Transcript SHN Programmes, A Global Good

SHN Programmes: A Global Good
Lesley Drake PhD
Executive Director
Partnership for Child Development
1.THE IMPORTANCE OF A GOOD START IN
LIFE: ALIVE & THRIVE
2.SCALING UP INTEGRATED INTERVENTIONS
3.SUPPORT FROM PARTNERS:
ALIGNING CONCEPTS
THE IMPORTANCE OF A GOOD START IN LIFE:
ALIVE & THRIVE
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
The Key to Sustainability and
Scalability
• Research needs to feed into ongoing
programming
• We learn as go
How did we get here?
80s: The evidence base – links between health,
nutrition & education.
90s: Developing school health policies.
00s: Mainstreaming approaches across sectors.
A Historical Reflection
Nairobi: Launch of
Africa SHN Training
Courses for
Government Staff
Jomtien: World
Conference on
EFA, EFA
Declared
1990
2000
Dakar: World
Education Forum,
Framework for
Action
2005
2007
Siem Reap: Workshop
to Strengthen the
Education Sector
Response to SHN
A Historical Reflection
Bangkok: Launch of
Asia SHN Training
MDGs become
Courses for
SDGs…
Government Staff
2010
Addis Ababa:
Declaration of
the High-Level
Group on EFA
2011
2015…
Fit for School
Regional
Conference
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’
The FRESH Framework: 15 Years
• Focusing
• Resources on
• Effective
• School
• Health, hygiene & nutrition programs
The FRESH Framework: 15 Years
Policy
Environment
Health
Education
Services
School Health & Nutrition
Policy
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.
Skills-based Health Education
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)
School-based Services:
School Feeding & Nutrition
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
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.aspx
Home Grown School Feeding
• 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
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
Maize porridge,
500 g.
48%
0%
31%
Energy 2000kcal
Protein 28g
0%
Vitamin C 45mg
Vitamin A 700mcg
0%
16%
20%
Iron 37mg
Zinc 15mg
Iodine 120mcg
Maize, CL,
++ Iodized Salt,
Groundnuts,
108%
74%
47%
61%
33%
31%
48%
Energy 2000kcal
0%
Protein 28g
Vitamin A 700mcg
100%
73%
31%
34%
0%
Vitamin C 45mg
0%
24%
16%
23%
20%
Iron 37mg
Zinc 15mg
Iodine 120mcg
School-based Services:
Deworming Programmes
Deworming Programmes
Ascaris lumbricoides
(roundworm)
Trichuris trichiura
(whipworm)
Ancylocstoma duodenale
Necator americanus
(hookworm)
Schistosoma haematobium
S. Mansoni
S. japonicum
Improved school attendance
following deworming
Treatment 1
0.85
Treatment 2
Attendance Rate
0.8
Treated Schools
0.75
0.7
Untreated Schools
0.65
0.6
0
2
4
6
8
10
12
Months Since Baseline
Busia, Kenya
Source: Miguel and Kremer 2000
School-based Services:
Health screening & inclusion
Integrating Inclusive Components
into SHN Programmes
-Innovative/inclusive IEC materials,
particularly for deaf children
-Improving accessibility and
outreach
-Training teachers and students on
inclusion
Health & disability screening in schools
• Trained teachers identify the presence
of health problems amongst children.
• Screening children for:
Refractive error & disabilities
Common infections
• Referral of children to local
health facilities and on-site
provision of assistive devices
(e.g. spectacles)
Cambodia Vision Screening & Scale-up: 2012-14
•
•
•
•
•
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
• Government of Cambodia scaling up
nationally in 2015, addressing this
need cost-effectively and raising
awareness
School-based Services:
Oral Health
Oral Health Provision
Addressing dental caries: can affect food intake,
reduce quality of life and lead to increased
absenteeism if not addressed
Safe & Sanitary School Environment:
WASH
Safe & Sanitary School
Environment: WASH
WAter
Sanitation
Image credits: Aubrey Wade/WaterAid/Panos
Hygiene
Image credits: UNICEF, UNICEFBANA2011-01020Shafiqul
http://www.unicef.bg/en/article/On-Global-Handwashing-DayUNICEF-says-It-s-not-complicated-but-it-s-crucial/375
Image credits: WSSCC http://www.wsscc.org/resources/resourcephoto/toilets-south-africa#3
FRESH: Strengthened Through Partnership
Under-pinned by effective partnerships,
especially between the education and health
sectors
INTEGRATING AND SCALING UP
SHN PROGRAMMES
Integrated SHN in Africa:
The Enhanced School Health Initiative
(ESHI)
Southern Nations Nationalities People’s Region
Ethiopia (SNNPR)
An Integrated Approach:
Situational analysis in SNNPR
STH prevalence
Schistosomiasis prevalence
Water collection in schools
School Feeding status
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.
School Health & Nutrition Case Study
Interventions
Deworming
Health
Education
ESHI
Improved WASH
School Feeding
Fully Integrated SHN
(Deworming, HGSF & WASH in Ethiopia)
Overall WASH and deworming:
$6.68/chd/yr
$1.05 in CC and $0.06 in
government contribution
Community
Government
14%
2%
Depreciation
(capital)
6%
Deworming:
$0.40 per child (drugs were
donated)
Made up of transport and
salary costs
Overall SF:
$28.01/chd/yr
Including a $4.16 CC &
$0.57 Local Government
cost
Food
43%
Indirect
7%
Training/Aw
areness
7%
Other Direct Monitoring
10%
3%
Transport
8%
Overall: $35.15 per child per year.
Integrated SHN in Asia
• Fit for School: Cambodia, Indonesia, Lao PDR, Philippines.
Hand washing | Oral Health | Deworming
Monitoring and Evaluating SHN
Programmes
MONITORING AND
EVALUATING SCHOOL
HEALTH PROGRAMMES
ystems
Approach
Better
Education
Results
Large exercise to
benchmark education
sub-systems
Comparative data and
Knowledge on
Education Policies and
Institutions
M&E OUTPUTS: FRESH & SABER
Structured
Identification
Gaps
Priorities
Stakeholder
mobilisation
Evidence
Base Action
Plan and
M&E
Stronger
coordination
SUPPORT FROM PARTNERS:
ALIGNING CONCEPTS
Partnerships and integrated policy
Community,
Schools &
Teachers
International
organisations
Donors
MoH
MoE
NGOs
Government
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.
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
Find out more:
www.imperial.ac.uk/pcd
www.hgsf-global.org
www.schoolsandhealth.org
Follow:
SHN @schoolhealth
HGSF @HGSFglobal
PartnershipforChildDevelopment
• Carry on with what you’re
doing
• Fit for school is an example
of global good practice