Improved school-based coverage through intersectoral coordination: The Kenya experience

Improved school-based deworming coverage through intersectoral coordination: The Kenya expereince

Kenya WHO/AFRO Library Cataloguing – in – Publication

Improved school-based deworming coverage through intersectoral coordination: the Kenya experience

1. Helminths – prevention and control – therapy 2. Intestinal diseases, parasitic – prevention and control – therapy 3. School health services 4. Health resources – supply and distribution – utilization 5. Organizational Case Studies 6. Public-Private Sector Partnerships

I. World Health Organization. Regional Office for Africa

ISBN: 978-929023260-5 (NLM Classification: WC 800)

© WHO Regional Office for Africa, 2013

Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: [email protected]. int). Requests for permission to reproduce or translate this publication, whether for sale or for non-commercial distribution, should be sent to the same address.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use.

Disclaimer: This report contains the collective views of the drafting team and does not necessarily represent the decisions or the stated policy of the World Health Organization. 9. References 8. Conclusion Analysis 7. 6. Results 5. Implementation 4. Methodology 3. Hypothesis Background 2. 1. Introduction Abstract Acknowledgments Contents ...... 12 11 10 iv 9 8 4 3 1 1 v

iii Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince iv Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince through theMinistryofHealthtoconductthisactivity. not but who cannotbementionedbyname.Last valuable inputsthroughouttheprocess Coordinator Risk Cluster; Africa The University ofCapeTown, SouthAfrica. However, The address socialdeterminantsofhealth. stakeholder level, on which waswidelydisseminatedduringtheWorldactions on intersectoral Conference An of prioritypublichealthconditions. experiences documentation ofcountrylevel of health.Itsupports and economicdeterminants social role ofMinistryHealthtoaddressing SDH istostrengthenleadershipandstewardship of of Health(SDH) was madeavailablethroughthe of This Acknowledgments the Health earlier Social least, overall final case Factors; the World are Dr product draft study Unit, review the gratefully we Determinants (Kenya); guidance in Davison policy Health in express drafting Dr using of World

WHO was received this Chandralall process is and acknowledged, Organization. prepared a intersectoral Dr case Health and Munodawafa, great HQ, team result Christine strategy of by leading study technical Health Geneva. included appreciation the of Organization, Sookram jointly collective Department was Spanish CoreContributionGrantforSocialDeterminants discussions actions The Kisia, to held namely: by inputs included We Programme the Dr overall the and in WHO Steward aimed are finalization for efforts Rio Ministry Regional to Mr Dr of the indebted aim in on the de Tigest Ethics (Kenya); Peter at a support of special of Kabaka, addressing Janeiro, project Area implementing of many Spanish of Office Phori; Health Ketsela, and to the Coordinator, and collection received from individuals the Social Brazil Ministry case for and and Core the Dr Director many Africa. WHO the intersectoral in key Determinants study Eshetu Dr Contribution from of of 2011. Social Eugenio social people Regional and global Determinants Public Financial Health generated the Bekele At organizations. Determinants determinants Government experiences the Health who Villar, Promotion actions Office of Grant support country Worku, Health made multi- SDH and and for for to The importantly,Most phase. this were dewormed. schools 8000 from children million 3.5 level personnel and16000 teachersweretrainedondewormingactivities attheendof division- districts, Over 1000 in theirrespectiveschools. pupils and toparents education health the dewormingtabletsandproviding foradministering teachers wereresponsible Training (SMC) includeparents,teachers,pupilsandcommunity representatives. GTZ, Security. and committee of coordinates and Coordinating Committee (SH-ICC) responsible forsocialandresourcemobilization Two 2009. programme and deworming and (Education This soil-transmitted helminthes(STH)isabove50%. deworming inareaswheretheprevalenceofworminfection WHO recommendsmass levels districtswithahighpopulationdensityappropriateformasstreatment. in 135 surveys, in in thecountry publicprimaryschools targetingall22000 based dewormingprogramme (MOPHS) launchedanationwideschool- HealthandSanitation the MinistryofPublic The school absenteeismby25%. western Kenyain Research (SBD) reduced deworming mass school-based that showed worm debts andexpenditure on healthcare.Studiesinthe United States have shown that life expectancy,performance, educational decreased and investments, and savings Existing levels duetoimpairedgrowthandphysicalfitness. children 2008 A Abstract national 2009. SBD programme coordination School Sanitation, parts crucial the report indicated JICA, infections at evidence in for using The Development community the of faecal Kenya. membership and technical AMREF national exercise. is Health the outlines Eastern Kenya district guided Geographic that Medical Public teachers recorded lower examination and also Existing and intestinal Medical and committees in aspects level provinces, the the The shows by and Health) literacy implementing include Services, Nutrition USAID the National coordination was evidence a was areas UN Information huge Research that National parasitic of of in levels partners done done school government 27 covering among improved Kenya, coordinate Programme targeted success Water School 729 shows through by through School worms the Institute and included schoolchildren and others. 13% other over Health first that (70%) included health activities. line the partnership Irrigation, affected the Health and of the line 45 phase (GIS) worm (KEMRI) The SBD: WHO, the ministries Technical district in status districts National lower ministries, terms Policy Coast, and Ministry school infections an The of the from Local the leads multisectoral undertook earnings a estimated established between planning of in Committee School of and World sub-national Master Central, 395 management scope this of Government the Education, to lead Guidelines Education increased schools private first Bank, later Health and two extensive Trainers and five to Western, worm committees. phase. (NSHTC), reduced implementation in million DFID, key was school-based sector, Public carried Inter-agency life and productivity, launched committees (MOE) prevalence (MT). extremely ministries The mapping UNICEF, by (56.8%) Nyanza Internal literacy Health NGOs which out 43%. SBD and The The in in

v Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince vi Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince programme. the that complement the sameexistingstructures which wereimplementedthrough meals, programmes This per childyear. cost-effective. deworming exercise such also The programme. deworming resulted as water, in sanitation This programme the has introduction and also had , ensured an and overall integration values sustainability cost and of of approximately life other of skills the school and deworming US$ school health 0.3 goals, levels, ontheagreedhealth international and at national both collaboration, intersectoral at the policy level with limited implementation.Implementationof policies requires which haveachieved good resultsandmadeanimpact,whilesome haveendedup have beenimplemented and programmes these policies development. Manyof economic The 2. Figure 1: targeting 22000publicprimaryschools. implemented DewormingProgramme inthreephases, a nationwideSchool-Based (MOPHS), launched HealthandSanitation of Public with theMinistry in partnership In better outcomesinchildandmaternalhealth. mortality relationship between the educationlevelandsubsequentchildmaternal of girls strong a have shown Studies conductedinthecountry health. child andmaternal of class and life expectancy,performance, educational decreased debts and investments, savings Evidence WHO guidelines(S.Brooker, 2008). worms andrequiredmassdewormingasper actually infectedwithintestinalparasitic survey based lower in benefits and infections. was According 1. No. of Public primaryschools No. ofPublic Population atriskofSTH Children outofschool School goingchildren Primary School(age)population Total population Related Data order the Kenya estimated expenditure social attendance earnings United including mass Background Introduction carried to of reduction; address has to access A Summary ofkeystatistics,Kenya Government and growing the deworming States out at shown later educational the 2008 10 on is in to these 624 with expected 2008 have health Millennium quality in body national that life 380 has two higher reduces estimated shown by of care. with education developed improved key outcomes. research to 43%. census, (primary Development determinants 9 positively that In school 108 addition, Research that worm 952 on the health various identifies Additional level) five absenteeism the (82%) total affect infections million individual the of Goals status education in policies number health, at strong health western overall high evidence (56.8%) (MDGs). leads lower by and the and of risk outcomes, links improvement levels 25%. school-age Kenya Ministry family of programmes school literacy to between also 10,624,380 40,863,000 intestinal There 9,108,952 1,963,047 8,661,333 A increased being 22,000 showed health national notes of specifically going levels is Education children directly children’s of an parasitic status. the for children the that urgent mass by productivity, social reciprocal student’s 13% linked in in school‐ Studies (MOE), worms Kenya health faecal areas need were and and to

1 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 2 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince primarily et al.,1993) memory andimmediate recallandlowoverallcognitiveability growth (,1993) live The of humidtropicsandarefoundcommonlyin school-agechildren and which aremostly water-borne,health conditions parasitic sanitary from poor resulting Kenyaand communicable facesnumerouschallengesinpreventingandcontrolling implementation ofdecentralizedpublichealthservices. motivation, inthecountry,by inadequateproduction inabilitytohireothers,braindrain,poor the healthsector,in resource crisis Human population. of to thestandards caused scarcity. helminthes to highsoil-transmitted which exposesthepopulation status, lowest socioeconomic and assistance financing The overwhelming majorityofhealthworkersareconcentratedinurbanareas. an and services Health facilities, centres. urban privileged elitesand weighted towards era andarethereforeunevenly of whatwasinheritedfromthecolonial they arereplicas problems and The and sanitation. have rural areas stands highlands the missionaryandcolonialsettlements,whichfavoured geographical morefertile .in absolute related to are still levels andpolicyactions education Literacyrates, DevelopmentHuman Report (national Kenya security. education, genderandculture,foodsecuritynutrition,environment,peace governance, as development such economic and social and health determinants among efforts andbystrengtheningthestronginterrelationship these goalsbyreinvigorating for the health years hygienic global average Eastern lack population access having has Kenya at and All in census of 80%; depends gaps and (Von-Shrinking,2002) (DALYs), a three from conflict disease . (STH) physical categories, young provision

provinces The to lower conditions. annual Government districts however, within modern has clusters: bilateral 2008). majority infections. population, of . Consequences associated with these infections include impaired with theseinfections . Consequencesassociated rates heavily ranked burden access fitness, expenditure the interest, of compared and particularly The

health the country due

new STH and the of and (52%) first the levels of to impaired (2004) the levels Lake to The multilateral technology corruption infections with these piped facilities . its limited in Lake have Kenyan Kenya’s

to on on of Victoria Kenyan development the 5-14

of doctors estimated other education the widened infections water. basin out-of-pocket information poverty youth access and years occur population and health donors. parts health to basin, health and (Western making More 40% address misuse that due in age to almost are of quantified partners sector nurses, the systems

part educational has The processing, than the system to 54% varied group up payments (90%) inequitable country of country. and the of no in Coast about 50% of is resources, Central are all access to the across new are 7% for also Nyanza) by is impoverished renew of in 48% are distributed province, total (Nokes et al., 1993, Bovin (Nokes etal.,1993, facilities. both index, The weak of reduced the for and short distribution faces and quite the to the of population services (Stephenson, 1994) population their has national males provinces re-emerging safe the and Eastern country disability-adjusted supply GDP. human high; Only parts undermined retrieval total commitment in drinking inappropriate, communities and of rural or 40% population Provinces, compared the with of resources was does have resource financial females Central of UNDP areas, health of some water living care long rate not the the the to . school and guideline documents has also been instrumental inguidingall health policyand guidelinedocumentshasalso school health school hence theacceptance of thenational various governmentsectors andpartners, among environment fromthegovernment andaconduciveenvironmentforcollaboration entry health. a in Since teachers trainedtoadministerdewormingtablets totheirpupils. Thirdly, as schoolsarenaturalplaces toaccessalargenumberofchildren. target population on First, for theselectionof mass dewormingexercise through the school healthprogramme. children goal ofthe comprehensive schoolhealthprogrammewhichaimstoachieve healthy The deworm schoolchildrenwasagreeduponasthebestpossiblesolution. the areas identified. help aged worms According 3. school attendance. competence andregular to educationandreducesocial achievement, hinderaccess damage selected status offamiliesthese children education There (above 50%)thatwereidentifiedformassdewormingtreatment. worm infections prevalence of density and population high with a districts 135 Provinces. areas levels (KEMRI) An Victoria basinhavehighhumiditymoisturessuitableforSTHsurvivalandgrowth. and country’s the the problem extensive school-based along of school-age point 13-14 country. 2003, in mapped is where Hypothesis results The (NSH) affect the the in the a children’s as using are the clear According a GIS, to programme for introduction economy an years country the conducive in the an directly the mapping Indian of This programme important the Kenya the included 135 evidence country estimated the prevalence children deworming national exhibited school health, Geographic is geographical was situation Ocean proportional and due and to environment is of has survey the cost-effective WHO used cost-effective suffer that discriminate social to health free the mass five by the on Coast taken the of (SBD) analysis need suggests primary to many guidelines, million the Information worm carried highest the recognition progress programme. identify faecal to targets deliberate Coastal and to highest for programme the (Kan, 1992) (Kan, infection stakeholders. control (56.8%) and education the and teaching as degree prevalence out that parts examination districts that and levels it cost-benefit mass GIS belt. System intensity of would by low steps the could There of also children education of is mapping. the . Consequently, massdewormingwas was The of and levels Eastern, STH in appropriate burden deworming above school use as to 2008 (GIS) of benefit Kenya Coastal was expected of The learning. survey infection, improve one STH activity existing worm of in 50%. in a of as development to Kenya. performance, general Central, Secondly, of supportive the from infection Medical STH establish one belt (2008), infections; the for There should to because the country infrastructure, Given so contribute mass infection, of of mass School-going major education is Western education the Kenya are easy low (70%).Through Research intestinal be the worm political deworming provided deworming. driving intestinal lower determinants several of socioeconomic this undertaken access magnitude and a to the and prevalence decision was and standards the especially academic forces the parasitic goodwill reasons children national Institute Nyanza a worms overall based health to good Lake were The the the to of of of in

3 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 4 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince ministry provided the deworming drugs, while the Ministry of Public HealthandSanitation ministry providedthe deworming drugs,whilethe Ministry ofPublic security, water The HealthandSanitationplayedtheroleofcoordinator.Ministries ofEducationandPublic committees, Various (SHN-TC) responsibleforproviding technicaladvicetotheSHN-ICC. programme. health and advocacy ofthecomprehensiveschool resource mobilization coordination, School intersectoral The Figure 2: guideline documents. safety. special responsibilits; areas, document wastoprovidecleardirectionsonthe implementation ofthe eight thematic Health the The 4. is duetothelong-termnatureofexpectedimpactindicators. rates, The as anentrye.g.water,point tootherschoolhealthprogrammes, sanitationandhygiene. implemented andusedeworming to havetheprogramme will atthattimewassupportive stakeholders National overall Ministries school-based Ministries and reduction which Methodology Policy The needs, Health especially government logistical National schoolhealthpolicyandguidelines documents,Kenya impact contributed Comprehensive organizational committees, The are: implementing and water of disability of Inter-Agency of other values Water Guidelines of Education school in dewormimg support the sanitation some sectors committee SBD and and most and abseentism jointly of to the programme rehabilitation; structure the were Coordinating and life School Irrigation the of and and school programme hard-to-reach skills; coordinated the schools. Public successfully is development hygiene; resources Health the and for gender health and on Health National drop implementation Internal and Committee education, Local (NCSH) was nutrition; the programme. and issues; out, school launched for and programme. implemented partners, Security Government School insecure the will programme. Sanitation, child including success disease infrastructure (SHN-ICC) be nationally Health analysed is and Finally, areas. rights, through clearly These Administration prevention of provided improvement under through Technical The The the child the responsible in in and spelt the programme. Medical are due 2009. existing National the protection environmental safe two two out the and course. umbrella Committee The of provided Services National in drinking national national political control; literacy for School policy these This and The the of played apivotalroleof advocatingforthedewormingactivityatalllevels ofsociety. myths inthecommunities resultinginvery high acceptancerates.Community leaders The community structures. and association parents-teachers existing the communitythrough involved intheplanningandimplementationof theprogrammewere parents, pupilsand school officers officers the assurance Public At andIECmaterialdevelopment. Advocacy • Monitoringandevaluation • Drugdistribution • Training • sub-committees, namely: The range ofgovernmentandnongovernmentalstakeholders. among awide and partnership cooperation programme istrulyanexampleofsuccessful school The programme data. for development information pills funding supportandsecuredmanagedthe assistance, donationofdeworming very the of evaluation and monitoring the planning, in especially support, technical WHO provided association forumsandlocalradiostations. media, parents-teachers media, print mass channels including on throughvarious receiving. they were and educateothermembersonthehealthmessages to inform formed groups to for administeringthe drugs andsupportedthe children physically by accompanying them The infections inthecountry. programme. Institute provided school. the programme; training Poverty training community school-based Japan from essential district Health health health in and (KEMRI) the the The charge With Education to International and of Action and material TAC They the health level, of Feed Officer, for teachers in teachers, messages the gave the support. training provided the Kenya tutors. divisional of also deworming provided the the World support staff health success the Officers District went District Children. provided and The Cooperation

parents, development materials consent for emphasized Bank, The evidence-based teams facilities, of a logistical trained Nutrition training has received of long Partnership Medical IPA programme DFID the crucial for which The pupils supported and way and activity. divisional the nurses and resource Agency Officer, KEMRI-Welcome support the the in Officer the other included information children and demystifying UNICEF training. for importance information master was The in deworming community-based community District Child (JICA) of teams charge persons. for ‘Deworm managed divisional Health, to provided the The training Development be by Education has finally any of of through dewormed, roll-out district-trained Trust monitoring The District efforts deworming dispensaries, the in been misconceptions public through financial sessions. trained a provided Kenya World’ cascaded and research a Officer NGOs, Clinical for health (PCD) long-term provided the various the support, for many provided Medical and teams The crucial trends and the area officers, head the Officer, supported to pattern. were or years. support Innovations interrelated community analysis two safe which partner cascaded education rumoured Research teachers, technical scientific of passed District clinical quality worm water Also This was the the of of

5 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 6 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince Figure 4: Figure The picturesbelowshowsomeofthetrainingmaterialsusedinprogramme. went smoothly andeachdistrictreceived enough materialsforthetrainingprogramme. ensured thattheroll-out but properadvanceplanning was quiteatediousprocess, district and Health materials hadbeenpreviouslydesignedandadoptedbytheMinistriesofPublic First, We Figure 3: will Sanitation the now training Training materialsproducedfor the school-based deworming programme A depictionofthetrainingcascade in Kenya talk and briefly action Education about plan was the and planning designed Training materials partners. and and Organizing logistics scheduled behind the with materials the timelines. deworming and The sorting roll-out. training by The Step Four: Divisiontoschools (teachertrainingsessions) sessions happenedconcurrently withthedrugdistributiontoschools. oversee specified their be dewormedin to targeted children of withthenumber accordance in headquarter The Step Three:Districttodivision(teacher trainingsessions) Poverty Action(IPA), anNGO, whichisactivelyinvolvedinthedeworming programme. the headquarters The Step Two: Movementofdrugsfromprovinces totargeteddistricts (Eldoret), Western (Kakamega)andCoast(Mombasa)provinces. Supplies The Step One:Nationalleveltoprovinces involved fivemajorsteps: The 500 mgwereusedduringthisfirstphase. million dosesofmebendazole in eachdistrict.116 mechanisms logistics communication and of transportation drug supplies(mebendazoleandalbendazole)establishment of the included theprepositioning Otherpreparations point. coordinating the central Nairobi, from the distance and district the the sizeof to according were planned trainings of doses of determined thenumber district each from deworming children targetedfor of On theotherhand,estimatednumber required foreachdistrict. materials training for All guide theentireprocess. This HealthandSanitation. training manualhadinitially been developed by the Ministry ofPublic gatherings and functions social out invarious to informandeducatethecommunitywerecarried community followedthereafter.teams andtheschool activities Communitymobilization Initiative Ministry training Ministry rolled The dewormers training each government divisional preparatory drug next drugs was peripheral out of of of and the Agency district. catchment ratified the phase distribution Public Education, 30 such materials were redistribution PCD programme. to national-level public for health (Ministry the activities as (KEMSA) The of Health and transported every coordinated churches, districts. distribution areas. health were number the adapted protocol facilities district. and of

involved Ministry of Thirty to organized officers The master Health Sanitation, The the the from of mosques, the by for facility Finally, involved regional in-charges trainees drugs master drug of the training the and (Divisional the trainers the Public into training in-charges/divisional quantity National national all Ministry KEMRI to national trainers medical chiefs’ the from pre-sorted logistics their session. Health on would distribution PHOs) of deworming each with estimates specified of School school meetings, were the storage depots and Education) relating Training support order master district oversee boxes selected, Sanitation, Health health in for schools. depot of the was etc.). Nyanza to public of from trainers, with determined each drugs the and personnel, the drugs Technical deworming done one of the appropriate A onward and district district health by The national (Kisumu), the from third Deworm the in the from from teacher Kenya May the core officers each Committee the and Innovation were transport distribution KEMRI. programme deworming the quantity 2009. quantities provincial Rift the team divisional from done Medical training district would World Valley and that The The the for by to of of

7 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 8 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince in August2009. national The support ofthedeworming programme. of and presided The 5. Figure 5: activities, therecording,reportingandmonitoringtoolswerealsodeveloped. Beforetheactualimplementationof whole cascadeprogrammeofthedrugdistribution. government together teacher/health Any Step Five:Reversecascade-schoolsbacktodivisiondistrict evaluation. the actualdewormingprocessandnecessarydocumentationforitsmonitoring drugs both National actual attended unused to Implementation ministries. level with the over deworming School healthcoordinationstructure,school-baseddeworming programme, Kenya of Deworming school drugs and the by by teacher/area Kenya both Honourable monitoring dissemination The are health Minister commenced and participants brought Programme the teachers/head education forms Ministers, of Innovation of back Education the made in back was June report through officer Assistant to speeches launched for teachers. 2009 and the to ensured Poverty the various divisional Minister while Ministers reverse on demonstrating The Action the April submission stakeholders of school data PHOs/facility Public 22, cascade. and (IPA) analysis 2009 head Permanent Health jointly of their at was the The teacher a was in-charges. strong colourful and supported accomplished unused school done Secretaries Sanitation oversees and drugs at event head firm The the the cost-effective. extremely in termsofscope, it wasalso Not onlywastheprogramme ahugesuccess the fivemillionchildrentargetedforphaseddeworming. benefited Most importantly,schools. in the8000 the dewormingprocess million childrendirectly 3.5 personnel all The 6. Minister forEducation,Hon.ProfessorSamOngeris,andthePublicHealthSanitation,BethMugo, successfully A schoolteacherdeliveringthedeworming tabletstothechildrenduringfirstphaseofprogramme inKenya. national Results from were programme the The reached. successfully programme cost to in A launching theschoolhealthdocumentsin2009. total Phase the trained and Government of One 16 were on 000 the targeted dewormed. teachers deworming of Kenya 45 districts and This was process. 1000 meant approximately and district- The 70% 8000 teachers success schools and US$ division-level supported rate that 0.24 out were per of

9 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 10 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince awareness onthebenefits ofdewormingschoolchildren. success various The entire community. involvement coordination the of led tothesuccess greatly helpedand infrastructures the school committees and The 7. programme foraperiodoffiveyearsuptoUS$14million. Nairobi. it inotherinitiallynon-targetedregions,e.g. government commitmentinsupporting Western comprehensive mechanisms thathavestructuresforimplementationofother enhanced coordination The mobilization, training,logistics,dewormingdrugs,monitoring,printedmaterials,etc. of from child approximately programme response use school-based development per Analysis channels The achieved of and year. Schoolchildren receivingdewormingtabletsduringthefirstphaseofprogrammeinKenya. the of increased of to Rift other This the school existing and US$ was the partners. by programme Valley deworming was line programme greater good 0.3 advocacy health reaching ministries, government supplemented per Provinces). in Therefore, involvement packages child the by cascading 70% has first through the development per also structures phase. of two The year. the by in the led the ministries of the approximately deworming programme programme This targeted This other to community initially the that partners, includes was partners. funding ( include targeted Health children evidenced programme has also UN US$ sensitization all of and the The established programme agencies, the regions raised and 0.06 national by Education) joint second had creating per the awareness (Coast, initiatives leadership an NGOs commendable child costs: coordinating phase coordination overall increased promoted per Nyanza, and social of using year cost and and the the other componentsofthe schoolhealthprogrammethroughestablished mechanisms. deworming target teachers community,donors, privateorganizations, including othergovernmentlineministries, of othersectors, of activities enabled theharmonization Sanitation Health and Public and The social mobilizationinitiative. teachers andcommunity,and activeinvolvementofschool by anintensive supported government various of the roles of coordination and effective leadership through made possible in A 8. ownership. community involvementand as wellstrong and infrastructures structures coordination to the intensive useofexisting partnerships insharingvariousrolesandresponsibilities, phase cost According and participationintheprogramme. and suppliesfromthe national level to theandincreasedpartnerinvolvement schools, of information the trainingofalltargetedteachersandgovernmentpersonnel,cascading The total the implementation establishment an population of 45 of Conclusion average 3.5 the and districts to School childrenutilizewatertanksandfacilitiesestablishedfordeworminghandwashing a million programme agencies existing child. students. of but targeted US$ school-going of The process evidence, it clear and proved This programme 0.4 was stakeholders, for per coordination intersectoral was US$ to the school-based child children be successful 0.3 first also quite per per phase year, (70% provided mechanisms action child use efficient, in deworming while of of of per achieving was the existing the for year. costing the target) not deworming the by overall The only programmes the introduction structures both less were low intended successful cost than cost Ministries successfully programme. in the and could and Kenya targets, in average other infrastructures in integration of be reaching dewormed for Education attributed countries including This the cost was first its of of

11 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince 12 Improved School-Based Deworming Coverage Through Intersectoral Coordination: The Kenya Expereince Kenya NationalCensus2008:MinistryofPlanningandVision,2030. presence oftreatmentexternalities. Miguel 1993, 87:148–15-21. helminthes Nokes Michael KremerandEdwardMiguel:Poverty ActionLabPaper No.6,September2001. 9. intervention received the that districts the 45 the impactin to compare experimental research trial increased performance, intelligence andacademic increased rates, absenteeism anddrop-out and One evaluation of References E.R C. the wage Bundy Kremer control. vis-à-vis strong of earnings D. the M. recommendations Transactions the Compliance programme’s (2002). districts and Worms: decreased that of and the outcome did Identifying from absenteeism Royal not health receive the Society indicators. care first impacts it in expenditure. phase in of schoolchildren: the Tropical These on first is health the phase include Medicine A need and randomized is education reduced implications recommended. for and monitoring Hygiene control school in the for

ISBN 978-929023260-5

978- 929023260- 5