School Health and Nutrition Programs Donald Bundy Human Development Network The World Bank Sana’a, Yemen, January 23, 2007.

School Health and Nutrition Programs

Donald BundyHuman Development Network

The World Bank

Sana’a, Yemen, January 23, 2007

0

20

40

60

80

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

School absenteeism and helminth infectionP

rop

ort

ion

of

year

ab

sen

t

Uninfected Low Moderate High

0.3

0.2

0.1

0

Whipworm Intensity (epg)

Nokes et al 1993

0 1-<2000 2000-<7000 >7000

Nokes et al 1992

Sc

ore

3 mths Post-intervention

25

24

23

22

21

20

Treatment

Placebo

Categorical Fluency

Pre-intervention

Uninfected

Improvement in Cognitive Performance with Treatment in School Children

Improvement in School Attendance Following De-Worming in Busia, Kenya

0.6

0.65

0.7

0.75

0.8

0.85

0 2 4 6 8 10 12

Months Since Baseline

Att

end

ance

Rat

e

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

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

Examples of 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, Hygiene & Nutrition

• Child Friendly Schools ….UNICEFChild Friendly Schools ….UNICEF

• 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

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

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

School Health and Nutrition Policy

• A Memorandum between the Ministry of A Memorandum between the Ministry of

Health and the Ministry of EducationHealth and the Ministry of Education

• National inter-sectoral steering committeeNational inter-sectoral steering committee

• Defined responsibilities for each MinistryDefined responsibilities for each Ministry

• Defined mainstream actions for each Defined mainstream actions for each

MinistryMinistry

The School Environment

• All schools to have gender separate All schools to have gender separate

sanitationsanitation

• Sanitation facilities to conform to Sanitation facilities to conform to

national guidelinesnational guidelines

• All school children to have access to All school children to have access to

safe water schoolsafe water school

Health Education

• National curriculum that addresses National curriculum that addresses

health, hygiene and nutrition issueshealth, hygiene and nutrition issues

• Life skills modules that promote Life skills modules that promote

positive behaviors: tobacco, HIV/AIDS, positive behaviors: tobacco, HIV/AIDS,

violenceviolence

• Peer education in all secondary schoolsPeer education in all secondary schools

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

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

Condition Need (evidence

from Situation Analysis and

MoH experience)

Scale of Benefit Cost($ per capita

Feasibility of universal access(based on experience elsewhere)

Type of ServiceEducation Health

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

PROVINCE Maekel Debub Anseba Gash Barka

Northern Red Sea

Southern Red Sea

Condition

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

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

• 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

The Key Steps • National survey of the health and nutrition National survey of the health and nutrition

of school childrenof school children

• Joint MoU between Education and Health Joint MoU between Education and Health

stating National School Health and stating National School Health and

Nutrition policyNutrition policy

• National workshop to include SHN in action National workshop to include SHN in action

plans at the national and provincial levelsplans at the national and provincial levels

For more information, please visit:

www.schoolsandhealth.org