Attendee at launch of Global Call to Action for WASH in Schools (Photo Credit: Ellyn Walter, Water Advocates)

With the school year underway for millions of children around the world, the continued lack of adequate

Children Without Worms (CWW) has resolutely voiced the need for a holistic approach to tackle the root causes of STH infection. Recently, CWW joined forces with UNICEF and other partners in the Global Call to Action for WASH in Schools (WASH in Schools). This initiative raises awareness about the lagging progress in water and sanitation, helps place WASH in Schools on global and national development agendas, and equips programs with appropriate resources to advocate for WASH.

On October 13, CWW joined 30 organizations in Washington, DC, to launch the Global Call to Action for WASH in Schools, urging policy makers and development partners to increase health, education, and water sector investments in school-based water, sanitation and hygiene programs.

The Benefits of WASH in Schools

WASH in Schools offers numerous benefits: it not only helps prevent worm infection, but also improves overall health, decreases school absenteeism, fosters improved learning, and facilitates gender equity in school attendance. In addition, WASH in Schools enables children to serve as agents of change, as they take the messages and behaviors they learn in school back to their families and communities.

For these benefits to be realized, local, national and global stakeholders need to strengthen their commitment and accelerate their efforts to provide safe drinking water, child-accessible latrines, separate girls/boys facilities, and hand washing facilities within schools. School curricula must also integrate hygiene education as a fundamental component of the school package, along with blackboards, notebooks, and teachers.

Your Call to Action

CWW urges its recipient countries and partners to join the Global Call to Action for WASH in Schools to help create a safer, healthier, worm-free environment for school children.

STH control programs can educate Ministries responsible for water and sanitation about the local STH situation and invite them to join the Ministries of Health and Education on the school health taskforce. STH control programs can also advocate for policies that mandate appropriate sanitary facilities in all schools, and work together with NGO partners to prioritize endemic areas for WASH interventions.

NGO partners can leverage school-based deworming programs to develop more comprehensive school health programs that include components such as health education, sustainable water and sanitation improvements, and nutritional supplement programs.They could also include overall hygiene messaging in social mobilization activities that precede deworming campaigns.

Donor organizations can support innovative and sustainable efforts focused on preventing infection and re-infection to ensure that any gains deworming programs achieve are maintained. For example, they could support efforts aimed at improving access to safe drinking water and sanitation.

CWW's advocacy for WASH

In addition to the WASH in Schools campaign, CWW has been energetically advocating for WASH as a vital component of comprehensive control of STH through other media:

• CWW Director Kim Koporc blogs about WASH and worms on Global Handwashing Day
   
• CWW launches WASH in Schools video
   
• CWW attends the Stockholm World Water Week Conference
   
• CWW calls for holistic approach for STH control
   
• CWW's Quarterly Dose Newsletter with a focus on the WASHED framework
   

For more information and resources to help your WASH in Schools advocacy efforts, visit UNICEF's Call to Action site.

Recognizing that the gains made through deworming could be maintained with improved hygiene education, the government of Cambodia partnered with Children Without Worms (CWW) and Helen Keller International (HKI) in 2009 to revise Cambodia's school curriculum to promote healthy practices to prevent reinfection. The partners determined that the project could be carried out in two phases: an initial situational analysis, followed by developing and piloting the revised curriculum.

Phase One: Conduct Situational Analysis

In September 2009, HKI worked with the School Health Department under the Ministry of Education, Youth and Sports (MoE) to perform a situational analysis. In this analysis, the project team inventoried existing materials relevant to hygiene, sanitation and soil transmitted helminthes (STH) control. They also identified other groups in Cambodia currently working in school health, surveyed them about their work, and interviewed key representatives of these groups. In addition, they surveyed and interviewed school representatives, including directors, teachers, and students, to learn what school health activities currently take place and to assess knowledge of worm control and prevention.   

Some of the key findings from the situational analysis included:

• Current strategies to prevent and control soil-transmitted worm infections have solid foundations, but need improvement.
• Training manuals and teaching materials focus primarily on general health, hygiene and sanitation; they include limited information about intestinal worm infections.
• Although the Ministry of Health provides materials specific to STH infections and teacher guidelines for mass distribution of medicines, they are not distributed evenly among primary schools. As a result, some schools have little or no resources for educating students about intestinal worms.
• Teachers often do not use all of the materials or allot enough time for lessons on health, hygiene and sanitation.
• The majority of students interviewed could name one activity that reduces the chance of worm infestation. However, only 18 percent--less than one in five children--knew that deworming tablets could be taken to treat intestinal worms.

WaterAid Australia and International Water Centre highlighted the results of this first phase in a case study published as part of the book, "Sharing Experiences: Effective hygiene promotion in South East Asia and the Pacific." The book includes 11 case studies from around the world, along with keynote papers from international experts in hygiene promotion. The book can serve as a useful resource for people developing programs to promote good hygiene practices.

Phase Two: Revise and Test Pilot Curriculum

Based on the results of the situational analysis, a technical committee of teachers, school directors, health workers, and NGO representatives revised the curriculum and submitted it to a steering committee for review. HKI and the MoE piloted the revised curriculum in four primary schools in Takeo and Kampong Spue provinces. The proximity of these provinces to Phnom Penh made logistics easier to coordinate and kept costs to a minimum.

HKI and MoE staff conducted site visits to all four schools to monitor and supervise the piloted activities. They also provided school directors and teachers with technical assistance, answering any questions that arose while teaching the primary school students with the revised curriculum.The results were highly successful, and based on the feedback, the curriculum on prevention and control of soil transmitted helminthes was finalized. On October 28, 2010, the Honorable Minister H. E. Mark Vann of the MoE, Youth and Sports officially approved and signed off on use of the newly revised curriculum by all of Cambodia's primary schools. The new curriculum will be taught to teachers in teacher training schools. These teachers will then teach the curriculum to school children throughout Cambodia.

Irina Spencer, working with Marco Albonico of the Ivo de Carneri Foundation to develop Plan of Action for Elimination of STH as a Public Health Problem in Cape Verde

A 2005 study by Cape Verde's Ministry of Health (MoH), the World Health Organization (WHO), the World Food Program (WFP), and the Institute for Scholastic Social Action (ICASE) determined that the prevalence of soil transmitted helminthes (STH) in Cape Verde was 49.2 percent. It also revealed that 60 percent of kindergartners were infected. Following this study, the National Nutrition Program developed the STH Program, with the aim of reducing the prevalence and intensity of STH infections.

Irina Spencer serves as the Program Coordinator. She is responsible for a wide range of activities supporting STH control, including finding and coordinating program partners, seeking mebendazole donations, monitoring the mebendazole inventory, monitoring deworming campaigns, and reporting on the program's impact.

The program relies on primary schools with an integrated kindergarten as the means of distributing deworming medication. The program objective is to increase and then maintain school attendance by students and improve their nutritional status. Overall, by ensuring Cape Verde's students have good health and receive an education, the program hopes to aid the country's development. Prior to the donation, the program conducted some deworming campaigns in schools, but encountered difficulties procuring doses to treat all children in the country.

Ms. Spencer learned about Children Without Worms (CWW) through the WFP and applied successfully for the donation program in 2007. Deworming treatment started in 2008. Since receiving the mebendazole donations from CWW, Ms. Spencer says, "The STH Program has administered the mebendazole tablets (500mg) twice yearly to children in all schools and kindergartens and has undertaken additional efforts to reduce infection rates." She continues, "These efforts include training school teaching and administrative staff on STH control, and expanding the general population's awareness of STH control through television and radio public service ads, billboards, posters and leaflets."

Ms. Spencer notes that the program faces several challenges, including a need to improve the mebendazole distribution mechanism, coordination among the various sectors, program monitoring and evaluation, and increased sanitation and hygiene in schools and communities. Fortunately, many partners, including the MoH, MOE, WFP, UNICEF, and WHO, are engaged in the campaign to fight STH and overcome these challenges. These partners and CWW will be working together in 2011 to help eliminate STH as a public health problem in Cape Verde. To that end, they've drafted a plan of action that includes conducting a parasitological survey in 2011 to assess the impact of deworming campaigns carried out to date, plus next steps to take to eliminate STH.