Seven-Flag Approach to Total Sanitation: Sharing Results of a Pilot in Nepali Schools


  • Sudan Raj Panthi
  • Hyder Khurshid Alam
  • Ehsanullah Tarin





Objective: to share the experience regarding an innovative approach, “Seven-Flag Approach to Total Sanitation (7FATS) in Schools” introduced in Nepal. Background: Safe drinking-water, use of improved sanitation and hand hygiene remained an unfinished millennial agenda and is carried over as part of SDG 6 and allied goals in Nepal. Particularly, to improve sanitation services in schools, Government of Nepal implemented several initiatives. While there was an apparent improvement, equally the continuing challenges have been the sustainability, the needed behaviorural change, and lack of motivation both amongst teachers and students. 7FATS or total sanitation in schools is an approach, which addresses these issues. Concept: The underlying concept is that, as minimum requirement, children in school should use clean toilets, wash hands with soap, and drink water from a safe supply. In this manner, children, who spend a substantial part of their time in schools, can improve their own hygiene behavior, and also take the message to their families and communities, thus acting as agents to improve their knowledge and impact behavior towards hygiene. Practice and process: Seven steps involved include: constitution of a school sanitation team; after training the team analyses the sanitation situation of school; organisation of a sanitation conference to orient all students on 7FATS concept and practice; students are divided into seven groups to compete for 7FATS activities; fund raising to support 7FATS in schools; winner groups are rewards; and school is declared as 7FATS School when all seven groups have raised their flags to full stand. Discussion: concept paper, documentary and leaflet, and a 7FATS-WASH handbook has been developed as advocacy and standardised implementation tool. But it is the technical assistance, demonstration effect, sanitation conferences attended by dignitaries and parents, reward and recognition of winner groups, and adoption of schools by national and international organisations for implementing 7FATS. Conclusion and recommendations: 7FATS approach proved to be a powerful tool for driving school towards total sanitation in an integrated, effective, and sustainable manner. However, for it to be more useful, there is a need for uninterrupted water supply, culturally sensitive promotional activities, resources for rewards and recognition, continuity of focal teacher and students’ leader, and develop mechanisms for monitoring and evaluation of initiative. Also, to enhance health impact, “One School, One Nurse” initiative may be replicated and scaled up.



How to Cite

Panthi, S. R. ., Alam, H. K. ., & Tarin, E. . (2021). Seven-Flag Approach to Total Sanitation: Sharing Results of a Pilot in Nepali Schools. Annals of King Edward Medical University, 27(1), 4-12.



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