What ails WASH In Schools: Criticality of Operations and Maintenance for Long-term Functionality of WASH Infrastructure - A Cross-sectional Study from South India

Introduction

Adequate, functional, and reliable Water, Sanitation, and Hygiene (WASH) infrastructure in schools constitutes an important component of a school environment that can protect health, inculcate healthy life habits among children, and promote academic learning. While its importance is universal, its criticality for the underprivileged and the marginalized cannot be overemphasized. Experiences from around the world has shown that WASH facilities in schools promote the entire cycle of school education right from enrolment to attendance to learning. School-aged children are at high risk for WASH–related morbidities; this age group experiences over 2.8 billion cases of diarrhoea annually and are associated with high absenteeism and dropout rates, contributing to decreased academic performance and ultimately leading to adverse economic and health impact.^1,2

The costs of implementing improved WASH services are less than the health costs associated with the management of waterborne diseases.² The WHO estimates that investment in WASH can lead to economic returns of $2 for every dollar spent on water and $5.50 for every dollar spent on sanitation.³ Nevertheless, inadequate WASH is still an issue in many countries due to a combination of lack of awareness, government policies, insufficient budget allocations, and financial resources.⁴ Millennium Development Goals (MDGs) gave an additional focus on WASH which resulted in accelerated progress globally.⁵ This focus was further escalated in the Sustainable Development Goals (SDGs), with SDG 6 setting the goal with greater clarity and more holistically for the WASH sector. Despite this, the recent report states that 2.2 billion people still lacked safely managed drinking water services, 3.4 billion lacked safely managed sanitation services, and 1.9 billion lacked basic hygiene services in 2022.⁶

The recent COVID-19 pandemic, which demonstrated how quickly a disease can spread in unclean, crowded environments, has been a rude reminder of this basic prerequisite. This explosive infectivity is not exclusive to COVID-19, but is true for many infections. G. Rajaratnan et al. proved that there was a statistically significant association between infection and the use of a common toilet for defecation in an outbreak of Hepatitis A.⁷ Having clean water, sanitation, and hygiene is hence crucial in preventing the spread of diseases and promoting positive health.

Recent efforts over the past couple of decades have accelerated the coverage of Government schools with WASH infrastructure through various schemes. Other drivers for such progress have been the judiciary and the civil society organizations which have advocated for ensuring safe WASH in schools. However, the functionality of the infrastructure so created has always been in question, mainly due to poor quality work and lack of focus on operations and maintenance (O and M).

Hence, an assessment of WASH infrastructure in schools was undertaken by Swami Vivekananda Youth Movement (SVYM), a developmental organization working in the field of WASH in many geographic locations in Karnataka, to understand the availability and functionality of WASH facilities.

Materials and Methods

Study design and population: A cross-sectional study was undertaken in 67 Government schools of Tirumakudalu Narasipura, and Nanjangud taluks of the Mysuru district, Karnataka, India in the month of September 2021. Eight trained investigators from the project team of SVYM undertook the survey. Using a structured questionnaire, information was gathered about the status of different components of WASH infrastructure, namely toilets, urinals, handwashing facilities, drinking water, gardens, compound/fencing, waste management (such as soak pits, etc.), and solid waste segregation, collection, and disposal.

Screening tool: A peer-reviewed assessment tool was created and validated by field testing. The survey was done including 67 schools using a paper-based questionnaire.

Data collection, management, and analysis: The data were entered and analysed using Microsoft Office Excel. The results were presented in tables as ratios and percentages. These ratios and percentages were compared with the standards recommended. Later, a detailed analysis of randomly selected six schools with defunct WASH was done. '

Results

I. Baseline Characteristics

Toilets and Urinals

Out of the 67 schools, 32 (47.76%) were Lower Primary Schools, 27 (40.3%) were Higher Primary Schools, and 8 (11.94%) were High Schools. Table 1 demonstrate facility to student’s strength ratio.

Boys toilets and urinals

● Of the schools surveyed, 58 (86.57%) had toilets (52 functional, 6 non-functional) and 48 (71.64%) had urinals (42 functional, one partially functional, 5 non-functional) for boys. 19 schools had no urinals, nine had no toilets and five had neither.

● 72/78 toilets (92.31%) and 73/81 urinals (90.12%) were functioning.

● There was one toilet for every 25 students in 26 (50%) schools, one toilet for every 26-40 students in 11 (21.2%) schools, one toilet for every 41-60 students in 11 (21.2%) schools and one toilet for every 61 or more students in four (7.7%) schools.

● There was one urinal for every 25 students in 27 (62.8%) schools, one urinal for every 26-40 students in seven (16.3%) schools, one urinal for every 41-60 students in seven (16.3%) schools and one urinal for every 61 or more students in two (4.6%) schools.

Girls toilets and urinals

● 64/67 (95.52%) had toilets (51 functional, 1 partially functional, 12 non-functional) and 47 (70.15%) had urinals (38 functional, 9 non-functional) for girls. Three schools had no toilets, 20 schools had no urinals and two schools had neither.

● 91/105 toilets (86.67%) and 62/73 urinals (84.93%) were functioning.

● There was one toilet for every 25 students in 32 (61.5%) schools, one toilet for every 26-40 students was there in 11 (21.2%) schools, one toilet for every 41-60 students in four (7.7%) schools and there was one toilet for every 61 or more students in five (9.6%) schools.

● There was one urinal for every 25 students in 24 (63.2%) schools, one urinal for every 26-40 students was there in eight (21%) schools, one urinal for every 41-60 students in four (10.5%) schools and there was one urinal for every 61 or more students in two (5.3%) schools.

Water Supply

Most of the schools (97%,65/67) had an independent water supply.

Water source and supply

There was a public water supply in 59 (90.8%) schools. The remaining eight schools utilized bore wells. Six schools had rainwater harvesting system, of which five were functional.

Water disbursement on the campus

There was water storage sump and motor in 50 (88.1%) schools.Apart from the tap provided as part of the public water supply system, 17 schools (26.2%) had hand-washing platforms with multiple taps. All these platforms had a functional water supply; however, no soap was provided at the platforms.

Solid and Liquid Waste Disposal

Waste water

A drainage system was in place for waste water disposal in 17 (25.4%) schools.

Solid Waste

Twelve (17.9%) schools had solid waste management systems.

Compound-Fencing, Campus Security

There were compounds in 59/67 (88.1%) schools, of which 25 were damaged.

Equity-Inclusion

Of the 6367 students from 67 schools, 74 (1.2%) students from 32 schools were classified as Children With Special Needs (CWSN). None of the schools had WASH infrastructure where structural modifications have been incorporated for enhancing accessibility for CWSN.

II. Analysis of Sanitation Complexes

To get a better deeper understanding, we analyzed the status of toilets in six schools (10% of all the schools surveyed) that had defunct toilet complexes in greater detail. Each toilet complex consisted of three urinals and one toilet. We classified them into seven infrastructural parts - namely flooring, doors, walls basins, roofs, water supply, and pits, looked at which of these were predominantly affected. The findings from the deeper analysis are given below.

Component-wise description of the damages identified, and rectification undertaken

Toilets

Damages were found in Flooring in 10/12 (83.3%) units (flaking, water stagnation); Doors in 10/12 (83.3%) units (rusting, loosened hinges, broken latches); Walls in 8/12 (66.7%) units (loosened plastering, cracks, exposed-damaged brickwork); Basins in 8/12 (66.7%) units (cracks, breakages); Roof in 3/12 (25%) units; Water supply in 7/12 (58.3%) (damaged pipelines, taps, and lack of source connection) and Pits in 5/12 (41.7%) units (leakage, broken covers, blockage) (Table 2).

Urinals

In all the ten urinals, all seven components were found to be damaged (Table 3).

Discussion

Availability and Functionality

School WASH infrastructure includes a safe water supply for drinking and other uses; safe sanitation including toilets and urinals, with water supply and with mechanisms for safe waste disposal; safe hygiene facility including hand-wash units, food hygiene, and general campus upkeep. It is expected that separate WASH infrastructure for boys and girls in adequate numbers be always available and functional in all schools. The generally accepted ratio of toilet-to-student ratio is 1:40.

In our study, WASH infrastructure was available in most schools with 86.5% of schools having boys’ toilets and 97.0% of schools having girls’ toilets. However, these sanitation complexes were found to be incomplete in some aspects. As many as 20 schools lacked girls’ urinals and 19 schools did not have boys’ urinals. The functionality of the physically available toilets was also found to be a challenge, as only 52 out of 67 (77.6%) had functional toilets for girls and boys. The reason for the non-availability of functional toilets was different for boys and girls. While boys’ toilets were not available at all in nine schools, only three did not have dedicated toilets for girls. This was contrary to the general assumption that the creation of dedicated toilets for girls is often neglected. However, in as many as 12 schools, the girls’ toilets were non-functional. Similarly, the presence of boys’ toilets in six schools was of no benefit as they were non-functional.

The study findings reiterated that the physical presence of toilets does not necessarily mean usability, highlighting the lack of regular O and M.

The pattern of infrastructure damage in sanitation complexes

The challenges for WASH in schools relate to the Hardware i.e., the infrastructure, and the Software i.e. the practices associated with the use of infrastructure.⁸ We looked at patterns of hardware disrepair and possible reasons for the lack of upkeep of the washrooms. The most common damages were to the doors and flooring. Children, especially girls, were hesitant to use the toilets with non-functional doors, thus making the entire toilet non-functional, gradually leading to the disrepair of other components as well. Damages to doors included non-functional latches and broken hinges. These are cheap and easy to repair, and the door itself is one of the cheaper components of the infrastructure. Thus, ironically, non-attention to such low-cost, easily correctable issues was seen to have escalated into non-use of the entire infrastructure. Damage to flooring imposed the risk of injury, especially as many children tend to use worn-out footwear due to economic and other compulsions. Damage to the roof was the least frequent. However, roof damage has serious repercussions, as it would allow accumulation of twigs/leaves leading to damage to pan and flooring, and to blockage of outlet pipes and pits.

Most of the toilet complexes were non-functional due to the non-functionality of a few repairable components. It was observed that the initial disrepair is generally with one of the seven components explored, leading to reduced usage. This leads to progressive neglect of the entire complex, with gradual deterioration in its upkeep and functionality.

As reported by the school authorities verbally, this initial damage is generally in the highly used but low-cost components like latches, handles, taps, etc, which do not get addressed in a timely manner. This sets in motion the cascade of events mentioned above, leading to the entire complex becoming non-usable.

Equity considerations

According to the WHO, 11% more girls attend school when sanitation is available (WHO REPORT 2022).⁹ Studies conducted by Christian Jasper et al. documented female discomfort in the school environment during menses due to lack of privacy, challenges of disposal of materials used during menstruation, or insufficient school water and sanitation facilities.¹⁰

For children with special needs (CWSN), slight alterations of the design would be beneficial. These include the elimination of barriers, adding grab-bars, and appropriate positioning of taps and flushes. However, there were no such modifications in any of the sanitation complexes. These are not very cost-intensive and can convert the current toilet units into ones that can be used by all persons. Increasing the space in the washroom would help easy manoeuvrability. These measures can be implemented as per the need and resources.

Key O and M Challenges

Leslie Deroo et al. in their analysis of WASH programs in a school identified five categories of barriers: (1) logistical challenges; (2) limited staff capacity; (3) limited funding; (4) inadequate management systems; and (5) socio-political barriers.¹¹ Our analysis has highlighted that all these barriers exist in the Indian context as well.

Maintenance logistics and Human resource Regular maintenance of the WASH infrastructure involves simple but repetitive functions like cleaning, swabbing and flushing, and periodic functions like clearing the surroundings and ensuring that the pipes are not clogged. Ensuring a regular water supply is another critical prerequisite.

It was observed that these basic requirements are often not fulfilled due to the paucity of logistic support and personnel for cleaning.

Financial resources

It is expected that with time, as with any other infrastructure, the components of WASH infrastructure will go out of repair. Till recently, there was no budgetary provision for the recurrent expenses for O and M of WASH infrastructure. Currently, this support has been introduced, with Lower primary, Higher primary, and High schools being eligible for annual grants of 6350/, 8000/-, and 9000/- respectively. However, all schools reported that this was inadequate even for regular O and M, ruling out the possibility of repairs and replacements. The release of funds was also not smooth and hassle-free. Replacement of affordable items like taps had been done on a few occasions by the teachers and the School Development and Monitoring Committee (SDMC), often on their own initiative. However, this could not be sustained. This is reflective of the findings of Shadi Saboori et al., who reported that repair and maintenance of WASH infrastructure in schools could not be undertaken due to lack of a definite source of funding, high costs, and lack of information about repair services.¹²

Quality and logistics of construction and repairs

The quality of initial civil works is of paramount importance. As reported by the school authorities, attention to quality at the time of construction including quality and quantity of materials used, workmanship, and attention to precision in terms of slopes and finishing was grossly inadequate. This lack of attention to quality precipitates an early need for repairs. Repair works are difficult to undertake as it is considered less attractive than building anew. It is also less remunerative for the workforce.

Ownership and Accountability

The understanding of school authorities of their role in ensuring the quality of construction and in O and M of WASH infrastructure was found to be variable and inadequate. Some of the school staff felt that this was not their responsibility and said they would not get involved. Some enthusiastic teachers were willing to get involved, but by and large, the predominant experience reported by such individuals was non-responsiveness on the part of the contractors who were executing the work.

Conclusion

From the current study, it can be surmised that though WASH infrastructure has been created in most schools, their functionality is less than desired, due to poor quality of construction and lack of timely O and M which are largely neglected. Non-functional status of WASH infrastructure is a gradual progression starting with one component, which is relatively easier and cheaper to repair. Neglecting such repairs at the right time very soon makes the entire complex unusable and thus precipitates a larger challenge. Ensuring proper O and M would help timely restoration of functionality and prolong the life of WASH infrastructure. This would also ensure substantial savings by avoiding demolition and re-building, both of which are cost intensive. It is important that we advocate for greater attention to O and M and for ensuring accountability and sustainability, rather than the creation of new infrastructure. Simple, cost-effective design modifications to incorporate the needs of the CWSN are needed to bring in better equity and inclusion.

The current provision for O and M needs to be revised, and it would be necessary to provide for periodic additional grants for graded degrees of repairs and replacements. A larger, longitudinal study over 5-7 years would help us understand the patterns of infrastructure damage, based on which grants can be planned.

While this study has focussed on the Toilet-Urinal complexes, a similar analysis would be useful in furthering our understanding of the functionality of other components of WASH services, including Water Supply, Liquid and Solid Waste Management, Menstrual Hygiene, and Campus Environment.

Conflict of Intreset

None