Strengthening School Water, Sanitation and Hygiene (WASH) Programme Implementation: Evidence from Expert Consensus in Uasin Gishu County, Kenya

Through a two-round Delphi study with 20 experts in Uasin Gishu County, Kenya, this paper identifies critical priorities for strengthening school WASH implementation, including coordinated governance, dedicated funding, inclusive infrastructure, and menstrual hygiene management, to improve learner health and educational equity.

The Gist

Imagine a school not just as a place for books and tests, but as a living organism. For this organism to thrive, it needs three vital organs working perfectly: Water, Sanitation, and Hygiene (WASH). If these organs are weak, the whole body (the students) gets sick, misses school, and struggles to learn.

This paper is like a group of expert mechanics (teachers, health officers, government officials, and engineers) gathering in Uasin Gishu County, Kenya, to figure out why the school "organs" are sometimes failing and how to fix them for good. They didn't just guess; they used a method called the Delphi Technique, which is like a high-stakes game of "telephone" where experts whisper their best ideas to each other over two rounds until they all agree on the perfect repair plan.

Here is the story of what they found, explained simply:

1. The Problem: A Leaky Roof and a Broken Engine

The experts found that while Kenya has a "rulebook" (policies) saying schools should have clean water and toilets, the reality is messy.

• The Funding Gap: It's like trying to bake a cake but having no money for flour. Schools get a tiny bit of money for everything (electricity, water, repairs), and the water bill eats it all up. There is no specific "WASH budget" ring-fenced just for keeping the toilets clean and the water flowing.
• The "One-Size-Fits-All" Trap: Some schools have pit latrines (holes in the ground). In this specific county, the ground is wet. It's like building a sandcastle right next to the ocean; the tide (groundwater) rises, the pit fills up, and the toilet collapses or becomes unsafe.
• The "Teacher Burden": Teachers are hired to teach math and science, not to be plumbers or janitors. Yet, they are often left fixing broken taps or cleaning toilets, which takes time away from teaching.

2. The Solution: The "Master Plan" for School Health

The experts reached a strong consensus (almost everyone agreed!) on what needs to happen. Think of this as the Ultimate School Health Recipe:

🏗️ Build a Stronger Foundation (Infrastructure)

• Ditch the Pit, Dig a Well: Instead of relying on pit latrines that flood, the experts say schools should have boreholes (deep wells) with solar pumps. Imagine a school having its own private water tower powered by the sun. No more waiting for the water truck or paying expensive utility bills.
• Modern Toilets: Swap the old, smelly pits for flush toilets connected to septic tanks. It's like upgrading from a campfire to a modern fireplace—cleaner, safer, and less likely to cause a mess.
• Disability-Friendly Design: The school must be a place for everyone. Just as a building needs a ramp for a wheelchair, the water taps and toilets need to be low enough for a child in a wheelchair to reach. If a child can't use the toilet, they can't stay in school.

💰 The Money Bag (Funding)

• Ring-Fenced Budget: The experts say the government must create a specific "WASH piggy bank" for schools. This money cannot be stolen by other needs. It must be used only for soap, water, repairs, and sanitary pads.
• Outsourcing the Grunt Work: Schools should hire professional cleaners and waste collectors, just like a house hires a gardener. This frees up teachers to teach and ensures the toilets are actually clean every day.

🩺 The "Girl Power" Factor (Menstrual Hygiene)

• The Missing Link: For girls, school is hard when their period starts and there are no pads, no private changing rooms, or no bins to throw used pads away.
• The Fix: The experts demand a steady supply of sanitary pads, private changing rooms, and special bins for disposal. It's about dignity. If a girl feels safe and clean, she won't skip school for a week every month.

🤝 The Village (Community & Coordination)

• No More Silos: Currently, the health department talks to the health department, and the water department talks to the water department. They need to hold hands. The experts want a unified team where the water guy, the health nurse, the teacher, and the local chief all sit at the same table.
• The "Coach" System: Schools need a dedicated person (a teacher or a department) whose only job is to manage WASH. You wouldn't let a student captain the football team without a coach; schools need a WASH coach too.
• The Trophy Case: The experts suggest an awards system. Schools that do a great job keeping their water clean and toilets fresh should get a trophy or a certificate. Just like a sports team plays harder to win the cup, schools will work harder to win the "Best WASH School" award.

3. The Bottom Line

This paper isn't just about toilets and taps. It's about fairness.

If a school has clean water, safe toilets, and pads for girls, the "organism" is healthy. Kids stay in class, they learn better, and the community grows stronger. The experts are saying: "Stop patching the holes with duct tape. Let's build a new, strong engine that runs on its own."

They have the plan, they have the agreement, and they have the experts. Now, they just need the political will and the money to turn this blueprint into reality.

Technical Summary

1. Problem Statement

Despite the existence of national frameworks like the Kenya School Health Policy and the Basic Education Act, the implementation of School Water, Sanitation, and Hygiene (WASH) programs in Kenya remains uneven. Key challenges identified include:

• Inadequate Infrastructure: Poor maintenance, reliance on pit latrines (which fail in high water table areas), and lack of reliable water sources.
• Funding Gaps: Lack of dedicated budget lines for WASH, leading to fragmented implementation and reliance on ad-hoc donor support.
• Coordination Failures: Weak inter-sectoral coordination between education, health, water, and public works departments.
• Equity Issues: Inadequate facilities for girls (Menstrual Hygiene Management - MHM) and learners with disabilities, contributing to absenteeism and dropout rates.
• Monitoring Deficits: Infrequent supervision and lack of accountability mechanisms for funded projects.

The study aims to identify priority components for strengthening school WASH implementation and generate policy-relevant recommendations based on expert consensus in Uasin Gishu County.

2. Methodology

The study employed a Delphi technique, a structured communication method designed to reach consensus among a panel of experts through iterative rounds.

• Study Design: Two-round Delphi process.
• Participants (Expert Panel):
  • Round 1: 20 purposively selected experts, including Sub-County Education Directors, Public Health Officers, Water/Public Works Officers, Quality Assurance Officers, Head Teachers, Board of Management (BOM) members, and NGO representatives.
  • Round 2: 18 experts (90% response rate; 2 transferred out of the county).
• Data Collection:
  • Round 1: Semi-structured Key Informant Interviews (KIIs) conducted via audio recording (30–40 mins). Data was transcribed and analyzed using NVivo 12 for thematic coding to identify emergent themes.
  • Round 2: A structured online questionnaire (via CommCare app) based on Round 1 themes. Experts rated items on a 5-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree).
• Analysis:
  • Quantitative: Descriptive statistics (Mean, Standard Deviation, Percentage Agreement). Consensus was defined by high agreement (scores of 4 or 5) and low variability.
  • Qualitative: Thematic analysis of interview transcripts.
• Ethical Considerations: Approved by the Durban University of Technology (IREC 113/23) and University of Eastern Africa, Baraton.

3. Key Contributions

This study provides a practice-oriented, expert-validated framework for school WASH implementation in Kenya. Its primary contributions include:

• Shifting Focus from Infrastructure to Systems: Moving beyond simple construction to emphasize governance, financing, operation & maintenance (O&M), and behavior change.
• Inclusive Design: Strong emphasis on disability-friendly facilities and Menstrual Hygiene Management (MHM) as non-negotiable components of school WASH.
• Multi-Sectoral Governance: Defining specific roles for a broad coalition of stakeholders (Education, Health, Water, Public Works, Private Sector, and Community).
• Context-Specific Solutions: Addressing local geographical challenges (e.g., high water tables in Uasin Gishu requiring septic tanks over pit latrines).

4. Key Results

The experts reached strong consensus (Mean scores between 4.5 and 4.8 on a 5-point scale; agreement levels ranging from 74% to 100%) on the following priority areas:

A. Governance and Coordination

• Multi-sectoral Collaboration: Essential involvement of education, health, water, public works, and community stakeholders.
• Private Sector Inclusion: Public and private schools must be included in WASH programs to ensure universal access.
• Role Clarity: Clear delineation of roles for Quality Assurance Officers, Public Health Officers, and CHEWs (Community Health Extension Workers).

B. Financing and Sustainability

• Dedicated Budget Lines: WASH requires a ring-fenced budget at national, county, and school levels, separate from general utility votes.
• Outsourcing: Support for outsourcing specific services (refuse collection, deep cleaning, waste disposal) to relieve teachers and ensure professional maintenance.
• Government Funding: The government must fund water provision for both public and private schools.

C. Infrastructure and Technology

• Water Supply: All schools should have sunken boreholes with solar pumping systems and storage tanks to ensure reliability and reduce electricity costs.
• Sanitation: Transition from pit latrines to flush toilets connected to septic tanks or sewerage systems due to high water tables and safety concerns.
• Disability Inclusion: Mandatory installation of ramps, accessible toilets, and adapted tap heights in all new and existing schools.

D. Menstrual Hygiene Management (MHM)

• Supply Chain: Government must ensure a constant supply of sanitary pads.
• Facilities: Construction of changing rooms for girls and installation of disposal bins in all school toilets.
• Waste Management: Outsourcing of sanitary waste collection and disposal.

E. Education and Monitoring

• Curriculum Integration: WASH content should be expanded in the curriculum, potentially as an independent subject, and reinforced through health clubs.
• Inspection Frequency: Increase the frequency of school inspections (e.g., quarterly) by dedicated officers.
• Accountability: Mandatory follow-up on funded facilities and recognition/awards for high-performing schools to drive competition and excellence.

5. Significance and Recommendations

The study concludes that infrastructure investment alone is insufficient. Sustainable school WASH requires a holistic implementation agenda integrating governance, predictable financing, and robust monitoring.

Actionable Recommendations:

1. Policy Reform: Establish structured coordination mechanisms involving all relevant ministries and the private sector.
2. Financial Allocation: Create ring-fenced budget lines for WASH covering infrastructure, O&M, consumables (soap, water treatment), and MHM commodities.
3. Infrastructure Upgrade: Prioritize solar-powered boreholes and septic-connected flush toilets; mandate disability-friendly designs.
4. Capacity Building: Train teachers and health officers; expand WASH in the curriculum; utilize mass media for sensitization.
5. Monitoring & Incentives: Increase the number of inspection officers, standardize reporting tools, and institute awards for best-performing schools.

Impact: Implementing these expert-validated priorities offers a practical pathway to improving learner health, reducing absenteeism (particularly among girls), and advancing educational equity in Kenya.