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EFA Flagship Initiatives


Focusing Resources on Effective School Health (FRESH)


Evidence has shown that investing in school-based health and nutrition programmes results in real advantages, including the five described below:

Better learning in school and better educational outcomes can be obtained by boosting attendance and educational achievement. For instance, provision of adequate water and sanitation facilities in schools in Bangladesh increased girls' attendance by 15 per cent. Interaction with families and demand for sanitation facilities at home were seen in 80 per cent of children who acquired these practices at school. Studies have shown that in Africa, more than half the schoolchildren are stunted in height and are anaemic, and that in many areas most schoolchildren are infected with worms, bilharzia and malaria parasites. These highly prevalent conditions are all associated with impaired cognitive ability.

New opportunities, unfulfilled needs: school health programmes can help ensure that children are healthy and able to take full advantage of what is often their first and only opportunity for formal education.

Enhanced equity: school health and nutrition programmes particularly benefit the poor and disadvantaged children, that is to say, two groups with the worst health and nutrition status.

Contribution to youth development comes as a result of tackling some major problems of adolescence: violence, substance abuse, teenage pregnancy and sexually transmitted diseases, including HIV/AIDS. For instance, in some countries in Latin America, more than a third of adolescent girls leave school prematurely, never to return, because of unplanned pregnancy.

A cost-effective investment in education (not just health) can be reached by promoting learning and simultaneously reducing repetition, absenteeism and dropout.


Launched at the World Education Forum (Dakar, April 2000), FRESH aims at:

Promoting child-friendly schools and promoting quality EFA by broadening the scope of school health programmes and improving their effectiveness.

Helping identify and address health-related problems that interfere with enrolment, attendance and learning.

Increasing awareness within the education community of the value of school health programmes as a strategy to achieve the EFA goals.

To achieve these goals, the following four components are defined, which should be made available together, in all schools.

Health-related school policies as a means to:

promote the overall health, hygiene and nutrition of children,

ensure a safe and secure physical environment and a positive psycho-social environment, and

address issues such as abuse of students, sexual harassment, school violence and bullying.

Provision of safe water and sanitation facilities the essential first steps towards a healthy physical, learning environment. By providing these facilities, schools can reinforce the health and hygiene messages, and act as an example to both students and the wider community

Skills-based health education - an approach to develop of knowledge, attitudes, values and life skills needed to make and act on the most appropriate and positive health-related decisions:

Changes in social and behavioural factors have given greater prominence to such health-related issues as HIV/AIDS, early pregnancy, injuries, violence, and tobacco abuse.

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.

School based health and nutrition services, both physical and psycho-social

Schools can effectively deliver some simple, safe and familiar health and nutritional services, including counselling for AIDS affected children and children traumatized by conflict 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 (six-monthly or annual) oral treatment and by changing the timing of meals, or providing a snack to address short-term hunger during school.

To reach the expected outcomes, strategies include effective partnerships between teachers and health workers, the involvement and support of parents and the community-at-large, and the active participation of young people in the design and implementation of the programme.

The FRESH framework responds to the specific needs of girls in the following areas: equal enrolment and protection from harassment and the provision of water and sanitation. The multi-country study on "young people, gender, sexuality and HIV/AIDS in education" drew the attention to the centrality of gender issues in the lives of young people.



At the policy level, activities consist of :

- Promoting inclusion of the Fresh Framework into national EFA action plans or other education reform documents through capacity-building and the training of EFA coordinators from Ministries of Education.

- Provision of financial and technical assistance to Education International to enable teachers' unions in Bukina Faso, Botswana, Côte d'Ivoire, Guinea, Haiti, Malawi, Mali, Rwanda, Senegal and Zambia to train teachers to use modern interactive methods to help adults and young people acquire skills that will help them avoid HIV infection and reduce related discrimination.

At the school level:

Campaigns launched to assist schools in planning and implementing their own school health projects (Afghanistan, Burundi, Bolivia/Chile, Timor-Leste, Kazakhstan, the Philippines, Samoa, Mozambique and Palestine).

Financial and technical assistance to primary, middle and secondary schools in Zhejiang Province (China) to strengthen nutrition and prevent tobacco use.


UNESCO, UNICEF, WHO, World Bank and Education International

Contact Information:

Anna Maria Hoffmann
Section on
Preventive Education for an Improved Quality of Life
Division for the Promotion of Quality Education
Education Sector
7, place de Fontenoy
75352 Paris 07 SP,
Phone : +33 (0)1 45 68 09 31
Fax : +33 (0) 145 68 56 22