SHN Programmes: A Global Good Lesley Drake PhD Executive Director Partnership for Child Development.

SHN Programmes: A Global GoodLesley Drake PhDExecutive Director

Partnership for Child Development

1.THE IMPORTANCE OF A GOOD START IN LIFE: ALIVE & THRIVE

2.SCALING UP INTEGRATED INTERVENTIONS

3.SUPPORT FROM PARTNERS: ALIGNING CONCEPTS

THE IMPORTANCE OF A GOOD START IN LIFE: ALIVE & THRIVE

State of the Problem

1. 58 million children still out of school

2. 400 million school aged children still infected

with worms

3. 690 million still suffering from poor vision

4. 66 million still going hungry to school

The Key to Sustainability and Scalability

• Research needs to feed into ongoing programming

• We learn as go

How did we get here?

80s: The evidence base – links between health, nutrition & education.

90s: Developing school health policies.

00s: Mainstreaming approaches across sectors.

A Historical Reflection

1990 2000 2005 2007

Jomtien: World Conference on

EFA, EFA Declared

Dakar: World Education Forum,

Framework for Action

Siem Reap: Workshop to Strengthen the Education Sector Response to SHN

Nairobi: Launch of Africa SHN Training

Courses for Government Staff

2010 2011 2015…

Fit for School Regional

Conference

Addis Ababa: Declaration of the High-Level Group on EFA

Bangkok: Launch of Asia SHN Training

Courses for Government Staff

MDGs become SDGs…

A Historical Reflection

2015: MDGs Become SDGs

MDGs (2000-2015):– Policy frameworks– Mainstreaming– Cross-sectoral relationships defined

SDGs (2015-2030):– Chance to build on mainstreaming– Making programmes inclusive– Ensuring that SHN ‘goes viral’

• Focusing

• Resources on

• Effective

• School

• Health, hygiene & nutrition programs

The FRESH Framework: 15 Years

Policy Environment

Health Education Services

The FRESH Framework: 15 Years

School Health & Nutrition Policy

Policy & Partnerships

• High-level political support

• Cross-sectoral collaboration

• Roles and responsibilities

Examples from Lao PDR: Policy and Implementation Guidelines, produced 2005, revised 2010 with Joint MOE/MOH sign-off.

Skills-based Health Education

Education a “social vaccine”?HIV prevalence by education category, Rural Uganda, 1990-2001.

Individuals aged 18-29.

De Walque and J Whitworth, MRC Uganda (2002)

School-based Services:School Feeding & Nutrition

School Feeding• In-School Feeding

– Meals– Fortified high-energy biscuits and snacks– Alleviate short-term hunger and micronutrient

deficiencies, increase attention span and facilitate learning. Also increase school access and enrolment

• Take-home rations– Transferring food resources to families conditional on

enrolment

• Micronutrient fortification and supplementation– Includes addition of iron, iodine, vitamin A, B

and zinc– Fortification of food, or sprinkles

School feeding: Country programs (2006-08)Category 1: Countries where school feeding is available in most schools, sometimes or always; Category 2: Countries where school feeding is available in some way and at some scale; Category 3: Countries where school feeding is available primarily in the most food insecure regions; Category 4: Countries where there is no school feeding. The sources, as detailed in the database link, are WFP data for low income and lower middle income countries and national data for the remaining countries.

Partnership for Child Development. http://www.schoolsandhealth.org/Pages/SchoolNutritionFoodforEducation.aspx

• Promoting agricultural development by improving access to the school feeding market

• A win-win– for children and

communities… improving their education, health, and nutrition

– Smallholder farmers…providing regular orders and a reliable income

Home Grown School Feeding

The School Meals Planner: Evidence into Action

A contextual approach to:

Cost effective and nutritious menu planning

Behaviour change and nutrition education

Improve market access for smallholder farmers

www.hgsf-global.org

Energy 2000kcal Protein 28g Vitamin A 700mcg

Vitamin C 45mg Iron 37mg Zinc 15mg Iodine 120mcg

31%48%

0%

0% 0%

16% 20%

Maize porridge, 500 g.

Energy 2000kcal Vitamin A 700mcg

Vitamin C 45mg Iron 37mg Zinc 15mg Iodine 120mcg

31%48%

0%

0% 0%

16% 20%

100%

33%

61%74%

73%

24% 23%

47%

++108% Maize, CL,

Iodized Salt, Groundnuts,

31%

Protein 28g

34%

School-based Services:Deworming Programmes

Deworming Programmes

Ancylocstoma duodenaleNecator americanus(hookworm)

Trichuris trichiura(whipworm)

Ascaris lumbricoides(roundworm)

Schistosoma haematobiumS. MansoniS. japonicum

Improved school attendancefollowing deworming

0.6

0.65

0.7

0.75

0.8

0.85

Att

end

ance

Rat

e

Untreated Schools

Treated Schools

Treatment 1 Treatment 2

0 2 4 6 8 10 12

Months Since Baseline

Busia, KenyaSource: Miguel and Kremer 2000

School-based Services:Health screening & inclusion

-Innovative/inclusive IEC materials, particularly for deaf children

-Improving accessibility and outreach

-Training teachers and students on inclusion

Integrating Inclusive Components into SHN Programmes

• Referral of children to local health facilities and on-site provision of assistive devices (e.g. spectacles)

Health & disability screening in schools• Trained teachers identify the presence

of health problems amongst children. • Screening children for:

Refractive error & disabilities Common infections

Cambodia Vision Screening & Scale-up: 2012-14

• Government of Cambodia scaling up nationally in 2015, addressing this need cost-effectively and raising awareness

• School-based screening (n=12,500) • Provision of eye glasses on the same day• Initial screening by trained teachers• 6 month follow up • 100% agreement between teacher

screening and professional screening

School-based Services:Oral Health

Addressing dental caries: can affect food intake, reduce quality of life and lead to increased absenteeism if not addressed

Oral Health Provision

Safe & Sanitary School Environment: WASH

Safe & Sanitary School Environment: WASH

WAter

Image credits: Aubrey Wade/WaterAid/Panos

Image credits: WSSCC http://www.wsscc.org/resources/resource-photo/toilets-south-africa#3

Image credits: UNICEF, UNICEFBANA2011-01020Shafiqulhttp://www.unicef.bg/en/article/On-Global-Handwashing-Day-UNICEF-says-It-s-not-complicated-but-it-s-crucial/375

HygieneSanitation

FRESH: Strengthened Through Partnership

Under-pinned by effective partnerships, especially between the education and health sectors

INTEGRATING AND SCALING UP SHN PROGRAMMES

Integrated SHN in Africa: The Enhanced School Health Initiative

(ESHI)

Southern Nations Nationalities People’s Region Ethiopia (SNNPR)

An Integrated Approach: Situational analysis in SNNPR

Schistosomiasis prevalenceSTH prevalence

Water collection in schools School Feeding status

A multi-partner response: Integrating school health interventions in SNNPR

Baseline mapping, 35,600 children screened.

Case study intervention in 30 schools, 31,000 children.

ESHI

Deworming

Improved WASH

Health Education

School Feeding

School Health & Nutrition Case Study Interventions

Fully Integrated SHN(Deworming, HGSF & WASH in Ethiopia)

Food43%

Transport8%

Monitoring3%

Other Direct10%

Training/Awareness

7%

Indirect7%

Deprecia-tion (cap-

ital)7%

Gov-ern-

ment2%

Com-munity

15%

Overall: $35.15 per child per year.

Deworming:$0.40 per child (drugs were donated)Made up of transport and salary costs

Overall WASH and deworming:$6.68/chd/yr$1.05 in CC and $0.06 in government contribution

Overall SF:$28.01/chd/yrIncluding a $4.16 CC & $0.57 Local Government cost

• Fit for School: Cambodia, Indonesia, Lao PDR, Philippines.

Hand washing | Oral Health | Deworming

Integrated SHN in Asia

Monitoring and Evaluating SHN Programmes

MONITORING AND EVALUATING SCHOOL HEALTH PROGRAMMES

Large exercise to benchmark education

sub-systems

Comparative data and Knowledge on

Education Policies and Institutions

SABER

SystemsApproach BetterEducationResults

M&E OUTPUTS: FRESH & SABER

Structured Identification

Gaps Priorities

Evidence Base Action

Plan and M&E

Stakeholder mobilisation

Stronger coordination

SUPPORT FROM PARTNERS: ALIGNING CONCEPTS

Partnerships and integrated policy

Community, Schools & Teachers

NGOs

Donors

International organisations

Government

MoH

MoE

Technical Development Planning

• Government-led and harmonised with partners

• A roadmap for development

• Roles and responsibilities defined

Examples from Ghana: the Ghana Minister of Local Government and Rural Development signs the joint TDP for school feeding with PCD Regional Manager, Daniel Mumuni.

Achieving Scalability and Sustainability

• Institutionalisation and mainstreaming into ESPs is key

• Strong M&E for evidence-based, contextual programming

• Roles and responsibilities of sectors defined at all levels

• Advocacy strategy crucial

Find out more:

PartnershipforChildDevelopment

Follow:SHN @schoolhealth HGSF @HGSFglobal

www.schoolsandhealth.org

www.imperial.ac.uk/pcd www.hgsf-global.org

• Carry on with what you’re doing

• Fit for school is an example of global good practice