Toolkit on Hygiene, Sanitation & Water in Schools
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Why Hygiene, Sanitation and Water in Schools?

Worldwide, an estimated 72 percent of primary school-aged children attend school which means that more children are going to school than ever before in history. The United Nations' Millennium Development Goals (MDGs) for 2015 and other initiatives that aim for Education for All, have achieved that significant efforts are being made to make more resources available to increase access to education.

Providing quality education, also implies the provision of an enabling learning environment in which children can perform to the best of their ability. Nonetheless, in most developing countries, the sanitary and hygienic conditions at schools are appalling, characterized by the absence of properly functioning water supply, sanitation, and hand washing facilities (figure 1). In many cases, toilets are heavily used and filthy; in other cases, the toilets, water supply, and hand washing facilities are spotlessly clean but are not used and are even locked because water is unavailable, because separate facilities for teachers are not provided, or because children are not trusted to use the facilities properly. In such an environment, children must resort to open defecation around or even at the school compound.

Figure 1. Typical Condition of a School Toilet in Central Asia
Source: UNICEF Central Asia, 2000

Because children spend a significant amount of time in and around their schools, such situations have a major impact on their wellbeing. The lack of appropriate facilities may discourage children from attending school; Girls who are menstruating, in particular, would rather not go to school than have to deal with such a lack of privacy, and with appropriate HSW facilities, gender can be addressed. Also, when a school lacks access to a basic water supply and sanitation facilities and its students have poor hygiene habits, the incidence of major childhood illnesses among its students will increase. This will adversely affect school children's participation, lowering enrollment rates and increasing absenteeism, poor classroom performance, and early school dropout. It will also decrease learning capacity as measured in educational performance, outcomes, and productivity. In addition, the unsanitary conditions typical of many school toilets will send children the wrong message about the importance of sanitation. Since many rural children do not have toilets at home, this will be their 'model' for sanitation, which clearly will not be a very motivating one.

Provision of adequate water supply and appropriate sanitary facilities in schools can be especially effective in reducing the incidence of diarrhea and helminth infections. Of the childhood diseases that are caused by the lack of proper sanitary conditions, these are the two that occur most frequently.

With governments around the world embracing an ambitious MDG agenda to reduce poverty and improve welfare, hygiene, sanitation and water in schools has a role to play. Hygiene, sanitation and water in schools can create the physical learning environment that benefits health and learning, and impact several of the MDGs.


A healthy school environment that optimizes children's learning capacity results when hardware (construction or rehabilitation of sanitary facilities) is combined with software (including provision of hygiene education and training for the operation and maintenance of facilities ) in an enabling policy environment. To achieve this result, task managers from the health, education, and water and sanitation sectors must work together to ensure that school sanitation programs will be successful in achieving their objectives.

The track record for successful design and implementation of interdisciplinary school hygiene, sanitation, and water programs is still relatively limited. Most activities to date have been characterized by efforts to provide facilities for schools in the context of community-based programs (box 2).

Box 2. Evolution of Global Efforts to Improve Hygiene, Sanitation, and Water Supply in Schools
Before 1990s Non-coordinated efforts on school hygiene and provision of toilets and water points at schools
1993 First studies and workshops by IRC and WHO on hygiene, sanitation, and water in schools (mainly small scale)
1998 Publication of UNICEF School Sanitation and Hygiene Education manual building on country experiences (developed in cooperation with IRC)
1999-2003 Pilot School Sanitation and Hygiene Education program in six countries funded by the Government of the Netherlands and implemented by UNICEF
April 2000 FRESH (Focusing Resources on Effective School Health) framework, a partnership of UNESCO, UNICEF, WHO, and the World Bank, launched at the World Education Forum
1999 - 2004 Increase in program support for SSHE/WES in schools and advocacy and international call for action
2004 Symposium on School Sanitation and Hygiene Education: The Way Forward held in Delft, the Netherlands, with 50 participants from ministries, NGOs, and international agencies

Adapted from presentation at SSHE-symposium, Delft, June 2004 by L. Burgers, UNICEF

To date, health, education, and water and sanitation task managers have learned important lessons about what works and what does not work in their respective sectors. This Toolkit draws on those lessons and is designed to help task managers tap into sector-specific knowledge of practices and approaches that are likely to yield positive results as they coordinate multi-sector efforts to improve sanitation and hygiene in schools. The outcome will be school environments that promote children's health and enhance their learning opportunities while contributing to achievement of the Millennium Development Goals.

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