schools on a substantial scale: over the last eight years, UNICEF helped build WASH facilities in more than 129,000 schools, including 10,596 schools in 2014

UNICEF and WinS Are we protecting the rights of children when…. Diarrhoea is a major contributor to the global burden of disease? Annually, 272 million school days are lost and 760,000 Children die due to diarrhoea alone (WHO) Intestinal worm infections diminish learning abilities? An estimated 400 million school children have diminished learning abilities due to intestinal worm infections: Average IQ loss per worm infection is 3.75 points Schools lack safe and private sanitation facilities? A girl can miss up to 10-20% of her school days due to during transition in to puberty Almost half of schools in least developed countries lack access to adequate water and sanitation facilities? EMIS systems within MoE do not describe acess in detail i.e functionality, number of units per children Access described as Adequate access which is not enough. The toilet in the photo maybe considered as a school with access in some of the Government EMIS !!! 6 out of 10 schools in developing world do not have access to WASH facilities. Hand washing facilities availability and accessibility is not monitored in many government EMIS Reference: Advancing WinS monitoring- synthesis of WinS coverage

WinS Rights of Children Provides healthy, safe and secure school environments that can protect children from health hazards, abuse and exclusion. Helps ensure quality education; healthy and well nourished children can fully participate in schooling and gain its maximum benefits. Quality education, in turn, leads to better health and nutrition outcomes, especially for girls. Encourages children’s pride in their schools and communities by providing dignity and privacy. Enables children to become agents of change for improving WASH practices in their families and communities. Investment in schoolchildren and the health of future generations. Helps children realize their full potential , prepares them for healthy living as adults when they become parents. Provides healthy, safe and secure school environments Helps ensure quality education. Encourages children’s pride in their schools and communities Investment in schoolchildren and the health of future generations.

WinS Growing Evidence Base Impact of school sanitation on student enrollment Findings from analysis of more than 100.000 schools data from India. Anjali Adukia’s research was focused on understanding factors that influence educational decisions and the potential role for institutions, such as government agencies and nonprofit organizations, to improve child outcomes, particularly at the intersection of education and health. Phd Thesis from Harvard _2014 . Anjali examines how the provision of basic needs such as sanitation, clothing, and transportation, can increase school participation in developing countries. "Addressing basic needs of health, privacy, and safety such as through the provision of adequate school sanitation has the potential to improve educational opportunities for children worldwide. Her findings are: 12% increase in enrolment at primary schools 8% in increase in enrollment at upper-primary school Increase in the proportion of female teachers (4.4%) Girls generally more impacted than boys Higher number of students passing state board exams 12% increase in enrolment at primary schools 8% in increase in enrollment at upper-primary school Increase in the proportion of female teachers (4.4%) Girls generally more impacted than boys

WinS Growing Evidence Base Impact of group handwashing, tooth brushing and bi-annual deworming on students: absence and STH infection significantly reduced. Low cost high impact programming. Basis for our Three Star approach. Daily repetition of activities providing opportunity for children to practice hygiene rather than building on knowledge. Findings from Fit for School Programme Philippines reaching to more than 3 million children At less than 1 usd/child/year Background: Child health in many low- and middle-income countries lags behind international goals and affects children's education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines. METHODS: A longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1-daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2-EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3-EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results. RESULTS: In the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately. CONCLUSIONS: Despite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed. http://www.ncbi.nlm.nih.gov/pubmed/23517517 Dental caries is a global public health problem, especially in children. Most caries in developing countries remains untreated. Only limited data are available on the clinical consequences of untreated dental caries because there is no measure to quantify the prevalence and severity of oral conditions resulting from untreated dental caries. The PUFA index records the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a).

Call to Action for WinS dd Call to Action for WASH in Schools: Raising Clean Hands Campaign: October 2012 More than 70 organizations have joined together to renew their commitments and create a more cohesive group to support and advocate for WASH in Schools. Partners called on decision makers and concerned stakeholders to join in this collaborative effort and support WASH in Schools – so that all children have the opportunity to go to a school with access to safe water, child-friendly sanitation facilities and hygiene education. Private sector, academia, faith based networks, UN NGOS etc.. Rotarians joining WinS can expand our outreach especially with advocacy and outreach to Government and business in many countries. They can bring innovation and creativity to the way we work within our wins community.

Call to Action for WinS Raising Clean Hands Campaign: Action Points Set minimum standards for WASH in Schools: Gradual Improvements Monitor WASH in Schools coverage through EMIS Engage with at scale WASH in Schools programmes Involve multiple stakeholders (Private sector, faith based networks, academia…) Contribute to evidence base on impact of WinS Raise the profile of WinS RI can help us in all these six action points both at global and national levels. Six Points of Action for WASH in Schools Because every child has the right to be in a school that provides safe water, sanitation and hygiene education, we call for renewed commitments to: 1. Set minimum standards for WASH in Schools. Adopt national, regional and local standards for WASH in Schools, based on UNICEF-World Health Organization guidelines. The minimum standards for WASH in Schools should be specific to each context. These standards should be the basis for national action plans that aim to reach all schools within a concrete time frame and should allow for gradual improvements to facilities and hygiene practices. 2. Monitor WASH in Schools coverage through Education Management Information Systems (EMIS). Advocate for the inclusion of WASH in Schools indicators in EMIS. Analyse data annually and use the findings for advocacy and better resource allocation. Support the compilation of data on coverage and practices at the global level to attract attention and funding to WASH in Schools. 3. Engage with at scale WASH in Schools programmes. Contribute to the bigger picture by bringing individual or small-scale projects into cooperative initiatives that effectively reach more schools. Gradual improvements to facilities and hygiene practices require less investment in operation and maintenance and can be sustained with local resources. Steady progress is key to establishing sustainable, at scale programmes for WASH in Schools. These programmes include budget lines for capital improvements, operation and maintenance of WASH facilities, and recurrent costs such as purchases of soap and materials for personal cleansing. 4. Involve multiple stakeholders to support WASH in Schools programmes. Community members, civil society advocates, members of the media, students, school staff, local and regional authorities, non-governmental organizations, faith-based groups, public-private partnerships, and ministries of education, water, health and finance, as well as donors, can all support planning and action for WASH in Schools. 5. Contribute evidence on the impact of WASH in Schools programmes. Local and global academic communities have expertise that can support the design of WASH in Schools programmes and chart their impact. Generating and sharing evidence will provide WASH in Schools advocates with a powerful tool to attract attention and funding to the sector. 6. Raise the profile of WASH in Schools programmes. Adapt global and regional publications, advocacy materials and knowledge for the local context and disseminate them widely. Encourage members of the community to participate in customizing global WASH in Schools experiences to local settings. The process can begin with translating Raising Even More Clean Hands into multiple languages. Local organizations can join the advocacy by endorsing a customized publication with their logos.

Call to Action for WinS Publications and websites www.unicef.org/wash/schools www.washinschoolsmapping.com http://www.washinschools.info/page/248 http://www.schools.watsan.net http://www.child-to-child.org/ http://www.savethechildren.org/ http://www.schoolsanitation.org/

Setting WinS Priorities: Bottleneck Analysis (synthesized) Bottleneck analysis (or performance analysis) is a method used to identify components of a process that limit the effectiveness of the process as a whole. It has been used to improve performance in numerous sectors. In 1978, Tanahashi adapted bottleneck analysis to evaluate effective health coverage from a systems perspective.1 By analyzing baseline data for specific indicators of supply and demand, health coverage bottlenecks can be identified to inform focus areas for intervention. Bottleneck analysis has been further adapted by UNICEF for WASH in Schools (WinS) by expanding the Tanahashi model to include categories of Enabling Environment and Quality, in addition to Supply and Demand, and suggesting determinants within each category. This model has been used by multiple UNICEF country program offices to identify bottlenecks to WinS program success by assessing indicators at the national, sub-national, school and student level within the broader categories provided. By identifying bottlenecks, improvement strategies can focus on key areas in need of intervention. However, this requires regular monitoring to evaluate the effectiveness of intervention and identify a stopping point once the bottleneck has been removed so that funds can be allocated to other program areas. Three key bottlenecks emerge on WinS sustainability as we apply and use bottleneck analysis. Creating a budget line in Gov. systems for WinS, Operation and maintenance of WASH facilities and the hygiene practice- especially handwashing with soap before eating and after using latrine. These bottlenecks forced us to move from construction of luxury wins facilities and heavy hygiene promotion programmes. We based our three star approach on to address these bottlenecks; incremental improvements both hardware and software component of wins programmes. “hygiene education is not consistently provided in most schools, and when programmes do exist, they are often of limited effectiveness”

Global WinS Practice: Three Star Approach The Three Star System for WASH in Schools is designed to improve the effectiveness of hygiene behaviour change programmes. It ensures that healthy habits are taught, and that they are practised and integrated into daily school routines.   As part of the broader child-friendly schools initiative, the Three Star System helps schools meet the essential criteria for a healthy and protective learning environment for children. Modelled on successful experiences in the field, it is aimed to address the bottlenecks that block the effectiveness and expansion of current WASH in Schools programmes. In the Three Star System, schools are encouraged to take the simple and inexpensive steps outlined in the Field Guide. These steps are designed to make sure that all students wash their hands with soap, have access to drinking water, and are provided with clean, gender-segregated toilets at school every day. Group activities drive this incremental system, beginning with daily, supervised group hand-washing sessions. Once minimum standards are achieved, schools can move from one to three stars by expanding hygiene promotion activities and improving infrastructure, especially for girls, and will ultimately achieve the national standards for WASH in Schools. The Three Star System encourages local action and support from host communities and does not depend on expensive hardware inputs from the education system or external support agencies. ‘Keep it simple, scalable and sustainable’ is the guiding concept for interventions at all stages, so the system can be inexpensively expanded countrywide. In countries where there are limited or no national standards, the global standards set by WHO and UNICEF should be applied Daily group handwashing is at the hearth of the three star approach. This is linked to addressing bottlenecks, a programme reaching to scale, addresses O&M via daily repetition of activities and can be financed locally at low cost.

Global WinS Practice: Three Star Approach Daily group handwashing, daily group toilet cleaning, drinking water bottle use One star + HWWS after toilet use, improved toilets, MHM, HWT Two star + school facilities and systems upgraded to meet national standards

Three Star Approach: The biggest shift is on the decision to become a STAR School 1. Philippines, Laos, Cambodia, Indonesia, Myanmar, India, Nepal, Liberia, Tanzania, Guinea… many others 2. We welcome adaptation of the three star approach keeping the principle of incremental improvements. 3. The Rotary WASH in Schools Target Challenge has modified the UNICEF/GIZ model to encourage Rotarians to build upon activities to which they are already investing time and resources in the field and to become facilitators of change rather than a driving force in the communities with which they work. Like the Three Star Approach, three tiers have been identified with specific benchmarks (Annex A) that must be met to be considered a one star, two stars, or three star school. Unlike the Three Star Approach, the Rotary WASH in Schools Target Challenge does incorporate infrastructure benchmarks in the first tiers, given that construction of infrastructure is currently a key activity for Rotarians in the field. Coupling this activity with key behavior change components in tier one, encourages a paradigm shift for Rotarians as they progress through the tiers. By tier three, Rotarians will be engaging in activities that are 100% “software” focused, such as facilitation, advocacy, training and education. In addition, the tiers of the Rotary WASH in Schools Target Challenge build in more educational components than the UNICEF/GIZ model in an attempt to engage further the Rotary Basic Education and Literacy constituency with the WASH sector. It is for this reason, that the target is focused on education and WASH as a mechanism to achieve that target.

Global WinS Best Practices: India Assisted by UNICEF, national versions of the approach are already being launched in a number of countries, including the Philippines, Lao People’s Democratic Republic, Mauritania, Nepal, Sierra Leone, Sri Lanka and in four Pacific Island nations. In India, the approach is linked to a major government policy announcement that makes group hand-washing with soap obligatory in the 1.2 million schools and 110 million children reached by the mid-day meals programme. India presents an important example of WinS progress. UNICEF contributed to the development of the Swachh Bharat Vidyalaya (Clean Schools) Mission, a national programme mandated to ensure that every school in the country has an essential WASH package that includes water, sanitation and daily group handwashing. In India, UNICEF and RI entered into an MOU, with Rotary, with Mr. Sushil Gupta and his senior colleagues. Rotary has already organized several meetings and consultations amongst their District Governors, Zonal Coordinators and District Coordinators over the last three months to prepare them for the task, mapped the 10000 schools for intervention in consultation with Ministry of HRD, and have also started leveraging resources for intervention. The Ministry is also regularly seeking updates on progress, from Rotary. Rotary and UNICEF India collaboration will definitely help Government of India and Private sector partners to scale up wins. School education department has launched a mobile application to monitor construction of toilets across the state. The app 'Swachh Patashala', will keep a check on the status of 8,583 new School toilets being built. The app will help to monitor not only the construction of the new toilets but also the dysfunctional toilets. As soon as the app is launched, the user has to enter the details of the school, including name, code, management and the head master's mobile number.  In each stage, the status of toilets is monitored by uploading pictures. In stage one, the officials have to upload the photo of the area selected to construct the toilet. After the foundation of the toilet is laid, the officials have to upload the picture in stage two. In the final stage, image of the constructed toilet is to be uploaded. The funds for the toilets won't be released until the final image of the constructed toilet is not uploaded, said officials   http://timesofindia.indiatimes.com/city/hyderabad/Mobile-app-to-monitor-status-of-school-toilets/articleshow/47169805.cms

UNICEF and Rotary WinS : the SDGs are coming Proposed SDG#6 By 2030: to eliminate open defecation; to achieve universal access to basic drinking water, sanitation and hygiene for households, schools and health facilities; to halve the proportion of the population without access at home to safely managed drinking water and sanitation services; and to progressively eliminate inequalities in access.

Rotary International and UNICEF: Partnership in a changing world The world of children is changing: A multi-polar world Institutional change Demographic shifts Environmental degradation, climate change and resource scarcity Poverty reduction Social unrest and fragility From inter-connectivity to hyper-connectivity Technological innovations. From UNICEF 3.0: A paper looking at how UNICEF might need to change itself in the near-term future to respond to a changing world and address children’s needs

Rotary International and UNICEF: Partnerships paradigm is shifting The old order of government, civil society and business acting in their own space will give way to more partnerships to address societal challenges. Demographic Shifts: One in three children globally will be African by mid-century. A greater proportion of the world’s children will also become urban and middle class. Can we add here something on India and China…? Environmental Degradation, Climate Change and Resource Scarcity: The bleak projected outlook for the environment is precarious for children. We need to we address the risks to children of environmental degradation, volatility of food prices, and ensure that children’s futures are more protected. Social Unrest and Fragility: In the coming decade, an increasing proportion of the world’s poor will reside in fragile contexts. Cam we build resilience in communities in fragile contexts, so that children and families can withstand recurrent shocks?

UNICEF and Rotary International Conclusion: UNICEF and Rotary International WinS Millions of children will learn, build self esteem and confidence through UNICEF and RI collaboration. WinS is a serious concern – it is a child rights issue- and needs attention. WinS programmes can be implemented at scale and can lead to enhanced education and health outcomes for children New Partnerships, like between UNICEF and Rotary International, are needed to meet the challenging demands of the SDGs.  Like in India with UNICEF and RI partnership,  especially in a changing world.  Through UNICEF RI collaboration we can make WinS concern recognized as a global priory , convene partners to join us and demonstrate programmes at scale with impact.

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