Elementary schoolchildren in the Philippines

This one-year project, led by the IWC, in partnership with the London School of Hygiene and Tropical Medicine and in collaboration with UNICEF Philippines and the WinS Technical Working Group, was created to address gaps in understanding barriers to hygiene and sanitation practices in schools.



Project Location:



UNICEF Philippines

Project Category:

Applied research

Key areas of work:

Water, Sanitation and Hygiene (WASH)

Research Partners:

London School of Hygiene and Tropical Medicine, UNICEF Philippines and the WinS Technical Working Group

Creating significant, sustained changes in hygiene and sanitation behaviours in schools remains a huge challenge for both the education and public health sectors. There are few rigorous examples of success, and no single, proven, accepted approach.

In the Philippines, 82,000 school-age children die every year from preventable diseases, including diarrhoea, pneumonia and respiratory infections.

The Philippine Essential Health Care Program (EHCP) introduced simple but radical new ideas, marking a turning point in how health promotion was approached in the Philippines primary education system.

While the EHCP has been well received by WinS stakeholders and students, there was a gap in understanding the barriers to independent hand-washing with soap (HWWS). To address these gaps, the Research and Development of Hygiene Behavioural Change of Elementary Schoolchildren in the Philippines project was initiated.The project was designed to respond to the following questions:

  • does daily group HWWS in school improve the prevalence of independent HWWS at critical times (after using the toilet in school and before eating/handling food)?
  • how can the practice of independent HWWS at critical times be improved in schools where daily group HWWS is practised?
  • how can the EHCP improve toilet use in schools?

Based on findings from the formative research, a set of locally-stylised tools was developed for use by teachers in classrooms. The intervention tools, entitled “HiFive for HySan”, comprises a package of five tools that are designed to be fun for children, and targeted at improving hygiene and sanitation behaviour in schools.

While HiFive was only implemented for a limited period and a range of implementation challenges were observed, where it was implemented fully, HiFive plus a re-energised group hand-washing program demonstrated consistent improvements in independent hand-washing at critical times, and resulted in improved functionality of independent hand-washing stations in both urban and rural schools.