HEALTH EDUCATION FOR AND BY CHILDREN Report of Workshop organised by CHETNA sponsored by Aga Khan Foundation New Delhi, 24-26 April, 1990 TABLE OF CONTENTS Page No. PREFACE 3 INTRODUCTION Objectives of the Workshop 5 Setting the Stage 7 SHARED EXPERIENCES Children in Urban Slums 11 A Hospital Gets Involved 13 Children on the Move 16 Going to Scale 18 Training at the Core 20 Child-to-Child through a Nutrition System 20 Community Contact is Critical 23 Working with the Most Deprived 24 Empowering Children 26 A State-Level Effort 28 INFORMAL EXCHANGES A Bouquet of Resources 35 OUR COLLECTIVE THOUGHTS 39 THE WORKSHOP'S RECOMMENDATIONS Group 1: Worker Selection and Training 44 Group 2: Media, Materials, Messages, Methods, Communication 45 Group 3: Coordination and Networking 46 Group 4: Monitoring and Evaluation 46 Group 5: Parent Education and Community Participation 47 A SESSION WITH POLICY-MAKERS 48 APPENDICES A. Workshop Programme i B. Workshop Participants and Resource Persons ii C. AKF-Funded Child-to-Child Projects in India viii D. Glossary ix PREFACE While child-centred health education in India is several decades old, health education efforts by children are relatively newer. Yet, both the governmental and non- governmental sectors have already gained considerable experience in health and education programmes. An exciting array of resources—human and material - is available to support and initiate efforts in health education for and by children. The Aga Khan Foundation sponsored a three-day Workshop which was organised on the Foundation's behalf by CHETNA in New Delhi during April 24-26, 1990. Over one hundred participants from all over India and a small number of key resource persons from overseas participated. A display of health education materials was an added attraction. This report is not just the traditional account of workshop "proceedings". Rather, it collates and analyses the presentations, collective thoughts and discussions of the participants over the three days. We hope this "state-of-the-art" document will stimulate further discussion and action in this important field. We are grateful to the many individuals and organisations who contributed to the conceptualisation and planning of the Workshop. We are especially grateful to the Central Health Education Bureau (CHEB), National Council for Educational Research and Training (NCERT), Voluntary Health Association of India (VHAI), and the Vishwa Yuvak Kendra, New Delhi. Special thanks go to the resource persons and participants who generously gave their time and engaged freely in discussions that have enabled the preparation of this report by Dr. Meera Chatterjee with assistance from Ms. Minaxi Shukla and Dr. Deepa Graver. INTRODUCTION The Workshop began. with a welcome by Dr. N.A. Siddiqui of the Aga Khan Foundation, India. He explained how AKF initiated Child-to-child projects in India, and described the background of the Workshop (see box. with an inaugural song by a group of children from a municipal school in Delhi. And with Minaxi Shukla and Sonal Mehta of CHETNA charting out the objectives and logistics of the Workshop. Objectives of the Workshop - To share and review the experiences of innovative approaches to health education for and by children, including the Child-to-child approach. - To identify and recommend strategies to integrate the lessons learned from governmental and non-governmental programmes. - To identify and recommend strategies to incorporate newer health education approaches into the larger education and health systems. The first day-and-a-half of the Workshop consisted of structured presentations of background information and issues, and of ten project experiences, with time for questions and discussion. From noon on the second day through the morning of the third day, there were informal exchanges, group discussions and presentations. The final afternoon was devoted to discussions with policy-makers, government officials and educationists from the Planning Commission, Ministry of Education, Ministry of Health and Family Welfare, the NCERT, and NGOs. The Workshop Programme is given in Appendix A How AKF Got Involved in Child-to-Child Projects in India and How this Workshop Came About Child health and development is a major area of programmatic interest at the Aga Khan Foundation (AKF). AKF initiated Child-to-Child programmes in India in 1986. The programmes, located at Bombay, Delhi and Gujarat, used different approaches to health and nutrition education. The programmes were conducted by a diverse range of agencies in equally diverse settings of urban formal schools, an urban slum, rural schools, and Mobile Creches for migrant groups. Programme delivery was through a Department of Community Medicine of an urban Medical College, Municipal Department and privately managed urban schools and NGOs. The basic premise of the programme was that children are natural communicators and, if equipped suitably, can be used to communicate health and nutrition messages to their peers, families and communities. The programmes had an in-built mechanism for training of teachers, supervisors and workers, as well as for on—going documentation, monitoring and evaluation. Concurrent evaluation of these projects was carried out by the Centre for Research and Development, Bombay, Lady Irwin College, New Delhi, and the M.S. University, Baroda. The Child-tp-child programme started with the organisation of a small workshop in 1985. A second workshop was sponsored by AKF in 1988 to review the experience gained thus far. It brought together implementors and those who were documenting and monitoring the projects. Both these workshops were organised by CHETNA. One of the recommendations of the second workshop was to hold a national workshop in 1989 to review the experiences accumulated over five to six years, see what lessons had been learned and where the programme should go. This Workshop was in the making for a year, with AKF, NCERT, VHAI and CHEB helping CHETNA to plan it. Although it was originally focussed on Child-to-child efforts, it was felt that broadening its scope to include other approaches to health and nutrition education would be beneficial. There was an enthusiatic response from invitees, and a mix of participants—representatives of implementing agencies in the government and NGO sectors, apex and funding agencies, public institutions, academics, researchers, government officials from the Education and Health Departments and from the Planning Commission (see Appendix B.) Participants were not compensated for their travel nor for attending the Workshop, an index of their keenness to attend. Althouth it started out as a National Workshop there were international participants as well - from Bangladesh, Pakistan, Tanzania, the Child-to-child Trust in London, and the Aga Khan Foundation, Geneva. Setting The Stage As learning from experience was a priority concern of the Workshop, it began by taking stock of past and existing efforts - exploring the "why" "what", "when", "where" and "how" of health education and the school-age child. To set the stage for the detailed project presentations and Workshop discussions, Dr. Deepa Grover and Dr. Meera Chatterjee presented a detailed review of health education efforts for and by school-age children, and raised issues emerging from this experience. Some major questions were: How can health education for and by children be incorporated into the large health and education systems? In general, how can these systems absorb the experience of smaller efforts? In particular, how relevant is the approach to India today? In the context of poverty and deprivation, how can children help themselves, help other children and help their families and communities, as the CtoC approach intends? To answer these questions, it was necessary to consider the school environment, the economic and social environments, and the bureaucratic environment. The School Environment. What is the physical and pedagogical "state-of- preparedness" of our schools? There are shortages of buildings, toilets, drinking water facilities, teachers, educational materials, and so on. However, there is the challenge of 700,000 schools and over 200,000 non-formal education (NFE) centers. For activity-based education, a change is clearly called for in the pedagogic environment. Is it necessary to introduce activity-based teaching across the curriculum? Can the education system handle this change with its current resources? In the short-run, CtoC efforts may be sustainable with intensive inputs as happens in pilot projects, but in the long-run, major systemic changes may be necessary. Teacher training has been emphasized as a critical need by several pilot projects, as the role of the teacher expands with health education. Teachers find activity based education time-consuming and an "extra burden". They say it does not fit into the exam- oriented system. It is necessary to deal with these resistances in order to propagate activity- based learning. Teachers have first to be socialised into new behavior. Both pre-service and in-service training are important, and training materials, manuals, etc. need to be reviewed. There is also the question of who should train teachers. A variety of modalities have been utilised in pilot projects. Teachers' value systems, beliefs, motivation, rewards, etc. also need to be examined. Another aspect of the pedagogic environment is the choice of health topics. How many topics should there be? Which ones? Who will select them?