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SHN Programmes: A Global GoodLesley Drake PhDExecutive Director
Partnership for Child Development
1.THE IMPORTANCE OF A GOOD START IN LIFE: ALIVE & THRIVE
2.SCALING UP INTEGRATED INTERVENTIONS
3.SUPPORT FROM PARTNERS: ALIGNING CONCEPTS
THE IMPORTANCE OF A GOOD START IN LIFE: ALIVE & THRIVE
State of the Problem
1. 58 million children still out of school
2. 400 million school aged children still infected
with worms
3. 690 million still suffering from poor vision
4. 66 million still going hungry to school
The Key to Sustainability and Scalability
• Research needs to feed into ongoing programming
• We learn as go
How did we get here?
80s: The evidence base – links between health, nutrition & education.
90s: Developing school health policies.
00s: Mainstreaming approaches across sectors.
A Historical Reflection
1990 2000 2005 2007
Jomtien: World Conference on
EFA, EFA Declared
Dakar: World Education Forum,
Framework for Action
Siem Reap: Workshop to Strengthen the Education Sector Response to SHN
Nairobi: Launch of Africa SHN Training
Courses for Government Staff
2010 2011 2015…
Fit for School Regional
Conference
Addis Ababa: Declaration of the High-Level Group on EFA
Bangkok: Launch of Asia SHN Training
Courses for Government Staff
MDGs become SDGs…
A Historical Reflection
2015: MDGs Become SDGs
MDGs (2000-2015):– Policy frameworks– Mainstreaming– Cross-sectoral relationships defined
SDGs (2015-2030):– Chance to build on mainstreaming– Making programmes inclusive– Ensuring that SHN ‘goes viral’
• Focusing
• Resources on
• Effective
• School
• Health, hygiene & nutrition programs
The FRESH Framework: 15 Years
Policy Environment
Health Education Services
The FRESH Framework: 15 Years
School Health & Nutrition Policy
Policy & Partnerships
• High-level political support
• Cross-sectoral collaboration
• Roles and responsibilities
Examples from Lao PDR: Policy and Implementation Guidelines, produced 2005, revised 2010 with Joint MOE/MOH sign-off.
Skills-based Health Education
Education a “social vaccine”?HIV prevalence by education category, Rural Uganda, 1990-2001.
Individuals aged 18-29.
De Walque and J Whitworth, MRC Uganda (2002)
School-based Services:School Feeding & Nutrition
School Feeding• In-School Feeding
– Meals– Fortified high-energy biscuits and snacks– Alleviate short-term hunger and micronutrient
deficiencies, increase attention span and facilitate learning. Also increase school access and enrolment
• Take-home rations– Transferring food resources to families conditional on
enrolment
• Micronutrient fortification and supplementation– Includes addition of iron, iodine, vitamin A, B
and zinc– Fortification of food, or sprinkles
School feeding: Country programs (2006-08)Category 1: Countries where school feeding is available in most schools, sometimes or always; Category 2: Countries where school feeding is available in some way and at some scale; Category 3: Countries where school feeding is available primarily in the most food insecure regions; Category 4: Countries where there is no school feeding. The sources, as detailed in the database link, are WFP data for low income and lower middle income countries and national data for the remaining countries.
Partnership for Child Development. http://www.schoolsandhealth.org/Pages/SchoolNutritionFoodforEducation.aspx
• Promoting agricultural development by improving access to the school feeding market
• A win-win– for children and
communities… improving their education, health, and nutrition
– Smallholder farmers…providing regular orders and a reliable income
Home Grown School Feeding
The School Meals Planner: Evidence into Action
A contextual approach to:
Cost effective and nutritious menu planning
Behaviour change and nutrition education
Improve market access for smallholder farmers
www.hgsf-global.org
Energy 2000kcal Protein 28g Vitamin A 700mcg
Vitamin C 45mg Iron 37mg Zinc 15mg Iodine 120mcg
31%48%
0%
0% 0%
16% 20%
Maize porridge, 500 g.
Energy 2000kcal Vitamin A 700mcg
Vitamin C 45mg Iron 37mg Zinc 15mg Iodine 120mcg
31%48%
0%
0% 0%
16% 20%
100%
33%
61%74%
73%
24% 23%
47%
++108% Maize, CL,
Iodized Salt, Groundnuts,
31%
Protein 28g
34%
School-based Services:Deworming Programmes
Deworming Programmes
Ancylocstoma duodenaleNecator americanus(hookworm)
Trichuris trichiura(whipworm)
Ascaris lumbricoides(roundworm)
Schistosoma haematobiumS. MansoniS. japonicum
Improved school attendancefollowing deworming
0.6
0.65
0.7
0.75
0.8
0.85
Att
end
ance
Rat
e
Untreated Schools
Treated Schools
Treatment 1 Treatment 2
0 2 4 6 8 10 12
Months Since Baseline
Busia, KenyaSource: Miguel and Kremer 2000
School-based Services:Health screening & inclusion
-Innovative/inclusive IEC materials, particularly for deaf children
-Improving accessibility and outreach
-Training teachers and students on inclusion
Integrating Inclusive Components into SHN Programmes
• Referral of children to local health facilities and on-site provision of assistive devices (e.g. spectacles)
Health & disability screening in schools• Trained teachers identify the presence
of health problems amongst children. • Screening children for:
Refractive error & disabilities Common infections
Cambodia Vision Screening & Scale-up: 2012-14
• Government of Cambodia scaling up nationally in 2015, addressing this need cost-effectively and raising awareness
• School-based screening (n=12,500) • Provision of eye glasses on the same day• Initial screening by trained teachers• 6 month follow up • 100% agreement between teacher
screening and professional screening
School-based Services:Oral Health
Addressing dental caries: can affect food intake, reduce quality of life and lead to increased absenteeism if not addressed
Oral Health Provision
Safe & Sanitary School Environment: WASH
Safe & Sanitary School Environment: WASH
WAter
Image credits: Aubrey Wade/WaterAid/Panos
Image credits: WSSCC http://www.wsscc.org/resources/resource-photo/toilets-south-africa#3
Image credits: UNICEF, UNICEFBANA2011-01020Shafiqulhttp://www.unicef.bg/en/article/On-Global-Handwashing-Day-UNICEF-says-It-s-not-complicated-but-it-s-crucial/375
HygieneSanitation
FRESH: Strengthened Through Partnership
Under-pinned by effective partnerships, especially between the education and health sectors
INTEGRATING AND SCALING UP SHN PROGRAMMES
Integrated SHN in Africa: The Enhanced School Health Initiative
(ESHI)
Southern Nations Nationalities People’s Region Ethiopia (SNNPR)
An Integrated Approach: Situational analysis in SNNPR
Schistosomiasis prevalenceSTH prevalence
Water collection in schools School Feeding status
A multi-partner response: Integrating school health interventions in SNNPR
Baseline mapping, 35,600 children screened.
Case study intervention in 30 schools, 31,000 children.
ESHI
Deworming
Improved WASH
Health Education
School Feeding
School Health & Nutrition Case Study Interventions
Fully Integrated SHN(Deworming, HGSF & WASH in Ethiopia)
Food43%
Transport8%
Monitoring3%
Other Direct10%
Training/Awareness
7%
Indirect7%
Deprecia-tion (cap-
ital)7%
Gov-ern-
ment2%
Com-munity
15%
Overall: $35.15 per child per year.
Deworming:$0.40 per child (drugs were donated)Made up of transport and salary costs
Overall WASH and deworming:$6.68/chd/yr$1.05 in CC and $0.06 in government contribution
Overall SF:$28.01/chd/yrIncluding a $4.16 CC & $0.57 Local Government cost
• Fit for School: Cambodia, Indonesia, Lao PDR, Philippines.
Hand washing | Oral Health | Deworming
Integrated SHN in Asia
Monitoring and Evaluating SHN Programmes
MONITORING AND EVALUATING SCHOOL HEALTH PROGRAMMES
Large exercise to benchmark education
sub-systems
Comparative data and Knowledge on
Education Policies and Institutions
SABER
SystemsApproach BetterEducationResults
M&E OUTPUTS: FRESH & SABER
Structured Identification
Gaps Priorities
Evidence Base Action
Plan and M&E
Stakeholder mobilisation
Stronger coordination
SUPPORT FROM PARTNERS: ALIGNING CONCEPTS
Partnerships and integrated policy
Community, Schools & Teachers
NGOs
Donors
International organisations
Government
MoH
MoE
Technical Development Planning
• Government-led and harmonised with partners
• A roadmap for development
• Roles and responsibilities defined
Examples from Ghana: the Ghana Minister of Local Government and Rural Development signs the joint TDP for school feeding with PCD Regional Manager, Daniel Mumuni.
Achieving Scalability and Sustainability
• Institutionalisation and mainstreaming into ESPs is key
• Strong M&E for evidence-based, contextual programming
• Roles and responsibilities of sectors defined at all levels
• Advocacy strategy crucial
Find out more:
PartnershipforChildDevelopment
Follow:SHN @schoolhealth HGSF @HGSFglobal
www.schoolsandhealth.org
www.imperial.ac.uk/pcd www.hgsf-global.org
• Carry on with what you’re doing
• Fit for school is an example of global good practice
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