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

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.

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 –…

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

source: UNAIDS A Window of Hope ?

HIV prevalence by education category, MRC General Population Cohort, Rural Uganda, Individuals aged De Walque and J Whitworth, MRC Uganda (2002)

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

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

Improved Cognitive Performance in Zambia

The Effect of Deworming on Cognitive Function 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). 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

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

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

Identifying a Common Framework for Action Towards Successful SHN Initiatives

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

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

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

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

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

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

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

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

Cost of Intervention per Child

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. The Longer Term Benefits of Investing in SHNPs

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

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

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