Promoting Clean Water, Sanitation, and Hygiene Behaviour Change Through Community-Based Research With Primary School Communities in Ghana

Background: Many public primary schools in Sagnarigu Municipality, Northern Region, Ghana, have toilets and water points but few working places where pupils can wash their hands with soap. Buckets stand empty, taps break and stay broken, and no school budget line covers soap or small repairs, so hygiene lessons in class are not matched by daily practice. Objective: This programme aimed to improve clean water use, sanitation, and hygiene behaviour in ten primary schools through community-based participatory research with school communities. Methods: The programme ran from February to November 2025. School teams of pupils, teachers, Parent Teacher Association members, and health coordinators mapped problems, co-designed handwashing stations using Veronica buckets and tippy taps, formed school health clubs, and set up toilet maintenance funds managed by the associations. Data came from facility audits, structured observation, questionnaires, registers, and group discussions. Results: Functional handwashing stations rose from 7 to 58. Pupils observed washing hands with soap after toilet use rose from 17.6 percent to 64.8 percent, and the mean hygiene knowledge score rose from 51.4 to 80.7. All ten schools operated a maintenance fund at the end of the programme. Conclusion and Implications: Change held where schools owned the design, the money, and the daily checks. Low cost stations work when a named group maintains them and small repairs are paid for without delay.