Evaluation of Water Supply, Sanitation and Hygiene Intervention in Schools, Health Care Facilities and Communities for the Prevention of Diarrhoea Diseases in Lindi Region, Tanzania

Abstract

Introduction: Water, sanitation, and hygiene (WASH) are vital for preventing diarrhoea. A 2019 baseline study in Mtama District Council and Lindi Municipal Council reported a 13% prevalence of diarrhoea among children under five. Only 3 of 12 primary schools had a reliable water supply, while none of the six health facilities did. School children and caregivers had low hygiene knowledge and practices. A three-year project was implemented to improve WASH services and raise hygiene knowledge and practices to reduce diarrhoea among children under five. This evaluation assessed improvements in WASH conditions in targeted schools, health facilities and communities, examined changes in diarrhoea prevalence, and explored the sustainability of implemented interventions.

Methods: The evaluation employed both quantitative and qualitative methods. Interviews with government officials, community members, and school children were conducted. An observation checklist was used to assess constructed or renovated water supply, sanitation, and hygiene infrastructure in schools and health facilities. The Organisation for Economic Co-operation and Development (OECD/DAC) criteria were used to evaluate relevance, effectiveness, efficiency, coherence, sustainability, and coordination.

Results: The prevalence of diarrhoea among children under five years of age decreased from 13% to 9.6%. Water supply infrastructure in all project schools and healthcare facilities was either renovated or newly constructed. Nearly all school children (99%) received training in handwashing practices; 98% demonstrated adequate knowledge of critical handwashing moments, and 91% accurately identified the proper handwashing steps. Among caregivers, 90% had adequate knowledge of proper handwashing. The project met all OECD/DAC evaluation criteria.

Conclusion: The WASH project achieved its objectives by improving infrastructure and services and by training schoolchildren and caregivers, thereby contributing to a reduction in diarrhoea prevalence. Basic drinking water coverage in targeted schools and health facilities increased, with a reliable year-round supply. The project met all OECD/DAC evaluation criteria, demonstrating relevance, effectiveness, efficiency, coherence, coordination, and sustainability. The evaluation recommends that Mtama District Council and Lindi Municipal Council sustain these achievements through continued collaboration, stakeholder engagement, and shared responsibility to maintain improved WASH outcomes and ensure long-term impact in the Lindi region.