Availability of School-Based Water, Sanitation and Hygiene (WASH) Facilities: Implications for Menstrual Hygiene Management, School Attendance and Learning Outcomes in Ghana

Abstract

Access to Water, Sanitation, and Hygiene (WASH) facilities at all levels, especially at the school level, is deemed a right for all. While there is a growing amount of evidence on the impact of WASH facilities on educational outcomes, limited attention has been focused on studying the interlinkages. For instance, the role of WASH facilities in mediating the effect of menstrual hygiene management (MHM) and school attendance on learning outcomes has not been fully established. In Ghana, the extant studies have largely focused on assessing knowledge, attitudes and practices on menstrual hygiene management and enrolment at higher levels of education. However, similar effects at the primary and Junior High School (JHS) level have been scarcely studied. This study therefore examined the interrelationships between WASH facilities in schools in Ghana, MHM, school attendance and learning outcomes – adding the learning outcome component to the WASH discussions. The study adopted a concurrent triangulation mixed method approach - using both quantitative and qualitative approaches. Data was collected from 24 primary and 24 Junior High schools across six districts in the three zones (Northern, Southern and Middle zones) of Ghana. In all, 875 girls across both primary and JHS were quantitatively surveyed in selected schools. With reference to the qualitative data, 43 Focus Group Discussions (FGD) with girls and 43 Key Informant Interviews (KII) with School Health and Education Programme (SHEP) Coordinators were conducted. Chi square test was used to determine the level of association between WASH facilities, MHM, school attendance and learning outcomes. An ordered logistic regression model was also fitted to establish the predictors of learning outcomes. The qualitative data was analysed using the thematic analysis approach with the aid of the Dedoose software. The study establishes that generally, the WASH situation across schools in Ghana has slightly improved, however, there is much more to be achieved in terms of coverage, especially in relation to hygiene facilities. On average, one out of every 10 public schools has no access to improved drinking water sources (12.5%) and a fifth (2 out of 10) of schools (20.8%) do not have sanitation (toilet) facilities or non-functional improved sources. The case of hygiene facilities is much more dire, with about four out of every 10 public schools (43.7%) having no hygiene (handwashing) facilities. Overall, the availability of WASH facilities in schools and school attendance are key predictors of learning outcomes. The findings show that there is a strong statistical association between the availability of WASH and school attendance (p=0.000) and learning outcomes. However, there is no association between MHM and learning outcomes (p<0.062). The results of the ordered logistic model further highlight the level of the association – showing that the availability of water facilities in schools increases the odds of having better learning outcomes compared no facility (water: odds ratio 3.223; [95% CI: 2.119 - 4.903], p=0.000). Again, the regularity of school attendance increases the odds of having better learning outcomes compared to irregular school attendance (odds ratio: 1.715 [95% CI: 1.304 - 2.257], p=0.000). However, the finding shows no statistically significant association between MHM and learning outcomes (odds ratio: 0.766 [95% CI: 0.576 - 1.018], p = 0.067). The results establish the importance of WASH and school attendance to improving learning outcomes in schools. The study therefore recommends continuous investment in school-based WASH facilities by Government – working through the Ministry of Education and the Ghana Education Service and donor Agencies including UNICEF as a basic necessity to improving MHM, school attendance, and learning outcomes in schools. The study also showed that learning outcome is generally poor with about a third of students (28%) having poor learning outcomes. The study therefore recommends that more effort be put in by the Ghana Education Service in strengthening classroom-level methodologies in improving teaching and learning for girls. Further, there should be more sensitisation at the school level by the Girl Child Officers in collaboration with other like-minded Civil Society Organisations (CSOs) in whipping up girls’ interest in learning and education in general. The evidence highlights that girls miss more school days as a result of factors other than access to WASH and menstruation. The study therefore recommends that a more holistic approach be adopted by Government – working through the relevant institutions in crafting interventions targeted at improving school attendance and learning outcomes of girls. Focus must be placed in addressing some of the social cultural and economic challenges that keep girls out of school and impacts on their learning.