Lessons of the Integrated School Health Policy (ISHP) in South Africa Lessons from implementation of the Integrated School Health Policy (ISHP) in South Africa Sue Jones, Health and Nutrition Lead Save the Children South Africa Astrid Korin, Education Specialist The Palladium Group

Outline of presentation The ISHP and the RMCH programme Lessons learnt from government Lessons learnt for development partners Conclusions Publications Acknowledgements

Making the connections…… Planning and resourcing Is participatory planning a panacea to effective policy formulation and implementation and systems improvement, as much as basic literacy and numeracy is a panacea to learning?

The ISHP Goal to improve general health of learners; environmental conditions in schools; address barriers to learning; enhance access, retention and achievement ISHP is the integration of the South African National Departments of Health (NDoH), Education (DBE) and Social Development (DSD)

9 Provinces, 25 districts, 400 schools

LESSONS LEARNT FROM GOVERNMENT

1. Participatory planning Situation ISHP viewed as solely a health policy; lack of consultation; roles and responsibilities misunderstood RMCH action Situational analysis; stakeholder integration workshops Recommendation Develop multi-sector, multi-stakeholder partnerships through a consultative and participatory process that takes place during policy development

Participatory planning

2. Roles and responsibilities Situation No terms of reference (ToR); confusion around leadership of the District ISHP task team (DTT);poor co- ordination of ISHP; lack of accountability resulted RMCH action Supported the NTT to develop a ToR that defined roles and responsibilities DoH, DoE and DSD, strengthening accountability mechanisms Recommendations Support all multi-sector policies with a very detailed and specific ToR and memorandum of understanding

3. Communication Situation Poor integration of departments; ad hoc reporting between all 3 government levels; irregularity of the “school based support team” structure RMCH actions District ISHP Integration workshops; development of the District Reporting Tool (DRT) Recommendations National directive for compulsory attendance at integrated planning workshops and provincial sharing forums. A clear communication management system in the ToR. A standardised reporting mechanism (DRT)

4. Capacity Building Situation Government officials with limited skills in leadership, planning, mentoring, budgeting; managing multiple programmes; weak translation and implementation of ISHP RMCH action Capacity building of the DTT and SBST to oversee implementation of ISHP in schools but also strengthened mechanisms to increase demand Recommendations Analysis of capacity gaps to determine specific needs prior to policy launch. Target the most decentralized level of government as possible within the resource envelope. Maximize the benefits and efficiency of cascade training

5. Beneficiary incentives Situation Conflicting incentives between government departments; Sexual and Reproductive Health (SRH) education and services not accepted by the whole school community RMCH actions Raised awareness of the ISHP throughout community; strengthened SBST to involve community network of care; gained support of SGB for learner SRH promotion Recommendations Understand the incentive structures that drive different stakeholders and ensure that all stakeholders speak a common language in respect to ISHP

LESSONS LEARNT FOR DEVELOPMENT PARTNERS

1. Programme planning Situation Project objectives: assumed district implementation was happening; lacked alignment with NTT priorities; recruitment of team with limited experience in health system strengthening and specialised roles RMCH actions Ongoing amendment of implementation plans according to government priorities; flexibility within the project team and in-house training allowed assignment of different roles to create district ISHP facilitators Recommendation Program objectives, activities, outputs and staffing requirements should be derived from a detailed review of the gaps between the status quo and the objectives of all beneficiary groups of stakeholders. The structure of the project implementation team must then be designed in line with the final work plan and project approach

2. Baseline analysis Situation The situational analysis was heavily biased towards DoH; it was stronger in qualitative data vs quantitative data Recommendation A baseline for a multi-sector programme should be designed by an M&E specialist in consultation with the team sector specialists, the beneficiary and the donor

3. Programme management Situation The National Steering Committee did not routinely integrate DBE and DSD leading to weaker support to and understanding of the context of ISHP Recommendation Programmes with components cutting across multiple sectors have a focal point within the donor organisation and the development partner responsible for ensuring synergies and alignment of incentives and language.

Conclusions Most efforts breakdown when there is misunderstanding, misinterpretation or oversight of the implications of a policy or programme for one or several groups of stakeholders. Cross sector interventions must be planned and managed by a team of specialists with expertise in and relationships with all stakeholder groups Co-ordination structures with clear leadership matrices and lines of accountability enable effective collaboration for planning, budgeting, implementation and reporting

Discussion Is participatory planning a panacea to effective policy formulation and implementation and systems improvement, as much as basic literacy and numeracy is a panacea to learning?

Acknowledgements The National Departments of Health, Education and Social Development and the National ISHP Task Team The RMCH consortium: Palladium Group, Save the Children South Africa, Health Systems Trust, Social Development Direct

Publications The RMCH School Health Manual (2015) The RMCH School Health Baseline summary and recommendations (2014) The RMCH programme case studies (2015) Contact

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