Partnerships for Promoting Health and Education Donald Bundy Human Development Network The World Bank Vancouver, Canada, June 7, 2007 0 20 40 60 80 100 0 10 20 30 40 50 Age (years) P ercentage infecte A s c aris T richuris H ookw o 0.6 0.65 0.7 0.75 0.8 0.85 0 2 4 6 8 10 12 Months Since B aseline A ttendance R ate U ntreate d School s Treate d School s Treatm ent1 Treatment2 Miguel & K rem er, 2000
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Partnerships for Promoting Health and Education Donald Bundy Human Development Network The World Bank Vancouver, Canada, June 7, 2007.
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Partnerships for Promoting Health and Education
Donald BundyHuman Development Network
The World Bank
Vancouver, Canada, June 7, 2007
0
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100
0 10 20 30 40 50 60
Age (years)
Perc
enta
ge infe
cte
d
Ascaris Trichuris Hookworm
0.6
0.65
0.7
0.75
0.8
0.85
0 2 4 6 8 10 12 Months Since Baseline
Attendance Rate
Untreated
Schools
Treated
Schools
Treatment 1 Treatment 2
Miguel & Kremer, 2000
Condition Prevalence/ No. Cases
IQ loss: Per Child
Total IQ loss/mentalretardation
Years ofschooling 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
IQ and schooling losses avoidable by school based SHN programs
Comparing returns to education
Add years schooling Cost US$ p.a.SHN Programs 1.2 – 2.5 < 4Textbooks 1.1 60Cash transfer – Nicaragua 0.45 77 Cash transfer – Progresa 0.66 136 School Feeding 0.4 – 1.2 22 -151
A FRESH Start: Focusing Resources on Effective School
• Health Promoting Schools…WHOHealth Promoting Schools…WHO
• Education for All…UNESCOEducation for All…UNESCO
• Food for Education…WFPFood for Education…WFP
• School Health Initiative…World School Health Initiative…World
BankBank
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
• Policies in schools …that ensure well maintained sanitation and specific agreement that teachers can deliver treatment • Healthy environments in schools ….with effective sanitation and safe water to reduce transmission • Skills based health education …that promotes hygiene and healthy behaviors • School based delivery of anthelmintics by teachers …that follows WHO guidelines
FRESH framework for action against worms
FRESH Framework (UNESCO, UNICEF, WHO, World Bank,
others)
Health-Promoting Schools (WHO)
Child-Friendly Schools (UNICEF)
PopEd (UNFPA) Global School Feeding Campaign (World Food
Program)
Policy Respects and recognizes the rights of the individual
Respects and recognizes the rights of the child
Creates an enabling environment for reproductive health and HIV education
Focuses on those most at risk (girls, poorest communities, AIDS affected and infected)
School Environment Healthy environment with opportunities for physical education and recreation
Healthy, safe, secure. Is protective emotionally and psychologically
Protects young people from unwanted pregnancy, STIs, sexual abuse and violence
Serves as platform for other interventions
Education Life skills education Promotes quality learning outcomes, provides skills based health education
Strengthens HIV and reproductive health education programs
Supports learning through good nutrition and promotes access to education
Services Provides services, nutrition and food safety programs, counseling and social support programs and health promotion programs for schools. Includes community outreach components
Promotes physical and mental health
Ensures access to youth-friendly sexual and reproductive health services
Provides food and promotes and supports deworming
Supportive Partnerships Engages health and education officials, teachers, students, parents, health providers, community leaders
Is child centered, family focused and community based
Targets young people in and out of school and ensures participation from parents, youth, community leaders and organizations
Promotes community and school partnerships
FRESH Partnership
• Launched at the World Launched at the World
Education for All Forum in Education for All Forum in
Dakar, Senegal April 2000Dakar, Senegal April 2000
• WHO, UNICEF, UNESCO, WHO, UNICEF, UNESCO,
World Bank & OthersWorld Bank & Others
Directory of School Based
Health and Nutrition Programmes:
Findings from a surveyof organisation support
Partnership for Child DevelopmentPartnership for Child Development
Jan W de Lind van WijngaardenJan W de Lind van Wijngaarden
Celia MaierCelia Maier
Lesley DrakeLesley Drake
Updated Survey – October 2006Updated Survey – October 2006
Comparison of integrated SHN programmes in 2006 with 2000
The move towards Intergrated Programming
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15
20
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30
35
2000 (n=41) 2006 (n=38)
Nu
mb
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of
org
an
isati
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Finding 2: Since FRESH, most agencies are moving towards Integrated SHN
Programmes
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10
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30
35
1 2 3 4
Num ber of pillars
Nu
mb
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of
org
an
isa
tio
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Number of organisationssupporting 1, 2, 3 or 4 pillars ofFRESH
Number of organisations explicitlysupporting the FRESH f ramew ork
Finding 3:Increasing partnerships between agencies
The move towards increased partnerships
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0
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15
20
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30
35
40
2000 (n=41) 2006 (n=38)
No
. o
rgan
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Accelerating the Education Sector Response to School Health and
HIV&AIDS: Four Years On
A Working Group of the UNAIDS Inter-Agency Task Team for
Education and HIV/AIDS.
Education Sector Funding of the Response to HIV/AIDS: Review of 38 Education projects in
Africa Region 1997-2004
• Only 42% specified a sectoral school health and HIV&AIDS program and budget
• 33% did not mention school health and HIV&AIDS at all
Allocation of Multi-sectoral Health Resources to the Education Sector (survey
of 22 projects)
• 60% did not disburse to education
• 18% disbursed >5% of budget to education
Key Correlates with an Effective Education Sector Response:
• Strong education sector leadership
• Inclusion of school health in the education sector plan
• Support from a mix of resources – education and health sector
• Technical assistance to the education sector in developing this new area
The Process
Regional Analytical Work
Sub-Regional Workshop
Establishment of National Development Partners Group
National Workshop and Follow Up
Fast FactsSince 2002:37.....the number of African countries in the Accelerate networks 76.....the number of agencies, NGOs and development partners that have participated in the process 60..... the average number of days between training events 120......the total number of training days to date 1,350....the number of education sector staff that have participated in training events 162,000......the number of person training days conducted
Objective 1: To promote leadership by the education sector and create sectoral demand for an HIV/AIDS response.
Participation of countries in the Accelerate Initiative since 2002
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5
10
15
20
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30
35
40
2001 2002 2003 2004 2005 2006
Year
Nu
mb
er o
f C
ou
ntr
ies Sub-Regional Activities
National Level Activities(including workshops,technical supportmissions etc)
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops
█ East Africa
2002
█ East Africa█ Nigeria
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops2003
█ East Africa█ Nigeria█ Central Africa
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops2003
█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops2004
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops
█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa█ Francophone West Africa
(Madagascar observer)
2004
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops
█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa█ Francophone West Africa
(Madagascar observer)█ Lusophone Countries
2004
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops2006
█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa█ Francophone West Africa
(Madagascar observer)█ Lusophone Countries
Accelerating the Education Sector Response to HIV and AIDS:
Sub-Regional Workshops and National Follow-up
2006
█ Sub-regional participation only█ Countries with National Follow-up
Objective 2: To harmonize support among development partners, in order to better assist countries and reduce transaction costs.
Level of representation of UN agencies, bilaterals and civil society organizations at the sub-regional and national level workshops and Network meetings held since 2002
43
57
8
54
7 7 7 7
2 23
23
4
8
23 3
5
86
5
3
2
33
25
6
9
57
2 22
22
2
2
24
4
25
8
1
3
4
8
2
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7
13
2 44
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East Africa
East Africa Meeting
Nigeria (2) Nigeria (1)
Central AfricaNigeria (3)
Zambia
Anglophone W Africa
Ethiopia
Francophone Africa Lusophone AfricaEA Network Launch
Nigeria (5)
Curriculum Workshop
Nigeria (6)Nigeria
Burkina Faso Sierra LeoneSenegal
EACEthiopia
Central Africa The Gambia
United Republic of TanzaniaCivil society
Bilateral donors
UN agencies
2004 2005 200620032002
Degree of participation of development partners in in sub-regional and national level workshops held since 2002
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2
23
5
7
5
10
23
23
7
7
6
24
18
12
21
5
12
11
0 2.4 4.8 7.2 9.6 12 14.4 16.8 19.2 21.6 24
Teacher Associations
Save
PCD
MTT
Action Health
Action Aid
USA
UK
Norway
Ireland
Canada
WFP
WB
UNICEF
UNFPA
UNESCO
UNDP
UNAIDS
ILO
Pa
rtn
ers
Percentage Workshops Attended
0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Objective 3: To promote coordination with the National AIDS Authorities, and enhance access to HIV&AIDS funds.
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5
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40
2001 2002 2003 2004 2005 2006
Year
Nu
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Co
un
trie
s Sub-Regional levelActivities
National Level Activities
Initiation ofDisbursement of NACFunds to MoE
Chronology of the initiation of MoEs accessing funds from their NACs
Objective 4: To enhance availability and sharing of information on HIV and AIDS that is of specific relevance to the education sector.
0
20000
40000
60000
80000
100000
120000
Jan-03
Mar-03
May-03
Jul-03
Sep-03
Nov-03
Jan-04
Mar-04
May-04
Jul-04
Sep-04
Nov-04
Jan-05
Mar-05
May-05
Jul-05
Sep-05
Nov-05
Jan-06
Mar-06
May-06
Jul-06
Sep-06
Nov-06
tota
l no
. hit
s e
ac
h m
on
th
Total number of website hits on www.schoolsandhealth.org each month, January 2003 – December 2006
Additionally, To date, approximately 250,000 hard copies of 95 titles have been distributed in at least the three main languages.
The sub-Regional Networks of HIV and AIDS Education Focal Points
• West Africa Network (ECOWAS and Mauritania) 16 countries: launched in 2004
• Eastern Africa Network 7 countries: launched in 2006
• Lusophone Africa (PALOPS)5 countries: launched in 2006
• Central Africa Network (ECCAS/SEMAC)7 countries: launched in 2006
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15
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25
30
35
40
2002 2003 2004 2005 2006
Year
Nu
mb
er o
f C
ou
ntr
ies
Education SectorPolicies
Education SectorStrategic Plan
Sub-Regional LevelActivities
National Level Activities
Progress made in the implementation of some activities in the area of policy against the number of activities carried out under the Accelerate Initiative.
0
5
10
15
20
25
30
35
40
2002 2003 2004 2005 2006
YearN
umbe
r of C
ount
ries
HIV Prevention Initiatedin Schools
Teacher TrainingInitiated
Sub-Regional LevelActivities
National Level Activities
Progress made in the implementation of some activities in the area of prevention against the number of activities carried
out under the Accelerate Initiative.
Objective 5: To strengthen the technical content and implementation of the education sector response to HIV&AIDS.
Key changes since EFA 2000
• More holistic approaches to school health, and increasing recognition of the need to work across the whole school
• More harmonization among sectors and development partners – more cost-effectiveness, lower transaction costs and less confusion
• More partnerships across sectors and among development partners around School health programs in low and middle income countries
Key issues going forward
• FRESH framework does not reflect developments, eg, in health promotion, addressing violence etc…needs to be RE-Freshed
• Accountability and monitoring of health issues by the education sector often the weakest part of the program…need for a common set of indicators
• Focus on low income countries has missed opportunities for cross learning with high and middle income countries….need for information sharing among networks