School Health and Nutrition Programs

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School Health and Nutrition Programs
Donald Bundy Human Development Network The World
BankSanaa, Yemen, January 23, 2007
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Improvement in School Attendance Following
De-Worming in Busia, Kenya
Treatment 1
Treatment 2
0.85
0.8
0.75
Attendance Rate
0.7
0.65
0.6
0
2
4
6
8
10
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Months Since Baseline
Miguel Kremer, 2000
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IQ and schooling losses avoidable by school based
SHN programs
Condition Prevalence/ No. Cases IQ loss Per Child Total IQ loss /mental retardation Years of schooling lost
Stunting 52/292m 3 points 877 (21.6m) 284m
Anaemia 53/298m 6 points 1788 (45.6m) 524m
Worms 30/169m 3.75 points 633 (15.8m) 201m

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Examples of school based SHN programs
Country Program No. Students No. Schools Cost US
Guinea Mainstream public sector 350,000 600 0.89
Madagascar Program public sector 430,000 4,585 0.78-1.08
Tajikistan Social Fund 100,000 200 1.00
Indonesia Private sector 161,000 627 0.10
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Comparing returns to education
Add years schooling
Cost US p.a. SHN Programs
1.2 2.5 lt 4 Textbooks
1.1
60 Cash transfer Nicaragua
0.45 77 Cash transfer
Progresa 0.66
136 School Feeding
0.4 1.2 22 -151
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A FRESH Start Focusing Resources on Effective
School Health, Hygiene Nutrition

• Child Friendly Schools .UNICEF
• Health Promoting SchoolsWHO
• Education for AllUNESCO
• Food for EducationWFP
• School Health InitiativeWorld Bank

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A FRESH Start Focusing Resources on Effective
School Health, Hygiene Nutrition

• Core intervention activities
• Effective health, hygiene and nutrition policies
  for schools
• Sanitation and access to safe water facilities
  for all schools
• Skills based health, hygiene nutrition
  education
• School based health nutrition services

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FRESH Partnership

• Launched at the World Education for All Forum in
  Dakar, Senegal April 2000
• WHO, UNICEF, UNESCO, World Bank Others

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A Strategic Plan for School Based Delivery of
Health and Nutrition Services in Eritrea

• Prepared jointly by the Ministries of Education
  and Health of the Government of Eritrea

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School Health and Nutrition Policy

• A Memorandum between the Ministry of Health and
  the Ministry of Education
• National inter-sectoral steering committee
• Defined responsibilities for each Ministry
• Defined mainstream actions for each Ministry

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The School Environment

• All schools to have gender separate sanitation
• Sanitation facilities to conform to national
  guidelines
• All school children to have access to safe water
  school

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Health Education

• National curriculum that addresses health,
  hygiene and nutrition issues
• Life skills modules that promote positive
  behaviors tobacco, HIV/AIDS, violence
• Peer education in all secondary schools

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School Based Delivery of Health and Nutrition
Services.

• Recommendations made based on
• The evidence of a national situation analysis
• The knowledge and experience of members of the
  Ministry of Health

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Situation analysis of Eritrean schoolchildren

• the prevalence of undernutrition
• the prevalence of anaemia
• the prevalence of infections with parasitic worms
  
• understanding of the knowledge, attitudes,
  practices and beliefs
• access to water and sanitation facilities in
  schools
• highlight focal problems

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Condition Need (evidence from Situation Analysis and MoH experience) Scale of Benefit Scale of Benefit Cost ( per capita Feasibility of universal access (based on experience elsewhere) Type of Service
Condition Need (evidence from Situation Analysis and MoH experience) Education Health Cost ( per capita Feasibility of universal access (based on experience elsewhere) Type of Service
Bilharzia (in certain areas) 0.80 Treatment in school
Anemia (in certain areas) 1.20 Treatment in school
Vitamin A supplementation 0.30 Treatment in school
Dental Caries 30.00 Referral to MoH services
Refractive Error 5.00 Referral to MoH services
Skin infections 3.00 Treatment in school
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PROVINCE Maekel Debub Anseba Gash Barka Northern Red Sea Southern Red Sea
Condition Maekel Debub Anseba Gash Barka Northern Red Sea Southern Red Sea
Bilharzia No Yes (above 1200m) Yes (above 1200m) Yes (above 1200m) No No
Anemia1 No No No No Yes Yes
Vitamin A supplementation Yes Yes Yes Yes Yes Yes
Dental Caries Yes Yes Yes Yes Yes Yes
Refractive Error Yes Yes Yes Yes Yes Yes
Skin infections Yes Yes Yes Yes Yes Yes
Eye infections Yes Yes Yes Yes Yes Yes
First Aid Yes Yes Yes Yes Yes Yes
Hearing impairment Yes Yes Yes Yes Yes Yes
Ear infections Yes Yes Yes Yes Yes Yes
Malnutrition Yes Yes Yes Yes Yes Yes
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Teacher Centred Approach

• Eritrea has many more teachers than health staff
  and many more schools than clinics
• plan seeks to maximize the input of teachers and
  minimize the input required of local health
  staff.
• Teachers always act under the supervision of
  local health staff

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• Where possible the results of the situation
  analysis have been used to recommend mass
  treatment for all school children in an area with
  no need for prior screening
• Where screening is required, wherever possible,
  teachers are given this responsibility
• Where treatment is required, wherever possible,
  teachers are given this responsibility
• Where treatment requires more complex medical
  training teachers should always refer children to
  local health staff

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The Key Steps

• National survey of the health and nutrition of
  school children
• Joint MoU between Education and Health stating
  National School Health and Nutrition policy
• National workshop to include SHN in action plans
  at the national and provincial levels

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For more information, please visit
www.schoolsandhealth.org