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Ministry of Education and Science of Georgia

Educational and Scientific Infrastructure Development Agency of Georgia

2013

WATER, SANITATION AND HYGIENE IN SCHOOLS


1 October 25, 2013

Every child has the right to live in a healthy, supportive environment - an environment that

encourages growth and development, and protects from diseases.

Lee Jong-wook,

Director-General World Health Organization

2004

Water, Sanitation and Hygiene in Schools

2013


2 October 25, 2013

Acknowledgements

Ministry of Education and Science of Georgia and Educational and Scientific Infrastructure

Development Agency of Georgia wish to express deep respect and gratitude to the office of the

United Nations Children’s Fund (UNICEF) in Georgia, whose support made it possible to prepare

given standards. We would like to extend our personal thanks to Mr. Sascha Baumann and Ms. Nana

Pruidze.

Special thanks for their contribution must be given to Tamar Jangulashvili, the project director and

the group of experts working on standards and composed of – Nia Giuashvili (team leader, public

health expert), Tamar Menapire (expert on regulation of educational institutions), Nana Gabriadze

(Head of Environmental Health Division, National Center for Disease Control & Public Health of

Georgia, Ministry of Labour, Health and Social affairs of Georgia National Focal Point UNECE/WHO

Protocol on “Water and Health” and GLAAS- NFP), Koba Ratiani (expert on educational

infrastructure), Vato Babutsidze (expert in architecture and planning).

We express our appreciation to the Ministry of Labor, Health and Social Affairs of Georgia and

personally to Ms. Marine Baidauri for technical support of the project.


3 October 25, 2013

Content Acknowledgements.............................................................................................................................. 2

I. Introduction ......................................................................................................................................... 6

1. Water and sanitation as problems of modern civilization ............................................................ 6

2. What do we know about water and sanitation problems in schools of Georgia? .................... 7

3. How will these standards help state agencies, school stakeholders, parents and civil society? 11

II. Water, sanitation and hygiene in schools (Wash in schools) - technical regulations .................... 12

4. General requirements ................................................................................................................ 12

5. Requirements for the water supply of schools ......................................................................... 13

6. Requirements for ensuring favorable sanitation and hygiene conditions in schools ............. 14

7. Requirements for ensuring cleaning and waste management ................................................. 21

III. Physical environment and health in Schools ............................................................................... 21

8. What is the meaning of healthy physical environment in schools? ....................................... 21

9. Why are efforts needed to improve the school physical environment? ................................. 22

10. Why are children more vulnerable to problems associated with the environmental health? 23

IV. The effects of school environment on schoolchildren’s health ................................................... 24

11. Water .......................................................................................................................................... 24

12. Sanitation infrastructure ............................................................................................................ 27

13. Indoor air in schools .................................................................................................................. 27

14. Outdoor air in schools ............................................................................................................... 29

15. Lighting ...................................................................................................................................... 29

16. Ultraviolet radiation .................................................................................................................. 30

17. Pesticides and other chemicals .................................................................................................. 30

18. Nutrition and School meals ....................................................................................................... 31

19. Location of the school building ................................................................................................. 32

V. How to protect the child’s health through improving of school environment .............................. 33

20. What are the recommendations of authoritative international organizations on improving

of school environment? ......................................................................................................................... 33

VI. Ensuring the availability of high quality and safe drinking water supply in schools ................ 36

21. Hygiene parameters of the quality of drinking water .............................................................. 36


4 October 25, 2013

22. Water safety control .................................................................................................................. 38

23. Low-cost interventions for ensuring water supply .................................................................. 38

VII. Supervision of the health of school children ................................................................................ 39

24. Morbidity in school age children .............................................................................................. 39

25. Water and sanitation related disease control and the role of a medical staff in the school life 40

26. Primary medical aid and the rules for setting up the medical office ...................................... 45

VIII. Strategies for developing hygiene habits and the principles of hygiene education ............... 47

27. Major theoretical and practical approaches – short overview ................................................. 47

28. FRESH Initiative - Focusing Resources on Effective School Health ....................................... 48

29. Health promoting school ........................................................................................................... 49

30. Educational principles ............................................................................................................... 49

IX. Water and sanitation surveillance in school ................................................................................ 49

31. Water quality and safety ........................................................................................................... 49

32. Water quantity ........................................................................................................................... 50

33. Access to water and water facilities .......................................................................................... 50

34. Hygiene promotion .................................................................................................................... 51

35. Toilets ......................................................................................................................................... 51

36. Control of vector-borne disease ................................................................................................ 52

37. Cleaning and Waste disposal ..................................................................................................... 52

38. Food storage and preparation .................................................................................................... 52

39. Self-assessment checklist for schools authorization ................................................................. 53

X. Water, sanitation and hygiene - process and results assessment strategies at the school level ..... 56

Part I. School information ......................................................................................................................... 57

Part II. Water ............................................................................................................................................. 57

Part III. Sanitation ..................................................................................................................................... 59

Part IV. Hygiene ........................................................................................................................................ 61

Part V. Waste disposal .............................................................................................................................. 63

Part VI: Operation and maintenance ........................................................................................................ 64

XI. Water, sanitation and hygiene - indicators for progress assessment at the national level......... 65

40. Recommendation of the authoritative international organizations for monitoring of water

and sanitation and progress assessment ................................................................................................ 65


5 October 25, 2013

41. Compendium of indicators for Georgia .................................................................................... 67

XII. Water and sanitation in schools of Georgia - National level survey ........................................... 69

42. National survey as the best tool for situation management and policy ascertain .................. 69

43. Recommendations on survey design and format ..................................................................... 69

References .......................................................................................................................................... 72


6 October 25, 2013

I. Introduction

1. Water and sanitation as problems of modern civilization

On May 13, 2013 the United Nations published a joint report prepared by the World Health

Organization (WHO) and the United Nations Children Fund (UNICEF), according to which one of

the main Millennium Development Goals was not achieved and some 2, 4 billion people or one-third

of world population will remain without access to improved sanitation in 2015. The report states that

at current rate of progress in water and sanitation outreach, the 2015 target on halving the proportion

of 1990 population with no access to sanitation will be missed by 8% or half a billion people.

Despite the fact that in 2012 WHO and UNICEF announced that the Millennium drinking water

target had been met and surpassed by 2010, the need of immediate implementation of measures

accelerating the progress towards improvement of the access to better sanitation became the main

topic of joint address of these two organizations to the global community.

“The world can turn around and transform the lives of millions that still do not have access to basic

sanitation. The rewards would be immense for health, ending poverty at its source, and well-being.”

said Dr. Maria Neira, WHO Director for Public Health and Environment in her report.

"This is an emergency no less horrifying than a massive earthquake or tsunami. Every day hundreds

of children are dying; every day thousands of parents mourn their sons and daughters. We can and

must act in the face of this colossal daily human tragedy,” said Sanjay Wijesekera, global head of

UNICEF's water, sanitation and hygiene (WASH) program.

The above-mentioned joint report highlights the following key findings from the 2010 data:

Almost two-thirds (64 %) of the world’s population has access to improved sanitation

facilities, which shows an increase of almost 1.9 billion people since 1990.

Approximately 2.5 billion people lack access to improved sanitation facilities. Of these, 761

million use public or shared sanitation facilities, while 693 million use facilities that do not

meet minimum standards of hygiene.

In 2011, 1 billion people still defecated in the open and 90% of all open defecation takes place

in rural areas.

By the end of 2011, 89% of the world population used an improved drinking-water source,

and 55% had a piped supply in dwellings. This left an estimated 768 million people without

improved sources for drinking water, of whom 185 million relied on surface water for their

daily needs.

There continues to be a striking disparity between those living in rural areas and those who

live in cities. Urban dwellers make up three-quarters of those with access to piped water

supplies at home. Rural communities comprise 83% of the global population without access to

improved drinking water source and 71% of those living without sanitation.


7 October 25, 2013

Faster progress on sanitation is possible, WHO and UNICEF say. The report summarizes the shared

vision of the water, sanitation and hygiene (WASH) sector including human rights and global

monitoring for a post-2015 world, where:

No one should be defecating in the open;

Everyone should have safe water, sanitation and hygiene at home;

All schools and health centres should have water, sanitation facilities and means to ensure

hygiene;

Water, sanitation and hygiene should be sustainable;

Inequalities in access to water, sanitation and hygiene should be eliminated.

2. What do we know about water and sanitation problems in schools of Georgia?

According to the World health Organization and the UNICEF (WHO/UNICEF) joint monitoring

program, the access to the drinking-water increased by 17% from 1990 to 2008 in Georgia. In urban

areas 100% and in rural areas 96% of population has an access to the safe drinking water. It should be

underlined that 90% of urban population has centralized piped water in dwellings, while only 48% of

rural population can enjoy the use of similar system. About 96% of urban population and 94% of

rural dwellers have access to improved sanitation in Georgia, however only 58% of urban and 33% of

rural population is provided by centralized sewerage.

No survey has been conducted in Georgia to study water supply, sanitation and hygiene (WASH) in

schools until now, when in autumn 2013 Educational and Scientific Infrastructure Development

Agency of Georgia conducted WASH research with technical and financial support of the United

Nations Children’s fund (UNICEF).


8 October 25, 2013

Survey findings show:

In around 70% of schools the drinking water is supplied from a piped water system. About

4% of urban and 12 % of rural schools use unimproved water sources. Water pipes are not

installed in 60 % of school buildings.

Accessibility of water sources including drinking water sources significantlt differ between

the schools according to school locations by regions:

o In 6 % of schools no water source has been identified in or near schools by the time of

observation. In 85 % of schools the piping systems of water supply are located outside

the school building.

o In every fourth of all observed schools in Samtske-Javakheti region the water source

was identified neither inside the building nor nearby; every tenth of checked schools

in Zemo Svaneti region gained water from unimproved water source.

In every tenth of observed schools the main water source was not functional by the moment

of observation. The great majority of these schools are located in the villages. In some schools

the water supply system is out of order for number of months now. About 20% of schools are

supplied with water according to the schedule. More than half of schools use water tanks or

containers for storing water.

The quality of drinking water in Georgian schools is not being regularily controlled. Since

2010 only 10 % of schools were checked on drinking water quality. Treatment or

recontamination of water had never been performed in more then 70% of schools, including

60% of those supplied from unimproved water sources such are unprotected wells and

springs.

One fourth of schools use only unimproved sanitation facilities. Some schools in certain

villages and cities still have hanging toilets or buckets.

Only 35% of observed schools have toilet compartments inside school buildings; only every

fifth rural school has indoor sanitation facilities. Outdoor sanitation facilities are located at a

distance of 10-200 meters from the school building.

In general the number of sanitation facilities are not enough in regard to the number of

schoolchildren in schools. The ratio is especially high in urban areas (one facility per 54

schoolchildren in average) and some regions, namely in KvemoKartly (1/55) and Kakheti

(1/43). It is noteworthy, that number of toilets do not depend on number of children at

schools. The difference is determined mainly by location of schools – capital city, urban or

rural area.

In vast majority of schools (with the exception of some small village schools) there are

separate toilets for boys and girls, although the numbers of these toilets are equal.


9 October 25, 2013

About half of schools have separate toilet for teachers. The findings in this case also depend

not on the size but on the type of dwelling.

The situation in regard with the accessibility of toilets for vulnerable people in schools of

Georgia is not favorable enough. Even in schools, where students with physical disabilities are

registered, there are no user-friendly toilets meeting special needs of disabled people. This

problem becomes more obvious in the capital city and urban areas.

Every tenth of schools has no functional hand washing facilities. This picture is mostly caused

by poor sanitation in rural schools (15 %).

No soaps, towels or napkins were in place in an absolute majority of schools for the moment

of observation.

According to observations the accessibility of hand washing facilities for schoolchildren of

primary grades and disabled people was significantly lower in rural schools. Generally, the

hand washing facilities for students with disabilities are accessible in half of schools while

80% of children in primary grades have access to hand washing facilities.

In one third of schools hand washing facilities are not located in adjacent area or nearby

toilets.

The observation revealed that nearly half of students do not wash hands after the toilet.

There is no difference between boys and girls in this regard nor whether the school is urban

or rural.

Over 90% of school directors mentioned that students are taught hand washing, oral hygiene,

body and hair care, although only 10 % said for sure there is at least one teacher at their

school, who has been trained in teaching hygiene. Over 86% of schools do not have guidance

on hygiene. The great majority of directors, who were interviewed, acknowledge the

necessity of having such guidance.

Solid waste disposal is done better in cities then in villages. The waste containers are installed

in every fourth rural school, while in urban schools the same indicator equals to 3-4%. In half

of rural schools solid waste is burned in the school yard or nearby with highest figures of

similar practice in Samegrelo-Zemo Saneti region (70%).

Only 40% of rural schools have a sewage system (including incomplete and partial sewage); in

urban schools this indicator is twice as high, while in Tbilisi the sewage system functions in

each of observed schools.

Majority of schools, where sewage system is not operating, do not have proper schedule for

disposal or removal of faecal matter. According to the information provided by school

directors, waste waters flow safely into sewage system only in 13% of observed schools;

mostly waste waters flow on the school territory (48%) or into a special canal (27%).


10 October 25, 2013

In regard with regions the worst practice of waste water removal is observed in Samtske-

Javakheti region.

According to the observation findings from across the country only half of toilets have been

considered clean and nearly every fifth of the sanitation facility was non-functional for the

time of the visit. In majority of schools there was no paper in the toilets.

The indicators of functionality and cleanliness of the toilets were higher in cities than in

villages. It should be noted that functionality of toilets is higher in Tbilisi, while in terms of

cleanliness the conditions in Tbilisi were the same as in other urban areas – 60% of toilet

compartments have been considered clean, while in the villages this indicator is around 50 %.

The conditions of the hand washing facilities in cities did not differ from that in villages, as in

case of toilets. Toilets are in better conditions in the cities while the hand washing facilities

are cleaner and function better in the villages. Only half of the hand washing facilities was

considered clean in Tbilisi and 70% in the villages at the time of observation.

No correlation has been found between the presence of piped water source and cleanliness of

the sanitation facilities – indicators of cleanliness were not higher in schools with piped water

supply system. Most probably the challenges related to the cleanliness of sanitation facilities

are caused by poor care and maintenance as well as violation of hygiene rules.

80% of rural schools are heated with wood stove in winter period that adversely affects the

cleanliness of classrooms.

Buffets operate only in 30% of public schools, of which most are in Tbilisi and other urban

areas. Approximately 90 % of schools in rural areas do not have any buffet.

Only finished food is provided in approximately half of urban school buffets and the most of

rural school buffets.

Study of products sold at school buffets by the time of observation showed that the range of

products is not supportive to healthy eating practice.

Products with high content of fat and salt are provided in most school buffets.

In most buffets there are no hand washing facilities; only 52% of schools keep finished and

raw products separately, only 48 % of schools have refrigerators; this creates the risk of food

borne diseases.

According to information provided by 60% of school directors, there is a fast food facility

close to their school.

Only 1-3% of school budget goes for sanitation, water and waste disposal expenditures; this

amount, as school stakeholders think, is not good enough for proper maintenance of the

school infrastructure.


11 October 25, 2013

Medical office operates in only 6 % of schools; in Tbilisi the indicator is about 30%,

respectfully 20% in urban and about 4% in rural areas. Only 2% of schools have a staff of

doctor in the medical office.

3. How will these standards help state agencies, school stakeholders, parents and civil

society?

The purpose of developing this document is to provide information to state agencies, school

stakeholders, parents and generally, to interested civil society about health risks related to the school

environment with a focus on water and sanitation, proper risk assessment and effective planning of

risk reduction measures.

Important part of the standard is a technical regulation, which sets sanitation and hygiene standards

on water, sanitation and hygiene in schools of Georgia ensuring child health as well as minimum of

requirement to arrangement of water and sanitation infrastructure.

The document provides a broad thematic framework defining main aspects, principles, approaches

and strategic visions related to water, sanitation and hygiene issues; accordingly, it serves as a

guidance for improving environment and health conditions in schools; it will help schools as well as

local and central authorities to:

Design health-oriented policy: the information provided in the document can be used to

improve the school environment and define children's healthcare policy and strategy.

Develop supportive environment: the document contains simple, low-cost interventions that

can be implemented to create a healthy school environment for children’s growth and

development.

Reorient healthcare services: school administrators, teachers and health care providers will

have a guidance enabling them to raise self-awareness about health problems related to the

school environment, take prevention measures and ensure proper problem management.

Develop skills: the information given in this document will enable children and the school

personnel to gain knowledge about health hazards related to the school environment and the

ways to mitigate the impact of those hazards.

Mobilize public activities: the document suggests measures to be implemented by school staff

and the local community to ensure healthy school environment.

The document provides tools for monitoring and assessment of water supply, sanitation and hygiene

in schools as well as for conducting national-level studies.


12 October 25, 2013

II. Water, sanitation and hygiene in schools (Wash in schools) - technical

regulations

4. General requirements

1. By water and sewage systems all school buildings on the territory of Georgia are

conventionally divided into two categories – category A and category B.

2. Category A includes all schools located in cities, municipal centers, large villages or any other

place where central water and sewage systems are installed.

3. Category B includes all schools located in high mountainous regions, small villages or any

other place where central water and sewage systems are still not installed.

4. Category B is divided into two groups:

a) Group 1 – school buildings, where indoor toilets can be set up according to the standard

requirements.

b) Group 2 II - school buildings, where indoor toilets cannot be set up according to existing

layout.

5. All category A schools should be provided with hot and cold water. Water supply should

encure the provision of 20 liters per student per day.

6. Hot and cold water should be delivered to all school facilities including:

a) offices for technical training;

b) office for the medical aid;

c) shower rooms;

d) kitchen;

e) toilets;

f) laboratories;

g) hand washing facilities;

h) hand washing facilities in each classroom for grades I-VI;

i) hand washing facility in the canteen;

j) shower rooms and toilets for school personnel;

k) corridors and drinking water standpipes in yards (with only cold water);

7. Hot water temperature should not exceed 600C.

8. All category B schools should be supplied by both drinking and hand washing water. Safety of

drinking water should be assessed by relevant competent services according to regulations

determined by law. If this requirement is met, spring water or water from dug well can be

used for drinking. If these sources are unavailable, drinking water should be stored and

protected in accordance with proper hygiene conditions.

9. Dug wells must be technologically protected from any kind of external contamination.

Drinking water from wells should be regularly examined for safety by relevant services

(especially after floods and other natural disasters).

10. Water collected from rainwater in the storage tank (but not in the system) or other type of

technical water can be used for toilets, but not for drinking or hand washing.


13 October 25, 2013

5. Requirements for the water supply of schools

1. The school should have both drinking and technical water supply systems.

2. School water supply system must provide safe and sufficient amount of water for drinking

and technical purposes (hand washing, food preparation, flushing toilets, and cleaning

facilities).

3. Drinking water used in schools should be safe for health and its quality should meet the

requirements of regulations adopted on December 17, 2007 by order #349/N of the Minister

of Labor, Health and Social Affairs of Georgia on “Approval of technical regulations for

drinking water”.

4. Quality of drinking water supplied to school should be controlled by order #349/N of the

Minister of Labor, Health and Social Affairs of Georgia on “Approval of technical regulations

for drinking water” on December 17, 2007.

5. If piped water supply is absent or water is usually supplied with delays, school must be

equipped with a water reservoir (tank).

6. Water reservoir must be a protected tank of sufficient volume, which should be regularly

cleaned and disinfected (after disinfection the tank should be rinsed with clean water).

7. To control the regularity of water reservoir cleaning, it is necessary to keep recordings on

performed works in a special log.

8. Water reservoirs should be cleaned on a monthly basis while the water in drinking-water

reservoir should be changed every 48 hours.

9. Any suitable detergent registered by the Ministry of Labor, Health and Social Affairs of

Georgia can be used for disinfection of water reservoirs.

10. Drinking water source can be a dug well, which also needs to be carefully treated following

the rules of proper placement, care and keep safe sanitation and hygiene norms, in particular:

a) Well shall be located at least 30 meters from any source of pollution (e.g. from outdoor

sanitation facility).

b) The use of pesticides within 100 meters of radius from the well is unacceptable.

c) Well should regularly be inspected to examine its structural integrity.

d) Fence should be installed around the well to protect it from animals.

e) Drainage system arranged around the well should protect the well from pollution caused

by surface and spilt water.

f) Utensils for taking water should be kept clean.

g) Well should be capped.

11. The school should have properly equipped drinking water points available for school children

and school personnel as well as for people with disabilities.

12. Schoolchildren are allowed to be provided with drinking water from water fountains and

water containers, additionally:

a. Water containers should be cleaned every day or every time when it gets empty.

b. Water containers should be tightly capped.

c. Water container should be placed on the table or on the shelf, but not on the floor.


14 October 25, 2013

13. Water dispensers should be equipped with disposable plastic water cups; water tank working

in synchronous mode with dispenser should be regularly cleaned and disinfected.

14. The basic water quantity needed in school shall be calculated according to the following

scheme:

Drinking water Secondary educational institutions with day

studies

5 liters per person per day (for all schoolchildren

and the school personnel)

Boarding school (24 hours) 20 liters per person per day (for all schoolchildren

and the full staff personnel of the school)

Technical water Toilet flushing devices connected to central water

supply system or the water tank

10 – 20 liters per person per day

Toilet flushing devices for toilets that should be

flushed with water brought by consumers

1.5 - 3 liters per person per day

15. To ensure the microbiological safety of drinking water, school administration has to perform

a decontamination of the water from unprotected source.

16. Decontamination of a drinking water in the school should be performed according to

methods and regulations approved by Georgian law.

17. Expenditures to ensure the affordable, high-quality and sufficient water supply should be

included in the school budget.

6. Requirements for ensuring favorable sanitation and hygiene conditions in schools

1. School toilets should be: well-equipped, comfortable, ensuring privacy, protected, clean, and

appropriate to the level of public culture and social development, accessible for

schoolchildren and the personnel, including people with disabilities.

2. All school buildings with indoor sanitation facility, should meet the following requirements:

a) Separate toilets for boys and girls should be arranged on each floor of the school (scheme

#1)


15 October 25, 2013

b) There should be a separate sanitation facility with special entrance for teachers and other

personnel in the school.

c) Sanitation facility should not be located in front or near the entrance fo a school building.

d) In front of the sanitation facility there should be a constantly ventilated portal or odor

removal area to avoid specific odor emission in corridors or lobby.

e) Sanitation facilities should be equipped with both natural and artificial lighting and

ventilation. The additional mechanical ventilation systems can also be installed.

3. Sanitation facilities should be:

f) Protected from direct solar radiation, especially in hot regions.

g) Toilet door should be opening outwards to avoid injuries to children, be elevated from the

floor level and be closing inwards, though for safety reasons it also should be considered

an opportunity to open it from the outside.

h) Urinals in toilets for boys must be separated by plastic tiles.

i) Floor covering should be made of anti-slip material that will retain its properties even in

wet conditions. Granite, marble or other similar materials for flooring are not acceptable

to use.

j) Walls of the sanitation facility should be covered by ceramic files not less than 1,5m high

from the floor or be processed by waterproof paint that can undergo wet cleaning and

disinfection.

4. School toilets should ensure privacy and protection.

5. The area needed for the sanitation facility should be calculated as 0,15m2 per schoolchild.

6. At least one toilet for disabled children should be placed in the school building with

following dimensions:

a) 122 x 142 cm (if the entrance is located from the transverse side)

b) 122 × 167 cm (if the entrance is located from the longitudinal side)


16 October 25, 2013

c) Lavatory pan should be of 45 – 48 cm high.

d) Water basin should be installed at height of 80 cm from the floor.

e) To change a seat from a wheelchair to the lavatory pan railings should be mounted to the

walls at about 91,5 cm height from the floor (see the scheme 2).

7. School sanitation facility should be arranged according to the following calculation:

a) one pan per 25 girls

b) one pan per 30 boys and 1 urinal per 80 boys’

c) one water facility for hand washing per 30 schoolchildren.

8. Hand washing basins in sanitation facilities should be placed at the height of 85cm.

9. Soaps and hand drying means should be accessible at each basin in the school.

10. Liquid soap is preferable for use at hand washing facilities.

11. Hand washing facilities should be installed at each critical point of the school including

toilets, kitchen and the dining room/canteen.

12. Hygiene education must be included in the school curriculum; regular practical training

should be conducted to develop positive hygiene behavior among school children on hand

washing, proper use of water and sanitation facilities, rules for using and maintaining these

facilities.


17 October 25, 2013

13. School toilet dimensions and devices installed in toilets should meet the requirements given

in the table 1 below:

# Facilities Quality Comments

1

Toilets

1 pan per 25 girls

Toilet cubicle dimensions: 80 X 110 cm

1 pan per 30 boys

2 Urinals 1 urinal per 80 boys Urinals should be separated by plastic tiles.

3

Hand washing facilities in

the toilets for boys 1 basin per 30 children

Hand washing facilities should be placed at height of:

0,5m – for grade I

0,6m – for grades II-IV

0,8m – for grades IV-XII

Hand washing facilities in

the toilets for girls 1 basin per 30 children

4

Sanitation facilities for

teachers

1 urinal + 1 basin for

women If the number of teachers in the

school is less that 30, this figure

might be halved and just 1 basin

for both women and men could

be installed

San

itat

ion

fac

iliti

es

for

teac

he

rs a

nd

th

e sc

ho

ol

adm

inis

trat

ion

sh

ou

ld n

ot

be

avai

lab

le f

or

sch

oo

lch

ild

ren

1 urinal + 1 basin for men

5

Sanitation facilities for school

administration

1 urinal + 1 basin for

women School administration can have

one shared basin

1 urinal + 1 basin for men

6 Sanitation facilities for

disabled children or teachers

1 sanitation facility on

each floor

More detailed information on this type of sanitation

facilities you can find in paragraph 7.4


18 October 25, 2013

Lavatory pan in the table could be changed to the “Turkish squat pan” or pit latrine

If the school building is designed only for the primary school grades, there is no necessity to

arrange urinals there.

14. School toilets must meet the following requirements:

a) The minimum dimensions of the toilet should be: 80 × 110 cm

b) The lavatory pan axis should be distanced from the wall at least by 40cm

c) Pan height should be 43 – 48,5cm

d) Urinals’ axis can be distanced from the wall at least by 40cm

e) The distance between axes of urinals should be at least 60cm

f) The basin’s axis can be distanced from the wall at least by 50cm

g) The distance between the axes of hand washing facilities should be at least 60cm

15. Toilets for boys and girls may have the common area for hand washing facilities that reduces

the risks of anti-social behavior. In addition, toilet block is recommended to be placed in the

vicinity of administration offices as this allows conducting of passive supervision throughout

the day.

16. Good design and cleanliness of toilets encourage the schoolchildren to develop positive

behaviors and reduce vandalism.

17. Category B schools have to meet the same requirements on arranging inside sanitation

facilities as category A schools. Water from sewage, liquid waste and waste waters should

flow into the septic tank installed outside the building (scheme 2).

18. The location of the septic tank should be selected in a way that makes it easy to be pumped

out. Pumping should be performed when a sludge (thick mud) dirt lining accumulated

exceeds 30 percent of tank capacity.

19. For category B schools outdoor sanitation facility should be installed on top of the septic tank

(scheme 3) or in a separate building connected to the septic tank by pipes.

20. Outdoor sanitation facility must be in a distance of at least 20m and no more than 100m from

the school building, playground and the recreation field. The toilet can be at a distance of not

less than 30-50m from captages of wells and water sources.


19 October 25, 2013

21. Outdoor sanitation facility must have:

a) sewage removal septic tank with waterproof floor, walls and a cap;

b) ventilation pipe equipped with a fly proof netting against mosquitoes;

c) natural and artificial lighting;

d) basin stand;

e) paved pathway leading to the toilet;

22. In schools with no permanent water supply the reservoir tank should be installed to provide

water to the sanitation facilities.

23. Shower and the dressing room with individual lockers for children should be arranged in the

sanitation block of the school gym according to the following scheme:

Shower

Dressing

Locker

Chair


20 October 25, 2013

24. In school gym showers flooring should be made of an anti-slip material preserving its

properties even in wet condition.

25. Areas needed for the sanitation facilities and dressing rooms of the school gyms should be

calculated as given in table 2:

# Facilities Units Comments

4 Gym toilets

2 pans for girls

toilet cubicle dimensions

80×110 cm

2 pans for boys

5

Showers of the gyms

15 dressing and showers

for girls

dressing and shower

dimensions should be: 0.9×1 m

+ 0.9×1 m

see Annex #4

15 dressing and showers

for boys

6

Shower and the toilet for

sports instructor

1 shower with dressing, 1

pan

Sports instructor’s shower and

the sanitation facility should

directly be connected with the

instructor’s office

26. There should be at least one shower for persons with disabilities in the school.

27. Routine toilet cleaning and checkup of technical maintenance should be performed to ensure

constant availability of clean and functional toilets for schoolchildren and the school

personnel.

28. School administration should set the instructions for toilet cleaning and regularity of care as

well as create a list of cleaning inventory and hygienic items for use.

29. Sanitation facilities should be cleaned with only specific for these purposes and properly

labeled agents, which should be stored separately and undergoe processing by end of each

working day.

30. Household chemicals and detergents used for school cleaning must be stored in special locked

containers/cabins in original packaging, which allows distinguish them by labeling and

keeping them out of reach of unauthorized persons.

31. Expenditures for cleaning of sanitation facilities, soaps and towels should be included in the

annual budget of the school.


21 October 25, 2013

7. Requirements for ensuring cleaning and waste management

1. School territory should be cleaned on a daily basis; garbage must be collected and disposed of

in a capped collecting containers placed at a distance of at least 25-30m from the school

building.

2. Solid wastes from classrooms, kitchen, administrative and other premises should be collected

on a daily basis and removed safely away from the school building.

3. Garbage containers have to be emptied as soon as they are 3/4 full to avoid over filling.

4. To avoid rotting and decomposition, garbage containers should be removed from the school

territory on a daily basis, especially in a warm period. Containers need to be washed and

disinfected on a monthly basis (using 10% chlorinated lime solution or any other appropriate

detergent).

5. Water wastes should be removed or derivated and septic tanks need to be emptied safely in

schools.

6. Through special services school administration should arrange cleaning of places, where

waste containers are installed as well as of warehouses and basements with agents for

controlling insects and rodents (disinfection, deratisation).

III. Physical environment and health in Schools

8. What is the meaning of healthy physical environment in schools?

Healthy school environment is crucial for children's health care and the effectiveness of a learning

process. Children all around the world spend more than eight hours a day, nine months a year in

classrooms, laboratories, school halls and courtyards. School and the adjacent areas may include many

physical, chemical and biological threats to child's health and development. Pollution of school

environment may cause or aggravate child’s health problems, as is in case of infectious disease or

asthma, and may also result in absences in schools, setback in education and restriction of

opportunities to gain knowledge. Some of pollutants in school environment can also cause chronic

health disorders including cardio-vascular diseases, neurological diseases and tumors that may arise

later.

Environmental hazards differ by rural and urban areas, countries and regions. Health and

environmental pollution problems are usually related to the level of social development and welfare,

and some are associated with certain climate and geographic locations, but the great majority of

problems are global in their nature.

Contaminated water and food may cause diarrheal diseases that are mostly characteristic for poor

countries, though this kind of problem may arise in developed countries as well. According to the


22 October 25, 2013

World Health Organization, diarrhea associated with water quality, poor sanitation and hygiene

practices cause 33000 deaths per year and 1182000 years lost on disabilities in European region. In

addition, 90 % of cases occur in the region's low-and middle -income countries. These types of deaths

can be completely avoided and prevalence of water-related diseases can be rapidly reduced if high

standards of water, sanitation and hygiene practices are achieved.

Air pollution in schools may be caused by industrial enterprises or heavy traffic on highways both in

developing and developed countries. According to WHO reports, in most European countries

newborn mortality caused by respiratory diseases declined, but current rates (overall newborn

mortality rate of 12 %) still remain a significant burden on health care systems, especially in Eastern

Europe. Among adolescents aged 13-14 about 5% to 25% suffer from asthma and allergic diseases,

which are leading causes of morbidity of children in the European Region. Exacerbation of asthma

symptoms is a result of air pollution, especially by Atmospheric particulate matter (PM10); studies

made in recent years demonstrate the correlation between air pollution and asthma incidence rates.

Number of studies conducted in developed countries confirmed the effect of lead (plumbum) on the

health of children, and is linked to the dyes used in the old urban schools.

Students may suffer health problems caused by using pesticides against disease-causing organisms or

in cultivating agricultural lands located close to schools.

9. Why are efforts needed to improve the school physical environment?

School's physical environment consists of the school building itself and all its constituents (physical

infrastructure, furniture, used or stored chemicals and biological substances), school location and all

surroundings (air, water, materials touched or used by children, nearby residential areas and roads).

Basic components of a healthy school environment include safe and sufficient water supply, proper

sanitation and provision of shelter. In regard to importance, this is comparable with the protection

from biological, physical and chemical hazards that may be harmful to the child's health (Table 1.)

Water-related infectious diseases and physical hazards associated with improper construction and

maintenance practices are the types of threats to students and school personnel that are faced by all

schools around the world.

Components of a healthy school environment:

Ensuring basic needs Shelter

Warmth

Water

Food


23 October 25, 2013

Lighting

Ventilation

Sanitation (with relevant premises)

Emergency medical services

Protect from biological threats Mould

Low-quality or insufficient water supply

Poor quality of food

Transmitted diseases

Rodents, snakes and insects

Other animals (e.g. dogs)

Protect from physical threats Transport and road safety

Violence and crime

Trauma

Extreme heat or cold

Radiation

Protect from chemical threats Air pollution

Water pollution

Pesticides

Wastes

Hazardous materials and coverings

Asbestos, dyes

Detergents used for washing and

cleaning

10. Why are children more vulnerable to problems associated with the environmental

health?

The school's physical environment strongly effects children's health for various reasons.

First of all, it should be noted that environmental factors are one of main determinants for child’s

health: contaminated water can cause diarrheal diseases; polluted air may result in serious

aggravation of respiratory infections and cause asthma attacks; lead, arsenic, solvents and pesticides

may have different effects on the child’s health and even become the reason for death.

Second, children are more vulnerable to chemical, physical and biological hazards than adults. Low

immunity, underdeveloped organs and functions, rapid growth and development put children's

health at higher level of risk than adults’ to the toxic effects of exposure to environmental factors.

Ratio of the air, water and food consumed by child to child's body size exceeds the similar ratio of

adults. Consequently, the impact of air, water and food pollutants on child’s body is stronger than

impact to adult body.


24 October 25, 2013

Potential effects of water pollutants

on health:

Diarrhea

Cancer

Renal failure

Liver diseases

Congenital defects

Neurological disorders

Especially essential is the fact that the most important stages of child's growth and development fall

within the school age and children spend most of their time in school's physical environment. Given

that the duration of the child's life rest exceeds that of adults’, the risk of developing chronic diseases

due to harmful effects also increases. Many of diseases related to environmental toxicants need tens of

years to develop. The risk of rising diseases caused by exposure to cancerogenic or toxic agents in the

early years of life (including prenatal period) is much higher than a similar impact in case of adults.

Third, children’s behavioral pattern significantly differs from that of adults’ and therefore, they are

put under different environmental risks. This type of behavior includes taking hands and other things

(e.g. school items) into mouth and ignoring washing hands before meals.

The children do not have enough experience for proper assessment of behavioral risks, therefore they

usually take more risks while climbing, jumping down, using some unsteady constructions.

Based on above-mentioned facts, it could be stated that improvement of the physical environment in

schools is one of the most effective interventions in promoting child's health and development. A

healthy school environment directly affects child's health and effectiveness of learning process

encouraging schoolchildren to develop healthy social lifestyle and motivates them to become active

and skillful members of the community. Schools should provide a certain example and a good model

for community. Students, school personnel, families and community members must possess sufficient

knowledge to identify environmental risks associated with the school and the home that will help

them to find and exercise effective ways to ensure safety.

Students with relevant knowledge about causal links between the environment and the health, will

be able to identify and reduce health hazards in their homes.

IV. The effects of school environment on schoolchildren’s health

11. Water

First of all, water must be safe for health. Drinking water

used in schools should be safe for health and its quality

should meet the requirements of regulations authorized

on December 17, 2007 by order #349/N of the Minister

of Labor, Health and Social Affairs of Georgia on

“Approval of technical regulations for drinking water”.

The water quantity consumed per day is vital for our

health and well-being. About 60% of human body is

made up of water. As body regularly loses water

through breathing, sweating and urination, it is


25 October 25, 2013

Early symptoms of dehydration:

Thirst

Heavy breathing

Headache

Dry cough

Stomach ache

Irritability

Drowsiness and fatigue

Low concentration

Reduced ability to perform sports

activities

necessary to replace the loss with fluid intake. Dehydration (excess loss of. water) develops even if

the body loses 1-2% of its water, so the intake of proper water quantity per day:

protects health;

promotes good mood;

increases vitality;

helps to avoid problems related to bladder and intestines.

It is hard for teachers to recognize the signs of mild

dehydration. Moreover, drowsiness, irritability and

concentration deficit can be considered as quite

normal by end of a school day, but teachers need

to remember that these are also signs of

dehydration in case, if the child does not receive

sufficient quantity of water. Even mild

dehydration has a strong impact on the health and

mood, which in turn adversely affects the child's

psycho - emotional state and capacity to learn.

Drinking water, unlike soft drinks, plays a

positive role in preventing dental caries and

obesity. Carbonated and caffeine-containing

beverages are not favorable for consuming as they

cause increased urination and therefore, their use

in schools should not be encouraged.

Children need much more water than adults, in addition, children drink water more frequently than

adults. The water quantity required for children differs and depends on following factors:

age

sex

size of the body

weather

level of activities

eating habits (type of foods consumed most frequently)

clothes

Average daily demand for drinking water in children is 1.5 - 2 liters or 6 - 8 cups a day (if volume of

the cup is 250 ml). According to various guidelines, the boys’ demand for drinking water over the age

of 14 years may be up to 2.6 liters per day.

During the school day children should consume almost the half of their daily need of drinking

water. In hot weather as well as in case of intense activities (e.g. sports games) this amount increases.


26 October 25, 2013

Many schoolchildren, especially of younger age, often do not realize the feeling of thirst and need to

be instructed on necessity to take water.

Water is the most essential and healthy drink for children and water intake needs to be sufficient

during a day. Water is also the best choice for breakfast, lunch, or dinner time instead of carbonated

or non-carbonated beverages, containing sugar, caffeine, food additives that are useless for health.

Moreover, these drinks may cause increased urination contributing to the loss of necessary trace

elements by body.

Schoolchildren may not drink water in school for various reasons:

1. Lack of access to the drinking water, i.e.:

Drinking water point is often located near the toilet or even in the toilet, which is non-

hygienic and aesthetically unacceptable;

Water fountain is inconvenient to provide the needed amount of drinking water;

Drinking water can be of a poor condition (warm, with specific odor, color and taste);

There are not enough drinking water points;

The access to drinking water is limited due to the flow of schoolchildren during breaks

between classes;

Often children are not allowed to leave the classroom to drink water or to bring a bottle of

drinking water with them;

Often the drinking water at schools is available only if children buy it.

1. Students are forbidden to bring drinks to school and even if allowed, they usually bring

carbonated, sugar- containing beverages.

2. Teachers and parents are often not well informed about the potential effects of dehydration on

child's health and capacity to learn.

3. Children may not always realize the feeling of thirst, when they are involved in games or other

leisure activities.

4. Provision of affordable, high-quality and sufficient water is not included in the school budget.

5. Modern and meeting hygiene requirements drinking water points, e.g. water dispensers (if

possible, in each classroom) are not included in new school’s design plan.

As a result of all above-mentioned factors, students drink much less water than their body needs,

some do not drink water at all.


27 October 25, 2013

Symptoms associated with the poor

indoor air quality:

Headache

Fatigue

Rapid breathing

Coughing and sneezing

Eyes and nasal mucosa

irritation

Lightheadedness

12. Sanitation infrastructure

Faecal matter is a major source of disease-causing microorganisms including parasites, bacteria and

viruses. Removal of faecal contaminants from the school environment includes many issues and

depends on informed and responsible students and school personnel, supervision practice, avoiding

intrusion of insects and animals (including protection of playground from animal faecal matters),

toilets layout and cleanliness, presence of odor, provision of privacy and appropriate equipment.

Sanitary infrastructure used in the country differs by type and depends on the level of cultural, civic

and social-economic development. The responsibility of educational and healthcare institutions lies

with ensuring the technical compliance and accessibility of school sanitation infrastructure as well as

supervision of community requirements.

13. Indoor air in schools

Most children spend the whole school day inside a building. The indoor air that children breathe in

schools may be much more polluted than the outdoor air. Poor indoor air quality can cause diseases

including asthma, allergies, infectious and respiratory diseases; it also may cause the distress of mental

abilities, particularly, reduced calculation abilities, lack of concentration and low memory.

In many countries, including Georgia, for heating and cooking most of rural schools use solid fuels

wood, coal, etc.), which have an adverse affect on

children's health due to dispersed small solid particles

of dust and other toxic pollutants into the air of school

premises. Use of solid fuel is a major source of air

pollution in rural schools. However, disease-causing

bacteria and viruses, mold and fungus, particles of

construction material, pesticides, chemical products

used in cleanup of houses, volatile chemical compounds

of school furniture and visual aids for learning, radon

gas and the pollutants coming from the outside, coating

materials containing asbestos and lead, can be found

practically everywhere; this is an assential public health

problem and the biggest threat among environmental

factors due to its significance. Improper heating,

ventilation and air conditioning systems can further aggravate problems related to the air quality.


28 October 25, 2013

Scientists have found that about 40 thousand micro-drops containing millions of bacteria spit out into

air and spread at a distance of 10m after one sneeze.

In this regards the proper techniques of sneezing plays an important role in avoiding the spread of

microbes and preventing air pollution in premises. The teachers' task is to familiarize themselves

with proper sneezing techniques, teach their students to use it and thus prevent infections that

can spread by airborne transmission.

Proper sneezing technique:

1. If you have caught cold and want to sneeze, get a sufficient number of disposable paper napkins;

2. If you feel the need to sneeze, immediately turn with your back the other people;

3. Use fresh and clean paper napkins to avoid hand contamination with mucous secretions;

4. If you do not have a napkin when sneezing, cover your mouth with bended elbow to prevent the

spread of microbes. Never sneeze into your bare hands.

5. If you feel like you are about to sneeze, do not try to cease sneezing by closing your nostrils with

fingers and do not inbreathe back. On the contrary, blow air out into a disposable paper towel and

Air pollution sources in the classrooms:

Emissions coming from the outside (e.g. diesel-powered school buses, proximity of

highways, emissions arising during cultivation of nearby agricultural lands, exhaust

gas from nearby enterprices);

Carpets (processed with formaldehyde )

The use of tobacco (eg, tobacco smoke penetration from places, where people smoke)

Industrial products (eg, dyes, household chemicals, pesticides)

Steam from various materials and equipment eg, laboratory chemicals , materials for

drawing and photographing , copy machines and printing machines, glues and

markers)

Radon gas, CO2, CO.

Lead (plumbum)

Rodents and insects

Mold and fungus

People (eg, the spread of disease-causing bacteria and viruses)


29 October 25, 2013

throw it immediately into the covered bin or plastic package.

Strong sneeze can cause microbes to penetrate in your middle

ear or other cavities in the skull

6. After sneezing and cleaning the nose you should wash your

hands with soap.

14. Outdoor air in schools

In urban areas children suffer from exposure to industrial and transport contaminants on their way

from home to school and back. Moreover, these contaminants may break in to the classrooms. Air

quality impacts on health are difficult to calculate, however the World Health Organization estimates

about 800 000 deaths worldwide every year due to air pollution.

Air pollution is a risk - factor to each child's health; even a short exposure to high concentrations of

pollutants among children with asthma increases the risk of asthma attack by 40%.

15. Lighting

The learning process is usually associated with an important eye strain. Normal or slightly elevated

levels of lightning in school premises helps reduce tension of the nervous system, maintain

performance and schoolchildren’s activity. School premises should have natural lightning. Premises

including storehouse, warehouse, radio unit, photo laboratory, library, boiler, water pumping,

ventilation and air conditioning cameras, nodes to control engineering and technology equipment or

disinfectant solution container, may operate without natural lighting.

Sunlight, particularly the ultraviolet rays help adolescent body’s normal growth and development,

reduce the risks of spreading infectious diseases and stimulate production of vitamin D in the body.

Under poor lighting of school premises schoolchildren have to bend heads down, when they are

reading and writing. This causes the excessive blood flow to eyes and rises eye strain resulting in

change of its shape and development of myopia or nearsightedness. To avoid these complications,

school premises need to have good natural lighting and the artificial lighting, meeting the

requirements of regulation.


30 October 25, 2013

The level of natural lighting at the working place of teachers and students depends on several

parameters: the layout of the school building on the school site (the orientation of a building), the

distance between high buildings, on keeping the indicated ratios for natural and artificial lighting.

Lighting level in the classrooms, auditoriums and laboratories shall comply with the following

standards:

desks _ 300 lux;

school boards _ 500 lux;

graphics room for drawing and drafting _ 500 lux;

for tables in the classrooms fo main subjects _ 300-500lux;

conference and sports halls (on floors) _ 200lux;

recreation area (on floor) _ 150lux;

dressing room _ 100lux;

lobby _ 100lux;

doctor’s office _ 200lux;

dining room, canteen _ 200lux;

staffroom/teachers’ room _ 200lux;

library _ 300lux.

16. Ultraviolet radiation

For most people, long exposure to the sunlight is associated to the childhood. Adverse affects of

the ultraviolet radiation and the sunburn may become a significant risk-factor for health in the

future, leading even to skin cancer and cataracts. Harm can be avoided through developing proper

behavioral skills from an early childhood period. Development of preventive health behavior pattern

in childhood will lead to long-term sustainable results and healthy elderly period. Schools, where

children spend most of their time, should play a vital role in cultivating skills among children on self-

protection from exposure to the sunlight.

17. Pesticides and other chemicals

The child's body is particularly sensitive to adverse affects of exposure to pesticides; accumulation of

significant risks to their health, which may arise in adulthood, occurs in a childhood period. The

affects of exposure to pesticides in schools may be linked to conditions inside as well as outside the

building. Children living in both developed and developing countries could be affected by pesticides

from drinking water, food, and things like books and toys.

Pesticides are often used improperly as consumers have no appropriate knowledge about the rules of

pesticide use and about toxicity. Labels on pesticides rarely contain information about rules for

health safety; in number of cases, banned pesticides are usually in use (such as DDT – “Douste”).


31 October 25, 2013

Most pesticides are harmful to health and this may be revealed in both short- or long-term effects,

including: vomiting, diarrhea, headache, skin irritation, liver dysfunction, neurological problems,

reproductive system disorders, symptoms typical to influenza and asthma, behavioral and emotional

disorders.

18. Nutrition and School meals

Nutrition is one of fundamental factors determining the body's growth and development, health and

capability as well as the degree of immunity to many unfavorable factors. It plays an enormous role

in ensuring effectiveness of the human adaptive capacity.

Healthcare for school children is not limited to the chemical, biological and physical safety of food,

but also includes the provision of healthy nutrients to adolescents and the same time, restriction of

hazardous products to avoid the adverse affects and development of healthy eating habits.

Prevention of food borne diseases should become the top priority of School nutrition. Most food

borne diseases are avoidable if food storage and preparation rules are properly kept. Vitally important

is the education of both children and the school kitchen / buffet service personnel on food and water

safety issues.

School meals should be a component of a healthy environment and be in line with a curriculum on

healthy diet and food safety issues. School education about healthy food should provide an

opportunity to schoolchildren to make a right and independent choice of food and develop hand

washing habit before eating.


32 October 25, 2013

19. Location of the school building

Location, security and comfort of the school site are of great importance for ensuring the health of

children. Safety of school environment is determined not only by good design and maintenance, but

by affects of neighboring areas, constructions and facilities, depending on their functional load. In

schools located close to transport corridors, bus depots, industrial plants, abandoned facilities,

landfills, cemeteries, military bases and construction sites, often arise health problems among

students and school staff.

Many schools in Georgia are located near highways that put the schoolchildren and the school

personnel under exposure to exhaust gases, containing number of cancerogenic substances and at

least 50 toxic air contaminants.

The basic principles of safe food preparation in schools:

• Food products should be thermally processed to reach the maximum internal temperature up to 700C

• Prepare food in amount that is fully consumed, avoid storing

• Avoid contact between raw food and finished products. Finished products can be contaminated in

contact with raw materials, hands, flies, surfaces and dishes. Kitchen staff shall wash hands after

touching high-risk products (eg, poultry, eggs, unwashed greens, etc.). Dishes for raw materials should be

washed after each use.

• Wash food and vegetables thoroughly before handling.

• Use only safe water for food washing and cooking.

• Protect food from insects and rodents.

• Store products intended for long- term use in a safe place.

• Insure cleanliness in the whole area of food preparation


33 October 25, 2013

V. How to protect the child’s health through improving of school

environment

20. What are the recommendations of authoritative international organizations on

improving of school environment?

The 5th ministerial on environment and health held in Parma in 2010 adopted the declaration on

specific goals of improving the environmental health. The first time under this declaration there are

identified the commitments to reduce environmental threats to children; these obligations are

reflected as Regional Priority Goals:

Regional Priority Goal 1: Ensuring public health by improving access to safe water and

sanitation.

Commitment: provide each child with access to safe water and sanitation in homes, child care

centres, kindergartens, schools, health care institutions and public recreational water settings by

2020, and to revitalize hygiene practices.

Regional Priority Goal 2: Addressing obesity and injuries through safe environments, physical

activity and healthy diet.

Commitment: provide each child by 2020 with access to healthy and safe environments and

settings of daily life in which they can walk and cycle to kindergartens and schools; prevent injuries

by implementing effective measures and promoting product safety.

Regional Priority Goal 3: Preventing disease through improved outdoor and indoor air quality

Commitment: provide each child with a healthy indoor environment in child care facilities,

kindergartens, schools and public recreational settings, implementing WHO’s indoor air quality

guidelines and, as guided by the Framework Convention on Tobacco Control, ensuring that these

environments are tobacco smoke-free by 2015.

Regional Priority Goal 4: Preventing disease arising from chemical, biological and physical

environments.

Commitment: protect each child from the risks posed by exposure to harmful substances and

preparations, focusing on pregnant and breast-feeding women and places where children live, learn

and play.


34 October 25, 2013

WHO pays special attention and applies efforts to provide the global community with evidence-based

information on the importance of sanitation improvement, according to which there follow:

10 Facts on sanitation

1. An estimated 2.6 billion people lack access to adequate sanitation globally. If the current

trend continues, by 2015 there will be 2.7 billion people without access to basic sanitation.

The regions with the lowest coverage are sub-Saharan Africa (31%), southern Asia (36%) and

Oceania (53%). Underlying issues that add to the challenge in many countries include a weak

infrastructure, an inadequate human resource base and scarce resources to improve the

situation.

2. Lack of sanitation facilities forces people to defecate in the open, in rivers or near areas where

children play or food is prepared. This increases the risk of transmitting disease. The Ganges

River in India has 1.1 million liters of raw sewage dumped into it every minute, a startling

figure considering that one gram of faeces may contain 10 million viruses, one million

bacteria, 1000 parasite cysts and 100 worm eggs.

3. Examples of diseases transmitted through water contaminated by human waste include

diarrhea, cholera, dysentery, typhoid, and hepatitis A. In Africa, 115 people die every hour

from diseases linked to poor sanitation, poor hygiene and contaminated water.

4. Health-care facilities need proper sanitation and must practice good hygiene to control

infection. Worldwide, between 5% and 30% of patients develop one or more avoidable

infections during stays in health-care facilities.

5. Each year more than 200 million people are affected by droughts, floods, tropical storms,

earthquakes, forest fires, and other hazards. Sanitation is an essential component in

emergency response and rehabilitation efforts to stem the spread of diseases, rebuild basic

services in communities and help people return to normal daily activities.

6. Studies show that improved sanitation reduces diarrhea death rates by a third. Diarrhea is a

major killer and largely preventable: it is responsible for 1.5 million deaths every year, mostly

among under-five children living in developing countries.

7. Adequate sanitation encourages children to be at school, particularly girls. Access to latrines

raises school attendance rates for children: an increase in girls’ enrolment can be attributed to

the provision of separate sanitary facilities.

8. Hygiene education and promotion of hand washing are simple, cost-effective measures that

can reduce diarrhea cases by up to 45%. Even when ideal sanitation is not available,

instituting good hygiene practices in communities will lead to better health. Proper hygiene

goes hand-in-hand with the use of improved facilities to prevent disease.

9. The economic benefits of sanitation are persuasive. Every US$1 invested in improved

sanitation, translates into an average return of US$9. Those benefits are experienced

specifically by poor children and in the disadvantaged communities that need them most.

10. The Millennium Development Goals target 75% global sanitation coverage by 2015. The cost

to reach this milestone is estimated at US$14 billion annually through the period. Among


35 October 25, 2013

other health gains, sanitation is estimated to reduce diarrhea cases by 391 million worldwide

each year.

In European region the necessary regulatory framework for implementing practical measures has

significantly improved in recent years. European Union has adopted international legal acts, such as

new directives on air quality and regulations for the safe handling of chemical substance that are

widely used in many countries in the region, including some non-EU countries. Nearly half of

normative acts on environmental health have been developed, revised and updated by non-EU

countries of the European region in recent years. Thus, for example, the "Protocol on water and

health" containing health norms and rules in areas such as the complex management of water

resources and sustainable water supply in every country in the region, was adopted by UN European

Economic Commission and WHO; two third (28) of European countries out of 42, who participated

in the 2009 survey and provided the information according to the questionnaire to WHO, have

already developed national or territorial action plan on “The environment and children's health," as a

part of the other national strategies or the part of the national plan on environmental health.

Another 10 countries of the European region are presently in the process of developing similar plans.

Implementation of the European policy on "Children's Health and the Environment in Europe" in

most countries has a positive impact on the effectiveness of the children's health-related

environmental risk reduction measures, creation of monitoring and information systems on

environmental health issues, raise of public awareness and cooperation between different sectors;

however, in one-fourth of the countries European plan did not result in mobilization of human

and/or the financial resources for resolving environmental health problems and failed to strengthen

organizational - human potential or deepen cooperation with other countries, who have similar

problems.

As is stated about progress achieved in the environmental health in World Health Organization's

2010 report on water-related health risk assessment, public access to improved water supply,

sewerage and wastewater treatment systems expanded over the last 20 years in the European region,

but not in all countries. In many eastern European countries only little progress is observed. For

example, 50% of rural population in 10 countries does not have access to quality and safe drinking

water that poses significant health-related inequalities. Data on outbreaks of water -related diseases

are pointing to the fact that in all countries of the European region, including economically

developed ones, the adverse affects of poor quality drinking water on public health still remains

problematic. Many countries of the European region still do not have neither standardized systems on

supervision of water-related disease outbreaks nor monitoring systems on risks associated with

recreation water quality.

Diarrhea associated with water quality, poor sanitation and hygiene practices cause 33000 deaths per

year and 1182000 years lost on disabilities in European region. In addition, 90 % of the disease cases

occur in the region's low-and middle -income countries. These types of deaths can be completely


36 October 25, 2013

avoided and the prevalence of water-related diseases will be rapidly reduced if high standards of

water, sanitation and hygiene practices are achieved.

One of the major policy determinant factors in the whole region, including the countries, which are

not members of the European Community, is EU legislation on water and health. Based on the

"Drinking Water Quality Control Manual” developed by WHO, the complex normative document for

everyone on health safety and protection, regulating the integrated water management, sustainable

water supply and adequate sanitation, is a Protocol on Water and Health adopted by United Nations

Economic Commission for Europe (UNECE) and WHO.

Access to safe drinking water and improved sanitation is the fundamental human need and a

basic human right; it is of vital importance to human dignity and health. Health and economic

benefits achieved by improving of water supply for families and each person (especially children) are

well founded and present the central paradigm of the environmental health.

VI. Ensuring the availability of high quality and safe drinking water supply

in schools

21. Hygiene parameters of the quality of drinking water

Use of non-potable water could be associated with short-term, medium and long term risks. Long-

term microbial risk is related with regular and long-term use of water contaminated by microbes,

while epidemic risk is associated with the use of water contaminated by most virulent microbes.

Drinking water used in schools should be safe for health; water quality should meet the requirements

given in regulations approved by Minister of Labor, Health and Social Affairs of Georgia.

The order #349/N on “Approval of technical regulations for drinking water” signed by the

Minister of Labor, Health and Social Affairs on December 17, 2007 provides the parameters for the

quality of drinking water and quality standards:

Organoleptic characteristics

Microbiological, viral and the parasitological characteristics

Chemical characteristics (general characteristics, inorganic and organic substances )

Radiation Safety Indicators

Standards on harmful chemical substances produced in result of water treatment

Requirements specified in the regulations for the safety of drinking water are as follows:


37 October 25, 2013

Drinking water should be safe in terms of epidemic and radiation, with safe chemical

composition and favorable organoleptic properties.

Water quality should meet the sanitary standards of above-given Technical Regulations.

Organisms visible with the naked eye and the surface coat are not allowed in drinking water.

Epidemic safety of drinking water is determined by compliance of its microbiological, viral

and parasitological characteristics with standards approved by regulations.

Indicators Measure units Standards

mesophilic aerobic and

facultative anaerobic

microorganisms

Colony-forming units per

ml – cfu/ml

370 C

220 C

No more than

20

100

Total Coliform bacteria Number of bacteria in

300ml

Not allowed

E. coli

Number of bacteria in

300ml

Not allowed

Pathogenic microorganisms

including Salmonella

in 100ml

Not allowed

Coliphages

Negative colony-forming

units in 100ml

Not allowed

Pseudomonas

aeruginosa (P. aeruginosa)

(only outer membrane

vesicles)

in 250ml

Not allowed

Streptococcus faecalis in 250ml Not allowed

Lamblia cysts Cysts in 50L Not allowed

Amoebic cysts Cysts in 50L Not allowed

To ensure the safety of drinking water the following pesticides, their metabolites, reaction

and degradation products are controlled under regulations:

• Organic insecticides

• Organic herbicides

• Organic fungicides

• Organic nematocide

• Organic acaricide

• Organic algicides

• Organic rodenticides

• Organic slimicides

• Similar products (including growth regulators)


38 October 25, 2013

22. Water safety control

Internal control and monitoring of a quality of drinking water is performed by water supplier. In

underground water distribution system, which supplies water to 20 thousand inhabitants, samples

should take place once a month to monitor the microbiological and organoleptic characteristics of

water. In floods and force majeure situations water quality should be controlled by reinforced

mechanisms in coordination with authorized state agencies.

Routine laboratory studies should be performed to monitor the following parameters:

• Organoleptic: smell, taste, coloration, turbidity

• Microbiological: mezophilic aerobes and facultative anaerobes, total coliform bacteria, E.coli

• Chemical: pH, forms of nitrogen (ammonia, nitrates, nitrites), chlorides, oxidation, residual

chlorine.

Ministry of Agriculture is authorized to perform the monitoring of drinking water safety

parameters and compliance of quality with requirements of established regulations as well as outside

selective laboratory control of the drinking water.

23. Low-cost interventions for ensuring water supply

Best and low-cost

intervention to improve access to

drinking water may be the

following: each student should be

allowed to bring his/her own, clean and

marked (with last name) bottle of

water to school (or schools should

distribute these bottles). Student

should be able to refill the bottle during

the day with quality drinking water from a tap, water

tank or dispenser. Water bottles need to be washed

every day, or several times a day in case of

contamination.

Different types of low-cost measures can be taken to

ensure hand washing facilities at school, for example:

1. Jar and the bowl (one is pouring out water, while the

other is washing his/her hands); water after washing is

http://www.ebay.com/itm/IRONSTONE-WATER-BASIN-AND-PITCHER-BLUE-WHITE-WITH-DUCKS-GREAT-SET-/331000679015


39 October 25, 2013

collected in the basin).

2. Small size water tank (or dispenser) with cover and a tap standing on the table. Bucket or bowl can

be used to collect the water after washing. This method is one of the simplest solutions and could be

used to improve access to the drinking water.

3. A Tipi Tap - a plastic gallon or a plastic bottle with an attached string, allowing a thin stream of

water to pour from the container by stepping on a string (please, see Annex 3).

VII. Supervision of the health of school children

24. Morbidity in school age children

It should be noted that children are particularly vulnerable to environmental hazards due to several

factors: their bodies grow fast, taking in consideration the body mass proportion, they breathe more

air, consume more food and water than adults; the child 's central nervous system, immunity,

reproductive and digestive systems are still being under development process and at certain stages

environmental factors may cause irreversible harmful affects; the child's behavior is different from

that of adults, therefore, the risk of harm from exposure to hazards is higher. Children do not have

ability to control the environment. Unlike adults, they are not aware of risks and are not able to make

healthy choices. Consequently, the rate of morbidity and mortality caused by exposure to harmful

environmental affects among children is relatively higher; for example, the number of healthy years

lost due to environmental hazards among children under age of 5 (per child) is five times as higher

compared to general population.

Current situation in Georgia in terms of child’s health and safety do not comply with standards of

developed countries due to objective reasons. Unfortunately, cardiovascular, metabolic, mental and

other disorders are quite common among adolescents. Not enough attention is paid to the education

on healthy behavior and healthy lifestyle in schools. Child's health and safety policy is not

comprehensive and effective.

The general trend of problems caused by infections among children in Georgia, as well as

throughout the world, reveals a positive dynamics. WHO analysis of immunization programs has

shown that eight out of ten adolescents worldwide are vaccinated against 6 major infections. Full-

scale vaccinations including BCG (against tuberculosis), Tdap (against Tetanus, Diphtheria, Pertussis),

Polio-3 (against poliomyelitis), against B Viral Hepatitis, MMR (against measles - mumps - rubella)

have been conducted in all regions (except for uncontrolled areas) of Georgia.

At the end of a reporting period of 2012 according to the distribution of diseases between 11

groups in Georgia, the share of the following diseases among school age groups was as follows:

respiratory diseases -28.5 %, diseases of the ear and mastoid process-7.11 %, diseases of eyes and

adnexa- 9.03%, nervous system disorders - 8.07 %, infectious and parasitic diseases - 4.95 %,

endocrine diseases - 2.77%, trauma and poisoning - 8.54 %.


40 October 25, 2013

Unfortunately, in recent years the problems related to the spread of TB and aggressive

dynamics of disease, including adolescents, became even more important.

25. Water and sanitation related disease control and the role of a medical staff in the

school life

Resolution of the problem with drinking water is essentially important to ensure child’s health.

Severity of the problem in Georgia is caused by deterioration of sanitary conditions of water sources

and challenges in water purification and treatment within modern systems of water preparation.

Hence, it’s reflected on a large number of water-related infectious diseases, for example, in 2006, the

total number of diarrhea, presumably caused by infections, was 7803, which is 5 % higher than in

2005; in 2006 there had been registered 27 cases of amoebiasis that is 33 % higher compared to the

corresponding figures of 2005. The number of Diarrheas and intestinal infections shows tend to

increase in 2012, for example, the number of diarrhea cases has reached 19428, which is 2,5 times as

higher than in 2006. First of all, this must be caused by unfavorable environmental sanitation and

hygiene.

Contaminants Diseases

Bacteria and viruses Acute gastrointestinal infections, viral infections, viral hepatitis,

amoebiasis, tularemia, typhoid fever

Organochlorine

hydrocarbons

Acute and chronic poisoning

Chlorides and sulfates Gastrointestinal and cardiovascular diseases

Nitrogen and chlorine

compounds

Chronic nephritis and hepatitis, toxicity in pregnancy,

congenital anomalies

Nitrites Inhibition of haematogenesis

Boron and bromine Pediatric digestive diseases

Cadmium Kidney diseases, Itai-itai, tissue injuries

Arsenic Circulatory system diseases, growth of risk of cancer

Copper Liver and kidney diseases

Cyanides Nervous system diseases, thyroid disorders

Lead (Plumbum)

Retardation of physical and mental development in children,

kidney diseases, hypertension


41 October 25, 2013

Child health’s study in Georgia carried out at the level of primary health care facilities

(ambulatories, outpatient clinics, family medicine centers) implies the regular assessment of child's

health and growth, also the preventive measures that promote health and identification of

symptomless children with hidden problems. The main goals of the study include:

• Improve health by reducing the incidence rate and the deviation from the norm;

• Early identification of common diseases;

• Identification of healthy children;

• Provide education for parents and their children on health issues;

• Introduce and support healthy lifestyle through counseling;

• Organize the necessary preventive measures: immunization, screening, patients’ education;

Outpatient services for children, the family doctor, pediatric consultation and preventive

immunization services are fully funded within the national health programs. Vaccinations included

in the national immunization calendar of Georgia are carried out in outpatient medical facilities.

Medical services for schoolchildren living in European countries are carried out in various

ways. In particular, the comprehensive school health service system funded by the Ministry of Health

operates in the UK. These services are aimed at certain stage of general healthcare for younger

generation and are carried out through coordination with national programs (e.g., immunization).

The physician conducts medical examination of students at important stages of their life, for example,

when entering the school, at school completion and during national immunization program, which is

widely implemented in schools. In some countries schools have their own school physician, to whom

the school principal applies with any question on school health. School physician:

conducts medical surveillance of schoolchildren and provides medical services to school;

regularly goes to the school medical center;

conducts polling using questionnaires with each new student to define the state of their

health and decide on their involvement in sports activities;

takes measures for timely immunization;

takes care of emergency medical services for children;

maintains close contacts with parents;

prepares an annual report on works performed;

conducts discussion on sanitary education, etc.

.

Closing a medical staff in most schools (whose effectiveness was doubtful in many cases) played a

significant role in growth of diseases among school children. Students had careful examination under

medical staff’s supervision. Particular attention had been paid to the condition of vertebral column,

since it often experiences deformation, mainly caused by wrong design of desks and heavy school

bags and books; as for problems with vision, attention was paid to standards of the classroom lighting.

Focus was made on disorders of spinal curvature and chronic tonsillitis; at deep medical examination

physician paid special attention to the process of acceleration, since acceleration and emotional stress


42 October 25, 2013

can increase the rate of endocrine diseases and cause menstrual irregularities in girls. Medical

examination also included the detection and management of chronic diseases together with primary

health care units to avoid further complications and disabilities; for these purposes they widely used

primary, secondary and tertiary prevention methods (immunization, screening, etc.).

Closing of schools’ medical staff in Georgia had a negative impact on the health of children and

adolescents. According to 2002-2009 disease statistics (2002 is taken to compare with due to the fact

that in 2002 the staff of school physicians was cancelled) the incidence of following diseases in

children under 18 was observed:

• Scoliosis (+ 30%)

• Disorders of vertebral curvature (35%)

• Hearing impairment (+ 27%)

Evidently, the number of preventive examinations has been lowered; together with other factors it

resulted in increased morbidity among children aged 15 compared to 2008 (i.e. on only a 3-year

interval) and showed the following findings:

• Diseases of eyes and adnexa (+ 27%)

• Diseases of the ear and mastoid process (+ 19%)

• Respiratory system diseases (+ 21%)

• Diseases of the digestive system (40%)

• Mental and behavioral disorders (+ 24%)

• Diseases of musculoskeletal system and connective tissue (+46 %)

• Diseases of the skin and subcutaneous tissue (+ 17%)

• Infectious and some parasitic diseases (+ 9%)

Within the Global School Health Initiative, launched in 1995, WHO seek to mobilize and

strengthen health promotion and education activities at the local, national and regional levels and

improve the health of students, school personnel, families and other members of the community

through schools.

The general direction of WHO's Global School Health Initiative was guided by the Ottawa

Charter for Health Promotion (1986), the Jakarta Declaration of the Fourth International Conference

on “Health Promotion” (1997) and the WHO's Expert Committee Recommendation on

“Comprehensive School Health Education and Promotion” (1995).

Particular attention has been paid to the close collaboration between health and education agencies,

which played a significant role in developing strategies and programs to improve health through

schools. This initiative has been first implemented in Europe, Western Pacific and Latin America.

To improve the healthcare of children and adolescents in public schools of Georgia, a group of experts

reviewed several options (within “National strategy and the action plan on physical education of


43 October 25, 2013

children and adults and their active involvement in sports in Georgia" 2010 ) and selected the version

given below.

For implementing measures aimed at promotion of schoolchildren’s health, it is highly

recommended (as practiced in many countries) to arrange medical offices with needed equipment and

specially trained nurse to work in school environment at each primary-basic-secondary school,

where the number of students is over 200.

To date, 1129 public schools of Georgia have more than 200 students each, among them: 520 schools

in towns, 43 schools in boroughs and 566 schools in villages; 1050 schools have less than 200 students.

The project implementation implies allocating of a school nurse’s staff unit and the school staff

composed of middle level medical personnel in 1129 schools. If presumably the medical personnel’s

average monthly salary is 200, 0 GEL, the total 225, 800 GEL will be needed per month, which

amounts to 2, 709, 600 GEL per year. Preferably nurse’s monthly salaries should vary in a range from

150 GEL (in schools with 200-500 students) up to 250 GEL (in schools with more than 500 students).

Moreover, a family doctor or a pediatrician should be assigned for every 2000 of school age children

by territorial primary care unit and they should receive additional 250 GEL to their basic salary.

As mentioned above, 576 803 students are currently studying in secondary schools of Georgia; 290

physicians are needed to provide medical services to them with monthly payment of 72, 500 GEL or

870, 000 GEL per year.

At present 1050 schools with more than 200 students in each remain without medical personnel, in

particular:

• 316 schools with 1 to 50 students




Agreements should be signed between the school administration and the heads of primary health

facility on provision of services of middle level medical personnel, who would perform works similar

to the works of school nurse determined by current regulations. At the same time, they should

receive payment in amount of 50 GEL additionally to their basic salary in schools with 1 to 100

students, and 100 GEL in schools with 100 to 200 students. Implementation of these measures will

need 844, 200 GEL per year.

Thus, the total amount needed for payment of medical personnel to ensure healthcare in

secondary schools is equal to 3, 580, 000 GEL per year.

The project should be implemented in three phases (step by step):

In its first phase the project could be implemented in Tbilisi, where the necessary sum will

account to 752, 000 GEL;

In the second phase, the project may cover rayon centers and boroughs, where the needed

sum will be equal to 913, 000 GEL;

The third phase will cover the villages and will need to be financed in amount of the

remaining amount - 1, 915, 000 GEL.


44 October 25, 2013

As a result, within 3 years the schools in Georgia will be covered within health care system, the

students will find themselves under the umbrella of medical support; the project will create 2, 500

jobs for doctors and the middle level medical personnel.

The responsibilities of the school medical personnel may include: division of students into

major medical groups based on presented documentation at the beginning of the academic

year:

A) I _ main;

B) II _ preparatory;

C) III _ special.

Main group should unite students, who have no deviations at health assessment.

Preparatory group should include students with minor deviations

Special group should include students with significant temporary or permanent health

problems or disorders of physical development.

.

School personnel may take part in following activities:

1. Drafting of the school day schedule;

2. Supervising sanitation and hygiene conditions in canteens for children and controlling food safety ;

3. Organizing students’ regular medical examination;

4. Surveillance of students with chronic diseases and frequently ill students;

5. Studying of the vaccination status according to the medical records and ensuring students highest

involvement in immunization programs.

6. Promote healthy lifestyles among teachers, parents and school children.

7. The surveillance of physical education classes;

8. Supervising sanitation and hygiene in school;

9. Controlling cleanliness of the school premises and maintenance of hygienic regime;

10. Checking how school furniture meets the hygiene requirements in school;

11. Hygiene education programs, activities promoting development of hygiene skills.

Pediculosis is one of the major problems among school age children in all countries including

Georgia. Therefore, it is recommended that school medical staff conducts the inspection at least 4 -

times a year, and additionally, after holidays and randomly (in 4-5 classes) on a monthly basis. The

visual inspection (of clothes and the hairy parts of the body) should be performed in a well- lit room

using a magnifying glass and a fine-tooth comb. After each inspection the comb should be rinsed

with boiling water or 70% alcohol solution. Medical personnel should consult the students and the

parents on needed treatment and hair care instructions using appropriate means.


45 October 25, 2013

26. Primary medical aid and the rules for setting up the medical office

School’s medical office should have minimum necessary equipment and medicines for emergency.

School administration is responsible for calling ambulance and informing patients in case of accident.

Before the ambulance arrives, the school medical personnel provide only the first aid emergency.

First aid instructions/protocol should be available to everyone in the office.

Medical office equipment should include:

Medical table

Couch

First-aid container

Medical scales

Height rod

Hand dynamometer

Thermometer

Tonometer

Stethoscope

Magnifying glass

Rubber tourniquet

Rubber heater

Ice balloon

Medical scissors

Tweezers

Mouth-to-mouth breathing mask

Disposable syringes for injections

Disposable spatula

Disposable rubber gloves

Stretcher

Refrigerator


46 October 25, 2013

First aid kit:

1. Medicines:

Analgesic/fever reducer: paracetamol, ibuprofen (tablets)

Cardiac medications: validol (tablsets); valerian and corvalol (drops)

Eye drops: 20% and 30% albucid solution

Spirit of hartshorn (10% ammonia solution)

No-spa (tablets)

Imodium (capsules)

Antibiotic ointment (levomecol, synthomycin), antihistamines (suprastin ampoules and tablets,

diazolin tablets, ketotifen tablets)

2. Antiseptics:

Eye irrigating solution

Rubbing alcohol (96% solution) )

Hydrogen peroxide (3% solutions)

Brilliant green (1% and 2% alcoholic solution)

Iodine (5% alcoholic solution)

3. Products for wound dressing and treatment:

Sterile pads of various size

Bactericidal wound plasters

Hygroscopic cotton

Gauze bandages/for surgical dressing


47 October 25, 2013

VIII. Strategies for developing hygiene habits and the principles of hygiene

education

27. Major theoretical and practical approaches – short overview

Educational strategies promoting the environmental health can be in different ways incorporated in

the curricula of disciplines such as history, mathematics, geography, literature, natural science, art,

etc.

Interactive approach is the best practice encouraging learning and development; it helps in gaining

information on various subjects as well as in acquiring practical skills. School infrastructure should be

used as a basis for interactive learning, which is a highly effective tool, providing skills-oriented

education on water, sanitation and hygiene issues.

Environmental objects (premises, infrastructure, equipment, technology, etc.) are extremely

important for stimulating children. Apart from visual perception, the spaces are shared with persons,

who are responsible for cleaning, maintenance and smooth running of facilities.

The types of stimulation can be categorized according to the following types of development:

Intellectual development: Children receive information about the environment through

vision, smell, hearing and touch that encourages their intellectual development. School water

supply and sanitation infrastructure may give a significant positive or negative experience to

the child in perception and learning of environment.

Social development: living space used privately or sharing the space with other people is very

motivating and can provide important experience to children. This is also essential in relation

with sanitation and hygiene to the extent that covers both confidentiality and space-sharing

elements.

Physiological development: health and sanitation infrastructure encourage the independent

use of motor- and self-care skills.

Developing creativity: creativity in children can be promoted by their involvement in the

selection and design of sanitation and hygiene infrastructure.


48 October 25, 2013

28. FRESH Initiative - Focusing Resources on Effective School Health

FRESH - Focusing Resources on Effective School Health is an action plan of WHO, UNESCO,

UNICEF WB that was initiated in 2000 and encourages the development of four component system

for school health programs to achieve health promoting, child-friendly schools with joint efforts. If

schools implement these four interventions there would be a significant immediate health benefits

for children and the school personnel and a basis for future development. The aim of the initiative is

to focus on interventions that are feasible to implement and put these interventions into practice.

Health-related school practices -health-related school practices should ensure a safe and

secure physical environment and a positive psycho-social environment, and should address

issues such as physical and psychological abuse of students and sexual harassment; guarantee

the further education of pregnant schoolgirls and young mothers; raise awareness and

reinforce health education among children and teachers.

Provision of safe water and sanitation – is a vitally important first step to ensure healthy

learning environment. By providing safe water and good sanitation facilities schools can

reinforce health and hygiene messages, and act as an example to both students and the wider

community.

Skills-based health education- this approach to health, hygiene and nutrition education

focuses upon the development of knowledge, attitudes, values, and life skills that help young

people to make and act on the most appropriate and positive health-related decisions. Health

in this context extends beyond physical health to include psycho-social and environmental

health issues. When individuals have such skills, they are more likely to adopt and sustain a

healthy lifestyle during schooling and for the rest of their lives.

Health-based health and nutrition services - schools can effectively deliver some health and

nutritional services that are simple, safe and familiar and address problems that are prevalent

and recognized as important within the community. For example, micronutrient deficiencies

and worm infections may be effectively dealt with by infrequent treatment (oral pills);

shortly after meals children again experience hunger that can contribute to school

performance. This factor should be neutralized by changing the timing of breaks for meals, or

providing a snack. If cannot be provided in schools, health and nutrition services are allowed

to be delivered close to schools by relevant facilities.

Several components can support the implementation of above components of FRESH:

Effective partnership between teachers and health workers, and between the education and

health sectors

Effective community partnerships

Students awareness and participation


49 October 25, 2013

29. Health promoting school

According to the definition of WHO health promoting school “is one that constantly strengthens its

capacity as a healthy setting for living, learning and working”. American Academy of Pediatrics

defines a healthy school environment as "an environment where students and school personnel are

protected from injuries and diseases, are provided by measures and approaches against well-

recognized risk - factors that can cause diseases or disabilities in the future”.

30. Educational principles

Effective hygiene education is not only focused on listening to the lecture material about health risks

and poor hygiene practice. Rather, it should promote the development of basic hygiene skills, which

will help the child in making decisions independently and also in self-care. Hygiene skills include

social skills (social contacts and self-esteem), analytical skills (social aspects and the responsibility for

decisions) and stress management skills.

IX. Water and sanitation surveillance in school

The format and design of surveillance at the school level should fully consider the Water,

Sanitation and Hygiene (WASH) principles and be composed of the following components:

31. Water quality and safety

Water for drinking, cooking, personal hygiene, cleaning and laundry is safe for the purpose intended

and meets the standards developed for relevant category of water.

Indicators:

1. Microbiological quality of drinking water.

Escherichia coli or thermotolerant coliform bacteria are not detectable in any 100-ml

sample.

2. Treatment of drinking-water.

Drinking-water from unprotected sources is treated to ensure microbiological safety.

3. Chemical and radiological quality of drinking water.

Drinking water meets WHO guidelines and Georgian national standards concerning

chemical and radiological safety parameters.

4. Acceptability of drinking water/organoleptic characteristics

Odor, color and taste of drinking water meets requirements set by regulations and no

characteristics would discourage consumption of the water.

5. Water for other purposes.


50 October 25, 2013

Water that is not of drinking water quality, but meets the general requirements for

safety, is used only for cleaning, laundry and flushing toilets.

32. Water quantity

Sufficient water is available at all times for drinking, personal hygiene, food preparation, cleaning and

laundry.

Basic quantities of water required

Quality of drinking water

Day schools 5 liters per person per day (for all schoolchildren

and staff)

Boarding schools(for 24 hours) 20 liters per person per day (for all

schoolchildren and school personnel on full-time

school staff)

additional quantities of water/unbootable water quality

Flushing toilets connected with central

water supply system or a water tank

10 - 20 liters per person per day

Pour-flush toilets that should be washed

by water brought by consumers

1.5 - 3 liters per person per day

33. Access to water and water facilities

Sufficient water-collection points and water-use facilities are available in the school to allow

convenient access to, and use of, water for drinking, personal hygiene, food preparation, cleaning and

laundry.

Indicators:

1. A reliable water point, with soap or hand dryer means, is available at all critical points within the

school, particularly in toilets and kitchens.

2. A reliable drinking-water point is accessible for staff and schoolchildren, including those with

disabilities.

3. One shower is available for 20 users in boarding (for 24 hours) schools (users include

schoolchildren and full-time school staff). Separate showers, or separate showering times, are

designated for staff and schoolchildren, and separate showers or times are designated for boys and


51 October 25, 2013

girls. At least one shower should be accessible for females with disabilities and one for males with

disabilities.

4. Hot water and detergents or chlorine solution are provided in laundry facilities (if there is one) of

boarding schools.

34. Hygiene promotion

Correct use and maintenance of water and sanitation facilities is ensured through sustained hygiene

promotion.

Indicators:

1. Hygiene education is included in the school curriculum.

2. Positive hygiene behaviors, including correct use and maintenance of water and sanitation

facilities, are systematically promoted among staff and schoolchildren.

3. Water and sanitation facilities and resources assigned for their maintenance enable staff and

schoolchildren to practice behaviors that control disease transmission in an easy and convenient

way.

35. Toilets

Sufficient, accessible, private, secure, clean and culturally appropriate toilets are provided for

schoolchildren and staff.

Indicators:

1. Sufficient toilets are available — one per 25 girls and one for female staff of the school; one toilet

per 30 boys plus one urinal per 80 boys, and one for male staff of the school.

2. Toilets are easily accessible to all, including staff and children with disabilities in terms of design

and distance — no more than 30 m from all users. Male and female toilets are completely separated.

3. Toilets provide privacy and security.

4. Toilets design and construction are appropriate to local cultural and social conditions, are age and

gender appropriate and accessible for children with disabilities.

5. Toilets are hygienic to use and easy to clean.

6. Toilets have convenient handwashing facilities close by.

7. A cleaning and maintenance routine is in operation and ensures that clean and functioning toilets

are available at all times.


52 October 25, 2013

36. Control of vector-borne disease

Schoolchildren, staff and visitors are protected from disease vectors (animals, insects).

Indicators:

1. The density of vectors in the school is minimized.

2. Schoolchildren and staff are protected from potentially disease-transmitting vectors.

37. Cleaning and Waste disposal

The school environment is kept clean and safe.

Indicators:

1. Classrooms and other teaching areas are regularly cleaned, to minimize or remove dust and

moulds.

2. Outside and inside areas are maintained free of sharp objects and other physical hazards.

3. Solid waste is collected from classrooms, kitchens and offices daily and is disposed of safely.

4. Wastewater is disposed of quickly and safely.

38. Food storage and preparation

Food for schoolchildren and staff is stored and prepared so as to minimize the risk of disease

transmission.

Indicators:

1. Food is handled and prepared with utmost cleanliness (hand are washed before preparing

food).

2. Contact between raw foodstuffs and cooked food is avoided.

3. Food is cooked with thorough thermal processing.

4. Food is kept at safe temperatures.

5. Safe water and safe raw ingredients are used.

To implement the surveillance system and assess performance according to the above

components, it is highly recommended to the school administration to put in practice the mechanism

for evaluation of effectiveness, part of which could be the conducting of internal audit by use of a

checklist.


53 October 25, 2013

39. Self-assessment checklist for schools authorization

Self-assessment checklist for the schools

N Design and construction Yes No Not

applicable

Water quality

1. Is water from a safe source (free from faecal contamination)?

2. Is water protected from contamination during transport from

the source and in the school?

3. If necessary, can water be treated at the school?

4. Does the water supply meet Georgian national standards

approved by regulations regarding microbiological, chemical

or radiological parameters?

5. Is water safe (smell, taste, appearance)?

6. Is the school water supply designed and built so that low-

quality water cannot be drunk?

Water quantity

7. Does the water supply have the capacity required?

8. Is there a suitable alternative supply in case of need?

Access to water and water facilities

9. Are there sufficient water points in the right places for all

needs (drinking-water, handwashing, washing, cleaning, and

flushing toilets)?

10. Are there sufficient drinking water points?

11. Are there convenient water points for disabled staff and

children?

12. Are there sufficient showers in boarding schools?

13. Are there laundry facilities in the boarding room?


54 October 25, 2013

Hygiene promotion

14. Is hygiene education included in the school curriculum?

15. Is the school staff trained in providing hygiene education?

16. Is responsibility for promoting hygiene in the school

identified clearly and supported?

17. Are school facilities designed and constructed to be easily and

hygienically used and maintained?

18. Do school children know how to use the facilities of water

and sanitation infrastructure correctly?

Toilets

19. Are the toilets arranged properly for girls, boys and the

school staff?

20. Are the toilets separated in blocks?

21. Are the toilets situated in the right place?

22. Do the toilets provide privacy and security?

23. Are the toilets safe to use?

24. Are the toilets appropriate to local culture and social

conditions?

25. Are the toilets appropriate to age and gender specifics?

26. Are the toilets appropriate to the children with disabilities?

27. Is there one accessible toilet cubicle for disabled females and

one for disabled males?

28. Are the toilets hygienic to use and easy to clean?

29. Are there handwashing facilities close by the toilets?

30. Is there soap and paper towel available at the handwashing

facilities?


55 October 25, 2013

31. Is there a supervision plan for effective cleaning and

maintenance of the toilets?

Control of various vector-borne diseases

32. Does the school have protective measures against vectors?

33. Are the school facilities equipped with barriers to reduce

exposure to vectors?

Cleaning and waste disposal

34. Are floors smooth and easy to clean?

35. Are buildings designed and built to avoid damp and moulds?

36. Are buildings designed and built to minimize physical

hazards?

37. Are there adequate bins and other equipment for managing

solid waste?

38. Is the wastewater drainage system correctly designed and

built?

Food storage and preparation

39. Are food storage and preparation areas designed and built so

as to be easy to keep clean?

40. Is there a handwashing facility in the kitchen?

41. Are there facilities and equipment provided for preventing

contact between cooked and raw foodstuffs?

42. Are cooking facilities adequate for heating food sufficiently?

43. Is there a refrigerator in the kitchen?

44. If dry foods are stored at the school, is the store appropriate?

45. Are only safe water and ingredients used for food

preparation?


56 October 25, 2013

X. Water, sanitation and hygiene - process and results assessment strategies

at the school level

Launching of routine monitoring system for Water, Sanitation and Hygiene issues in schools

(WASH in Schools) of Georgia to perform a comprehensively assessment of current situation and the

progress achieved through years will have a particular importance. Similar systems are implemented

in many countries and are recommended by international organizations such as the United Nations

Children's Fund (UNICEF) and the World Health Organization (WHO).

Ministry of Science and Education of Georgia is assigned as an institution responsible for launching

of routine monitoring system for Water, Sanitation and Hygiene (WASH) in schools (as in most

countries) and the most cost - effective and sustainable way is the integration in existing Education

Monitoring Information Systems – EMIS, instead of creation of the other parallel system of

monitoring.

Below-given module of Water, Sanitation and Hygiene for EMIS is aimed at integration in existing

system and is based on the following three criteria:

1. The number of questions is limited to a minimum to make the integration easy;

2. The module includes only questions that do not require answering by people who have

professional knowledge about WASH; they can be easily answered by school

directors/principals, who complete EMIS questionnaires.

3. The module is focused on questions that allow gaining data on progress in WASH by

using key indicators.

The module is defined as the basic tool for routine monitoring and therefore, it is limited to only

core information. Accordingly, it does not cover fully all issues recommended by United Nations

Children's Fund (UNICEF) monitoring of WASH in Schools (for example, it does not include

indicators of water quality and food hygiene). Thus, to get the full picture the additional regular

studies are needed to be conducted at the national level.

The module is divided into six sections, including: school information; water; sanitation; hygiene;

waste disposal; operation and maintenance.

Each section of the module includes the following:

Indicator(s)

Core questions

Additional questions

Explanatory notes for questions (to help school directors/principals complete

the questionnaire)


57 October 25, 2013

According to the module, information collected in monitoring process needs to be administered

by a group of qualified researchers as some of the questions and the observed data require technical

knowledge and relevant experience in fields of water, sanitation and hygiene.

Module: Water, Sanitation and Hygiene in schools of Georgia

Questionnaire for education management information system (EMIS)

Part I. School information

name of person responsible for completing the questionnaire

designation of person completing the questionnaire (it is recommended that the school director

or other head of school administration)

date when the questionnaire is completed (day/month/year)

school name

school identification code

school address

school type (primary/middle/secondary/boarding school, etc.)

school area (urban/rural)

school legal status (public/private)

student statistics (total number; number of girls; number of boys)

number of shifts at school (one; two; three)

students with disabilities (total number; number of girls; number of boys)

teachers (total umber; number of female teachers; number of male teachers)

other school personnel (total number; number of female personnel; number of male personnel)

does the school have teachers, students and parents association?

does the association helps in supporting WASH in school?

does the school have any system for annual self-assessment and/or improvement planning? does

this system cover WASH in School issues?

Part II. Water

Indicator (core questions): school has a functional water supply

Indicator (core plus additional question): school has a functional water supply that provides a

sufficient quantity of drinking water, safe water and is accessible for students including children with

disabilities.


58 October 25, 2013

Core questions

Question 1. What is the school’s main water source? (check one or more)

1 Piped water (piped into the school building)

2 Piped water (piped to school yard/plot)

3 Piped water (piped to the neighbor) )

4 Piped water (tap connected to the public pipe)

5 Tube well

6 Protected jug well

7 Unprotected jug well

8 Protected spring

9 Unprotected spring

10 Rainwater collection

11 Cart with big tank

12 Cart with small tank

13 Surface water (river, lake, canal, pond, irrigation channel)

14 Bottled water

15 No water is available in or near school

16 Other (please, specify) ______________________________

Question 2: Is the main water source currently functional? (check one)

Yes No

Additional question

Question 3: is the water quantity sufficient for the school supply? (check one)

Yes No

Question 4: Is the water treated/purified before it is used for drinking? (check one)


59 October 25, 2013

Yes No

Question 5: Are water facilities accessible to children with disabilities?

Yes No

Explanatory notes for questions

Question 1:

Select and indicate school’s main as well as alternative water sources

Question 2:

If for time, when you are completing the questionnaire, the main water source is functional, your

answer should be “Yes”, if only alternative source is functional or none of sources is functional, your

answer should be “No”.

Question 3:

Answer “Yes” only if the water quantity supplied to school is sufficient for all school needs, especially

the basic ones: drinking, hand washing, food preparation, flushing toilets, cleaning.

Question 4:

Answer should be “Yes” only if you are completely sure that piped water has been treated/purified

(chlorified) or its treating/purifying is insured in school by use of some recommended methods

(boiling, chlorification, filtration).

Question 5:

If there is at least one water point in the school adapted to the needs of children with disabilities, the

answer to this question should be “Yes”.

Part III. Sanitation

Indicator (core questions): the school has a sufficient number of toilet compartments for girls, boys

and teachers

Indicator (core plus additional question): the school has a sufficient number of toilet compartments

for girls, boys and teachers and they are accessible also for children with disabilities.


60 October 25, 2013

Core questions

Question 1: Where are the toilet compartments situated?

1 Inside the school building

2 Outside the school building

3 Toilets are shared with others

4. School has no any toilet facilities

Question 2: What type of toilet facilities are there in the school? (check one or more)

Flush toilets with a pan connected to the sewage system

Flush toilets with a pan connected to the septic reservoir/tank

Flushing toilet of a “pit latrine” type (“Turkish toilet”/Nil pad) connected to the sewage system

Flushing toilet of a “pit latrine” type (“Turkish toilet”/Nil pad) connected to the septic reservoir/tank

Flushing toilet with a drainage system

Pit latrine of a toilet-septic type, without flushing, made of cement or other solid safe premise

Bucket

Hanging toilet/hanging latrine

No toilet facilities/bush/field

Other (please, specify) _________________________________________

Question 3: How many toilet compartments are there in the school? (insert number)

Functional Not functional

Exclusively for girls

Exclusively for boys

Communal toilet compartments for boys and girls

Exclusively for female teachers and female staff

Exclusively for male teachers and male staff


61 October 25, 2013

Communal toilet compartments for female and male

teachers

Communal toilet compartments for the use of anyone

Question 4: Are toilets accessible for children with disabilities?

Yes No


Questions 2 and 3

Toilet compartment is an isolated premise designed for one person or a single cubicle in a complex

composed of several cubicles, where the privacy can be ensured.

The type of toilet in the school should be selected and checked in the list of types or the description

should be specified in the last graph.

“Exclusively for girls” means that toilets are designated for girls only and boys cannot use them; and

vice versa for boys’ toilets. If toilets can be used both by girls and boys, the number should be

entered in “Communal toilet compartments for boys and girls”.

“Functional” means that the toilet facilities by time of questionnaire completion are functioning, not

physically broken and can be used by children/teachers/school freely.

“Not functional” means that toilet facilities by time of questionnaire completion are not functioning,

are damaged and cannot be used by children/teachers/school staff freely.

Question 4:

If there is at least one toilet compartment in the school adapted to the needs of children with

disabilities, answer to the question should be positive.

Part IV. Hygiene

Indicator (core questions): Does the school have functional handwashing facilities, where the soap is

available for all school children and is hygiene taught at the school?

Core questions

Question 1: Does the school have handwashing facilities? (check one)


62 October 25, 2013

Yes No

Question 2: How many handwashing facilities are there in the school? (insert number)

Functional Not functional

Exclusively for girls

Exclusively for boys

Communal handwashing facility for everyone

Question 3: Is the soap available at the handwashing facility? (check one)

Yes No

Question 4: Is hygiene taught at the school? (check one)

Yes No


Question 1:

Handwashing facility can be of a standard type as the central water system faucets and basins

connected to the sewerage system, as well as a specially designed handwashing facilities connected to

or supplied from various types of water tanks and without connection to collecting and utilization

system, providing approximately ½ liters of water each time, when the student needs hand-washing.

The need of handwashing for students /teachers/staff becomes critical after toilet and before eating. If

children are provided with school meals, the staff should also have the handwashing facility.

Question 2:

In most schools handwashing facilities are situated near toilets or just in the toilet blocks and

therefore, are used exclusively by girls or by boys. In this case, please insert the number of

handwashing facilities “exclusively for girls” and “exclusively for boys” in the corresponding fields.

Indicate the number of handwashing facilities that can be used both by girls and boys (in corridor,

classrooms, buffet, etc.) in the graph “communal handwashing facility for everyone”.


63 October 25, 2013

Question 3:

If soap is available in 80% of hand washing needs (or 4 school days out from 5), you may check the

answer “Yes”.

Question 4:

Hygiene education can be provided to children as stand-alone special lessons or as a component of a

regular curriculum and should include the various aspects of personal hygiene, but it is mandatory to

teach about the importance of handwashing and provide training in correct handwashing techniques.

Part V. Waste disposal

Indicator (core questions); Are the solid wastes and waste waters regularly disposed of the school?

Core questions

Question 1: Are the solid wastes (garbage) collected and disposed of the school on a daily basis?

(check one)

Yes No

Question 2: Are the waste waters from school toilets and other facilities regularly disposed of? (check

one)

Yes No

Explanatory note for questions

Question 1:

Answer should be “YES”, if solid wastes from facilities are collected on a daily basis and disposed at

one place and then removed with some intervals (for example, once a week).

Question 2:

If the school has the waste utilization or aseptic tank for collecting waste waters, they should be

emptied regularly to avoid over-flowing. If the school building is connected to the central sewage

system and there is no need for removing waste waters, the answer should also be positive.


64 October 25, 2013

Part VI: Operation and maintenance

Indicator (core questions): Does the school have an effective system for the management of water and

sanitation facilities?

Core questions

Question 1: Are the water facilities of the school functional and successfully maintained? (check one)

Yes No

Question 2: Are the school sanitation facilities functional, successfully maintained and clean? (check

one)

Yes No


Questions 1 and 2:

Each question should be answered positively, if school water and sanitation facilities are functional,

successfully maintained and regularly cleaned to ensure their smooth running according to needs (for

at least 90% of the academic years).


65 October 25, 2013

XI. Water, sanitation and hygiene - indicators for progress assessment at the

national level

40. Recommendation of the authoritative international organizations for monitoring of

water and sanitation and progress assessment

The United Nations (UN) leads and recommends the monitoring and evaluation of progress on

water and sanitation globally. In particular, every 2 years World Health Organization and United

Nations Children's Fund (WHO/UNICEF) publish the JMP - Joint Monitoring Programme for Water

Supply and Sanitation) report, as well as the report on GLAAS, Global Analysis and Assessment of

Sanitation and Drinking Water, in which Georgia is taking part for the first time.

JMP report aims to inform the UN member states on progress of United Nations Millennium

Development Goals, and support countries in improvement of monitoring, in effective management

and planning.

According to the updated information in 2013 JMP report titled “Progress on sanitation and

drinking water”, 98 % of the Georgian population use water from improved water sources and 93%

use improved sanitary conditions. However, only 78% of the population have access to the piped

water into dwelling (96% of the urban and 58% of the rural population), while 6% of the urban and

1% of the rural population uses unimproved sanitation facilities, 2% of rural population have open

defecation. Open defecation is not a problem with any of our neighboring states, except Russia. It

should be noted that a significant progress is observed in Georgia in improving the accessibility to

piped drinking water at the national level (1990 - 53 %, 2000 - 61% , 2011 -78 %). Meanwhile, the

progress has not been achieved in increasing access to improved sanitation, moreover, we have a

setback in this regard in the period after 1990 (1990 - 96 % , 2000 - 95%, 2011 - 93 %). It should also

be noted, that data on water and sanitation in Georgia are gained from a household survey conducted

by the State Department of Statistics, and it does not include education, childcare, health and other

public institutions.


66 October 25, 2013

Figure. Proportion of the population practicing open defecation.

Source: WHO, UNICEF. Progress on sanitation and drinking-water 2013 update: Joint Monitoring Programme for Water

Supply and Sanitation.

Table 1. Progress in access to drinking water and sanitation JMP

a) Use of drinking water sources (percentage of population)

Year Urban Rural National

Improved1 Unimrpoved Imrpoved Unimrpoved Imrpoved Unimrpoved

Tot

al i

mp

rove

d

Pip

ed o

n p

rem

ises

Oth

er i

mp

rove

d

Un

imp

rove

d

Surf

ace

wat

er

Tot

al i

mp

rove

d

Pip

ed o

n p

rem

ises

Oth

er i

mp

rove

d

Un

imp

rove

d

Surf

ace

wat

er

Tot

al i

mp

rove

d

Pip

ed o

n p

rem

ises

Oth

er i

mp

rove

d

Un

imp

rove

d

Surf

ace

wat

er

1 According to JMP (WHO and UNICEF, 2012), “improved” drinking water sources are defined as sources protected

from outside pollution, especially from faecal contamination and includes the following technologies of water supply: piped water into dwelling, boreholes, protected dug wells, protected springs, rainwater collection.


67 October 25, 2013

1990 95 80 15 5 0 72 21 51 28 0 85 53 32 15 0

2000 97 86 11 3 0 81 34 47 19 0 89 61 28 11 0

2010 100 96 4 0 0 96 58 38 4 0 98 78 20 2 0

Source: WHO, UNICEF. Progress on sanitation and drinking-water 2013 update: Joint Monitoring Programme

for Water Supply and Sanitation.

b) Use of improved sanitation facilities/toilets (percentage of population)

Year

Per

cen

tage

of

urb

an p

opu

lati

on (

%)

Urban Rural National

Imp

rove

d

Unimproved

Imp

rove

d

Unimproved

Imp

rove

d

Unimproved

Shar

ed

Un

imp

rove

d

Op

en d

efec

atio

n

Shar

ed

Un

imp

rove

d

Op

en d

efec

atio

n

Shar

ed

Un

imp

rove

d

Op

en d

efec

atio

n

1990 55 97 3 0 0 96 1 1 2 96 2 1 1

2000 53 96 3 1 0 94 1 3 2 95 2 2 1

2010 53 96 3 1 0 91 1 6 2 93 2 4 1

Source: WHO, UNICEF. Progress on sanitation and drinking-water 2013 update: Joint Monitoring Programme

for Water Supply and Sanitation.

41. Compendium of indicators for Georgia

Environment and health indicators have various functions and are used to:

monitor trends in environmental conditions to identify potential risks

monitor health in order to detect environmental impacts

compare situation within the country and between countries, take responsive measures and

distribute resources correctly

assess the effectiveness of measures

increase awareness in different groups (decision -makers, health professionals, industry,

community and media)

identify the potential links between the environment and the health to develop policy and

health interventions


68 October 25, 2013

Below is given the wide range of monitoring and evaluation indicators on water, sanitation and

hygiene in schools to be used for various purposes and recommended mostly by UNICEF and WHO

guidelines. At the same time, Georgia as the member state of UN and participant of WHO/European

Process on Environment and Health takes responsibilities for management and improvement of the

environmental health. Consequently, the list of general environmental health indicators must be

considered while planning studies at the national level.

Environmental health

issue

Definition Data source Comments

Regional priority goal (RPG) 1: Significant reduction of morbidity and mortality caused by digestive disorders and other health problems

through improved access to safe drinking water for all children and implementation of appropriate measures aimed at improvement of

sanitation services.

Key indicators

Outbreaks of water

borne infections

(DPSExEA)

Number of outbreaks of

water borne infections

and cases separately for

drinking and recreational

waters

National statistics Outbreaks are two or more

epidemiologically linked

two or more cases or

increase in number of

cases above certain limit;

outbreaks occure in a short

period of time (less than

within one month)

Access to improved

source of dinking water

and public water supply

(DPSExEA)

Proportion of population

with stable access to safe

drinking water in

dwelling

a) WHO/UNICEF JPM

data on improved water

source

b) Eurostat environment

statistics on water

a)see. improved water

sources include piped

water into dwelling, yard

or plot, faucet for

communal use, borehole,

dug well, protected well.

(see indicators for use of

improved drinking water.

b) water obtained from

public water supply

includes purified and

distributed water from

economic units: only

EU/EU candidate countries

Recreational water

quality (DPSExEA)

Recreatonal (coastan and

fresh) water proportion

that falls under the

definition of recreational

water directive and

meets the requirements

of Eurocomission.

WISE recreational water

quality database

Only EU countries, Croatia

and Switzerland. The main

indicator is CS122. Data

are published in the annual

report.

Additioanl indicators Regional priority goal (RPG) 1: ensure public care through imrpoved access to safe water and sanitation. Commitment to Parma Declaration

(ii): our goal is to ensure access to safe water and sanitation in housing, childcare facilities, schools, kindergartens and medical facilities as

well as access to public recreational waters by 2020 a\for each child and improve hygiene behavior.


69 October 25, 2013

Incidence of hepatitis A

(DPSExEA)

Annual incidence of viral

hepatitis A

WHO / HFA database

and WHO/Europe CISID

database

Stratification is preferable by age

(children/adults)

Access to improved,

adequately functioning

and maintained

sanitation facilities in

schools and

kindergartens

(DPSExEA)

a) proportion of children

in schools and

kindergartens, who have

access to improved

sanitation facilities

(discrepancies

urban/rural)

b) proportion of children

in schools and

kindergartens, who have

access to sanitation

facilities with ensured

maintenance and

functionality

(discrepancies

urban/rural)

Survey in schools and

kindergartens

Cluster random sampling

of schools and

kindergartens.

Questionnaire should be

similar to the

WHO/UNICEF JMP

questionnaire. Information

about proper functionality

and maintenance of

sanitation facilities involve

data on how often toilets

are cleaned, what

detergents are used, etc.

XII. Water and sanitation in schools of Georgia - National level survey

42. National survey as the best tool for situation management and policy ascertain

Regardless of what format and design of water, sanitation and hygiene routine monitoring is used at

the school level, the best tool for gaining a full image and evaluating the progress is a survey

conducted at the national level. National survey design should consider all components

recommended by UNICEF on Water, Sanitation and Hygiene in schools (WASH in School) and

somewhat complete, verify and check the information gained under routine monitoring.

Accordingly, the aim of the research is to be the assessment of the current situation in Georgia on

water, sanitation and hygiene in schools and how well it meets the international standards; what has

been improved and what still remains as an unsolved problem, what is the students’ hygienic

behavior pattern and what measures should be taken to ensure good sanitation in schools and develop

proper hygiene practices and behavior.

43. Recommendations on survey design and format

National survey should be carried out by random selection of schools in all regions of the country,

both in urban and rural areas. National Survey should use the global assessment and monitoring


70 October 25, 2013

methodology developed by UNICEF water, sanitation and hygiene in schools, which includes three

main components:

A) Face to face interviews with school directors/administrators;

B ) Supervision of infrastructure and students’ hygiene behavior;

C) Focus groups with students and teachers in the school.

Questionnaire, observation forms, and manual for the focus groups should also be developed within

the framework of the above-mentioned methods, based on standard forms.

Selection

For quantitative component the selection should be made considering the location of the school

(urban/rural), region, ethnicity, and school type (public / private). Also, attention should be paid to

the accessibility of water and sanitation facilities to children and school staff with disabilities.

For qualitative component focus groups should be composed of teachers and students recruited from

other schools of the same region/district. Focus group studies should be conducted within the survey

framework. Territorial location (Tbilisi, regional administration center, small town, village, and

mountainous region) should be considered while planning the focus group. In focus group

questionnaire there should also be taken in view factors associated with gender, ethnic and disability

issues, which may affect the student's hygiene behavior.

The technical performance

Quantitative and qualitative research methods as well as the observation method should be used in

study.

On the first stage, it is necessary to create a work force. The work force shall include researchers,

statisticians, and the representative of the research ordering organization authorized to perform

supervision. The work force should discuss the content and the technical aspects of the study,

prepare field works, develop research tools, as well as discuss the current stage of study, planning and

follow-up activities .

On the second stage, the work should be carried out in accordance with the focus groups . Focus

groups should be held school students and teachers from selected schools. Specifics of the school

selection and students recruitment details for the focus groups need to be discussed at the meeting of

the work force, on the preparatory stage of the survey. Focus groups with video recording and

transcripts should be organized by moderators.

Focus group study allows to:

A) Evaluate the study results;


71 October 25, 2013

B ) Identify whether there are other opportunities for the interpretation of the quantitative data ;

C) Determine what kinds of limitation these data have;

D) Identify the study directions that have not been taken into account in the planning process.

On the third stage of the study quantitative research should be conducted; observation of the

infrastructure and students’ hygiene behavior should also be performed.

It is recommended to attach photos and direct findings from observing water and sanitation

infrastructure as well as students’ hygiene behavior to the quantitative study data from each school.

Group leaders and interviewers should be trained by the project coordinator before they start their

field work.

Expected results

In case of successful implementation of the national survey the obtained quantitative data should:

reflect the current situation in public and private schools;

show the various mind-sets and attitudes, as well as the opinions of school principals on

school sanitation and hygiene problems and the ways for their resolution.

allow to create the basic information for piloting the school model in Georgia meeting the

international standards on water, sanitation and hygiene.

Based on the results obtained from the qualitative research, the data will reflect:

behaviors and factors determining some specific behaviors

topical themes related with water and hygiene; problems that were identified while working

with focus groups; prioritization of these problems with students and teachers.

some unique issues related to the subject of the study and associated with the respondents’

behavior.

additional issues, which have not been taken into account in the planning process and were

revealed on various stages of the study.

The results of the study conducted at the national level allow assessing the current situation in

schools of Georgia with water, sanitation and hygiene, evaluating the progress and developing further

strategy of improvements as well as making the coordination better to find ways of problem

resolution for both governmental and non-governmental sectors.


72 October 25, 2013

References

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http://www.who.int/water_sanitation_health/publications/wsh_standards_school/en/

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2012. http://www.unicef.org/publications/files/CFS_WASH_E_web.pdf

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11. WASH in Schools Monitoring Package. UNICEF.2011.

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http://www.ncdc.ge/uploads/publications/angarishebi/saqarTveloSi%20garemos%20janmrTelobis%20sferoSi%20arsebuli%20mdgomareobis%20mimoxilva%20da%20Sefaseba.pdf


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16. UK. Department for Education and Employment. GUIDANCE ON FIRST AID FOR SCHOOLS. A

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