Water, sanitation, and hygiene facilities: enabling or impeding handwashing? An assessment of a primary school infrastructure in Palwal, India

The importance of water, sanitation, and hygiene (WASH) facilities in school cannot be ignored in protecting children from communicable diseases. However, reports from UNICEF suggest that there is a lack of adequate WASH facilities and a dearth of adequate data on available facilities, particularly from developing countries. The present study sought to address this gap and build on the evidence-base of school hygiene and sanitation facilities in rural India. The study also assessed the association between available facilities and the handwashing behavior of students. Data were collected from 28 schools using a modified Joint Monitoring Program (JMP) observation checklist and a self-administered questionnaire. Results indicate a universal coverage of WASH facilities in the sampled schools, though the sufficiency and usability of the infrastructure were inadequate. The study also found better hand hygiene KAP scores among students in schools that had handwashing stations closer to toilets (p = 0.018). We conclude that while India has improved access to facilities under the recent National policy push, there needs to be a continued focus on increasing sufficiency, maintenance and usability of the facilities. Additionally, health promotion activities that include teachers, parents and the community are required to improve the hygiene and sanitation behavior of school children. HIGHLIGHTS Adds to the evidence-base of the school WASH facilities available to rural, primary school children in India.; There are hardly any studies that benchmark the available WASH facilities against global standards. The present study maps the findings on the basis of the WHO/UNICEF JMP's new service ladder for WASH in schools.; Explores the association between the quality of WASH services and students' handwashing behavior.;