The Role of the School in Health, Learning and Development in Low Income Countries

1. The Role of the School in Health, Learning and Development in Low Income Countries Lesley Drake, Coordinator

2. Presentation Outline • Health and education benefits of SHNPs and their contribution to the achievement of EFA and the MDGs • The impact of HIV and AIDS in low income country settings • Challenges of implementing SHNPs in low income country setting, in particular, issues dealing with sustainability, costs and scale.

3. Health Benefits of SHNPs • SHNPs in low income settings primarily address infectious disease issues: • ARIs • Diarrhoeal Disease • HIV and AIDS • Intestinal Worms • Malaria • Malnutrition (dual burden?) • Trachoma • …

4. (study population 110,000; survey sample 3,054)

6. A Window of Hope ? source: UNAIDS

7. HIV prevalence by education category, MRC General Population Cohort, Rural Uganda, 1990-2001. Individuals aged 18-29. De Walque and J Whitworth, MRC Uganda (2002)

8. Educational Benefits of SHN • Increased enrolment • Reduced absenteeism • Reduced drop out • Increased cognitive performance

9. Schools Treated Untreated Schools 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 12 Months Since Baseline

10. Improved Cognitive Performance in Zambia

11. The Effect of Deworming on Cognitive Function Traditional – Digit Span Task: Scores in the digit span test at baseline and at 3 and 16 months after initial treatment for hookworm and S. haematobium Dynamic – Syllogisms: Improvement in learning potential Changes in syllogisms test scores in Treatment (N=273), Placebo (N=450) and Uninfected (N=194) children, aged 9-14, from Grigorenko (submitted).

12. The Role of SHN Programs in Achieving EFA and the MDGs Learning does not take place in isolation. Societies, therefore, must ensure that all learners receive the nutrition, health care, and general physical and emotional support they need in order to participate actively in and benefit from their education. World Declaration on Education for All, Jomtien 1990

13. SHNPs Contributing to Access to Education for the Last 10% • The last 10% of out of school children are often also the poorest and most vulnerable • Getting them into school is both costly and difficult for MoEs • In the pursuit of EFA and the MDGs the process of enabling them to access education can be facilitated by effective SHNPs

14. Identifying a Common Framework for Action Towards Successful SHN Initiatives

15. Global SHN Initiatives • Child Friendly Schools (UNICEF) • Health Promoting Schools (WHO) • International School Health Initiative (World Bank) • Model Schools (JICA) Etc...etc…etc…

16. FRESH School health and nutrition policy Safe School Environment Skills based health education School based delivery of health services

17. Partnership as a Key Supporting Strategy • Effective partnerships between teachers and health workers • Effective community partnerships • Fully engaged students

18. Zambia • MoU established between MoH and MoE • Clear roles identified for all stakeholders including teachers, health workers, community leaders and partnering NGOs • Collaboration between donors in funding activities – basket funding

19. Ghana • strong partnerships at all levels to accelerate the delivery of HIV prevention education within the existing SHNP • national standards for SHNP delivery (including HIV&AIDS prevention) by ALL NGOs • Co-ordinates the efforts of all stakeholders (including governmental, CSO, NGOs) in SHNP delivery • Program delivered by many: teachers, peer educators, resource persons and NGOs

20. Eritrea • National level situation analysis • Use of GIS to overlay epidemiological data and remotely sensed data to develop risk maps • Enables interventions to be targeted in areas where risk of STH infection and/or anaemia is high  reduce costs by reducing unnecessary interventions  easier to take SHNP to scale • Development of indicators

21. The Geographical Distribution of Anaemia Among School Children in Eritrea The Geographical Distribution of S. mansoni Among School Children in Eritrea

22. Addressing the Challenges:3 Countries, 3 Responses • Zambia: strong partnerships at all levels  implementation coordination • basket funding  donor coordination • Eritrea: targeted interventions  reduced waste of resources • all staff trained  sustainability • effective M&E  constant review and improvement of SHNP • Ghana: sectoral leadership  effective use of incumbents • collaboration with NGOs  maximum use of resources

23. Cost of Intervention per Child

24. The Longer Term Benefits of Investing in SHNPs • School health and nutrition interventions can add: • 4-6 points to IQ levels • 10 % to participation in schooling • 1-2 years of education • This scale of benefit can add: • 8-12 % to labor returns and provide a rate of return that offers a strong argument for public sector investment.

25. Distinctive Features of SHNPs in the Context of Low Income Countries • Different health issues • HIV and AIDS (demand and supply side) • Gender issues (e.g. gender sensitive sanitation facilities, gender based violence, sexual abuse) • Teachers as providers of school based health services

26. Common Operational Features of Effective SHNPs • Effective sectoral leadership • Effective coordination of all stakeholders by MoE and MoH • Clear roles for all stakeholders (including donors and implementers) • Effective targeting of interventions • Effective monitoring & evaluation

27. Operational Good Practice Guidelines We are currently developing a sourcebook of operational guidelines based on the evidence of existing good practice For more information please visit www.schoolsandhealth.org