1. Lessons learned in the implementation of strategies in schools: the case of Chile. Marcia Erazo

3. 3 www.thelancet.com Published online February 4, 2011 BMI (K G / M 2)

5. School-based strategies Chile, following the guidance of the World Health Organization, in 2007 implemented a series of strategies at schools (1000 schools nationwide).

6. Main strategies Healthy kiosks: To reduce the exposure to “junk food” at school. Physical education: To increase the total hours of physical activity Health promotion: To introduce health topics on a regular basis at school

7. Objective To analyze the barriers and facilitators to the implementation of strategies in schools. Complete reports at: http://www.minsal.cl/portal/url/page/minsalcl/g_proteccion/g_alimen tos/prot_ego.html

8. First evaluation (2010) Qualitative evaluation, aimed to evaluate the process of implementation at regional and community level. Focus group and key stakeholders interviews.

9. Results At regional level: Horizontal articulation: Technical orientations are applied al community level. Metropolitan area, there is a lack of coordination. There is inter-sectorial work between sports and educational institutions, that work together.

10. Results Vertical integration: There is intra-sectorial integration, especially when, at community level, there is a person designated to work the health promotion. Monitoring, supervising and accompanying the implementation at community level

11. Results Horizontal articulation at community level: There is inter-sectorial work. Only actions at school level, once a month. “The school” sees this activity as an “extra”.

12. Second evaluation (2010) Quantitave and qualitative methods Weight, height Interviews

13. Results

17. Third evaluation (2011)

18. Facilitators Principal’s will, by encouraging healthy habits. Possitive assessment of students in more hours of physical activity.

19. Barriers Selling unhealthy foods at school. To give money to children Lack of continuity of interventions. Lack of intra-extra sectorial coordination Managerial failure Lack of “political agreement”

20. School-based intervention in one community Presented in a seminar of successful practices to prevent childhood obesity, organized by PAHO, in Santiago-Chile, January 21-22, 2013. Conducted by Municipalidad de Peñalolén http://www.paho.org/chi/

21. School-based intervention in one community Intervention: Physical activity: 3 hours a week, in different days, specialized teacher, active pauses. Healthy eating and nutrition Anthropometry Healthy eating education to children, parents and school community. Healthy kiosks Health promotion

22. Results Physical activity 20092012 Hours100% <2 a week100% 3 hrs a wek Distribution1 day a week3 days a week ProfessionalGeneral teacherSpecialized teacher

23. Active pause

24. Healthy kiosks Change in “terms of reference” to manage to kiosks

26. Lessons learned Sustainability of the program is given by: Central management Coordinated Inter-sectorial work Inclusion of the strategies in the community health plans and official documents.

27. Lessons learned Successful of the program is given by The leadership and commitment of the school principal, Permanent monitoring of the correct implementation of strategies, Fcus on promoting healthy habits to children and their families, Reinforcement by regulation within and outside of the schools of junk food