1. SHN Programmes: A Global Good Lesley Drake PhD Executive Director Partnership for Child Development

2. 1.T HE IMPORTANCE OF A GOOD START IN LIFE : A LIVE & THRIVE 2.S CALING UP INTEGRATED INTERVENTIONS 3.S UPPORT FROM PARTNERS : A LIGNING CONCEPTS

3. T HE IMPORTANCE OF A GOOD START IN LIFE : A LIVE & THRIVE

4. State of the Problem 1.58 million children still out of school 2.400 million school aged children still infected with worms 3.690 million still suffering from poor vision 4.66 million still going hungry to school

5. The Key to Sustainability and Scalability Research needs to feed into ongoing programming We learn as go

6. How did we get here? 80s: The evidence base – links between health, nutrition & education. 90s: Developing school health policies. 00s: Mainstreaming approaches across sectors.

7. A Historical Reflection 1990200020052007 Jomtien: World Conference on EFA, EFA Declared Dakar: World Education Forum, Framework for Action Siem Reap: Workshop to Strengthen the Education Sector Response to SHN Nairobi: Launch of Africa SHN Training Courses for Government Staff

8. 201020112015… Fit for School Regional Conference Addis Ababa: Declaration of the High-Level Group on EFA Bangkok: Launch of Asia SHN Training Courses for Government Staff MDGs become SDGs… A Historical Reflection

9. 2015: MDGs Become SDGs MDGs (2000-2015): – Policy frameworks – Mainstreaming – Cross-sectoral relationships defined SDGs (2015-2030): – Chance to build on mainstreaming – Making programmes inclusive – Ensuring that SHN ‘goes viral’

10. F ocusing R esources on E ffective S chool H ealth, hygiene & nutrition programs The FRESH Framework: 15 Years

11. PolicyEnvironment Health Education Services The FRESH Framework: 15 Years

12. School Health & Nutrition Policy

13. Policy & Partnerships High-level political support Cross-sectoral collaboration Roles and responsibilities Examples from Lao PDR: Policy and Implementation Guidelines, produced 2005, revised 2010 with Joint MOE/MOH sign-off.

14. Skills-based Health Education

15. Education a “social vaccine”? HIV prevalence by education category, Rural Uganda, 1990-2001. Individuals aged 18-29. De Walque and J Whitworth, MRC Uganda (2002)

16. School-based Services: School Feeding & Nutrition

17. School Feeding In-School Feeding –Meals –Fortified high-energy biscuits and snacks –Alleviate short-term hunger and micronutrient deficiencies, increase attention span and facilitate learning. Also increase school access and enrolment Take-home rations –Transferring food resources to families conditional on enrolment Micronutrient fortification and supplementation –Includes addition of iron, iodine, vitamin A, B and zinc –Fortification of food, or sprinkles

18. School feeding: Country programs (2006-08) Category 1: Countries where school feeding is available in most schools, sometimes or always; Category 2: Countries where school feeding is available in some way and at some scale; Category 3: Countries where school feeding is available primarily in the most food insecure regions; Category 4: Countries where there is no school feeding. The sources, as detailed in the database link, are WFP data for low income and lower middle income countries and national data for the remaining countries. Partnership for Child Development. http://www.schoolsandhealth.org/Pages/SchoolNutritionFoodforEducation.aspxhttp://www.schoolsandhealth.org/Pages/SchoolNutritionFoodforEducation.aspx

19. Promoting agricultural development by improving access to the school feeding market A win-win –for children and communities… improving their education, health, and nutrition –Smallholder farmers…providing regular orders and a reliable income Home Grown School Feeding

20. The School Meals Planner: Evidence into Action A contextual approach to: Cost effective and nutritious menu planning Behaviour change and nutrition education Improve market access for smallholder farmers www.hgsf-global.org

21. Energy 2000kcalProtein 28gVitamin A 700mcg Vitamin C 45mgIron 37mgZinc 15mgIodine 120mcg 31% 48% 0% 16% 20% Maize porridge, 500 g.

22. Energy 2000kcalVitamin A 700mcg Vitamin C 45mgIron 37mgZinc 15mgIodine 120mcg 31% 48% 0% 16% 20% 100% 33% 61% 74% 73% 24% 23% 47% ++ 108% Maize, CL, Iodized Salt, Groundnuts, 31% Protein 28g 34%

23. School-based Services: Deworming Programmes

24. Deworming Programmes Ancylocstoma duodenale Necator americanus (hookworm) Trichuris trichiura (whipworm) Ascaris lumbricoides (roundworm) Schistosoma haematobium S. Mansoni S. japonicum

25. Improved school attendance following deworming 0.6 0.65 0.7 0.75 0.8 0.85 Attendance Rate UntreatedSchools Treated Schools Treatment 1 Treatment 2 024681012 Months Since Baseline Busia, Kenya Source: Miguel and Kremer 2000

26. School-based Services: Health screening & inclusion

27. -Innovative/inclusive IEC materials, particularly for deaf children -Improving accessibility and outreach -Training teachers and students on inclusion Integrating Inclusive Components into SHN Programmes

28. Referral of children to local health facilities and on-site provision of assistive devices (e.g. spectacles) Health & disability screening in schools Trained teachers identify the presence of health problems amongst children. Screening children for: Refractive error & disabilities Common infections

29. Cambodia Vision Screening & Scale-up: 2012-14 Government of Cambodia scaling up nationally in 2015, addressing this need cost-effectively and raising awareness School-based screening (n=12,500) Provision of eye glasses on the same day Initial screening by trained teachers 6 month follow up 100% agreement between teacher screening and professional screening

30. School-based Services: Oral Health

31. Addressing dental caries: can affect food intake, reduce quality of life and lead to increased absenteeism if not addressed Oral Health Provision

32. Safe & Sanitary School Environment: WASH

33. WAter Image credits: Aubrey Wade/WaterAid/Panos Image credits: WSSCC http://www.wsscc.org/resources/resource- photo/toilets-south-africa#3 Image credits: UNICEF, UNICEFBANA2011-01020Shafiqul http://www.unicef.bg/en/article/On-Global-Handwashing-Day- UNICEF-says-It-s-not-complicated-but-it-s-crucial/375 H ygiene S anitation

34. Safe drinking water at school

35. FRESH: Strengthened Through Partnership Under-pinned by effective partnerships, especially between the education and health sectors

36. I NTEGRATING AND S CALING U P SHN P ROGRAMMES

37. Integrated SHN in Africa: The Enhanced School Health Initiative (ESHI) Southern Nations Nationalities People’s Region Ethiopia (SNNPR)

38. An Integrated Approach: Situational analysis in SNNPR Schistosomiasis prevalence STH prevalence Water collection in schoolsSchool Feeding status

39. A multi-partner response: Integrating school health interventions in SNNPR Baseline mapping, 35,600 children screened. Case study intervention in 30 schools, 31,000 children.

40. ESHI Deworming Improved WASH Health Education School Feeding School Health & Nutrition Case Study Interventions

41. Fully Integrated SHN (Deworming, HGSF & WASH in Ethiopia) Overall: $35.15 per child per year. Deworming: $0.40 per child (drugs were donated) Made up of transport and salary costs Overall WASH and deworming: $6.68/chd/yr $1.05 in CC and $0.06 in government contribution Overall SF: $28.01/chd/yr Including a $4.16 CC & $0.57 Local Government cost

42. Fit for School: Cambodia, Indonesia, Lao PDR, Philippines. Hand washing | Oral Health | Deworming Integrated SHN in Asia

43. Monitoring and Evaluating SHN Programmes

44. M ONITORING AND E VALUATING S CHOOL H EALTH P ROGRAMMES

45. Large exercise to benchmark education sub-systems Comparative data and Knowledge on Education Policies and Institutions Comparative data and Knowledge on Education Policies and Institutions

46. SABER DOMAINS

47. M&E OUTPUTS: FRESH & SABER Structured Identification Gaps Priorities Evidence Base Action Plan and M&E Stakeholder mobilisation Stronger coordination

48. S UPPORT FROM PARTNERS : A LIGNING CONCEPTS

49. Partnerships and integrated policy Community, Schools & Teachers NGOs Donors International organisations Government MoH MoE

50. Technical Development Planning Government-led and harmonised with partners A roadmap for development Roles and responsibilities defined Examples from Ghana: the Ghana Minister of Local Government and Rural Development signs the joint TDP for school feeding with PCD Regional Manager, Daniel Mumuni.

51. Achieving Scalability and Sustainability Institutionalisation and mainstreaming into ESPs is key Strong M&E for evidence-based, contextual programming Roles and responsibilities of sectors defined at all levels Advocacy strategy crucial

52. Find out more: PartnershipforChildDevelopment www.schoolsandhealth.org www.imperial.ac.uk/pcd www.hgsf-global.org

53. Carry on with what you’re doing Fit for school is an example of global good practice