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World
Education Forum
Dakar, Senegal 26-28 April 2000 |
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| A
FRESH Start to School Health: Improving learning and educational
outcomes by improving health, hygiene and nutrition |
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Issues
Paper
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| Strategy
Session III.4 |
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Original
: English
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Organizers:
WHO, UNESCO, UNICEF,
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World
Bank, Education International (EI)
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 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
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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. |
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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. |
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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. |
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"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
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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. |
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| 1. Implementation
and effectiveness of school health programmes |
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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. |
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| 2. Thematic
study suggestions for EFA 2015 |
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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: |
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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.
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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
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-- Focusing Resources on Effective School
Health: a FRESH Start to Improving the Quality and Equity
of Education
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| 3. The
basic framework for an effective school health and nutrition
programme |
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The basic framework consists of four core components that
should be made available together, in all schools.
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The basic framework consists of four core components that should
be made available together, in all schools. |
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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.
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| 4. Supporting
Activities |
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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. |
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| 5. Comments
on the Draft Framework for Action |
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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,
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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:
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"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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