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

Improvement in School Attendance Following De-Worming in Busia, Kenya Months Since Baseline Attendance Rate UntreatedSchools Treated Schools Treatment 1 Treatment 2 Miguel & Kremer, 2000

ConditionPrevalence/ No. Cases IQ loss: Per Child Total IQ loss /mental retardation Years of schooling lost Stunting52%/292m3 points877 (21.6m) 284m Anaemia53%/298m6 points1788 (45.6m) 524m Worms30%/169m3.75 points633 (15.8m) 201m IQ and schooling losses avoidable by school based SHN programs

CountryProgramNo. StudentsNo. SchoolsCost US$ GuineaMainstream public sector 350, MadagascarProgram public sector 430,0004, TajikistanSocial Fund100, IndonesiaPrivate sector161, Examples of school based SHN programs

Comparing returns to education Add years schooling Cost US$ p.a. SHN Programs 1.2 – 2.5 < 4 Textbooks Cash transfer – Nicaragua Cash transfer – Progresa School Feeding 0.4 –

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 BankSchool Health Initiative…World Bank

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 Education for All Forum in Dakar, Senegal April 2000Launched at the World Education for All Forum in Dakar, Senegal April 2000 WHO, UNICEF, UNESCO, World Bank & OthersWHO, UNICEF, UNESCO, World 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 Health and the Ministry of EducationA Memorandum between the Ministry of Health 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 MinistryDefined mainstream actions for each Ministry

The School Environment All schools to have gender separate sanitationAll schools to have gender separate sanitation Sanitation facilities to conform to national guidelinesSanitation facilities to conform to national guidelines All school children to have access to safe water schoolAll school children to have access to safe water school

Health Education National curriculum that addresses health, hygiene and nutrition issuesNational curriculum that addresses health, hygiene and nutrition issues Life skills modules that promote positive behaviors: tobacco, HIV/AIDS, violenceLife skills modules that promote positive behaviors: tobacco, HIV/AIDS, violence 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

ConditionNeed (evidence from Situation Analysis and MoH experience) Scale of BenefitCost ($ per capita Feasibility of universal access (based on experience elsewhere) Type of Service EducationHealth Bilharzia+++ (in certain areas) Treatment in school Anemia+++ (in certain areas) Treatment in school Vitamin A supplementation Treatment in school Dental Caries Referral to MoH services Refractive Error Referral to MoH services Skin infections Treatment in school

PROVINCEMaekelDebubAnsebaGash Barka Northern Red Sea Southern Red Sea Condition BilharziaNoYes (above 1200m) No Anemia 1 No Yes Vitamin A supplementation Yes Dental CariesYes Refractive ErrorYes Skin infectionsYes Eye infectionsYes First AidYes Hearing impairment Yes Ear infectionsYes MalnutritionYes

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

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