Access to safe drinking-water is a fundamental requirement for good health and is also a human right. Further, clean water, adequate sanitation and hygiene education in schools is essential to children’s survival and as critical to quality education as books and pencils. The Sustainable Development Goals (SDGs), Goal #6, calls for the achievement of universal and equitable access to safe and affordable drinking water for all to be achieved in an interconnected manner with other SDGs relating to health, education and protection.
Throughout Africa, including Kenya, women and girls are the main providers of household water supply and sanitation, and also have the primary responsibility for maintaining a clean home environment. The lack of access to safe water and sanitation facilities therefore affects women and girls most acutely.
About 157 million people in the Eastern and Southern Africa region (ESAR) are not connected to clean and safe water distribution systems, and thus need to use alternative water that should be treated to be safe for consumption. Despite global recognition that all primary schools need access to clean water for drinking and washing, over half of primary schools in developing world don’t have access to clean water (1). More than 440 million school days are lost each year due to water-related diseases (2), of which 272 million are lost due to diarrhoea cases alone with 40 percent of the cases are due to transmission in schools.
In Kenya, most public primary schools do not meet minimum water, sanitation and hygiene (WASH) standards due to: i) low prioritization of WASH in schools; ii) poor enforcement and inadequate maintenance; and iii) overcrowded schools – the introduction of Free Primary Education (FPE) in 2003 resulted in a rapid increase in the number of children in primary schools, placing severe strain on school infrastructure and facilities which were already inadequate (3). Despite the national school health policy calling for the provision of adequate and safe drinking water for school children on a daily basis, most school water supply interventions in Kenya have gaps in supplying adequate and clean water. Most schools are supported only by small-scale rainwater harvesting systems. Besides being basic (consisting of small storage tanks, gutters and downpipes only) compared to RaHa Solutions for rainwater harvesting, these small-scale rainwater-harvesting systems are often poorly maintained, giving rise to poor quality water for students and teachers.
The provision of safe and adequate water, sanitation and hygiene services and education form the basis of a sustainable solution to the threat of water, sanitation and hygiene related diseases among school children. Safe water in schools is a first step towards a healthy physical learning environment, benefiting both learning and health – especially for girls, as they can be particularly discouraged by inadequate sanitation. School children are also an important entry point for the promotion of household water treatment and safe storage in their own households.
The introduction of cost-effective, scalable and context-relevant technologies such as portable toilet, roof top rainwater harvesting systems and non-rooftop rainwater harvesting systems introduced by RAHA Solutions, along with the integration of hygiene education, contribute to improved student retention, and increase demand for such services.
The WASH Status in health facilities
The WHO/UNICEF global action plan, launched in 2015, aims to ensure that all health care facilities in all settings have adequate water, sanitation and hygiene services by 2030. Achieving and maintaining WASH services in health care facilities is a critical element for a number of health aims including those linked to quality universal health coverage (UHC), infection prevention and control (IPC), and maternal and child health.
In 2016, WHO launched its “Standards for Improving Quality of Maternal and New-born Care in Health Facilities”, which includes eight standards and 31 quality statements which aim to address a “critical aspect of the maternal and new-born health agenda…around labour and delivery and in the immediate postnatal period”?
Quality of care is defined as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve [quality], health care must be safe, effective, timely, efficient, equitable and people-centred” (WHO, 2016). Quality of care depends on the physical infrastructure, human resources, knowledge, skills and capacity to deal with both normal pregnancies and complications that require prompt, life-saving interventions. Without adequate WASH services, it is impossible to meet these demands (4).
Devolution of Services in the Country.
With the amalgamation of the new constitution in 2010, Kenya adopted the devolution system of governance where the focus of development is at the county level (grassroots). Devolution is stipulated as the dispersal of political power and economic resources from Nairobi to the grassroots, for targeted development in various sectors and in general, to bring government closer to the people.
It is expected that each county develops a county strategic plan to guide the development process and how resources are utilised to achieve the various programs. This transition has seen counties use resources allocated from the national government over the last five years with different levels of success and challenges. Resource allocation from the national government to each county follows a development index which informs the amount of resources allocated to bridge the gaps in service delivery especially for those that are devolving education and water and sanitation. The needs still remain huge and the development plans partially fulfilled. The gaps are complemented by development partners including NGOs like Plan International Kenya, which works closely with the county governments in respective counties focusing on unmet needs and services that are relevant to the strategic direction of the county and the organization.
As a devolved function, health services provision under which water, sanitation and hygiene falls, still faces a challenge in getting adequate funding from the county governments as dictated by development priorities and needs. The water and sanitation sector has suffered from inadequate resources rendering the poor water, sanitation and hygiene status in the counties, including Kisumu and Siaya.
Kisumu and Siaya counties, as some of the 47 counties in Kenya, have embraced devolution of services at all levels. Kisumu county health department aims at transforming the health of the people of Kisumu County through responsive and sustainable technologically-driven evidence-based and client centered health system for accelerated attainment of highest standards of health.
PROBLEM STATEMENT AND SITUATION ANALYSIS
In early 2009, Participatory Situational Analysis (PSA) was conducted from a child rights perspective in Bondo Programme Unit (PU). It was done in partnership with Community Based Organizations, schools, Government of Kenya partners and other Civil Society Organizations. The PSA confirmed that child rights situation in Kisumu and Siaya counties, where Plan International Kenya Bondo PU operates, is in dire need of improvement. A significant proportion of children in these districts were found to be losing out on opportunities for learning, recreation, participation, growth, development, nutrition, and shelter and not having access to adequate health care. Child rights situational assessment (CRSA) findings in health indicate high mortality (and morbidity) rates among children from preventable diseases; non-fulfilment of the right to potable water and improved sanitation facilities (5).
Through combined efforts by both state and non-state actors on health, there has been increasing changes reported in the health sector in Kenya. As a result, only 62% of Kenyans currently use improved drinking water (82% for urban and 51% for rural), and only 32% of Kenyans use improved sanitation facilities. Access to improved sanitation in most communities especially in urban settings in Kisumu County still remains a challenge with reported cases of open defecation and use of unsanitary facilities. To this effect, the rural set up of Kisumu has also not been exempted. Poor access to sanitation continues to contribute to the cause of mortality, hence denying children their right to survival. The quality of water is highly variable and water related infrastructure in the county remains inadequate especially in Sianda zone, Kisumu west Sub County. While Kisumu County has made considerable progress in recent years, problems persist. Sadly, water-borne diseases such as cholera, dysentery and typhoid contribute to numerous deaths every year. Kisumu’s water production is not keeping pace with its rapid population growth, while the existing infrastructure is operating at between 85 and 93% of its design capacity.
In Siaya County a large proportion of the communities, including children, still continue to be ill with preventable diseases and other health conditions. Infant mortality rate and under-five mortality rates are estimated to be at 114.6 and 208 per 1,000 births respectively, which are way higher than the national statistics which are at 52 and 74 respectively per 1,000 births as per the KDHS 2008-09. This is despite the efforts made by the GOK and other agencies. The major contributors to infant and under-five morbidity and mortality are malaria, diarrheal diseases, Acute Respiratory Infections (including Pneumonia), Vaccine preventable diseases and malnutrition which are ranked among the top 10 diseases in the area according to Bondo district health facility records.
The 2009 PSA further details that despite the availability of water sources such as river Yala, Lake Victoria, boreholes, roof catchments, pipelines and earth dams in the communities, there are challenges associated with these water sources which hinder the Bondo – Rarieda community from fully facilitating the right to safe drinking water.
These include inadequate water supply during the dry season, poor quality of water in some of the sources due to contamination by livestock and human activities (e.g. bathing), long distances to the water points, poor management by water committees etc. The two counties have been hit by sporadic outbreak of water borne diseases as many people do not have access to clean & safe drinking water. The available sources of water such as water pans are poorly managed & unsafe. According to Bondo district development plan, 57% of the population in the district lack access to clean drinking water.
There are inadequate sanitation facilities and basic information on good hygiene practices at both schools and household level. Most of the households do not have access to any kind of sanitation facilities (Annual work plan 2017). The MOH estimates latrine coverage to be at 58.5% up from 40% in 2016. The slight increase in latrine coverage is as a result of attempts made by Plan in collaboration with the MOPHS and other none state actors within the community to alleviate the problems. This is still considerably low.
Inadequate access to safe water supply, sanitation and hygiene facilities in schools within both Kisumu and Siaya counties deny children the right to access good health. Almost all the schools have low latrine coverage relative to the GOK stipulated standards of 1 door of latrine per 30 boys and 1 door latrine for 25 girls. Based on Plan’s recent assessment conducted in 30 schools of Siaya and Kisumu, 6,532 students are enrolled in 30 schools with latrine coverage of 211 only compare to require standards of 441 latrines in these schools and current gap is 230 latrines. Inadequacy of sanitation and hygiene in schools has contributed to poor learning environment leading to poor academic performances in the national examinations. In addition, children continue to fall ill as a result of sanitation and hygiene related diseases. These result to absenteeism from schools and ultimately affecting children’s academic performance. Mature girls who receive their monthly periods are also adversely affected since sanitary facilities at their schools do not guarantee them comfort and privacy to manage their menses therefore opting to stay at home to avoid being made fun of by boys at school. These girls ultimately drop out of school and that explains the disparity in the ratio of girls to boys in primary schools especially upper primary (6).
The WASH situation in Health facilities in both counties is not any different. Inadequate access to Sanitation facilities for patients and staff is a major challenge. Most of the health facilities in Kisumu and Siaya also face major challenge in water access especially due to storage capacity.
Despite the efforts made by Plan and the GOK [to contribute to the United Nation’s (UN) SDG 6, Target c of halving by 2030 the proportion of people without sustainable access to safe drinking water and basic sanitation], inadequate funds (to facilitate community sensitization on the benefits of constructing and using sanitary facilities and promoting behaviour change) has hampered the efforts of ensuring the communities have access to latrines.
Current Plan International WASH & Health programs Kisumu and Bondo
The PU programming aims at enhancing the overall health and living conditions of communities, increasing access and participation of boys and girls (including those with disabilities) in education, strengthening community based child protection systems and resilience within Kisumu and Siaya Counties.
This is achieved through the following interventions focusing on WASH and Health related interventions;
- Implementing the community health strategy to ensure functional community health units
- Implementing sustainable sanitation and hygiene interventions through the CLTS and sanitation marketing initiatives/approaches.
- Improving maternal and child health services through integrated programming including nutrition.
- Implementing effective comprehensive school health program CSHP while ensuring the school health policy and guidelines are implemented in schools focusing on water supply, hygiene and sanitation interventions compliance.
- Implementing community ASRH focused dialogue/action days for young people including school going children.
- Functional mentor groups for adolescent mothers.
- Established and equipped youth friendly corners in schools and health centers.
Plan is proposing to address the above issues by partnering with RAHA Solutions, a company working on rooftop rainwater harvesting, non-rooftop rainwater harvesting and sanitation technologies for schools and health facilities to implement a 1 year project that will enhance access to safe water, sanitation and nutrition services or the target beneficiaries. The project will be implemented in 30 schools (15 in each county) and 20 health facilities (10 in each county).
The schools will benefit from both the roof water harvesting systems and non-rooftop rainwater harvesting systems that have special component for water treatment to ensure water is safe for drinking and the SANISOLAR sanitation facility for the children to use.
RAHA solutions will provide these facilities as a Gift-in-kind to Plan International Kenya and offer the initial trainings to Plan International staff and selected school health patrons on the use and maintenance of the facilities. Selected Health facilities will be supported with either a roof water harvesting system, non-roof water harvesting or a SANISOLAR sanitation facility depending on the gap analysis as per the health facility assessment.
The project will integrate a component of kitchen gardening in the schools to support school children to access green vegetables for their meals that will contribute to improved child health as a result of improved nutrition. Public schools in Kenya have a school meal programme that this project can further add value to.
♣ To improved access to sustainable safe water, hygiene, sanitation services in target schools
♣ To improve WASH conditions in target health facilities
♣ To contribute to the improved nutrition for school children.
Project Outcomes / Results
♣ Improved sanitation and hygiene practices in target schools
♣ Improved water, sanitation and hygiene (WASH) services in health facilities
♣ Improved nutrition status for young children.
Project implementation framework/strategy
This project will be implemented in a total of 30 schools and 20 health facilities in Kisumu and Siaya Counties. The following are the project activities that will be implemented in a sequential manner.
• Assessment of water and sanitation facilities at schools and health facilities.
A rapid assessment involving different stakeholders within the schools and identified health facilities will be undertaken at the beginning of the project. This will give a basis for the implementation of the interventions and also act like a baseline for gathering data that will be useful in measuring the impact of the interventions.
• Selection of targeted schools and health facilities
The information collected from the rapid assessment exercise will inform on the gaps that exist in the respective schools and health facilities for informed intervention planning and targeting and thus help in the joint selection of actual sites for the toilets and water harvesting systems. A total of 30 schools and 20 health facilities will be selected and targeted for the interventions.
• Project launch of the project with required communication and visibility.
The project will be piloting improved technologies in sanitation and water harvesting and lessons from this will be used to inform the replication and scaling up to other parts of the country. To ensure the projects gains a good profile in the start, a launch event will be organised together with RAHA solutions who will share more on the proposed technologies and their benefits as compared to the existing facilities currently implemented across the country.
Prior to this event, a series of communications will be developed and conveyed in different media including the local dailies supplements. The branding plan proposed for the project will be discussed in this forum and agreed upon. The launch event will be held in both Kisumu and Siaya counties and draw participants from other NGOS working in the WASH sector as well as county government officials from the health, education, water and agriculture.
• Introduction of the project to stakeholders and formation of project oversight committee
Prior to project implementation, Plan will hold a joint stakeholders forum to introduce the project and the intended goal for information sharing, ownership and support during implementation. RAHA solutions will be in attendance during the project initiation meeting to further share the technologies proposed for the project for more awareness and ease of adoption in the target institutions. Participants will be drawn from the ministry of health; public health department, water and education and agriculture. These departments will offer technical support of the project in respective areas.
During the meeting a project oversight committee will be formed and tasked with overseeing the project activities per site are implemented as planned. This committee will be conducting joint supervisory visits each quarter to assess and monitor the school committees and health facility committees.
• Training and signing MoUs with schools boards of management and health facility management committees
Given the fact that the project will be looking at the access of sanitation and hygiene and water components that are critical components in the institutions, Plan will work closely with schools boards of management and health facility management committees and offer training on their roles to improve on the institutions water supply, sanitation, hygiene management and operations. This will then lead to concrete agreement through signing of Memorandum of understanding (MOU) that outlines each party’s role in management of the facilities. The 2-day trainings for each committee will equip the respective committees with skills in O&M and ensure proper measures are put in place to see the efficient day to day operation of the project interventions.
• Installation of the toilets and water harvesting systems
While introduction of the technology of the RAHA toilets have been discussed with the government departments on the need and agreed upon, the project will also hold awareness meetings with the identified potential beneficiary schools and health facilities to educate them on the RAHA solutions water harvesting and sanitation technologies. RAHA will conduct demonstration trainings for
TOTs in the initial beneficiary institutions and enhance capacity in installation among community beneficiary members. The TOTs will train other schools and health facility representatives on the installation in their institutions as appropriate.
• Health education sessions for school children and health facilities
Children are by large the most important population affected by WASH related diseases. Their participation in the project will be key to enhancing positive behaviour change since they have proved to be agents of change. To enhance this, the project will facilitate training of school health clubs (SHCs) on sanitation and hygiene through PHASE and Child to child (CTC) methodologies. This will ensure that children adapt the desired good practices for water safety, sanitation and hygiene that will result in improved health among the school children.
• Training on kitchen gardening for vegetable production in schools
In the schools that will benefit from water harvesting technology intervention, trainings will be conducted on kitchen gardening to initiate the kitchen gardens using simple technologies. The ministry of agriculture officials will work closely with the BOMS and school children to train on the type of vegetables to be grown and good crop husbandry practices.
Each school will have a patron in charge of the school kitchen gardening intervention who will also be the focal person for the project interventions.
RAHA solution technologies will have a double fold benefit to the project beneficiaries. The SANISOLAR sanitation facilities will enhance the sanitation status of the beneficiary schools and help with the fertiliser that will be used to grow the vegetables. The water tanks too will have a double benefit here as the water will be used for drinking purposes and at the same time assist with the irrigations for the kitchen gardens.
On a regular basis the project will be monitored to inform on the progress, lessons and challenges that will be used to inform on the necessary measures to be put in place for the project to realise the intended outcomes. Plan International monitoring and evaluation coordinator at the Kisumu Hub will be tasked with ensuring the project monitoring data is collected and reported on a quarterly basis. The monitoring and evaluation bit of this project will also entail monitoring the trends of the waterborne illnesses among the school children will be tracked over time to inform on the impact of the project. The findings of this will be shared with the stakeholders during the project period.
Completion of the work and handing over ceremonies
Once the project interventions for each beneficiary are successfully completed, the project oversight committee will conduct a final assessment to inform on the status and functionalities of the piloted technologies and interventions to inform handing over to the communities for continued utilization and maintenance to ensure beneficiaries get sustained services.
The ministry will act as a key technical partner that will provide their staff i.e. Public Health Officers will support during the implementation process within the target populace. They will also support in capacity development, monitoring, quality assurance and sustenance of the project activities. This will in turn lead to improved capacity of the schools and health facilities in managing the project interventions.
The Ministry of Education will mobilize teachers, pupils and BOMs while the ministry of health will mobilise health facility committees to enhance participatory implementation of the project activities and where possible further replication to communities where we work. In addition, they will act as the gate-keepers and custodians of the sanitation facilities and water harvesting tanks upon installation to ensure the beneficiaries get the necessary services.
The capacity development of the respective institution management committees will enhance the skills and capacity of the respective committees for improved operation and maintenance of the sanitation, water harvesting facilities and kitchen gardens.
 UNICEF. “Water, Sanitation and Hygiene” Updated May 2010. http://www.unicef.org/media/media_45481.html
 United Nations Development Programme. “Human Development Report 2006: Beyond Scarcity: Power, Poverty and the Global Water Crisis.” 2006. Available at http://hdr.undp.org/en/reports/global/hdr2006/
 WHO/UNICEF-WASH for health facility improvement tool Kit 2017
 Plan Kenya CRSA Report-2014
 Siaya County Annual Plan 2016