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1.1 Background Information

Sanitation and hygiene remain a challenge in many parts of the world. About 50% of the developing world’s population (2.5 billion people) lack improved sanitation facilities and over 884 million people still use unsafe drinking water sources (WHO & UNICEF, 2010). This contributes greatly to morbidity and mortality in children. It leads to impoverishment and diminished opportunities for many more children (WHO & UNICEF, 2010). To address this global challenge, the United Nations came up the eight Millennium Development Goals (MDGs) in the year 2000. The MDGs address various sectors with the objective of spurring efforts to meet the needs of the world’s poorest nations by 2015. The objective of Millennium Development Goal Number Seven (7) was to halve the proportion of people without sustainable access to drinking water and basic sanitation by 2015 (UN, 2000). This target appears to be out of reach as poor physical planning in urban areas coupled with the proliferation of unplanned settlement is a challenge to the provision of safe drinking water and sanitation.

Some efforts have been made towards improving public health in schools by various stakeholders. Globally, the “Call to Action for WASH in Schools” campaign was formally launched in 2010. This major initiative involved UNICEF and key partners who called on decision-makers to increase investments in the area of safe water supply and sanitation concerns (JCA, 2010). The ultimate goal was to expand water and sanitation (WASH) programmes in school to improve health, foster learning and enable children to participate as agents of change within their homes and communities. The campaign was structured to strategically focus on efforts and resources into key areas (JCA, 2010).

Kenya has made significant milestones in improving sanitation and hygiene in schools. The enactment of the National Environmental Sanitation Policy of 2005 and the launch of School Health Policy and School Health and Guidelines in 2010 illustrate the government’s commitment to improving Public health in schools. This was done to enable various stakeholders to implement school health programmes based on well-defined regulations and standardised guidelines. It was also aimed at improving the effectiveness and quality of health intervention programmes in schools as stipulated in the National School Health Strategy Implementation Plan of 2011-2015. This was meant to improve primary health care in Kenya through the full participatory approach by the school children.

Although policy has been in favour of a comprehensive primary health care (PHC) approach, especially school health, there is a disjuncture between policy enactment and its realisation. Health services continue to be highly focused on curative care at higher levels of the Kenya’s health system (WHO, 2008). As a result, prevention of diseases has lagged behind. For example, safe drinking water and sanitation provision have dropped from 49% to 43% in Kenya in recent years (MoH, 2005). Consequently, approximately 80% of outpatient hospital attendance in Kenya is attributed to cases of preventable diseases while 50% are water, sanitation and hygiene-related (GoK, 2008). In Kakamega Municipality Division, there is 10% coverage of piped water and over 300 bore holes and yet the common sanitation system is pit latrine being used by about 97% of households (MoPND, 2004). Despite the division having plenty of water resources, use of pit latrines makes access to potable water be at 60% due to pollution of the underground water system (MoPND, 2004).

A report by UNICEF on Kenya Country Profile points out that water and sanitation facilities in schools are increasingly recognized as fundamental for promoting good hygienic behaviour and children’s well-being. However, many schools in Kenya have very poor water and sanitary facilities (UNICEF, 2009). These conditions vary from inappropriate and inadequate sanitary facilities to the outright lack of latrines and safe water for drinking and hygiene. UNICEF (2009) further observes that this situation contributes to absenteeism and the high drop-out rates of pupils especially girls. Lack of sanitation and hygienic facilities in schools has a stronger negative impact on girls than on boys because girls need safe, clean, separate and private sanitation facilities in their schools (UNICEF, 2011). Since girls and boys are affected in different ways by inadequate water, sanitation and hygiene conditions in schools, this may contribute to unequal learning opportunities.

School children make up a large proportion of the total national population in Kenya (MoPHS/MoE, 2009). This makes schools the largest and widest spread of all the social services- approximately ten times the size of the health services (AMREF, 2007). School children also spend a lot of their time in school (Lutomia, 2006). These factors coupled with a lower immunity to most diseases and relative lack of sanitation knowledge exposes the young school-goers to a multitude of health risks (MoPHS/MoE, 2009). These health risks range from those that are mild forms of ailments and discomfort to those that are potentially life-threatening. It has been established that infections and co-infections are prevalent in schools in developing countries as they offer a suitable environment in which diseases can spread from one child to another (WHO, 2009); (JCA, 2010); (UNICEF, 2012).


1.2 Problem Statement


The government of Kenya has continually adopted policies and strategies over the years in order to combat the present challenges in health services (WHO, 2008). However, the challenges of improving sanitation have been due to rising population and increasing rural-urban migration. For primary schools, heavy investment in the education sector has accelerated reforms such as the launch of Free Primary Education in 2003. This occasioned an increase in the enrolment of learners in public schools leading to an influx of over 1.3 million learners in the education system (UNICEF, 2011).

The rapid increase strained the hygiene and sanitation facilities in primary schools, consequently resulted in low standards of sanitation and hygiene in many primary schools all over the country (MoEST, 2006). As a result, only 29% of all schools at both primary and secondary levels have access to clean and safe drinking water and appropriate sanitation facilities (MoEST, 2006). For example, in most primary schools a pit-latrine serves over 100 pupils. Moreover, the quality is often very low in places where the facilities exist (SWASH, 2009).

In Kakamega Municipality division, incidences of collapsing pit latrines and frequent closure of primary schools by the public health department are frequent experiences, (MoPND, 2004). The Kenya Water Development Report (2006), also pointed out that water conservation measures are generally not practised in schools. Therefore, pupils fetch water from nearby water systems and ferry it to school for drinking and washing. However, this water is of questionable quality which may cause sickness to many children (UN-Water, 2006). To a large extent, the quality of hygiene and sanitation in schools has become compromised.


1.3 Justification of the study


Poor sanitation and hygiene hinder education attainment and drain households’ resources due to diseases imposed (WHO, 2008). It causes sickness in thousands of children every day and leads to impoverishment and diminished opportunities for thousands or more (WHO & UNICEF, 2010). To ensure proper literacy levels, a clean learning environment is needed and would enable a healthy learner population (GoK, 2008). Over time, the population of Kakamega Municipality has expanded without the equivalent improvement or upgrading of the existing sanitation facilities in public schools. Most research on sanitation in schools has also been done on aspects of latrine and water. But sanitation of other facilities like classrooms, urinals, kitchens, and physical environment has not been adequately addressed. Therefore, there was a need for updated in-depth information on sanitation and hygiene in schools in all aspects. This data can be used for development of indicators for monitoring sanitation and hygiene in primary schools. Gaps would be identified in the school health system and would inform policy and decision makers on appropriate mitigations or interventions to improve public health in schools. This will foster a healthy learning environment and improve performance in public primary schools.


1.5 Research question


  1. What are the prevailing conditions of the available hygiene and sanitation facilities within public primary schools in Kakamega Municipality?


  1. What factors affect sanitation and hygiene in public primary schools in Kakamega Municipality?


  • What is the knowledge, attitude and practice sanitation of pupils in public primary schools in Kakamega Municipality?


1.6 Objectives


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