Health and hygiene in government schools

Examining key areas in the aftermath of COVID-19
Vignesh Krishnan, Ngawang Lakhey and Bhaavya Batra

COVID-19 has unleashed a severe shockwave on children globally. In India, an estimated 1.5 million primary and secondary schools with 247 million children have been affected by school closure (UNESCO, 2020). While we are faced with a widening learning gap, the consequences of continued school closure on the health and well-being of children, especially those from disadvantaged communities, will have a detrimental effect for years to come.

Let us take the case of Aseem, a grade 10 student from a government school in Hyderabad. It has been over 18 months since Aseem and his family have had access to a nutritious meal. Sahana, another student from a low-budget private school, mentions that the economic consequences of the pandemic have forced her and her mother to use rags during their menstruation instead of sanitary pads. Aseem and Sahana are not exceptions. Their stories are indicative of the effect the pandemic has had on the health and hygiene of millions of children from disadvantaged communities.

Since the COVID-19 pandemic took over our lives, there has been a push to relay a sharper focus on health and hygiene in general. Pavani, a student from a government school in Hyderabad, acknowledged the increased importance of health and hygiene due to the pandemic, “COVID helped us to take care of our health and our surroundings as well. People started washing their hands regularly and started to clean their environment, wearing masks for protection.”

Although health and hygiene are conceived as being integral aspects of our lives and community well-being, when it comes to conscious and effective implementation towards making schools a safe haven, the concerns are too often ignored or relegated to the background; sometimes, to a perilous extent. As more and more states begin to reopen schools, we have been forced to acknowledge the gaps in our infrastructure and policies when it comes to basic health, hygiene, nutrition and sanitation in schools.

Schools need to be spaces that, besides helping in the prevention and control of the spread of COVID-19, put first the health and hygiene of everyone involved, especially the students. The question is, how can schools be that space? It is imperative that we deep dive into the key areas that are central to the well-being of children in government schools such as nutrition, menstrual hygiene for girls, infrastructural facilities, among others.

Globally, the pandemic put an estimated 115 million children at risk of severe malnutrition (Lancet Covid-19 Commission, 2021). School closures have come at a high cost to health and hygiene for all children, but especially for children from the most vulnerable and marginalized communities. Many children and youth from these communities who rely on their schools for food and healthy nutrition (mid-day meals) have found themselves cut off from access to cooked meals during lockdowns.

Through a concurrent rapid needs assessment, Save the Children* found that around 40% of eligible children didn’t receive mid-day meals during the lockdown. Oxfam** arrived at similar findings and reported that approximately 35% of children did not receive their mid-day meals. This limited access to cooked meals during the lockdown had a lethal effect on children’s nutrition and health. It was also observed that the impact of insufficient nutrition and mid-day meals may be worse for girls and children from marginalized groups.

The Global Nutrition Report 2020 concluded that India is among 88 countries that will miss global nutrition targets by 2025. Thus, to tackle the grave problem of malnutrition, the government needs to lay down strong policies to guarantee consistent availability of a variety of good quality, nutritious and cooked meals to children and also ensure that children in government schools are satisfied with the mid-day meal. Furthermore, increased allocation of government funds and consistent monitoring of mid-day meal schemes is critical to improve the quality of food across government schools.

Speaking of mid-day meals provided at schools, a child says, “We don’t like the taste of the food that is provided in the mid-day meal. We are given only rice and dal with some vegetables.” When the meals are restricted to a certain menu every day, children are disinterested in consuming them. It is only natural that a child or anybody for that matter would prefer to have a variety of food on their plate, particularly because they don’t get to eat such variety at their home due to financial constraints.

The roots of mid-meals take us back to the Integrated Child Development Services (ICDS) Scheme launched in 1975 with an aim of improving the nutritional and health status of children in the age group of 0-6 years by providing supplementary nutrition and immunization. More than 89 million have benefited from this scheme. However, effective implementation of the scheme is still lacking due to insufficient budgetary allocation, untimely supply of food and inadequate logistic supply. The recent National Education Policy (2020) recommends the basic requirements of nutrition and health (including mental health) for children by promising a simple, nutritious but energizing breakfast in addition to healthy mid-day meals.

Another critical issue of utmost significance is that of menstrual hygiene. A UNICEF and NIUA (National Institute of Urban Affairs) study on adolescents in India (2020) indicates that one in every two adolescent girls living in poor urban settings is unable to use sanitary pads or tampons during their menstrual period because they cannot afford it. Inadequate clean and functional menstrual hygiene management facilities and non-availability of sanitary pads in schools are also key factors that force girls to take time off from school when they are menstruating, sometimes missing too many days every month, even leading to drop-outs. The presence of such facilities and greater socio-emotional support can increase their attendance with far-reaching consequences such as lowering the rate of early marriages and pregnancy.

When a few girls were surveyed on the status of menstrual hygiene management in their schools, they were quoted as saying, “We feel embarrassed while changing the sanitary napkin in school, and many of them do not know how to use the disposal machine, it is difficult to understand the usage of the machine.” Even though they appreciated the installation of disposal machines by the school, these measures are only the tip of the iceberg. Apart from having proper resources, amenities and infrastructure, one should also pay heed to removing the stigma surrounding menstruation and educating children about personal hygiene and guiding girls on the usage and disposal of sanitary napkins. Girls also need to be educated on the physiological changes they are likely to encounter during adolescence and the coping mechanism they can employ to deal with such stress and emotions. As many as 70% from the interviewed group also claimed that post COVID, their schools had stopped providing sanitary napkins.

The Ministry of Health and Family Welfare (MoHFW) had launched a scheme to promote and spread awareness about menstrual hygiene among adolescent girls (10-19 years) in rural areas as part of the Adolescent Reproductive Sexual Health (ARSH) programme. They aimed to supply and make accessible high-quality sanitary napkins. Disposal of pads in a safe and environmentally conscious manner was also promoted. In 2018, the government launched “Suvidha” a highly subsidized (INR 2) oxy-biodegradable sanitary pad and made them available in Jan Aushadi centres.

In addition, the MoHFW also launched a scheme called Rashtriya Kishore Swasthya Karyakram (National Adolescent Health Programme) in 2014. Under this scheme, they strived to enhance menstrual hygiene knowledge and practices, provide subsidized sanitary absorbents and raise awareness about menstrual hygiene management at school. Apart from this, the scheme also focuses on the health and nutrition of adolescents (10-19 years). More than ever, it is critical to ensure robust implementation of some of these well-intentioned initiatives.

Another vital issue is the maintenance of accessible amenities and infrastructural facilities that promote health and hygiene such as safe and potable drinking water and sanitation facilities in all schools especially in rural schools in India.

To focus on the improvement of infrastructure, the National Education Policy has introduced Infrastructure Development of private aided/unaided Minority Institutes (IDMI) (elementary secondary/senior secondary schools), which aims to augment and strengthen school infrastructure and physical facilities in schools including building additional classrooms, science/computer lab rooms, library rooms, toilets, drinking water, etc., to expand facilities for formal education to children.

Government schools with three WASH facilities (Water, Sanitation and Hygiene) have increased significantly over the years, from 24.4% (2018) to 51.1% (2021). This shows a positively increasing graph for drinking water and handwashing facilities in both elementary and secondary schools over the period, but according to a UDISE (Unified District Information System for Education) report, more than 15% of government-run elementary schools and 10-12% of government-run secondary and higher secondary schools don’t have proper drinking water facilities.

Badly maintained school sanitation and hygiene not only make schools risky places for the transmission of communicable diseases, but also negatively impact the learning environment with regular absenteeism, limited educational progress and low enrollment. WASH practices in schools through the provision of clean toilet infrastructure for both boys and girls with functional and infallible water-line and sewage disposal facilities, water purification technologies and handwashing facilities must be ensured.

Sadly, despite the implementation of positive measures by the government, most schemes fall short of providing conclusive results. An array of loopholes are found in the policies, deeming the programs ineffective.

Many times, there are gaps between what is planned and what is ultimately implemented. On top of that, lack of cost-effective child health interventions and efficient monitoring mechanisms, poor management and implementation of regulatory controls and schemes, inadequate infrastructure, funding and skilled personnel all play their part in plaguing the health system. Implementation of schemes without proper prior research, unclear decentralization processes, low political prioritization and lack of accountability are also major causes of concern.

Collaboration with congruent goals among various stakeholders across communities with the government as the key player needs to be positioned at multiple levels to contribute towards the improvement of health and hygiene in all aspects of schools as we reel from the effects of the COVID-19 pandemic and begin to reassess the things that were done pre-pandemic in this regard. As we head to a new phase in the post pandemic period, the following recommendations could accelerate the progress towards building safer schools.

• Open schools safely: health and sanitation measures; vaccination and testing of teachers; pre-planned seating arrangements; limit numbers per classroom by alternate day attendance, using additional public buildings.
• Communicate with parents and engage them in school reopening plans. Bring every child back to school.
• Provide mid-day meals to all students in publicly funded schools, whether they are attending physically or remotely.
• Design effective strategies and policies based on proper and detailed research for schools and teachers to support students’ socio-emotional well-being and address learning gaps.
• Mobilize institutions and partners – public and private – to revamp infrastructure and upgrade the quality of standards.
• Timely implementation of schemes with proper monitoring and evaluation of their performance in real-time, if possible.
• Allocation of higher funds for healthcare and hygiene especially to government schools and institutions.
• Availability of skilled and well-trained social workers, teachers, counsellors, etc., to solve the issues at the base level.
• Continuous revision and reassessment of policies, regulations and accreditations according to the circumstances and context.
• Proper accreditation focuses on patient rights and benefits, safety, control and prevention of infections in hospitals and proper protocols such as special care for vulnerable groups and children.

One needs to realize that even though schools are centres of learning, we cannot just focus on improving academic infrastructure and scholastic performance. A lot of variables like nutritious food, clean water, sanitized washrooms, proper lighting, etc., work together to supplement a child’s learning. The pandemic has forced us to acknowledge the gaps in our infrastructure and policies when it comes to basic health (both physical and mental), hygiene, nutrition and sanitation, particularly in schools. Therefore, strong policies have to be introduced and implemented by the government and proper collaboration involving public and private stakeholders needs to be undertaken at every level to improve the standards of health and hygiene.

Research Team: Akash Andasu, Challapally Mahathi, Dnayneshwar Wankhede and Priyanka Rambol (Teach For India, Hyderabad)

*An NGO working to improve the lives of children.
** An NGO working to alleviate poverty.

The authors work with Teach for India, Hyderabad. They can be reached at [email protected].

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