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Sabuhene Primary School sits atop its own hill¡ªone of the many rolling hills of Buhigwe district in Kigoma region of northwestern Tanzania. The beautiful setting¡ªtwo red-brick buildings set in an L-format, standing in sharp contrast with the lush green of eucalyptuses and vines on the well-kept, hedged compound¡ªwould be appealing for a parent looking for a school for their child. 

Yet Sabuhene was never the automatic choice for most people from the nearby Kitambuka village who opted to send their children to the other two schools nearer to the center of the village. The distance¡ªthree kilometers from the village to Sabuhene¡ªwas never really the concern. 

¡°The biggest concern for most parents, even those who had no choice but to bring their children there, was the school¡¯s toilets,¡± said Mr. Lawi Yakobo, the chair of the School Committee. ¡°Everybody was concerned about the safety of the old pit-latrine structure built using tree bark, earthen floors, and straw thatching; and for this reason, parents would willingly endure the formal processes required to move a child to another school rather than have them here where they had been officially assigned.¡± 

With the school¡¯s 700 pupils sharing eight toilets (1:87), the ensuing queues saw most children missing entire lessons, yet they were physically present at the school. 

¡°The toilets had no doors, so we had no privacy, and the hygiene situation inside was extremely poor,¡± said Dorotea Yusto, 14, a Standard Seven pupil at the school. ¡°Some of the little children in the lower grades would often go on the open grounds because they couldn¡¯t hold on in the long queue, while others feared that the structure could collapse on them.¡±

In 2019, the toilets did collapse, and the school management, using contributions from parents amounting to Sh3 million (approx. $1,300) began construction of a more permanent, improved toilet building. With the amount, however, they only managed to set up the below-ground structures for 16 toilets. The Tanzania Sustainable Rural Water Supply and Sanitation Program (SRWSSP), an Å·ÃÀÈÕb´óƬ-financed Program for Results (PforR), was underway by then, and the school was selected by the district officials to receive Sh25 million (approx. $10,800) with which they brought the toilets to completion in January 2021. The 16 student toilets are split evenly among the genders, including one for people with disabilities on each side, and two for teachers.

¡°The impact of the new facilities has been phenomenal,¡± said Mr. Sylvester Amos, the Headteacher at Sabuhene. ¡°The funding came with supporting infrastructure such as water harvesting and storage to support the flushing toilets, and now we have a much cleaner school environment with no open defecation at all, and fewer cases of absenteeism due to illness than we had before. It has attracted more pupils to come and study here.¡±

An Enrollment and Retention Factor

The sanitation sector in Tanzania has achieved gains in coverage in recent years, but still has a long way to go, especially with the WASH in schools and dispensaries which has often received limited attention. Recent statistics show that in nearly two-thirds of the districts across the country, only 50 percent of public schools in rural areas have the required number of drop holes and only 43 percent have functional handwashing stations. Poor access to sanitation was exacerbated by a cholera outbreak in 2015 where a total of 30,121 cholera cases and 466 deaths (equivalent to a case fatality rate of 1.5 percent) were reported.

Recent suggests that poor sanitation is the second leading risk factor for child stunting worldwide and that diarrhea and chronic environmental enteropathy (intestinal inflammation) in children are linked to a lack of sanitation and have a significant impact on childhood development. Up to 43 percent of may be due to gut infections caused in part by poor water, sanitation, and hygiene. Stunting is a predictor of many developmental constraints, including cognitive deficits and loss of future economic opportunities. The effects of stunting are permanent; when stunted children become adults, they are likely to earn 20 percent less than their peers. Some estimate the overall GDP losses from stunting at 4¨C11 percent.

At the time of program preparation, about 57 percent of schools in Tanzania had no functional hand washing facilities and almost 40 percent had no water supply in the premises. In addition, more than 60 percent did not have a place to dispose of sanitary pads. More than half of the latrines for girls did not have doors, increasing the risk of Gender-based Violence (GBV) at schools and girls dropping out altogether. Moreover, World Bank in Tanzania showed that adequate sanitation and menstrual hygiene management helped increase adolescent girls¡¯ retention and participation in schools in the country. The government¡¯s National Guideline for Water, Sanitation and Hygiene for Tanzania Schools (2016) also recognized the importance of promoting adequate conditions especially for girls to attain education, considering only 52 percent of the eligible student population was enrolled in lower secondary schools at the time.

Established in 2003, Sabuhene has 339 girls out of 700 pupils. Of this female population, at least 114 girls were reported to have reached adolescence in March 2022. Felicia Maliko, 15, the sixth out of nine children supported by their widowed mom, dreams of becoming a doctor one day. 

¡°Before we got the new toilets, I would never attend school on the days when I experienced heavy menstrual flow,¡± narrated Felicia. ¡°Some of my friends who insisted on going to school would go to the homes neighboring the school to request to use their toilets for changing. It was also difficult for these homeowners because there were so many of us requesting.¡±

All the new school toilet structures constructed as part of the SRWSSP are equipped with a changing (or ¡®Menstrual Health and Hygiene¡¯) room. ¡°The environment is not only clean, but supportive, so now I come to school during my periods without any worry,¡± said Felicia.

In addition to having improved sanitation facilities, the schools are using some of their capitation grants to ensure these changing rooms are supplied with sanitary towels which are provided to students for emergency use. This has provided extra incentive for children to come to school during their menstrual periods where they would have chosen to stay home.  

¡°We have strong reasons to believe reduced absenteeism related to MHH has contributed significantly to this strong attendance,¡± said Amos. ¡°For instance, why should the child stay home if they know they might be able to get sanitary pads at school which, in this area, their parents may not always be able to afford?¡±

While the school authorities are not able to segregate the statistics directly linked to truancy and those related to absenteeism due to MHH, the school records show that the overall attendance rate only reached 70 percent on the best days before the SWASH. Since the facilities became available, average attendance is 97 percent. 

Ensuring School Time Counts

At Filimule Primary School in the southwestern region of Rukwa, Amina Ibrahim, 17, also recalls the difficulties girls like her faced before their school acquired its brand-new toilet facilities. Before the SWASH program, the school had six toilets for its pupil population of 858 (including 437 females), with an access ratio of 1:143 students.

¡°The situation was unpleasant for everyone,¡± said Amina. ¡°We suffered as older students because the school policy required us to allow the younger pupils to go first, and there were quite many, so you ended up waiting in the queue for a long time. By the time you got back to class, the lesson was ending.¡±

While Amina did not experience any MHH mishap, she does recall a friend¡¯s experience. ¡°It was last year in May; she got up in class and the whole class was roaring with laughter and heckling her. She has never returned to the school since then; I don¡¯t know where she is.¡±

Sekani Mwampashi was teaching Swahili at Ifunda Primary School in Iringa region before the program arrived and she was selected to also take up the MHH focal point role which is also known in Swahili as ¡®Hedhi Salama¡¯ (meaning ¡®Safe Periods¡¯) for classes five to seven. 

She often asks her adolescent students if their parents are aware they are going through their periods and usually the response is negative. ¡°I believe that is why some feel withdrawn and shy, so we encourage them not to feel ashamed, and we help them understand this is a normal biological process. Now I am seeing these girls confidently walk to the changing room whenever they need to change,¡± said Sekani. She, too, believes the provision of sanitary towels and changing rooms has significantly impacted female participation. 

¡°Before this program, we didn¡¯t offer much beyond comforting the crying child who has had an accident and sending her home until she completes her period,¡± she said. ¡°Now, however, we are offering them emergency sanitary towels and the privacy to change.¡±

A Performance Game Changer

As attendance and participation rates improve, some schools are already observing an upward trend in performance. At Sabuhene, where the SWASH has been effective since early 2021, they analyze the changes in the performance of their Standard Seven pupils who sit for the end of calendar-year national assessments, by taking the total marks of all candidates and dividing them by the number of students they have each year. The highest average is taken as 250, nationally. 

From their analysis, the school¡¯s performance for 2021 (150 points) is the highest ever they have achieved, with 69 students sitting for the exams, and they were ranked first in their Katanga ward out of six schools, and 8th out of 17 in wider Buhigwe district. Previous averages were: 130 for 2020 (with only 38 students); 137 for 2019 (53 students); and 118 for 2018 (68 students).  

A similar trend has been observed at Ifunda Primary School in Iringa, where 15 SWASH toilets were constructed to serve the 699 pupils and have been in use since September 2020. Though the school always performed respectably in the national matriculation in the past, Headteacher Alto Mgimba says they too have observed improvements. ¡°Since we acquired the new facilities, we have achieved 99 percent attendance, from an average of 77 percent in the year before the program,¡± he said. Before the program, the school had 12 latrines, with a ratio of 1:58, no staff toilets and no facilities for PWDs nor for MHH. 

¡°We required the pupils to carry a jerry can of water to school, but not all of them would bring one, as they, too, faced water difficulties at home,¡± said Mgimba. ¡°We had a lot of cases of stomach and urinary tract infections.¡±

From their analysis of the total marks attained in the exams, divided by the number of students who sat for the exams, the performance of the standard seven class at Ifunda has risen gradually from 149.5 in 2018 (with 78 students, of which 36 were female); to 149.7 in 2019 (113 students, 70 female); 152.3 in 2020 (83 students with 45 girls) and 181.5 in 2021 (with 80 students, 42 girls).

¡°The program¡¯s support for the provision of sanitation services, especially the handwashing facilities, was quite timely, as we believe it helped with the reduction of disease spread. In Tanzania, we never really closed schools during the COVID-19 pandemic,¡± said Mr. Justine Mwombeki, the SRWSSP coordinator at the Ministry of Education, Science and Technology. ¡°In addition, we observed other effects, for example, with students effectively playing the role of agents of change after experiencing the new sanitation facilities at school and influencing their families in this direction where they have been mostly acquainted with dry pit latrines.¡±