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Nutrition-Friendly Schools Initiative

(NFSI)

A school-based programme to address

the double burden of malnutrition

Department of Nutrition for Health and Development

Originally developed as a follow-up to the

WHO Expert Meeting on Childhood Obesity in Kobe (2005)

� effectively addressing the increasing global public health problem of the

double burden of malnutrition requires common policy options

� school-based programmes offer opportunities to gain access to children

and promote healthy dietary and physical activity patters for children

Nutrition-Friendly Schools Initiative

A brainstorming meeting in Montreux, February 2006

among partners (EDC, FAO, SCN, WFP and WHO)

� reviewed ongoing school-based health and nutrition-related programmes

� reviewed evidence base

� developed the NFSI framework

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1. Provide a framework for school-based programmes which

address the double burden of nutrition-related ill health

2. Serve as a mechanism for inter-connecting on-going

school-based programmes

Objectives

Surveillance

Nutrition and HIV/AIDS

Advocacy

Partnership development

Hygiene and food safety

Food security

Obesity & diet-related NCDs

Undernutrition

Vitamin and mineral deficiency

Healthy lifestyle

NFSI is designed to

address all aspects of malnutrition according to

country situation

NFSI is addressing

underlying factors through multiple strategies that are part of multisectoral food and nutrition action plans

NFSI, a school-based initiative with potential to address the double-burden of nutrition problems throughout the lifecourse

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Expected outcomes

To increase the number of schools that:

1. Provide an enabling environment for promoting health

and nutritional well-being of children and in turn

contribute to their improved learning and academic

achievements

2. Have close links with parents, local community and health

services in order to promote health and nutritional well-

being of children

3. Are accredited Nutrition-Friendly Schools

Why should schools care for nutrition?

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Child and adolescent nutrition is at a crossway in the lifecourse – nutritional well-being is crucial for

- Maximising their own intellectual potential and school performance

- Preventing the development of malnutrition in all its forms (i.e. undernutrition, micronutrient

malnutrition, obesity and diet-related NCDs)

- Securing the health of future generations through ensuring nutrition of adolescent girls

Child

malnutrition

Adolescent malnutrition

Fetal & infant

malnutrition

Elderly

malnutrition

Adult

malnutrition

Pregnancy

Low weight gain

Higher maternal

mortality

Reduced capacity for care

RapidRapid

growthgrowth

Inappropriate food, health & care

Inadequatecatch up growth

Impaired mentaldevelopment

Higher mortality rateInappropriate feeding practices

Frequent infections

Inappropriate food, health & care (including untimely/inappropriate

complementary feeding)

Societal and

environmental

factors

Inadequatefetal

nutrition

Source: Darnton-Hill, Nishida & James, 2002 (adapted)

Low birth weight & compromised body compositionLifecourse:

causal links

Reduced intellectual potential & reduced school performance

Inappropriate food, health & care

Inappropriate food, health & care

Reduced intellectual potential & reduced school performance

ObesityAbdominal

obesity

Diabetes,

CVD

Advantages of the school setting

• School settings offer many opportunities to promote healthy diet and physical activity habits for children

• Schools act as access points for engaging parents and community members in the prevention of diseases associated with poor child nutrition

• Healthy nutrition and sufficient physical activity improves child well-being and learning ability, leading to better academic performance

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Concept and principles

NFSI builds on the WHO/UNICEF Baby-friendly Hospital Initiative (BHFI)

Global Award Global Award Global Award Global Award PlaquePlaquePlaquePlaque

A school will be accredited as

Nutrition-Friendly Schools

when fulfilling

26 essential criteria identified in

5 core components of the NFSI

framework

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NFSI core components

1. Having a written Nutrition-Friendly Schools policy

2. Enhancing awareness and capacity building of

the school community

3. Developing a nutrition and health-promoting

school curriculum

4. Creating a supportive school environment

5. Providing supportive school nutrition and health

services

(5)

(3)

(4)

(11)

(3)

1. Having a written Nutrition-Friendly Schools policy

Essential criteria:

1. Written “Nutrition-Friendly Schools” policy that

addresses all five key components, and includes:

2. Rationale that covers healthy diet and eating practices,

physical activity, prevention of all forms of malnutrition,

and contributory factors

3. Objectives with timelines and clear milestones.

4. Action plan that takes a "whole school" approach and

describes processes, organizational structure, roles

and responsibilities, rights/ equity/ non-discrimination,

and a strong commitment by all concerned

stakeholders, including family and community.

5. Monitoring and evaluation plan for the school policy.

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2. Enhancing awareness and capacity building

of the school community

Essential criteria:

1. Dissemination of the “Nutrition-Friendly Schools” Policy.

2. Activities for families and community, community

involvement and outreach in the area of nutrition and

health related issues.

3. School staff training in nutrition and health related

issues.

3. Developing a nutrition and health-promoting

school curriculum

Essential criteria:

1. Culturally appropriate and effective nutrition education.

2. Age, sex and culturally appropriate physical education

curriculum.

3. Healthy living and life-skills education curriculum.

4. Regular monitoring of school curriculum relevant to the

NFSI, and evaluation of the impact of the education

against the objectives.

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4. Creating a supportive school environment

Essential criteria:

1. School meals, food vendors, snack bars promote healthy eating

2. Positive messaging towards nutrition and physical activity

3. Absence of marketing of unhealthy foods and beverages

4. Access to an adequate eating place

5. Adequate school cooking facilities.

6. Access to safe drinking water.

7. Promotion of safe hygiene and sanitary behaviour.

8. Availability of clean and separate toilets, for boys and girls.

9. Opportunity to access space and school sporting facilities

10. Affirmative action against bullying, stigmatization, discrimination.

11. School staff as role-models in encouraging healthy eating, physical activity and a healthy lifestyle.

5. Providing supportive school nutrition and health

services

Essential criteria:

1. Regular monitoring of children’s growth development.

2. Effective feedback system for parents and children of

findings of the regular monitoring.

3. A supportive school health service, including a referral

system.

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How to implement the NFSI?

Establish NFSI National Coordinating Committee

Country level implementation

Identify existing programmes and tools relevant to NFSI

Form NFSI National Designation Authority

Develop a NFSI dissemination plan

Coordinate and perform external school assessments and designations

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

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Form a Core Action Group

Implementation in schools

Conduct 1st Self-Appraisal

Develop School Action Plan

Report results of 1st appraisal to NFSI-NCC

Implement School Action Plan

Conduct 2nd Self-Appraisal

Request NFSI-NCC for external assessment

After 2 years, request external assessment

Maintain NFSI accreditation

Global Award

Plaque

Certificate of

commitment

Step 1:

Step 2:

Step 3:

Step 4:

Step 5:

Step 6:

Step 7:

Step 9:

Step 10:

AccreditationStep 8:

Progress to date

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Brazil Hungary

Canada India

Croatia Italy

Denmark Latvia

Finland Lithuania

Georgia Slovenia

Greece Switzerland

Grenada Uganda

Countries undertaken pilot-testing

of NFSI framework

Developments in EURO

• Capacity building workshop in Durham University

March 2009

• An official Member States Action Network on NFSI

was launched in March 2010

• First meeting was held 10 November 2010

• After finalization of the NFSI Modules (early 2011),

WHO EURO will scale up implementation and follow

up of NFSI

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Developments in EMRO

• NFSI utilised as a tool to implement the WHO Global

Strategy on Diet, Physical Activity and Health

• United Arab Emirates has taken the lead in the region,

requested and held series of advocacy and information

meetings plus a national workshop 29 Nov - 2 Dec

2010

How does NFSI link to other

school health initiatives?

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Nutrition-Friendly Schools Initiative

4 basic components

1. Health-related school policies 2. W&S, healthyschool environment3. Skills-based health

education 4. Health and nutrition services

3 strategies:1. Partnerships between teachers and health workers2. Community

partnerships3. Pupil participation

Improve learning outcomes through

health

2000

UNESCO, UNICEF, WHO, World Bank ,others

FRESH (Focusing Resources on Effective School Health)

Content

Goal

Year

Partners

5 key components with

22 essential criteria regarding nutrition-friendly schools policy, awareness and capacity building of the school

community, nutrition and health-promoting school curriculum, supportive school environment, and

school nutrition and health services

12 cost-effective

interventions to improve the health and nutrition of school-age children, including basic

education, food for education, W&S, health education, deworming, MN

supplementation, etc.

13 characteristic:

1. Children's rights2. Whole child3. Child centered4. Gender-sensitive5. Quality learning

6. Reality education7. Flexibility, diversity8. Inclusion 9. Mental and

physical health10. Affordable and accessible11. Teacher capacity12. Family focused

13. Community based

6 strategies regarding

1. Engagement of staff, students, parents and communities2. Safe and healthy environment

3. Skills-based health education4. Health services 5. Health-promoting

policies and practices6. Focus on community health concerns

Address the double burden of nutrition-

related ill health

Improve learning through health (focus

on undernutrition)

Rights-based, quality basic education in a

healthy environment

Health promotion according to context

200620021995 1995

EDC, FAO, SCN ,UNESCO, UNICEF, World Bank, WFP,WHO, others

UNICEF-WFPUNICEFWHO

NFSIEssential package (EP)

Child-Friendly Schools (CFS)

Health-Promoting Schools (HPS)

• psycho-social support

• Skills-based health/nutrition education

• Tri-partite

3. Strategies

• Nutrition education

• Health education

• School feeding/nutrition services

• Health and nutrition interventions*

• Healthy and secure school buildings and grounds

• Sanitation

• Water

• School policies

2. Core Components

• rights

• learning/education

• nutrition

• health

1. Main focus

NFSIEPCFSHPSFRESH

none / negligible

little

some

considerably

primarily / predominantly* Deworming; supplementation, screening)

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NFSI addresses all forms of malnutrition

What is specific to NFSI?

NFSI uses a global standardized evaluation and accreditation scheme

NFSI has a strong focus on developing supportive school environment which promotes nutritional well-being and

physical activity

Thank you!

For further information, please contact: NFSI@who.int