+ Strengthening effective school health in Nepal Dr Lonim Prasai Dixit/Mr Madhukar Shrestha Coordinator/co coordinator School Health and Nutrition Network, Nepal.

+ School Health and Nutrition for health promotion To ensure that a better health status is enjoyed by all Nepalese children through the promotion and implementation of School Health and Nutrition program at national level

+ Some points to reflect? What is the situation of health promotion in schools in Nepal? Is it adequate/appropriate?

+ INTRODUCTION There is a wide consensus that healthy school environment leads to improved cognitive, physical, emotional development of the child and contributes to educational goals. Health of children in low-income countries are far beyond national and international goals.

+ The Government of Nepal (GON) has recognized the importance of healthy school environment in achieving Millennium development Goals and has taken many initiatives. Despite government efforts, studies have reported many of the 28,057 basic and secondary community schools lack minimum school health and nutrition package.

+ STRENGTHS Policies and strategies in place. National School Health and Nutrition Strategy (2006) Child Friendly School Framework Sanitation and Hygiene Master Plan School Sector Reform Plan Multisectoral Nutrition Plan.

+ strengths contd School Health and Nutrition Network (SHNN) Interest and commitment: Many external development partners, I/NGOs working in SHN Community support: Many communities see schools as the most important Institution in the communities.

+ Strengths contd School Health minimum package developed on basis of National SHN Strategy 1) School-Based Health and Nutrition Services 2) Healthful School Environment 3) Life Skill-Based Health, Hygiene and Nutrition Education ( check list – attendance record, daily and weekly checklist, child club mobilization 4) Coordinated and Collaborative Efforts

+ CHALLENGE Despite government efforts, studies have reported many of the 28,057 basic and secondary community schools lack minimum school health and nutrition package. SHN package is not implemented in all schools in the country.

+ School based health and nutrition services Provide annual general health checkup ( make available to all, mechanism ) Establish counseling, referral and follow-up mechanism Strengthen local health system and establish linkage with schools. Capacity building of school teachers and child club

+ First aid kit ( available to all, refilling) De-worming, Iron tablet – supplied by Health facilities Management of school feeding program Monitoring and Evaluation mechanism – timely, correct reporting and timely acquisition of data.

+ Health school environment Adequate water supply ( 77 % ), Toilet facilities (79%) Separate toilets for girls ( 36% ) Nepal has reported lack of menstruation hygiene in schools as one of the primary reason for dropout rates in adolescent girls. ( Department of Education, Consolidated Report, 2011/12 ).

+ Student -Toilet ratio in secondary schools, Dolakha 132:1 (UNICEF/DOE 2012.)

+ FACTS: Some egs: Sunsari, Dolakha and Doti 8% of schools had access to safe drinking water (0% in Dolakha) 10% of schools with sufficient water in toilets 56% of schools with access to soap

+ 8% menstruation friendly WASH facilities. 31%girls absent during menstruation Good Management of solid waste (64%) Safe and clean school premises and play ground (88%)

+ Life Skill-Based Health, Hygiene and Nutrition Education Schools in Nepal have basic health and physical education as part of their curriculum 5% schools had extra curricular activities. 6% schools with child club involement Life skilled based education. Capacity building of teachers Teachers motivation

+ Coordinated and Collaborative Efforts Strengthen coordinated efforts of the concerned Ministries and Departments and stakeholders at all levels in order to develop the technical, managerial and financial aspects of the programs. Strengthen coordination of MOHP, MOE at national level, Health and Education Directorates at Regional level, DEO, DHO and DPHO at district level and SMC/PTA, child club at local level.

+ Strengthen Child Club, SMC, PTA and ownership of local governing bodies 6 % of schools with child club involvement Establish a school health unit at the MOE and MOHP.

+ WAY FORWARD Mainstream SHN in national development policy The Minimum Package goes side by side with the “National Joint Action Plan on SHN” that offers a good opportunity to scale up in sustainable program. Endorsement of JAP of MOHP and MOE

+ Make the mandatory implementation of the minimum package of SHNP in each school of the country by law and acts. Revision of 6-10 grade school curriculum incorporating practical activities for health, hygiene and nutrition component

+ Improve quality of EMIS, M and E Provide financial and technical supports Joint monitoring / support visits. Community ownership/management of available resources

+ THANK YOU