Water, Sanitation and Hygiene (WASH) is generally a challenge in Ethiopia with coverage levels amongst the lowest in the world. The 301 Alternative Basic Education Centers (ABECs) in which Pact implements Alternative Basic Education (ABE) program to reach the unreached with education through its project “Transforming Education for Adults and Children in the Hinterlands” (TEACH) are situated in the most disadvantaged, remote and peripheral woredas/districts, where the WASH situation is even more challenged. ABECs are faced with two pronged WASH related challenges.
First, they bring together many children and adults in a circumscribed space, most often without WASH facilities, putting them in heightened health risk, and secondly, the lack of WASH facilities in the ABECs affects educational enrolment and retention.
An End line survey was conducted in May, 2015 with the major objective of measuring the changes achieved as compared to the baseline survey conducted in November of 2012 before the WASH intervention was initiated among ABE learners and communities around the ABECs. Key areas of measurement includes: Assessing accessibility of safe water and sanitation facilities by the target population and assessing the Knowledge, Attitude and Practice (KAP) of the target population on hygiene and sanitation including ways/approaches used in Behaviour Change Communication (BCC) interventions.
The End line survey employed cross-sectional study design and quantitative and qualitative data collection methods the same tools used for the base line survey that was developed with extensive desk review and consultations to define key indicators in designing data collection tools. The end line survey was conducted in four purposively selected woredas of four regional states where the WASH interventions have been carried out. Quantitative data was collected from a total of 295 randomly selected respondents, the majority of respondents being from level 3 followed by level 2 students who have been exposed to the WASH interventions for not less than 2 years. Qualitative data was collected from 12 key informants in the selected woredas. Spot check/observation was also employed to assess the availability and utilization of safe water and sanitation facilities.
Findings of the baseline show that distance to water points for the majority of the community living around the ABECs is more than an hour walk, thus increasing absenteeism of children and women learners as they are most often responsible to fetch water. In some regions, extended dry seasons affect the whole community forcing them move away from their village, as a result of which ABECs are also abandoned. The source of water in the ABECs and their environs is not safe and adequate that its impact on enrolment and retention is visible. About 80% of the ABECs do not have latrines and hand wash facilities that learners are at high health risk. Though there is an encouraging level of WASH knowledge among learners and community members, the practice was found to be too low.
In this connection, findings of the end line survey revealed that 39.8% of students have access to safe drinking water as compared to only 4.4% during the baseline. Similarly, the community’s access to drinking water has improved from 48% to 62.2% since communities surrounding the schools partly access the services from the school water points established through this project in a way also cutting the distance to fetch water. During the baseline, 30% of the learners reported that getting water while they are in the ABEC including getting water in the ABEC neighbourhoods was too difficult. This situation has vividly changed in that only (1.36%) of the respondents said they do not drink water while in school. As far as utilization of sanitation facility is concerned, only (68%) of the ABEC leaners were using latrines at baseline that dramatically improved to (92%) during the end line survey. None of the surveyed ABECs were found to have hand washing facility and segregated latrines for male and female learners at baseline. During the end line survey, it was observed that almost all visited ABEC/schools have segregated latrines for boys and girls with hand washing facilities including detergents (soap/ash). It was noted that more girls use latrine than boys.
The composite index developed to gauge the WASH knowledge of learners revealed a score of 22.8 for children out of 50 points during the baseline that remarkably rose to 35.5 during the end line survey. Knowledge of learners on latrine utilization grew from (2.7 to 9.1), solid waste management from (4.5 to 5.8) diarrhea (4.6 to 6.6), the knowledge on hand washing and food hygiene rose from (6.2 to 7.5) and (4.8 to 6.5) out of 10 points respectively.
The practice of hand washing was found to be amongst the lowest during the baseline and a very significant change was observed at the end line. There is a significant difference in practicing hand washing during critical times, the majority of ABEC learners most often doing it before and after eating food (88% and 73% respectively) at the base line and (98% and 85.7%) during the end line respectively. The practice of hand washing before preparing food and before feeding others was (30% and 29%) respectively that improved to (39.5% and 35.7%) respectively at end line.
The end line survey also depicted hand washing among children has improved significantly from the baseline (26% to 74.8%). Children respondents who do not usually wash their hands say lack of water and forgetting to wash their hands. However, the proportion of those who do not wash their hands have reduced from (18% to 6.1%). Reported episodes of diarrhea has reduced to 68.8% as compared to 81.3% during the baseline, including reduced absenteeism for 2-5 days from (33% to 25%) and 7 – 10 days from (19% to 8.3%). The proportion of respondents burning and disposing waste in the designated waste pit stood at (12% and 21%) respectively while it was (22.7% and 74.2%) respectively at end line.
As the ABECs are located in the remotest and peripheral areas, where the Health Extension Program (HEP) is not too strong to provide the required services, the need for an integrated WASH programming was found to be important not only for improving the enrolment and retention of ABEC learners, but to enable the ABEC and the surrounding communities adopt healthier sanitation and hygienic behaviour. To this end, the project among other things has been engaged in the establishment of appropriate water schemes for over 160 schools, construction of 345 segregated latrines that provides safe space for both male and female learners. Intensive behaviour change communication interventions and linkages with the health extension program and woreda education offices also resulted in hygienic practices of the target population.
Therefore, future programming should consider the practice of an integrated programming of making the WASH facilities available, tailored Behaviour Change Communication (BCC) backed up by customized BCC materials, working in collaboration and coordination with key stakeholders such as Health Extension Workers (HEWs), Health Development Armies (HDAs), Woreda Education Offices (WEO) and Woreda Water Offices (WWO), with inclusion of communities/parents as key targets in the implementation process.