Strategic Governance of School WASH and Physical Education in Ghanaian Basic Schools: A Narrative Literature Review

Water, sanitation, and hygiene (WASH) and physical education are both central to healthy schools, yet they are often planned, implemented, and monitored as separate domains in basic education systems. This narrative literature review examined how school governance can connect WASH and physical education within one school health system and identified strategic areas for improving coordination between WASH and physical activity promotion in Ghanaian basic schools. Relevant peer-reviewed studies published mainly between 2021 and 2026 were identified through searching five electronic databases (Scopus, Web of Science, PubMed, ERIC, and Google Scholar), screened for relevance, and synthesised thematically. Twenty studies met the inclusion criteria and were included in the synthesis, of which four were conducted in or specifically about Ghana. The review found that effective coordination depends on governance practices such as policy alignment, role clarity, intersectoral collaboration, resource planning, facility oversight, and routine monitoring. The literature also shows that WASH and physical education interventions often produce mixed results when implementation is fragmented, measurement is inconsistent, or leadership capacity is weak. In the Ghanaian context, governance challenges appear in uneven WASH implementation, limited parental and community participation, weak collaboration, and insufficient support for physical education delivery. The review contributes to school health scholarship by integrating WASH and physical education within one governance framework and argues that strategic governance is essential for creating healthier, safer, and more active school environments.

school governance, WASH, physical education

1. Adams, D., Tan, K. L., Sandmeier, A., & Skedsmo, G. (2023). School leadership that supports health promotion in schools: A systematic literature review. Health Education Journal, 82(6), 693–707. https://doi.org/10.1177/00178969231180472 [Google Scholar] [Crossref]

2. Adomako Gyasi, P., Zhou, L., Chen, Z., Numawoseh, E. E., & Opoku-Agyemang, A. S. (2024). Barriers to school-based health programs implementation in basic schools in Ghana: Education stakeholders' perspective. Health Education Research, 39(1), 55–67. https://doi.org/10.1093/her/cyad045 [Google Scholar] [Crossref]

3. Bick, S., Davies, K., Mwenge, M., MacLeod, C., Braun, L., Chipungu, J., Chidziwisano, K., & Dreibelbis, R. (2025). WASH and learn: A scoping review of health, education and gender equity outcomes of school-based water, sanitation and hygiene in low-income and middle-income countries. BMJ Global Health, 10(5), e018059. https://doi.org/10.1136/bmjgh-2024-018059 [Google Scholar] [Crossref]

4. Chigbu, U. E., Atiku, S. O., & du Plessis, C. C. (2023). The science of literature reviews: Searching, identifying, selecting, and synthesising. Publications, 11(1), Article 2. https://doi.org/10.3390/publications11010002 [Google Scholar] [Crossref]

5. Duah, H. (2024). The level of implementation of water, sanitation, and hygiene (WASH) practices among the public basic schools in Ghana. Journal of Water, Sanitation and Hygiene for Development, 14(9), 780–793. https://doi.org/10.2166/washdev.2024.307 [Google Scholar] [Crossref]

6. Hall, A., Lane, C., Wolfenden, L., Nathan, N., Sutherland, R., Brown, H., Reilly, K., Oldmeadow, C., Lecathelinais, C., McCarthy, N., Boyer, C., Wiggers, J., & Bauman, A. E. (2023). Evaluating the scaling up of an effective implementation intervention (PACE) to increase the delivery of a mandatory physical activity policy in primary schools. International Journal of Behavioral Nutrition and Physical Activity, 20, 106. https://doi.org/10.1186/s12966-023-01498-y [Google Scholar] [Crossref]

7. Hall, A., Wolfenden, L., Shoesmith, A., McCarthy, N., Wiggers, J., Bauman, A. E., Rissel, C., Sutherland, R., Lecathelinais, C., Brown, H., Trost, S. G., & Nathan, N. (2022). The impact of an implementation intervention that increased schools' delivery of a mandatory physical activity policy on student outcomes: A cluster-randomised controlled trial. Journal of Science and Medicine in Sport, 25(4), 321–326. https://doi.org/10.1016/j.jsams.2021.12.005 [Google Scholar] [Crossref]

8. Ismaila, N., Baddianaah, I., Fielmua, N., Nandzo, S. D., Salifu, F. R., & Abdulai, M. (2023). Condition of water, sanitation and hygiene (WaSH) in Ghana's basic schools: Empirical evidence from Wa municipality. Journal of Water, Sanitation and Hygiene for Development, 13(3), 165–173. https://doi.org/10.2166/washdev.2023.164 [Google Scholar] [Crossref]

9. Kelley, G. A., & D'Souza, R. S. (2025). Narrative reviews in anesthesia and pain medicine: Guidelines for producers, reviewers and consumers. Regional Anesthesia and Pain Medicine, 50(9), 725–729. https://doi.org/10.1136/rapm-2024-105661 [Google Scholar] [Crossref]

10. Leksy, K., Gawron, G., Rosário, R., Sormunen, M., Velasco, V., Sandmeier, A., Simovska, V., Wojtasik, T., & Dadaczynski, K. (2024). The importance of school leaders in school health promotion: A European call for systematic integration of health in professional development. Frontiers in Public Health, 11, 1297970. https://doi.org/10.3389/fpubh.2023.1297970 [Google Scholar] [Crossref]

11. McLoughlin, G. M., Allen, P., Walsh-Bailey, C., & Brownson, R. C. (2021). A systematic review of school health policy measurement tools: Implementation determinants and outcomes. Implementation Science Communications, 2, 67. https://doi.org/10.1186/s43058-021-00169-y [Google Scholar] [Crossref]

12. McMahon, C., Webster, C. A., Weaver, R. G., El Haber, C., Tekkurşun Demir, G., Ismail, Z. M., Naqvi, S. Z. F., Ghani, M., Kepenek, Ş., Kherraf, M., Krishnakumar, T., Prakash, P., Seo, Y., & Booth, J. N. (2024). Whole-of-school physical activity implementation in the context of the Dubai Fitness Challenge. PLOS ONE, 19(3), e0290856. https://doi.org/10.1371/journal.pone.0290856 [Google Scholar] [Crossref]

13. Morris, J. L., Chalkley, A. E., Helme, Z. E., Timms, O., Young, E., McLoughlin, G. M., Bartholomew, J. B., & Daly-Smith, A. (2023). Initial insights into the impact and implementation of Creating Active Schools in Bradford, UK. International Journal of Behavioral Nutrition and Physical Activity, 20(1), 80. https://doi.org/10.1186/s12966-023-01485-3 [Google Scholar] [Crossref]

14. Ourda, D., Skoufa, L., Brighi, A., Crone, D., Edwards, L., Failo, A., Fourlari, S., Huhtiniemi, M., Jaakkola, T., Raptis, G., Sellars, P., Papacosta, E., & Barkoukis, V. (2025). A whole-school approach for the promotion of physical activity: An evaluation of stakeholders' and educators' perceptions about education in six European countries. Education Sciences, 15(5), 560. https://doi.org/10.3390/educsci15050560 [Google Scholar] [Crossref]

15. Poague, K. I. H. M., Blanford, J. I., & Anthonj, C. (2022). Water, sanitation and hygiene in schools in low- and middle-income countries: A systematic review and implications for the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(5), 3124. https://doi.org/10.3390/ijerph19053124 [Google Scholar] [Crossref]

16. Sasaki, H., Sari, D. P., Warnaini, C., Andiwijaya, F. R., Takeuchi, R., Kadriyan, H., Shibuya, F., & Kobayashi, J. (2024). Leadership of school principals for school health implementation among primary schools in Mataram, Indonesia: A qualitative study. Tropical Medicine and Health, 52(1), 5. https://doi.org/10.1186/s41182-023-00568-y [Google Scholar] [Crossref]

17. Sofo, S., & Asola, E. F. (2023). Ghana's new physical education curriculum for primary schools: An analysis and future directions. Canadian Journal of Educational and Social Studies, 3(6), 1–14. https://doi.org/10.53103/cjess.v3i6.182 [Google Scholar] [Crossref]

18. Stylianou, M., Woodforde, J., Duncombe, S., Kolbe-Alexander, T., & Gomersall, S. (2022). School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature. Health & Place, 73, 102705. https://doi.org/10.1016/j.healthplace.2021.102705 [Google Scholar] [Crossref]

19. Wendt, J., Scheller, D. A., Flechtner-Mors, M., Meshkovska, B., Luszczynska, A., Lien, N., Forberger, S., Banik, A., Lobczowska, K., & Steinacker, J. M. (2023). Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research. Frontiers in Public Health, 11, 935292. https://doi.org/10.3389/fpubh.2023.935292 [Google Scholar] [Crossref]

20. Woods, C. B., Volf, K., Kelly, L., Casey, B., Gelius, P., Messing, S., Götschi, T., Foster, C., Cowburn, G., & Estabrooks, P. (2021). The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review. Journal of Sport and Health Science, 10(3), 263–276. https://doi.org/10.1016/j.jshs.2021.01.006 [Google Scholar] [Crossref]

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