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Resources on Effective School Health ~rvw jarf Resources on Effective School Health: Public Disclosure Authorized a FRESH Start to Enhancing the Quality and Equity of Education 24523 July 2002 Public Disclosure Authorized 4i4 A= ;|~ Public Disclosure Authorized Chad, Mali, Mozambique, Tanzania, Uganda Public Disclosure Authorized a___ unicefu sFund *IN[ C United Nations Children's Fund School Health Situation Analyses Chad, Mali, Mozambique, Tanzania, Uganda A Situation Analysis: A Participatory Approach to Building Programmes that Promote Health, Nutrition and Learning in Schools-The Partnershipfor Child Development A Survey of the Health of School Children in Chad-MichaelBeasley and Simon Booker School Based Health and Nutrition: Preliminary Information for the Development of a Program in Mali-MichaelBeasley, Penelope Bender, Don Bundy, and Robert Prouty School Health, Hygiene and Nutrition: Mali, Mission Report-MartineLugat Pre-identification of a School Health and Nutrition Component in the Education Sector in Mozambique-Annegrete Liljestrand A Situation Analysis of the Health of School Children and Current School Health and Nutrition Programs in Tanzania-Matthew Jukes and DamarisNgorosho Preliminary Situation Analysis: School Health in Uganda-Seung-heeF. Lee Foreword School health and nutrition programs provide one of the most cost-effective ways to promote the education, health, and nutrition of school children, particularly if they are developed as part of community partnerships and delivered by the education sector. Such programs have an additional importance today because they provide one of the most important ways to reach adolescents and the broader community with messages about HIV/AIDS prevention. School-based health and nutrition programs are not a new concept, but historically such programs have often been inefficient and retrogressive, usually favoring the better off children in urban centers. A new efficient and progressive approach to school health has now been developed by a partnership of agencies, including UNESCO, WHO, UNICEF, WFP, and the World Bank. This framework for action seeks to Focus Resources on Effective School Health through the FRESH concerted action program and was launched by its sponsoring agencies at the World Education Forum in Dakar, April 2000. The four "pillars" of the FRESH framework are: (i) health-related school policies; (ii) provision of sanitation and clean water; (iii) a skills-based approach to health, hygiene, and nutrition education; and (iv) school-based health and nutrition services. The FRESH framework is intended to assist governments in selecting interventions that respond to the health and nutrition needs of school children, and that are feasible to implement in even the most resource-poor schools. This approach depends on carefully identifying the most important problems for which solutions are available. The cost effectiveness of this approach is dependent on careful selection and targeting of interventions. The essential first step for governments in preparing or updating their school health programs is to conduct a situation analysis which can identify the major health and nutrition challenges that are relevant to education, and which can characterize the operational opportunities to respond. Developing a cost-effective approach to such analysis was an important part of the process of creating the FRESH framework and is described in some detail in the first section "Guidelines" of the present document. But the major aim of this document is to provide some examples of how countries have in practice implemented situation analyses, and what their conclusions were. The analyses presented here were conducted by different people in a wide range of countries in Africa with very different health and education systems. Nevertheless, it is apparent that there are some common conclusions and a remarkable consensus around the need for the four major pillars of the FRESH framework. Finally, we thank the Government of Norway for providing financial support through the Norwegian Education Trust Fund for the preparation of this report. Ruth Kagia Education Director Human Development Network World Bank Introduction This book is intended to help the development of school health and nutrition programs that are cost effective and which respond to local needs. It is aimed at those who are about to develop a national school health program and who would like to learn from the experiences of others. The first part of the book offers some guidelines on how to conduct a Situation Analysis. The situation analyses aim to show: What are the challenges to the health and nutrition of school children in a specific country? What is already being done to improve the health and nutrition of schoolchildren at the district or national level? and What opportunities there are for strengthening this response. These guidelines were developed by a consortium of agencies using a remarkably participatory process that has resulted in a deceptively simple approach that has proven effective in practice. The history of the development of the approach is described in the introduction to the guidelines, which are the joint product of collaboration among UNICEF, USAID (Africa Bureau), WHO, the Edna McConnell Clark Foundation, the Partnership for Child Development, and the World Bank. The book then presents a series of actual Situation Analyses conducted in very different countries in Francophone, Lusaphone, and Anglophone areas of Sub-Saharan Africa. These reports help illustrate the real challenges and opportunities that exist for school health and nutrition programming. The examples all arise from the preparation of World Bank Projects, but were conducted by very different teams, even though they used a consistent framework for analysis. The reports describe some countries with relatively extensive data sources, but also describe those for which information on the health of schoolchildren is almost completely lacking. They illustrate that, even among the low-income countries of Africa, very different approaches-and levels of effort-may be required to achieve a sufficient level of understanding to plan an effective school health program. The guidelines and the reports are the products of real experience. As a result the situation analyses are often incomplete-perhaps because it would be too expensive to find out more-and often flawed-perhaps because real infrastructures fall short of ideal systems. There has been no attempt to fill in gaps or remove inconsistencies. The situation analyses are presented here not as examples of perfect studies, but rather to share real world experiences. This compilation was assembled by Don Bundy, Seung-hee Frances Lee, and Robert Prouty working with the Africa Region and Human Development Network of the World Bank. GUIDELINES A Situation Analysis A Participatory Approach to Building Programmes that Promote Health, Nutrition and Learning in Schools Partnership for ISHI hWRLOANK I I ____ IIr. k7 OtEAL Child Development _^ US AGLNCY FORINl ERNAl tJNAL World Health f The Edna McConnell ; DFMLOPMFNT BURFAU FOR AFRICA, Organisation Clark Foundation 1 1 DLVLLOPMLN r, LDuCAIEION rEN1 The Partnership for ChildDevelopment (PCD)was established In 1992 to help co-ordinate global efforts to assess the deneoprrental burden of ill health andpoor nubtitn at sool age.It bdngs togethera ronsortium of countries, donororganisations and centres of academic excellence to design andtest strategies to Improve the health and education of schooP-agechildren. The Partnership has Intemational agency support from UNDP, vVHO,UNICEF, The World Bank and British DFID, andis sustained through support from participating govemments, the Rockefeller, Edna McConnell Clark andJames S McDonnell Foundations and the Welkome Trust The Sdentitlc Coordinating Centre for the Partnership Is based at: The Department of Infectious Disease Epidemiology, Imperial Collea School of Medicine, SL Mary's Campus,Norfolk Place,London, W2 IPG, UK. TeUFax:+44 (0) 207 262 7912 Web: htln /twww.schoolsandhealghoro Guidelines 2 Acknowledgements * Susan Zimicki and others who did field-testing. * French Translation by Daniel Dupecher, for the ABEL II Project (AED), USAID. * Portuguese translation by Ana Leao for Save the Children (USA)/ Mozambique. * Hindi translation by Ms. Saumya with assistance from Dr. Shally Awasthi, Uttar Pradesh, India. * Kiswahili translation by Ms. Damaris Ngorosho MAKWAMI project, Bagamoyo, Tanzania. * Spanish translation by Sergio Meresman, World Bank, Washington, DC, USA. * Extracto de "Escuelas Promotoras de Salud: Modelo y Gufa para la Acci6n" de la Serie de Desarrollo y Fortalecimiento de los Sistemas Locales de Salud, HSP/SILOS- 36, Organizaci6n Panamericana de la Salud, Washington, DC, 1996. Guidelines 3 About this Document The development of this Situation Analysis document is an example of inter-agency collaboration in response to a common challenge. This challenge emerged at the end of the 1980s when it became apparent that child survival programmes were becoming increasingly successful and that an increasing proportion of children - more than 90% on average, world- wide - were surviving to reach school age. At the same time there was an acceleration of efforts to provide education for all, and to work towards achieving universal access to basic education. A new vision for the 1990s was established: more children of school age, and more in school, than at any time in human history. But who were these 'new' schoolchildren? Overwhelmingly,
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