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The interagency initiative FRESH
(Focusing Resources on Effective School Health)

The interagency initiative FRESH (Focusing Resources on Effective School Health) was launched by UNESCO, UNICEF, WHO and the World Bank during the World Education Forum, Dakar, April 2000 It is a united agency response to recent trends in growing recognition on the need to improve holistic approaches and multiple strategies - rather than individual approaches - to promote health and nutrition through schools. It is not necessarily intended to create new structures and projects, but to build in the approach in various educational projects and programmes and is in this sense a truly collaborative effort both among and within the concerned agencies.


Improving the health and learning of school children through school-based health and nutrition programmes is not a new concept. Many countries have school health programmes, and many agencies have decades of experience. These common experiences suggest an opportunity for concerted action by a partnership of agencies to broaden the scope of school health programmes and make them more effective. Effective school health programmes will contribute to the development of child-friendly schools and thus to the promotion of education for all.

This interagency initiative has identified a core group of activities, each already recommended by the participating agencies, that captures the best practices from programme experiences. Focusing initially on these activities will allow concerted action by the participating agencies, and will ensure consistent advice to country programmes and projects. Because of the focused and collaborative nature of this approach, it will increase the number of countries able to implement school health components of child-friendly school reforms, and help ensure that these programmes go to scale. The focused actions are seen as a starting point to which other interventions may be added, as appropriate.

The actions also contribute to existing agency initiatives. They are an essential component of the "health promoting schools" initiative of WHO and of global efforts by UNICEF, UNESCO and the World Bank to make schools effective as well as healthy, hygienic and safe. Overall, the inter-agency action is perceived as Focusing Resources on Effective School Health, and giving a FRESH Start to improving the quality and equity of education.


The following four components should be made available together, in all schools.

(i) Health-related school policies

Health policies in schools, including skills-based health education and the provision of some health services, can help promote the overall health, hygiene and nutrition of children. But good health policies should go beyond this to ensure a safe and secure physical environment and A positive psycho-social environment, and should address issues such as abuse of students, sexual harassment, school violence, and bullying. Policies regarding the health-related practices of teachers and students can reinforce health education: teachers can act as positive role models for their students, for example, by not smoking in school. The process of developing and agreeing upon policies draws attention to these issues. The policies are best developed by involving many levels, including the national level, and teachers, children, and parents at the school level.

(ii) Provision of safe water and sanitation - the essential first steps towards a healthy physical, learning environment

The school environment may damage the health and nutritional status of schoolchildren, particularly if it increases their exposure to hazards such as infectious disease carried by the water supply. Hygiene education is meaningless without clean water and adequate sanitation facilities. It is a realistic goal in most countries to ensure that all schools have access to clean water and sanitation. By providing these facilities, schools can reinforce the health and hygiene messages, and act as an example to both students and the wider community.

(iii) Skills based health education

This approach to health, hygiene and nutrition education focuses upon the development of knowledge, attitudes, values, and life skills needed to make and act on the most appropriate and positive health-related decisions. Health in this context extends beyond physical health to include psycho-social and environmental health issues. Changes in social and behavioural factors have given greater prominence to such health- related issues as HIV/AIDS, early pregnancy, injuries, violence and tobacco and substance use. The development of attitudes related to gender equity and respect between girls and boys, and the development of specific skills, such as dealing with peer pressure, are also central to effective skills based health education and positive psycho-social environments. When individuals have such skills they are more likely to adopt and sustain a healthy lifestyle during schooling and for the rest of their lives.

(iv) School based health and nutrition services

Schools can effectively deliver some health and nutritional services provided that the services are simple, safe and familiar, and address problems that are prevalent and recognized as important within the community. For example, micronutrient deficiencies and worm infections may be effectively dealt with by infrequent (six-monthly or annual) oral treatment; changing the timing of meals, or providing a snack to address short term hunger during school - an important constraint on learning - can contribute to school performance; and providing spectacles will allow some children to fully participate in class for the first time.

Contact information:

Anna Maria Hoffmann
Section for Preventive Education and Sports
Division for the Promotion of Quality Education
UNESCO - 7, place de Fontenoy
75352 Paris 07 SP, FRANCE
Fax +33145685622 / Tel +33145680931

Members of flagship programme:

UNESCO (see contact information above)
World Bank
Education International