{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:59Z","timestamp":1792787279760,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"World Vision US","award":["62999354-127176"],"award-info":[{"award-number":["62999354-127176"]}],"id":[{"id":"https:\/\/ror.org\/01s0tbj55","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,9,7]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Government of India has invested substantially in school water, sanitation and hygiene (WASH) infrastructure through the Swachh Vidyalaya Abhiyan (Clean Schools Programme), yet low facility use persists, often due to weak operation and maintenance (O&amp;M).<\/jats:p>\n                    <jats:p>\n                      Guided by Pu\n                      <jats:italic>et al<\/jats:italic>\n                      , this study examines causes of poor O&amp;M in school WASH systems in Uttar Pradesh, focusing on resources, information flows and accountability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>70 in-person interviews and nine WASH facility observations were conducted across nine government primary schools in three administrative blocks of one district in Uttar Pradesh, India. The respondents included, amongst others, headmasters (n=9), teachers (n=18), cleaners (n=7), local officials (n=5) and elected representatives (n=7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Resources: Schools depend heavily on the Gram Panchayat (Village Council) for staff and funds. One cleaner typically serves multiple public spaces and schools within a panchayat, leaving schools with infrequent cleaning support. Education department funds are limited, so schools rely on Panchayat funds for cleaning and repairs. However, Pradhans tend to prioritise visible upgrades, such as infrastructure improvements or wall painting, which offer greater community visibility and electoral value.<\/jats:p>\n                    <jats:p>Information: Cleaners are aware of their roles and responsibilities. However, school headmasters do not formally monitor their activities and there are rarely any penalties for lapses.<\/jats:p>\n                    <jats:p>Accountability: There is a disconnect between the authorities responsible for school WASH services and those overseeing their implementation. Cleaners report to Pradhans 4 under the Panchayati Raj Department rather than the Education Department, creating misaligned accountability. Consequently, inadequate maintenance of facilities often goes unaddressed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Poor O&amp;M of WASH facilities has historically been linked with inadequate financial and human resourcing. However, we argue that this underperformance is exacerbated by poor accountability mechanisms. The study\u2019s findings informed the design of an intervention aimed at directly addressing this issue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2026-004893","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:20:44Z","timestamp":1790702444000},"page":"e004893","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Functionality of school WASH infrastructure: a qualitative observational study of operation and maintenance systems in Uttar Pradesh, India"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5842-800X","authenticated-orcid":false,"given":"Riddhi","family":"Banerjee","sequence":"first","affiliation":[{"name":"Oxford Policy Management, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavita","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Oxford Policy Management, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3123-7971","authenticated-orcid":false,"given":"Gracie","family":"Hornsby","sequence":"additional","affiliation":[{"name":"Civil and Environmental Engineering, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anvesh","family":"Badamikar","sequence":"additional","affiliation":[{"name":"Civil and Environmental Engineering, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Priya","sequence":"additional","affiliation":[{"name":"Oxford Policy Management, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Oxford Policy Management, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Pu","sequence":"additional","affiliation":[{"name":"Civil and Environmental Engineering, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Winter","sequence":"additional","affiliation":[{"name":"Civil and Environmental Engineering, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Davis","sequence":"additional","affiliation":[{"name":"Civil and Environmental Engineering, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary L","family":"Darmstadt","sequence":"additional","affiliation":[{"name":"Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruhi","family":"Saith","sequence":"additional","affiliation":[{"name":"Oxford Policy Management, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"2026092910203391000_4.3.e004893.1","unstructured":"Adams J , Simms J , Chartier Y , et al . 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