A qualitative comparative analysis of well-managed school sanitation in Bangladesh

BMC Public Health

Mohini Venkatesh¹  Laure Bottinelli²  Kawser Alam²  Karl G Linden³  Amy Javernick-Will³  Christie Chatterley³ 

[1] Department of Education and Child Development, Save the Children, Washington, USA;School Health and Nutrition Department, Save the Children, Dhaka, Bangladesh;Department of Civil, Environmental and Architectural Engineering, University of Colorado, Boulder, USA

关键词: Asia;    Bangladesh;    Sustainability;    Hygiene;    Qualitative comparative analysis;    Handwashing;    School sanitation;   

Others  :  1161377
DOI  :  10.1186/1471-2458-14-6

 received in 2013-04-24, accepted in 2013-12-17,  发布年份 2014

【 摘 要 】

Background

Continued management of sanitation and hygiene services, post-intervention, is a global challenge, particularly in the school-setting. This situation threatens anticipated impacts of school sanitation and hygiene investments. To improve programming and policies, and increase the effectiveness of limited development resources, we seek to understand how and why some schools have well-managed sanitation post-intervention, while others do not.

Methods

Based on in-depth qualitative data from 16 case schools in Meherpur, Bangladesh, we employ fuzzy-set qualitative comparative analysis to identify the necessary and sufficient conditions, or combinations of conditions (referred to as pathways), that lead to either well-managed or poorly managed school sanitation. We include posited sustainability determinants from the literature and factors that emerged from the cases themselves in the analysis.

Results

We identified three distinct pathways sufficient to support well-managed services, providing multiple options for how well-managed school sanitation could be encouraged. Two of these are applicable to both government and non-government schools: (1) quality construction, financial community support and a champion; and (2) quality construction, financial government support, a maintenance plan and school management committee involvement. On-going financial support for operations and maintenance was identified as a necessary condition for continued service management, which was absent from many schools with poorly managed services. However, financial support was insufficient alone and other conditions are needed in conjunction, including quality construction and incentivizing conditions, such as school management committee involvement in sanitation specifically, a sanitation champion, and/or one teacher clearly responsible for toilet maintenance. Surprisingly, the number of students per toilet (ranging from 18–95 students) and toilet age (ranging from 8–32 months) had no significant effect on sanitation conditions.

Conclusions

Findings corroborate those from a similar study in Belize, and comparison suggests the need for financial community support and the possibly tenuous reliance on local champions in the absence of adequate government support for operations and maintenance. Sub-determinants to the necessary conditions are also discussed which have implications for school sanitation in Bangladesh and may have broader relevance for other low-income countries though further research is needed.

【 授权许可】

   
2014 Chatterley et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R: Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster: randomized trial. Trop Med Int Health 2012, 17(3):380-391.
• [2]Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, Hoekstra RM, Luby S: A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in chinese primary schools. Am J Trop Med Hyg 2007, 76:1166-1173.
• [3]Greene L, Freeman MC, Akoko D, Saboori S, Moe C, Rheingans R: Impact of a school-based hygiene promotion and sanitation intervention on pupil hand contamination in Western Kenya: a cluster randomized trial. Am J Trop Med Hyg 2012, 87:385-393.
• [4]Dreibelbis R, Greene LE, Freeman MC, Saboori S, Chase RP, Rheingans R: Water, sanitation, and primary school attendance: a multi-level assessment of determinants of household-reported absence in kenya. Int J Educ Dev 2013, 33(5):457-465.
• [5]Njuguna V, Karanja B, Thuranira M, Shordt K, Snel M, Cairncross S: The Sustainability and Impact of School Sanitation, Water and Hygiene Education in Kenya. The Hague, Netherlands: United Nations Children’s Fund and IRC International Water and Sanitation Centre; 2008.
• [6]Mathew K, Zachariah S, Shordt K, Snel M, Cairncross S, Biran A, Schmidt W: The sustainability and impact of school sanitation, water and hygiene education in southern India. Waterlines 2009, 28(4):275-292.
• [7]Lopez-Quintero C, Paul F, Neumark Y: Hand Washing Among School Children in Bogotá, Colombia. Am J Public Health 2009, 99(1):94-101.
• [8]Saboori S, Mwaki A, Porter SE, Okech B, Freeman MC, Rheingans RD: Sustaining school hand washing and water treatment programmes: lessons learned and to be learned. Waterlines 2011, 30(4):298-311.
• [9]Saboori S, Mwaki A, Rheingans RD: Is soapy water a viable solution for handwashing in schools? Waterlines 2010, 29(4):329-336.
• [10]Curtis V, Schmidt W, Luby S, Florez R, Toure O, Biran A: Hygiene: new hopes, new horizons. ncet Infect Dis 2011, 11(4):312-321.
• [11]Koopman JS: Diarrhea and School Toilet Hygiene in Cali, Colombia. Am J Epidemiol 1978, 107(5):412-420.
• [12]Xuan LT, Hoat LN, Rheinländer T, Dalsgaard A, Konradsen F: Sanitation behavior among school children in a multi-ethnic area of Northern rural Vietnam. BMC Public Health 2012, 12:140. BioMed Central Full Text
• [13]Mooijman A, Snel M, Ganguly S, Shordt K: Strengthening Water. IRC International Water and Sanitation Centre: Sanitation and Hygiene in Schools - A WASH guidance manual with a focus on South Asia; 2010.
• [14]IRC: Towards Effective Programming for WASH in Schools: A manual on scaling up programmes for water, sanitation and hygiene in schools. Delft, The Netherlands: IRC International Water and Sanitation Centre; 2007.
• [15]Snel M: The Worth of School Sanitation and Hygiene Education (SSHE): Case Studies. Delft, The Netherlands: IRC International Water and Sanitation Centre; 2004.
• [16]Chatterley C, Linden KG, Javernick-Will A: Identifying drivers of sustainable school sanitation in Belize. J Water Sanit Hyg Dev 2013, 3(3):411-422.
• [17]OneWorld South Asia: Government to take over all primary schools in Bangladesh. New Delhi: OneWorld South Asia; 2013.
• [18]Save the Children: Shishuder Jonno baseline survey report. Dhaka: Save the Children-USA; 2009.
• [19]Berg-Schlosser D, De Meur G, Rihoux B, Ragin CC: Qualitative Comparative Analysis (QCA) as an Approach. In Configurational Comparative Methods: Qualitative Comparative Analysis (QCA) and Related Techniques. Edited by Rihoux B, Ragin CC. Thousand Oaks, CA: Sage Publications; 2009:1-18.
• [20]Ragin CC: The Comparative Method: Moving Beyond Qualitative and Quantitative Strategies. Berkeley and Los Angeles: University of California Press; 1987.
• [21]Jordan E, Gross M, Javernick-Will AN, Garvin MJ: Use and misuse of Qualitative Comparative Analysis. Construction Management and Economics 2011, 29(11):1159-1173.
• [22]Ragin CC: Qualitative Comparative Analysis Using Fuzzy Sets (fsQCA). In Configurational comparative methods: qualitative comparative analysis (QCA) and related techniques. Edited by Rihoux B, Ragin CC. Thousand Oaks, CA: SAGE Publications; 2009:87-122.
• [23]Ragin CC, Sonnett J: Between Complexity and Parsimony: Limited Diversity, Counterfactual Cases, and Comparative Analysis. Department of Sociology, UCLA: Los Angeles; 2004.
• [24]Ragin CC: User’s guide to fuzzy-set qualitative comparative analysis. Tuscon, USA: University of Arizona Department of Sociology; 2008.
• [25]Ragin CC: Redesigning Social Inquiry: Fuzzy Sets and Beyond. Chicago: University of Chicago Press; 2008.
• [26]Rihoux B, De Meur G: Crisp-set qualitative comparative analysis (csQCA). In Configurational comparative methods: qualitative comparative analysis (QCA) and related techniques. Edited by Rihoux B, Ragin CC. Thousand Oaks, CA: SAGE Publications; 2009:33-68.
• [27]Vernon S, Lundblad B, Hellstrom AL: Children’s experiences of school toilets present a risk to their physical and psychological health. Child Care Health Dev 2003, 29(1):47-53.
• [28]Berg-Schlosser D, De Meur G: Comparative research design: case and variable selection. In Configurational comparative methods: qualitative comparative analysis (QCA) and related techniques. Edited by Rihoux B, Ragin CC. Thousand Oaks, CA: SAGE Publications; 2009:19-32.
• [29]Glaesser J, Cooper B: Selecting cases for in-depth study from a survey dataset: an application of Ragin’s configurational methods. Methodological Innovations Online 2011, 6(2):52-70.
• [30]Basurto X, Speer J: Structuring the calibration of qualitative data as sets for qualitative comparative analysis (QCA). Field Meth 2012, 24(2):155-174.
• [31]Harry B, Sturges KM, Klingner JK: Mapping the process: An exemplar of process and challenge in grounded theory analysis. Educational Researcher 2005, 34(2):3-13.
• [32]Save the Children: School health and nutrition program cost analysis in Bangladesh. Dhaka: Save the Children International; 2012.