Lessons learned in the implementation of strategies in schools: the case of Chile.

Marcia Erazo

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Obesity prevalence

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www.thelancet.com Published online February 4, 2011BMI (KG/M2)

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School-children obesity rates

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School-based strategies

• Chile, following the guidance of the World Health Organization, in 2007 implemented a series of strategies at schools (1000 schools nationwide).

Main strategies • Healthy kiosks: To reduce the exposure to “junk

food” at school.

• Physical education: To increase the total hours of physical activity

• Health promotion: To introduce health topics on a regular basis at school

Objective

• To analyze the barriers and facilitators to the implementation of strategies in schools.

• Complete reports at:• http://www.minsal.cl/portal/url/page/minsalcl/g_proteccion/

g_alimentos/prot_ego.html

First evaluation (2010)

• Qualitative evaluation, aimed to evaluate the process of implementation at regional and community level.

• Focus group and key stakeholders interviews.

Results

•At regional level:•Horizontal articulation:

• Technical orientations are applied al community level.

• Metropolitan area, there is a lack of coordination.

• There is inter-sectorial work between sports and educational institutions, that work together.

Results

• Vertical integration:

• There is intra-sectorial integration, especially when, at community level, there is a person designated to work the health promotion.

• Monitoring, supervising and accompanying the implementation at community level

Results

• Horizontal articulation at community level:

• There is inter-sectorial work.• Only actions at school level, once a

month.• “The school” sees this activity as an

“extra”.

Second evaluation (2010)

• Quantitave and qualitative methods

• Weight, height• Interviews

Results

Results

Results

Results

Third evaluation (2011)

Facilitators

• Principal’s will, by encouraging healthy habits.

• Possitive assessment of students in more hours of physical activity.

Barriers• Selling unhealthy foods at school.• To give money to children• Lack of continuity of interventions.

• Lack of intra-extra sectorial coordination• Managerial failure

• Lack of “political agreement”

School-based intervention in one community

• Presented in a seminar of successful practices to prevent childhood obesity, organized by PAHO, in Santiago-Chile, January 21-22, 2013.

• Conducted by Municipalidad de Peñalolén• http://www.paho.org/chi/

School-based intervention in one community

• Intervention:• Physical activity:

• 3 hours a week, in different days, specialized teacher, active pauses.

• Healthy eating and nutrition• Anthropometry• Healthy eating education to children, parents

and school community.• Healthy kiosks• Health promotion

Results

Physical activity

2009 2012

Hours 100% <2 a week 100% 3 hrs a wek

Distribution 1 day a week 3 days a week

Professional General teacher Specialized teacher

Active pause

Healthy kiosks

• Change in “terms of reference” to manage to kiosks

Lessons learned• Sustainability of the program is given by:

• Central management• Coordinated Inter-sectorial work• Inclusion of the strategies in the community

health plans and official documents.

Lessons learned

• Successful of the program is given by • The leadership and commitment of the school

principal, • Permanent monitoring of the correct

implementation of strategies, • Fcus on promoting healthy habits to children and

their families, • Reinforcement by regulation within and outside of

the schools of junk food

Thank you!!