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Transcript of School Health and Nutrition Programs Donald Bundy Human Development Network The World Bank Sana’a,...
School Health and Nutrition Programs
Donald BundyHuman Development Network
The World Bank
Sana’a, Yemen, January 23, 2007
0
20
40
60
80
100
0 10 20 30 40 50 60
Age (years)
Perc
enta
ge infe
cte
d
Ascaris Trichuris Hookworm
0.6
0.65
0.7
0.75
0.8
0.85
0 2 4 6 8 10 12 Months Since Baseline
Attendance Rate
Untreated
Schools
Treated
Schools
Treatment 1 Treatment 2
Miguel & Kremer, 2000
School absenteeism and helminth infectionP
rop
ort
ion
of
year
ab
sen
t
Uninfected Low Moderate High
0.3
0.2
0.1
0
Whipworm Intensity (epg)
Nokes et al 1993
0 1-<2000 2000-<7000 >7000
Nokes et al 1992
Sc
ore
3 mths Post-intervention
25
24
23
22
21
20
Treatment
Placebo
Categorical Fluency
Pre-intervention
Uninfected
Improvement in Cognitive Performance with Treatment in School Children
Improvement in School Attendance Following De-Worming in Busia, Kenya
0.6
0.65
0.7
0.75
0.8
0.85
0 2 4 6 8 10 12
Months Since Baseline
Att
end
ance
Rat
e
Untreated Schools
Treated Schools
Treatment 1 Treatment 2
Miguel & Kremer, 2000
Condition Prevalence/ No. Cases
IQ loss: Per Child
Total IQ loss/mentalretardation
Years ofschooling lost
Stunting 52%/292m 3 points 877(21.6m)
284m
Anaemia 53%/298m 6 points 1788(45.6m)
524m
Worms 30%/169m 3.75 points 633(15.8m)
201m
IQ and schooling losses avoidable by school based SHN programs
Country Program No. Students No. Schools Cost US$
Guinea Mainstream public sector
350,000 600 0.89
Madagascar Program public sector
430,000 4,585 0.78-1.08
Tajikistan Social Fund 100,000 200 1.00
Indonesia Private sector 161,000 627 0.10
Examples of school based SHN programs
Comparing returns to education
Add years schooling Cost US$ p.a.SHN Programs 1.2 – 2.5 < 4Textbooks 1.1 60Cash transfer – Nicaragua 0.45 77 Cash transfer – Progresa 0.66 136 School Feeding 0.4 – 1.2 22 -151
A FRESH Start: Focusing Resources on Effective School
Health, Hygiene & Nutrition
• Child Friendly Schools ….UNICEFChild Friendly Schools ….UNICEF
• Health Promoting Schools…WHOHealth Promoting Schools…WHO
• Education for All…UNESCOEducation for All…UNESCO
• Food for Education…WFPFood for Education…WFP
• School Health Initiative…World School Health Initiative…World
BankBank
A FRESH Start: Focusing Resources on Effective School
Health, Hygiene & Nutrition
Core intervention activities• Effective health, hygiene and nutrition policies for
schools
• Sanitation and access to safe water facilities for all schools
• Skills based health, hygiene & nutrition education
• School based health & nutrition services
FRESH Partnership
• Launched at the World Launched at the World
Education for All Forum in Education for All Forum in
Dakar, Senegal April 2000Dakar, Senegal April 2000
• WHO, UNICEF, UNESCO, WHO, UNICEF, UNESCO,
World Bank & OthersWorld Bank & Others
A Strategic Plan for School Based Delivery of Health and Nutrition
Services in Eritrea
Prepared jointly by the Ministries of Education and Health of the
Government of Eritrea
School Health and Nutrition Policy
• A Memorandum between the Ministry of A Memorandum between the Ministry of
Health and the Ministry of EducationHealth and the Ministry of Education
• National inter-sectoral steering committeeNational inter-sectoral steering committee
• Defined responsibilities for each MinistryDefined responsibilities for each Ministry
• Defined mainstream actions for each Defined mainstream actions for each
MinistryMinistry
The School Environment
• All schools to have gender separate All schools to have gender separate
sanitationsanitation
• Sanitation facilities to conform to Sanitation facilities to conform to
national guidelinesnational guidelines
• All school children to have access to All school children to have access to
safe water schoolsafe water school
Health Education
• National curriculum that addresses National curriculum that addresses
health, hygiene and nutrition issueshealth, hygiene and nutrition issues
• Life skills modules that promote Life skills modules that promote
positive behaviors: tobacco, HIV/AIDS, positive behaviors: tobacco, HIV/AIDS,
violenceviolence
• Peer education in all secondary schoolsPeer education in all secondary schools
School Based Delivery of Health and Nutrition Services.
Recommendations made based on:
• The evidence of a national situation analysis
• The knowledge and experience of members of the Ministry of Health
Situation analysis of Eritrean schoolchildren
• the prevalence of undernutrition • the prevalence of anaemia • the prevalence of infections with parasitic worms • understanding of the knowledge, attitudes,
practices and beliefs • access to water and sanitation facilities in schools • highlight focal problems
Condition Need (evidence
from Situation Analysis and
MoH experience)
Scale of Benefit Cost($ per capita
Feasibility of universal access(based on experience elsewhere)
Type of ServiceEducation Health
Bilharzia +++ (in certain areas)
+++ +++ 0.80 +++ Treatment in school
Anemia +++ (in certain areas)
+++ +++ 1.20 +++ Treatment in school
Vitamin A supplementation
+++ + +++ 0.30 +++ Treatment in school
Dental Caries ++ + +++ 30.00 + Referral to MoH services
Refractive Error +++ +++ ++ 5.00 ++ Referral to MoH services
Skin infections + + + 3.00 ++ Treatment in school
PROVINCE Maekel Debub Anseba Gash Barka
Northern Red Sea
Southern Red Sea
Condition
Bilharzia No Yes (above 1200m)
Yes (above 1200m)
Yes (above 1200m)
No No
Anemia1 No No No No Yes Yes
Vitamin A supplementation
Yes Yes Yes Yes Yes Yes
Dental Caries Yes Yes Yes Yes Yes Yes
Refractive Error Yes Yes Yes Yes Yes Yes
Skin infections Yes Yes Yes Yes Yes Yes
Eye infections Yes Yes Yes Yes Yes Yes
First Aid Yes Yes Yes Yes Yes Yes
Hearing impairment
Yes Yes Yes Yes Yes Yes
Ear infections Yes Yes Yes Yes Yes Yes
Malnutrition Yes Yes Yes Yes Yes Yes
Teacher Centred Approach
Eritrea has many more teachers than health staff and many more schools than clinics:
• plan seeks to maximize the input of teachers and minimize the input required of local health staff.
• Teachers always act under the supervision of local health staff
• Where possible the results of the situation analysis have been used to recommend mass treatment for all school children in an area with no need for prior screening
• Where screening is required, wherever possible, teachers are given this responsibility
• Where treatment is required, wherever possible, teachers are given this responsibility
• Where treatment requires more complex medical training teachers should always refer children to local health staff
The Key Steps • National survey of the health and nutrition National survey of the health and nutrition
of school childrenof school children
• Joint MoU between Education and Health Joint MoU between Education and Health
stating National School Health and stating National School Health and
Nutrition policyNutrition policy
• National workshop to include SHN in action National workshop to include SHN in action
plans at the national and provincial levelsplans at the national and provincial levels
For more information, please visit:
www.schoolsandhealth.org