The effectiveness of primary school health and hygiene interventions by environmental health practitioners in the Western Cape, South Africa

Abstract

According to the World Health Organization poor sanitation, unsafe water, and insufficient hygiene is the underlying reason for outbreaks of diseases such as cholera, dysentery, hepatitis A and typhoid. Inversely, eradicating poverty; encouraging good health and well being education; clean water and access to adequate sanitation prevent diseases and associated death. Yet, the implementation of improved water, sanitation and hygiene infrastructure could prevent the annual deaths of 395 000 children aged under five years. South Africa with a population of 61 million people and a poverty rate of 55%, has shown an overall increase from 61.7% to 83% of household having access to sanitation (South African Government, 2024). The Western Cape Province, which is the focus of this study, leads with a 93.8% accessibility followed by Mpumalanga at 68.1%. The focus of this study is to assess the effectiveness of environmental health practitioners’ (EHPs) WASH interventions (infrastructure provision and awareness programmes) at schools in the Western Cape Province in South Africa. Children are particularly vulnerable to preventable deaths such as diarrhoeal diseases (Srivastava & Mishra, 2022) with some sub-Saharan Africa regions continuing to have the highest rates of mortality in children younger than 5 years (Gatimu & Kimani, 2022; Kehoe, et al., 2023). The Three Star Approach for Water and Sanitation Hygiene (WASH) in schools was used as an evaluation criterion, along with the Environmental Health Norms and Standards and Integrated School Health Policy (ISHP). A mixed methods case study research design were followed, employing semi-structured interviews, observations, questionnaires, photographic gestalt, and sanitation audits to obtain data from the Grade 7 students, teachers, groundsmen and environmental health practitioners (EHPs) to achieve the objectives of the study. Applying the various data collection techniques, the case study determined the ways in which 1) EHPs are informed to conduct a health and hygiene interventions at schools, 2) methods they use to conduct these interventions, 3) monitoring and evaluation methods and 4) the overall effectiveness of the interventions. The research revealed that none of the schools reached a one star. With data producing main themes – such as a lack of infrastructure in schools, limited legislative and policy knowledge of EHPs and a lack of strategy used by EHPs. The study recommends the establishment of inter-department relationships and re-education on the use of the current monitoring and evaluation tool. In conclusion, the study produced a baseline template to assist EHPs to conduct sanitation audits and environmental assessments.