SWASH+

School Water, Sanitation and Hygiene plus Community Impact (SWASH+) was an action‐research and advocacy project focusing on increasing the scale, impact and sustainability of school water, sanitation and hygiene (WASH) interventions in Kenya. These applied research objectives included:

• Identify, develop, and test innovative approaches to school‐ and community‐based water, sanitation, and hygiene interventions that promote sustainability and scalability.

• Provide and test an integrated safe water, sanitation, and hygiene‐promotion program in schools and communities that maximizes impact, equity, sustainability, and cost‐ effectiveness.

• Positively influence Kenyan government investments in school water, sanitation and hygiene by leveraging learning on sustainable, scalable, and effective approaches.

During its first phase (2006-2012), SWASH+ conducted a series of rigorous quantitative and qualitative studies in 185 schools. Findings showed that access to WASH services in schools increased girls’ attendance by up to 58%. Other research from the project revealed a reduction in diarrheal disease and intestinal worm infection and drew attention to the significant psychosocial stress experienced by adolescent schoolgirls when they lack the support and resources to manage their periods. The Government of Kenya’s enthusiastic uptake of recommendations during the first phase of SWASH+ resulted in the doubling of government subsidies for public school WASH. Read more on major findings of the first phase of SWASH+ on it’s official project website (www.washinschools.info).

The second phase (2012-2019) built on school WASH learning of the first phase. In particular, we worked closely with the Government of Kenya to better test innovative ways to improve the sustainable provision of WASH services through our “governance trials” in 360 primary schools. Further, we identified financial resources required for the overall lifetime costs of WASH facilities through “life cycle data” collection in 189 urban and rural schools. Lastly, we tested alternative models of services delivery in schools (e.g. outsourcing WASH provision and maintenance to the private sector) through our “private sector trial” in 20 schools in urban informal settlements of Nairobi.

Publications:

1. The Sustainability and Scalability of Private Sector Sanitation Delivery in Urban Informal Settlement Schools: A Mixed Methods Follow Up of a Randomized Trial in Nairobi, Kenya (2020)

2. Physical, Social, and Political Inequities Constraining Girls’ Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya (2017)

3. The Life-Cycle Costs of School Water, Sanitation and Hygiene Access in Kenyan Primary Schools (2016)

4. Comparing Sanitation Delivery Modalities in Urban Informal Settlement Schools: A Randomized Trial in Nairobi, Kenya (2016)

5. Estimating the Effect of School Water, Sanitation, and Hygiene Improvements on Pupil Health Outcomes (2016)

6. Factors Associated With Pupil Toilet Use in Kenyan Primary Schools (2014)

7. Assessing the impact of a school-based latrine cleaning and handwashing program on pupil absence in Nyanza Province, Kenya: A cluster-randomized trial (2014)

8. Exploring the Relationship between Access to Water, Sanitation and Hygiene and Soil-Transmitted Helminth Infection: A Demonstration of Two Recursive Partitioning Tools (2014)

9. If you build it will they come? Factors influencing rural primary pupils' urination and defecation practices at school in western Kenya (2014)

10. Field report: Large-scale school rainwater harvesting systems: a pilot study in Nyanza Province, Kenya (2014)

11. Using structural‐nested models to estimate the effect of cluster‐level adherence on individual‐level outcomes with a three‐armed cluster‐randomized trial (2013)

12. The Impact of a School-Based Hygiene, Water Quality and Sanitation Intervention on Soil-Transmitted Helminth Reinfection: A Cluster-Randomized Trial (2013)

13. Impact of Regular Soap Provision to Primary Schools on Hand Washing and E. coli Hand Contamination among Pupils in Nyanza Province, Kenya: A Cluster-Randomized Trial (2013)

14. The impact of a school-based water supply and treatment, hygiene, and sanitation programme on pupil diarrhoea: a cluster-randomized trial (2013)

15. A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment (2013)

16. The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: a Cluster-Randomized Trial in Kenya (2013)

17. Improving service delivery of water, sanitation, and hygiene in primary schools: A cluster-randomized trial in Western Kenya (2013)

18. Water, sanitation, and primary school attendance: A multi-level assessment of determinants of household-reported absence in Kenya (2013)

19. Assessing the impact of a school‐based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster‐randomized trial (2012)

20. Impact of a School-Based Hygiene Promotion and Sanitation Intervention on Pupil Hand Contamination in Western Kenya: A Cluster Randomized Trial (2012)

21. Sustaining school hand washing and water treatment programmes: Lessons learned and to be learned (2012)

22. Anal cleansing practices and faecal contamination: a preliminary investigation of behaviours and conditions in schools in rural Nyanza Province, Kenya (2011)

23. 'The girl with her period is the one to hang her head' Reflections on menstrual management among schoolgirls in rural Kenya (2011)

24. Is Soapy water a viable solution for hand washing in schools? (2010)

Briefs, reports, case studies:

• Summary: Celebrating 13 years of working with national government for lasting water, sanitation and hygiene in schools in Kenya

• Summary: Practice guidelines: private sector sanitation for schools in Kenya

• Research note: Exploring key drivers and barriers to private sector sanitation delivery in urban primary schools

• Research note: The piloting of a WASH in school budgeting tool: feedback from trained end-users

• Policy brief: Life cycle costs of water, sanitation, and hygiene access in Kenyan primary school

• Policy brief: Private sector delivery of school sanitation in urban informal settlements

• Policy brief: Engaging parents in school WASH

• Policy brief: New approaches to WASH education policy brief

• Report: 2017 annual review meeting

Resources

• WASH in Schools Budget Estimation Tool

  • Summary: The development of a WASH in school budgeting tool: evidence to action of SWASH+ life cycle costing studies

In the press:

• CARE: SWASH: Working with National Government for Lasting Water, Sanitation and Hygiene (WASH) in Schools

• WASHfunders: Spotlight on School Water, Sanitation, and Hygiene Plus Community Impact program (SWASH+)

• CARE Falling Forward: Answering Practical Questions Instead of Academic Ones: How to design research that makes more sustainable programming

• CARE Falling Forward: Understand Your Entry Points: How admitting failure transforms policy

Media:

Study Location

Kenya

Target Population

Primary schools and school children

PRINCIPAL INVESTIGATORS

Matthew Freeman

IMPLEMENTING partners

CARE International, Sanergy, Kenyan Ministry of Education, Science and Technology, Georgetown University, Great Lakes University of Kisumu

Funders

Bill & Melinda Gates Foundation

Project Staff

Kelly Alexander, Kate Bohnert, Bethany Caruso, Anna Chard, Robert Dreibelbis, Joshua Garn, Leslie Greene, Shadi Saboori, Jedidiah Snyder

Collaborators

Safe Water and AIDS Project: Alex Mwaki

Sanergy: Lindsay Stradley, Joseph Githinji, Polycarp Sifuna, Mitchell Oguna

Enumerators

Charles Boera, Dorothy Adhiambo, Jackline Okumo