The Fit for School (FIT) approach recognises WASH as an integral factor in creating conducive learning environments. It therefore supports Ministries of Education (MoE) to apply school-based management to implement national WASH in Schools (WinS) programmes. Improving access to WASH addresses key determinants of health and well-being.

The FIT approach is based on four core principles: simplicity, sustainability, scalability and systems thinking. An effective WinS programme must be based on the best possible evidence, be cost-effective and simple to implement in all schools. The approach aims to ensure sustainability, clarification of roles and responsibilities, allocation of financial resources as well as functional Monitoring M.2 systems that inform different levels of programme management.

Leveraging existing systems and resources are essential elements of the FIT’s scalability. The approach works through the education sector, especially on a sub-national level, to establish sustainable programme management and implementation within local structures. By introducing performance transparency and Accountability M.4 measures, organisational behaviour is guided to prioritise WASH. The speed of implementation may be slow at the onset, but its systemic focus ensures change in the longer-term and at scale.

Aligned with these principles, a package of low-cost WinS interventions is developed, based on the country context, with a particular focus on the development of low-cost handwashing facilities, daily group hygiene activities, biannual deworming and the creation of cleaning and maintenance routines for WASH infrastructure. Institutionalising these interventions addresses some of the most prevalent diseases among school children. Basic and functional WASH infrastructure is a prerequisite for positive hygiene behaviour. To provide a healthy environment, schools need access to drinking water P.3, usable and gender-segregated toilets P.4 and handwashing facilities with water and soap P.2.

Tools and Methods used

• School-Based Management (SBM) builds on the capacity of school heads to manage their schools (including financial management) and engage with the wider school community. Members of the community can contribute in various ways to improve the WASH conditions in the school based in their community; this could include the construction of Handwashing Facilities P.2, participation in Monitoring M.5 or cleaning, repair and maintenance. Even schools with limited resources can start the journey to improve WASH conditions and routines one step at a time
• Monitoring M.2 and Accountability M.4 systems measure step-wise improvements that are made transparent through digital dashboards. Practical action is guided by the use of Checklists T.2 while translating performance into recognisable metrics 
• The use of enabling measures such as policy support, stakeholder alignment, integration into planning and resource allocation and large-scale capacity strengthening through the MoE

Applicability

The FIT approach is mainly used in development contexts using the school setting to support the institutionalisation of health-promoting behaviour in children. It can be used in conjunction with the Three Star Approach F.11. Recognising the value of SBM, FIT strengthens the capacity of the education sector to implement and monitor WinS and open the doors of schools to strong partnerships with parents and the school community. As resources are limited, the support and efforts of community members, local governments and NGOs are needed to address the gaps so that national WinS standards can be reached. The involvement of the school community guarantees that solutions are pragmatic, affordable and relevant to the local context. The FIT approach was developed in the Philippines in close collaboration with the MoE and adapted for three other countries (Cambodia, Lao PDR and Indonesia) through the development of replicable implementation models and guidelines. As the models have been integrated into WinS programmes, government-led scale-up in the respective partner countries is ongoing.

Main Requirements / Investments Needed

At the core of the FIT approach is support to schools wherever they are in their WinS journey. Capitalising on existing systems and resources is an essential strategy for scalability and sustainability. The involvement of all levels of the education system in partnership with the school community is imperative to maximise ownership, transparency and accountability. By assigning practical actions to responsible actors, the success of the programme is mostly driven by the collaborative effort of the relevant stakeholders to reach a certain, clearly designed WASH status (see also Three Star Approach, F.11).

Evidence of Effectiveness

The FIT approach has shown great promise in contributing to the scale-up of WinS programmes. For example, the Laotian Ministry of Education and Sports has expanded the approach from 22 model schools to over 1100 schools in five years. The positive effects of the interventions aimed at changing everyday routines have been demonstrated in all countries. For example, a long-term study in the Philippines shows improved children’s health and less absenteeism in participating schools. 

Do

• Focus on activities that can be easily implemented without the need for major investment and that lie within the skills and mandates of the government workforce

• Use locally available resources to make procurement and logistics easier and to simulate the real situation in the long-term

• Only promote interventions which the government could and would fund independently

Don't

• Do not introduce interventions that require external support to maintain

Practical Example

A longitudinal health outcome study measured the impact of FIT interventions in partner countries, specifically in Cambodia, Indonesia and Lao PDR. Over the initial two-year implementation period from 2012 to 2014, it was revealed that FIT contributed to better access to WASH facilities and improved practice of handwashing with soap at critical times. Furthermore, the programme strengthened the implementation of existing national deworming programmes. Daily tooth-brushing practices led to between 17% and 37% less tooth decay among students in implementing schools. The interventions showed additional positive health effects in weight increase and a reduction of absenteeism. In the WinS programme in the Philippines public schools recorded impressive improvements in their compliance with WASH indicators. The number of schools meeting the indicators and reaching national standards has tripled from 9% when the WinS programme started to 26.5% of the nearly 40,000 participating schools.