May 11,2012

CWW and Helen Keller International (HKI) Work to Improve Hygiene Education in Cambodia

Cambodian School ChildrenCWW, Helen Keller International (HKI), and the Cambodian government collaborated on a project that developed a primary school health curriculum to better promote hygiene to break the cycle of infection.

In 2004, 6 years ahead of schedule, Cambodia became the first country to reach the World Health Organization's target of reaching 75 percent of at-risk school-age children with regular deworming treatment by 2010. Cambodia's school-based deworming program currently reaches nearly 2.5 million children. Prior to the deworming program, approximately half of all children suffered from infection by intestinal worms.

Recognizing that the gains made through deworming could be maintained with improved hygiene education, the government of Cambodia partnered with Children Without Worms(CWW) and Helen Keller International in 2009 to revise Cambodia's school curriculum to promote healthy practices to prevent reinfection. The partners determined that the project could be carried out in two phases: an initial situational analysis, followed by developing and piloting the revised curriculum.

Phase One: Conduct Situational Analysis

In September 2009, HKI worked with the School Health Department under the Ministry of Education, Youth and Sports (MoE) to perform a situational analysis. In this analysis, the project team inventoried existing materials relevant to hygiene, sanitation and soil transmitted helminthes (STH) control. They also identified other groups in Cambodia currently working in school health, surveyed them about their work, and interviewed key representatives of these groups. In addition, they surveyed and interviewed school representatives, including directors, teachers, and students, to learn what school health activities currently take place and to assess knowledge of worm control and prevention.   


Some of the key findings from the situational analysis included:

  • Current strategies to prevent and control soil-transmitted worm infections have solid foundations, but need improvement.
  • Training manuals and teaching materials focus primarily on general health, hygiene and sanitation; they include limited information about intestinal worm infections.
  • Although the Ministry of Health provides materials specific to STH infections and teacher guidelines for mass distribution of medicines, they are not distributed evenly among primary schools. As a result, some schools have little or no resources for educating students about intestinal worms.
  • Teachers often do not use all of the materials or allot enough time for lessons on health, hygiene and sanitation.
  • The majority of students interviewed could name one activity that reduces the chance of worm infestation. However, only 18 percent--less than one in five children--knew that deworming tablets could be taken to treat intestinal worms.

WaterAid Australia and International Water Centre highlighted the results of this first phase in a case study published as part of the book, "Sharing Experiences: Effective hygiene promotion in South East Asia and the Pacific." The book includes 11 case studies from around the world, along with keynote papers from international experts in hygiene promotion. The book can serve as a useful resource for people developing programs to promote good hygiene practices.

Phase Two: Revise and Test Pilot Curriculum

Based on the results of the situational analysis, a technical committee of teachers, school directors, health workers, and NGO representatives revised the curriculum and submitted it to a steering committee for review. HKI and the MoE piloted the revised curriculum in four primary schools in Takeo and Kampong Spue provinces. The proximity of these provinces to Phnom Penh made logistics easier to coordinate and kept costs to a minimum.

HKI and MoE staff conducted site visits to all four schools to monitor and supervise the piloted activities. They also provided school directors and teachers with technical assistance, answering any questions that arose while teaching the primary school students with the revised curriculum.The results were highly successful, and based on the feedback, the curriculum on prevention and control of soil transmitted helminthes was finalized. On October 28, 2010, the Honorable Minister H. E. Mark Vann of the MoE, Youth and Sports officially approved and signed off on use of the newly revised curriculum by all of Cambodia's primary schools. The new curriculum will be taught to teachers in teacher training schools. These teachers will then teach the curriculum to school children throughout Cambodia.

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