A Policy Analysis of School-Based WASH Clubs and Diarrhoeal Disease Incidence in Freetown, Sierra Leone: A Three-Year Sustainability Assessment

Diarrhoeal diseases are a leading cause of childhood morbidity in Sierra Leone. School-based Water, Sanitation, and Hygiene (WASH) clubs are a promoted policy intervention to instil hygiene behaviours and reduce disease. Evidence on the sustainability of their impact beyond initial implementation is scarce. This policy analysis assesses the three-year sustainability of WASH clubs in Freetown’s primary schools and evaluates their continued influence on reported diarrhoeal disease incidence among pupils. A qualitative case study methodology was employed. This involved document analysis of policy frameworks and programme reports, supplemented by semi-structured interviews and focus group discussions with education and health officials, school staff, and club members. Data were analysed thematically to identify sustainability factors. Findings indicate a marked decline in club functionality and associated health benefits over time. Initial reductions in pupil absenteeism due to diarrhoea were reported, but sustained impact depended on continuous external support. A key theme was the lack of formalised funding and institutionalisation within the school system, leading to club dissolution in most schools assessed. While WASH clubs show initial promise, current policy approaches fail to ensure their long-term sustainability and public health impact. Without structural integration, clubs are vulnerable to collapse after project funding ends. Policy recommendations include integrating WASH club activities and budgets into core school governance; developing a formalised training and mentorship cascade for teachers; and establishing clear monitoring and reporting lines between schools and district health offices. WASH, sustainability, school health, diarrhoeal diseases, policy analysis, Sierra Leone This analysis provides critical evidence for policymakers on the structural weaknesses undermining WASH club sustainability, informing necessary revisions to implementation and financing strategies.