African Journal of Public Health and Health Systems | 22 July 2015
An Ethnographic Study of School-Based WASH Interventions and Diarrhoeal Absenteeism in Volta Region Primary Schools, Ghana, 2015
E, s, i, M, e, n, s, a, h, ,, K, o, f, i, A, g, y, e, m, a, n, -, B, a, d, u, ,, K, w, a, m, e, A, s, a, r, e
Abstract
Diarrhoeal diseases are a significant cause of school absenteeism among children in Ghana, adversely affecting educational outcomes. School-based water, sanitation, and hygiene interventions are promoted to mitigate this, yet there is limited in-depth qualitative understanding of their real-world implementation and perceived impact within specific socio-cultural contexts. This ethnographic study aimed to explore the lived experiences and perceptions of pupils, teachers, and school management regarding a specific school-based WASH programme in the Volta Region. It sought to understand how the programme's components were integrated into daily school life and to examine stakeholder views on its relationship with diarrhoeal absenteeism. An ethnographic approach was employed, involving approximately three months of immersive fieldwork in three primary schools. Data were collected through participant observation, in-depth interviews with teachers, school health officers, and pupils, and focus group discussions with parent-teacher associations. Field notes and interview transcripts were analysed using thematic analysis. Observations revealed significant disparities between the provision of WASH infrastructure and its consistent, correct use. A key theme was the critical role of teacher supervision and hygiene education in influencing pupil behaviour. In schools where teachers actively promoted handwashing, pupils and staff reported a perceived reduction in diarrhoea, with one school estimating a halving of related absenteeism. However, unreliable water supply and lack of maintenance frequently undermined the interventions. The study concludes that the mere presence of WASH infrastructure is insufficient. The sustained impact on diarrhoeal absenteeism is heavily dependent on contextual factors including resource reliability, active teacher engagement, and the embedding of hygiene practices into the daily school culture. Future WASH programmes should prioritise secure water supplies and earmarked budgets for maintenance. Teacher training should be enhanced to include behaviour-change communication strategies. Programme design must allow for greater community and school-level adaptation to local realities. absenteeism, diarrhoea, ethnography, Ghana, hygiene, sanitation, school health, WASH, water. This study provides a nuanced, contextual understanding of the implementation challenges and social dynamics influencing the perceived effectiveness of school-based WASH programmes in reducing diarrhoeal absenteeism.