COVID-19 and Water, Sanitation and Hygiene in Schools, Implications Challenges, Solutions
Kasandra Mingoti Poague is a PhD student in the department Department of Earth Observation Science. (Co)Promotors are prof.dr. J.I. Blanford; dr. C. Anthonj and dr. J.A. Martinez from the faculty of Geo-Information Science and Earth Observation.
In an attempt to contain the spread of COVID-19, governments around the world temporarily closed educational institutions. These closures have impacted children and all school stakeholders, including school employees and students' families. Therefore, safely reopening schools so that children can return to a “normal” life and learning environment is crucial. However, schools in many low- and middle-income countries (LMICs) lack the necessary water, sanitation, and hygiene (WASH) infrastructure to ensure a safe reopening. Brazil, a global COVID-19 hotspot, has consistently struggled to implement a national response plan against SARS-CoV-2, including the safe reopening of schools. The provision of WASH in schools is essential not only to contain the spread of COVID-19 but also to prevent the transmission of various other WASH-related infectious diseases, such as soil-transmitted helminth infections, schistosomiasis, diarrhoea, cholera, and other gastrointestinal diseases. Ensuring the safe reopening of schools in Brazil and other LMICs is a short- and medium-term investment in enabling students to continue their studies during the ongoing crisis and a long-term investment in sustainable learning and the prevention of future outbreaks. This thesis aims to describe WASH conditions in schools in Brazil during the COVID-19 pandemic and identify possible barriers, enablers, and solutions related to WASH from the perspective of different school stakeholders.
A mixed-methods approach with a partially mixed sequential equal status design was employed, comprising four phases: (i) a systematic literature review, (ii) quantitative analysis of secondary data, (iii) qualitative analysis of secondary data, and (iv) qualitative empirical field research. First, a systematic review was performed to (i) describe the current situation of WASH conditions in schools in LMICs and (ii) understand the implications of these conditions for the safe reopening of schools amidst the COVID-19 pandemic. Sixty-five of 6,287 publications identified in MEDLINE (via PubMed), Web of Science, Scopus, AJOL, and LILACS met the inclusion criteria. Data from 18,465 schools across 30 countries were extracted and analyzed according to the Joint Monitoring Programme (JMP) definitions and the normative contents of Human Rights to safe drinking water and sanitation. The systematic review established a baseline of WASH in schools in LMICs, highlighting how the Human Rights to Safe Drinking Water and Sanitation (HRtWS) are reflected in the learning environment and identifying key elements that require heightened focus to realize this fundamental human right. Findings indicate violations of all the contents of the HRtWS. In the context of the COVID-19 pandemic, results showed that the largely insufficient and inadequate school infrastructure hampers students' ability to practice healthy hygiene habits, particularly handwashing. Considering the paucity of data and research on WASH in schools in Latin America and noting that Brazil has been among the top three countries with the highest number of cumulative cases and deaths related to COVID-19, coupled with logistical advantages, Brazil was chosen as the study area for the subsequent quantitative and qualitative analyses.
Second, secondary data from the BNSC was analyzed to better understand (iii) the current situation of WASH in schools in Brazil and (iv) to what extent Brazilian schools have been making progress in providing WASH since the beginning of the COVID-19 pandemic. Results of this study, considering 173,700 schools, indicate that most schools in Brazil (as of 2021) have bathrooms, drinking water of suitable quality for human consumption, improved sanitation facilities, and solid waste collection. Nonetheless, findings highlight the urgent need for improvements in public schools, schools located in rural areas, and in the North and Northeast regions of the country. Schools particularly need changes in sanitation infrastructure and solid waste management within the WASH domains. For the comparison of WASH in schools pre- and peri-COVID-19 pandemic (2020 vs. 2021), 170,422 schools were analyzed. Mixed changes in the variables, with both improvements and deterioration, were observed in schools across all regions of the country. Schools in the South and Southeast regions presented the best WASH infrastructure for safe reopening, whereas schools in the North and Northeast regions were the least prepared.
Third, a content analysis of an inventory of 66 public policies was performed to (v) describe the WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (vi) discuss their potential to enhance schools' capacity to remain operational during a new pandemic or outbreak. One hundred and fifty-nine solutions for reopening schools in Brazil amidst the COVID-19 pandemic, divided into five WASH domains and five population groups, were extracted. While most of the suggested measures had the potential to provide a cleaner and safer environment and thereby enhance schools' resilience, some recommendations did not comply with the principles of the HRtWS, the JMP service ladder and definitions, international guidelines for WASH and IPC in schools, and the Sphere minimum standards for humanitarian aid. Highly recommended suggestions included: (i) installing hand hygiene stations in open areas of the schools (outdoor areas); (ii) adapting water fountain stations to allow consumption via cups or bottles, with pedal-operated taps and devices such as sensors; (iii) integrating WASH and health principles into school books and curricula. Moving on from COVID-19 and following the proposed solutions, policymakers and schools can follow three different paths and outcomes: (i) not proceed with any further intervention, most likely resulting in school closures during the next pandemic; (ii) implement measures that violate the frameworks or are scientifically incorrect, leading to schools being open with a false impression of safety; (iii) implement a combination of hardware and software measures in accordance with the four proposed frameworks, allowing schools to remain open or only closed for a short period during future pandemics.
Last, in January 2024, fieldwork was carried out in a small municipality located in the Southeast of Brazil to (vii) assess how WASH-friendly the schools in the study area are and for which stakeholders and (viii) identify what WASH measures were implemented in the schools during the COVID-19 pandemic and which have persisted until the present. Four different activities tailored to specific stakeholders were performed: (i) semi-structured interviews with school staff; (ii) semi-structured interviews with parents and/or legal guardians; (iii) on-the-spot observations in the schools; and (iv) art-based research with students. Several inconsistencies were identified when comparing primary findings with the information previously provided by the BNSC, including differences in the number of schools and levels of education offered, water sources, absence of bathrooms for people with disabilities or limited mobility, bathrooms with showers for students, and waste burning instead of solid waste collection. We observed a clear violation of all the normative contents of the HRtWS, which, in turn, were triggering and exposing students to incidents of violence such as bullying and verbal abuse. Regarding the WASH interventions implemented during COVID-19, there was a misalignment among stakeholders about which interventions are still in place. During school visits, we observed that these interventions did not persist.
