Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Human Development DIRECTIONS INDEVELOPMENT A Key Component of Education forAll ofEducation Component A Key Rethinking School Health Donald Bundy Rethinking School Health Rethinking School Health A Key Component of Education for All Donald Bundy © 2011 The International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org All rights reserved 1 2 3 4 14 13 12 11 Preparation of this volume was led by staff of the International Bank for Reconstruction and Development / The World Bank. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: [email protected]. ISBN: 978-0-8213-7907-3 eISBN: 978-0-8213-8397-1 DOI: 10.1596/978-0-8213-7907-3 Library of Congress Cataloging-in-Publication Data Rethinking school health : a key component of education for all / Donald Bundy, editor. p. cm. — (Directions in development) Includes bibliographical references. ISBN 978-0-8213-7907-3 (alk. paper) — ISBN 978-0-8213-8397-1 1. School health services—United States—Evaluation. 2. School health services—United States—Planning. 3. School children—Health and hygiene—United States. 4. School hygiene—United States. I. Bundy, Donald. II. World Bank. LB3409.U5S355 2011 371.7'1—dc22 2010044310 Cover photo: Lesley Drake/Deworm the World Cover design: Quantum Think Contents Foreword xiii About the Book xv Acknowledgments xvii Contributors xix Abbreviations xxv Executive Summary1 A Strong Education Rationale for Ensuring Good Health and Avoiding Hunger at School Age2 Education Sector Benefits from a Life-Cycle Approach to Child Development 2 Health and Nutrition Interventions that Promote Gender Equity and Equality and Contribute to MDG3 3 Schools that Effectively Deliver School Health and Nutrition Interventions 4 The Substantial Experience of School Health and Nutrition Programs in Practice5 Important Technical Challenges Remain7 v vi Contents The Importance of Partnerships to the Development of School Health and Nutrition Programs7 Evolving Roles for Development Partners8 Benefits of Simplification and Consolidation of Program within Education Sector Plans9 Enough Known to Act Now 10 Notes 11 Chapter 1 Context and Rationale 13 How This Book Is Organized 13 100 Years of School Health and School Feeding Programs in Rich Countries 15 Movement of School Health and Nutrition Programs to a Pro-Poor and Education- Outcomes Focus 16 Greater Harmonization of School Health and Nutrition Programs around a Common Framework 17 Growth in School Health Programs in Low-Income Countries since Dakar 2000 20 Emergence of HIV as a Programmatic Issue for the Education Sector 20 Growing Recognition of the Importance of School Feeding for Education 23 Rising Prevalence of Noncommunicable Diseases in School-Age Children in Low-Income Countries 26 Ensuring Support for the Most Marginalized Out-of-School Children 26 School Health and Nutrition Programs Today 27 Notes 28 References 28 Chapter 2 Evidence of the Importance of Health and Nutrition for Education for All 33 Impact on Education of Health and Nutrition Interventions at Different Stages in the Life Cycle of the Child 33 Contents vii Evidence for Strategic Objective 1: Ensuring that Children Are Ready to Learn and Enroll on Time 36 Evidence for Strategic Objective 2: Keeping Children in School by Enhancing Attendance and Reducing Dropout Rates 40 Evidence for Strategic Objective 3: Improving Learning at School by Enhancing Cognition and Educational Achievement 42 Estimating the Scale of Impact of Health and Nutrition on Educational Outcomes 48 Estimating the Scale of Benefit of Health and Nutrition Interventions 51 Conclusions: Evidence of the Importance of Health and Nutrition for Education for All 59 Notes 61 References 62 Chapter 3 Education Sector Responses to the Health and Nutrition of Schoolchildren 67 Interventions before School Age 67 Maternal and Child Health 68 Early Child Development Programs 69 Interventions at School Age 73 Deworming 74 School Feeding 77 Micronutrients 88 Malaria Control 94 HIV Prevention and Care 98 Hygiene, Water, and Sanitation 109 Promoting Oral Health 111 Childhood Disability, Education, and School Health 116 Vision: Correcting Refractive Error 120 Prevention of Noncommunicable Diseases 126 Conclusions: Education Sector Responses to the Health and Nutrition of Schoolchildren 134 Notes 138 References 139 viii Contents Chapter 4 School Health and Nutrition Programs in Practice 159 Issues in Designing School Health and Nutrition Programs 160 Expanding Coverage and Targeting the Poor 160 Defining Sectoral Roles 161 Delivery Costs and the Use of the School as a Platform 164 Prioritizing Interventions on the Basis of Cost and Need 165 Examples of Programs in Practice 168 Expanding and Refining Existing Programs 168 The Philippines’ Fit for School Program 168 The Sri Lanka School Health Promotion Program 174 School health and school feeding in Guyana 177 Including the Components of School Health and Nutrition Programs in a Sectorwide Education Approach 180 The Kenya education SWAp approach 180 Strengthening school health in Indonesia 184 Conclusion: School Health and Nutrition Programs in Practice 188 Note 190 References 190 Chapter 5 Partnerships to Develop Consensus and Share Knowledge 193 Design and Implementation Issues for School Health and Nutrition Programs 194 Design and Implementation Issues for HIV/AIDS and Education Programs 208 Intergovernmental Regional Networks that Share Knowledge among Countries 215 Support for National Programs 223 Conclusions: Partnerships Develop Consensus and Share Knowledge 232 Notes 235 References 235 Contents ix Chapter 6 School Health and Nutrition Programs as a Component of Education for All 237 The Education Sector Case for School Health and Nutrition Programs 238 A Life-Cycle Approach to Child Development and Education 240 Health and Nutrition Interventions Can Promote Gender Equity and Equality and Contribute to MDG3 241 The Unfinished Research Agenda 241 An Evolving Role for Development Partners 242 A Time for Consolidation 244 Safe and Simple Interventions that Reach the Poor 244 Enough Known to Act Now 245 Appendix A Selected Bibliography of Source Materials and Toolkits 247 Appendix B Accelerating Deworming by the Education Sector: Checklist of Good Practice 255 Appendix C Accelerating the HIV/AIDS Response of the Education Sector in Africa: Checklist of Good Practice 261 Appendix D School Health and Nutrition Programs by Country in Sub-Saharan Africa, the Greater Mekong Subregion, and the Caribbean 269 Index 287 Boxes 3.1 Home-Grown School Feeding 84 3.2 Effective Sexuality Education 105 3.3 Promoting Hand Washing with Soap in Schools: The Institutionalizing of Hygiene in the Education Sector in Peru 112 xContents 3.4 Kenya’s Innovative Way to Provide Safe Drinking Water to Schoolchildren 113 3.5 EFA–Fast Track Initiative and the Assessment of Childhood Disability 121 3.6 New Approaches: Bridging the Gap and Lowering the Barrier to Refractive Services 127 4.1 Identifying Priority Interventions in Eritrea 166 4.2 Kenya’s National Deworming Program 169 5.1 Excerpt from Statement of Technical Meeting on Building School Partnerships for Health, Education Achievements, and Development (Vancouver, 2007) 201 5.2 Thematic Areas for Monitoring and Evaluation 206 5.3 Nine Criteria for Identifying M&E Indicators for HIV and AIDS Education Responses 208 5.4 Countries Participating in the Accelerate Initiative 216 6.1 A Development Partner Dilemma: No DAC Purpose Codes Exist for School Health Programs 243 Figures 1.1 Support for School Health Activities by Education Sector Development Partners, 2000–07 21 1.2 Support for School Health Programs in Sub-Saharan Africa and South and East Asia since 2000 22 2.1 Health and Nutrition Interventions throughout Childhood Contribute to Education Outcomes 34 2.2 Relationship between Stunting and Late Enrollment in Schoolchildren from Ghana and Tanzania 37 2.3 Impact of Early Childhood Malaria Chemoprophylaxis on Educational Attainment in The Gambia 40 2.4 Age Distribution of Infection-Specific Morbidity 43 2.5