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Strategy sessions III.4 > School Health
World Education Forum
Dakar, Senegal 26-28 April 2000
A FRESH Start to School Health: Improving learning and educational outcomes by improving health, hygiene and nutrition
Issues Paper
Strategy Session III.4
Original : English
Organizers: WHO, UNESCO, UNICEF,
 World Bank, Education International (EI)

  The link between learning and health clearly shows that Education for All (EFA) is unlikely to be achieved without significant improvements in the health of students and teachers.

EFA Thematic Study on School Health and Nutrition, 2000

While programmes of informal education, early child care and development, and adult education contribute significantly to the goal of EFA, this session focuses on strategies for improving learning and educational outcomes by improving school health, hygiene and nutrition programmes.
Schools have the potential capacity to improve the health of nations. In 1995, WHO's Expert Committee on Comprehensive School Health Education and Promotion concluded that "Research carried out in both developing and developed countries demonstrates that school health programmes can simultaneously reduce common health problems, increase the efficiency of the education system and advance public health, education and social and economic development." Yet, the implementation of school health programmes is often neglected as a viable strategy for improving education as well as health.
Indeed, at the World Conference on Education for All (1990), roundtables on school health and education gave strong and clear guidance for improving school health programmes as a means of achieving Education for All, yet those recommendations were not presented as priorities in the final report or in the Framework for Action to Meet Basic Learning Needs following Jomtien. Despite this, throughout the last decade, the EFA Secretariat has called attention to school health programmes as a means to achieve EFA. Thus, this strategy session is a critical opportunity for all persons concerned to apply their collective wisdom and call for the implementation of effective school health and nutrition programmes as an important part of the overall EFA strategy. Importantly, WHO, UNICEF, UNESCO, the World Bank and Education International come to this session united in support for such programmes, and are seeking participant support.

"It is no longer possible to ignore the fact that nutrition and health can severely affect the ability of children to learn. We are constructing the future with the precious resource of the present-our children. It is essential that they be given the opportunity to derive maximum benefit from the schooling they receive"

-- Director-General, UNESCO 1990

Since Jomtien, a significant amount of research has been conducted concerning 1) the interrelationships among health, cognition, school participation, and academic achievement and 2) the effectiveness of school health interventions. Experience has shown that if the quality and quantity of school health programs are to increase, the education sector must take a lead role.
1. Implementation and effectiveness of school health programmes
The Thematic Study of School Health and Nutrition, prepared for the EFA 2000 Assessment by Education Development Center (EDC), presents ten major findings about the implementation and effectiveness of school health programmes: 1) School-based nutrition interventions can improve academic performance. 2) Health and nutrition status affect enrolment, retention and absenteeism. 3) Education benefits health. 4) Education can reduce social and gender inequities. 5) Health promotion for teachers benefits their health, morale, and quality of instruction. 6) Health promotion and disease prevention programs are cost effective. 7) Treating youngsters in school can reduce disease in the community. 8) Multiple, co-ordinated strategies produce a greater effect than individual strategies, but multiple strategies for any one audience must be selective and targeted. 9) Health education is most effective when using interactive methods in a skills-based approach. 10) Trained teachers produce more significant outcomes in student health knowledge and skills than untrained teachers do. An extensive listing of evidence of school health programme effectiveness can be found in Figure I of the Thematic Study.
2. Thematic study suggestions for EFA 2015
An international initiative, Focusing Resources on Effective School Health (FRESH), will be proposed as a means of implementing co-ordinated action towards a common vision. The Thematic Study emphasises the development of a shared vision, a commitment to act, a pledge to work collaboratively and the importance of a global effort to share and acquire information. The suggestions are:

1) Major players in the field must join together around a common framework

, 2) To be successful, school health, hygiene and nutrition efforts must be led by educators, with support and assistance from health professionals, and made an integral part of efforts to improve education through educational policies and goals.

3) We must continue to deepen and expand collaboration, especially between the education and health sectors, with mechanisms that sustain and nurture joint planning, action, and learning together over time.

4) More investment is needed in health services for children and adolescents that they can reach easily, without stigma.

5) Access to information as well as sustained support to use it (e.g. professional development, technical co-operation, and mentoring) must be improved for education and health workers.

6) Multiple targeted and co-ordinated strategies are needed to improve desired behaviour patterns and health outcomes.

7) Indicators that provide universal measures of progress are needed to focus efforts and improve what is possible to report by 2015. 8) Because countries vary in terms of what they can afford, model programs should be developed for differing levels of investment.


Poor health and malnutrition are important underlying factors for low school enrolment, absenteeism, poor classroom performance, and early school dropout, as reflected in the World Declaration on Education for All . Programmes to achieve good health, hygiene and nutrition at school age are therefore essential to the promotion of basic education for all children

. -- Focusing Resources on Effective School Health: a FRESH Start to Improving the Quality and Equity of Education

3. The basic framework for an effective school health and nutrition programme
The basic framework consists of four core components that should be made available together, in all schools.
The basic framework consists of four core components that should be made available together, in all schools.

1. Health-related school policies. Health policies in schools 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. The process of developing and agreeing upon policies draws attention to these issues

2. Safe water and sanitation: essential first steps towards a healthy environment. The school environment may damage the health and nutritional status of school children, 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.

3. 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 psychosocial and environmental issues.

4. 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.

4. Supporting Activities
The planning and implementation of school health and nutrition programmes should involve effective partnerships between teachers and health workers and between the education and health sectors, positive interaction between the school and the community, and participation by students, parents and community members. Children and adolescents who participate, learn about health by doing.
5. Comments on the Draft Framework for Action

The following issues might be considered in strengthening the proposed Framework: for Action. Section III: The headings of the EFA goals contain no reference to health. However, --

Section III.1, concerning early childhood care and education, begins with a powerful statement that promotes health and learning: "All young children must be nurtured in safe and caring environments that allow them to become healthy, alert, secure, and able to learn." It is a model for other sections.

Section III.2, concerning access to and completion of a primary education of good quality, makes no mention of health. It is perhaps one of the most important places to address the health and safety of learners and their environment. The health-related statement in section III.1 is very relevant here, too.

Section III.6 ,Improving all aspects of the quality of education, contains a clear reference to the importance of health, stating that successful education requires healthy and motivated students and an environment is healthy, and safe.The final paragraph offers an excellent opportunity to describe how health affects the demand for education and what actions are required to increase participation and learning. The following content could be included:

"There are clear and essential reasons for the education and health sectors to work more closely together: Good health and nutrition are essential for learning and participation in education and literacy programmes; ill-health can prevent children from attending school and from learning while there; ensuring that children are healthy and able to learn is especially relevant to efforts to increase enrollment which encourage the poorest and most disadvantaged children to attend school, children who often are the sickest and most malnourished, and they also have the most to gain educationally, especially girls; and school health and nutrition programmes can greatly enhance participation and educational achievement."

Section IV.4 outlines a strategy to create safe and healthy educational environments: This section implies an important emphasis on the link between education and health, yet the text contains no specific reference to health and no specific strategies to create a safe and health educational environment. To enhance learning and create safe and healthy educational environments, this section could recommend that:

"Education, health workers, teachers, students, parents and community members should work together to implement effective school health and nutrition programmes consisting of at least four core components: 1) health-related school policies, 2) water and sanitation as first steps in creating a safe and protective physical and psychosocial environment , 3) skills-based health education focusing on knowledge, attitudes, values, and life skills needed to make and act on positive health-related decisions, and 4) access to or linkages to health and nutrition services. These four components should be made available together, in all schools."

Section IV.9, proposing a strategy to address the HIV/AIDS pandemic, presents very well the threat posed by HIV/AIDS to the achievement of EFA goals, especially in Sub-Saharan Africa, but no broader reference to "health" is included, such as "other important health problems and conditions that significantly affect school attendance and learning".

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