Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

Denise Duijster (), Bella Monse, Marvin Marquez, Ubo Pakes, Nicole Stauf and Habib Benzian
Additional contact information
Denise Duijster: Department of Oral Public Health, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
Bella Monse: Regional Fit for School Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 10th Floor, Bank of Makati Building, Ayala Avenue Extension near Corner Metropolitan Avenue, Makati City 1209, Philippines
Marvin Marquez: Population Institute, College of Social Science and Philosophy, University of the Philippines Diliman, Diliman, Quezon City 1101, Philippines
Ubo Pakes: Center for Environmental Informatics, University of the Philippines Cebu, Gorordo Avenue, Cebu City 6000, Philippines
Nicole Stauf: The Health Bureau Ltd., Whiteleaf Business Center, 11 Little Balmer, Buckingham MK18 1TF, UK
Habib Benzian: WHO Collaborating Center Quality Improvement & Evidence-Based Dentistry, Department of Epidemiology & Health Promotion, College of Dentistry, New York University, 433 First Avenue, 7th Floor, New York, NY 10010, USA

IJERPH, 2022, vol. 19, issue 16, 1-11

Abstract: This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability—defined as accessible, functional and private—and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment ( p = 0.024). CTBF results found a similar result, although this was not statistically significant ( p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment ( p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.

Keywords: Water, Sanitation and Hygiene (WASH); operation and maintenance; toilets; sanitation; schools; cleanliness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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