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The findings > Thematic Studies> School Health and Nutrition>Part 2 >cont. 2
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Chapter III: Looking Forward: Suggestions for EFA 2015
With the research findings of the past ten years as a guide, the forthcoming decade shows great promise for strengthening the links between health and education. The record of the last decade affirms that the world community can translate its highest aspirations for children into effective programs. If the past is indeed a prelude to the future, we can say with confidence that the pace in responding to the learning and health needs of children greatly accelerates once consensus has been achieved on policies and programs that work. We hope that the following suggestions will encourage consensus on what countries must do to meet the health and learning needs of their school-age citizens. These suggestions emphasize the development of a shared vision, a commitment to act, a pledge to work collaboratively, and the importance of a global effort to acquire and share information.
1. Major leaders and change agents in the field must come together around a common framework, relevant to the education sector.

Such a framework should be part of a larger effort to improve the general quality of the schools and the education children receive. The creation of frameworks in the past decade (see Chapter V) contributed enormously to driving the school health agenda forward. Frameworks have increased creativity, generated experimentation, and inspired a broad range of research and program activities. At this juncture, however, we run the risk of allowing the proliferation of so many frameworks to diffuse human and financial resources and to confuse those who are ready to take action. A shared framework should drive an action agenda that:

1) promotes healthy development and focuses on the most serious and common health threats through the coordinated implementation of core components of a school health and nutrition program in schools everywhere;

2) sets specific, quantifiable goals for the agenda;

3) applies lessons learned from the past decade on how best to implement the core components; and

4) establishes indicators to monitor the implementation and effectiveness of the core components in countries and schools worldwide.

A shared framework must view the school as a dynamic system in which people can effect change to promote health and learning and which focuses not only on children but staff, teachers, parents and community members, and links to health services.
2. To be successful, school health, hygiene, and nutrition efforts must be led by educators, supported and assisted by health professionals, and made an integral part of the efforts to improve education through policies and goals.
School health and nutrition efforts can have a powerful effect on improving the status of schools (through efforts by schools and communities) as well as education (through policies and goals). Much of the power of school health programs lies in their ability to mobilize schools and communities around the improvement in educational quality and outcomes for their children. Educators must be convinced that such programs are practical and doable, yield results, are beneficial to staff and students, and advance learning. It is equally important that leaders relate the efforts to the social and economic agenda in gaining support. Recruiting a small but highly influential group of well-known and respected international educators to champion the school health agenda would be valuable.
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 over time.
Experiments have taken place at the world, regional, and national levels to bring the education and health sectors together. Where successful, these collaborations have created a common language, provided unique contributions for sharing and learning, and leveraged resources (e.g., Short, Talley, & Kolbe, 1999). However, sustaining the collaboration is difficult. It is also important to identify and use the unique roles of various participants. Collaboration does not mean that everyone does the same thing, but each sector makes it unique contribution to common goals. Successful collaboration must identify the most relevant role for the educator, the health worker, and the parent and community members. More must be done to sustain emerging networks for collaboration, providing professional development, resources, and materials to increase their capacity and learning and to sustain energy and commitment in the face of obstacles.
4. More investment is needed in health services for children and adolescents that they can reach easily, without stigma.
More health services should be located in or near schools and staffed with people trained to work with youth. Young people all over the world need health services, particularly those that are "youth friendly." Traditional health services must move beyond medical treatment to preventive services and early intervention and accommodate the particular needs of young people (e.g., for emotional support, confidentiality, and accessibility).
5. Access to information as well as sustained support to use it (e.g., professional development, technical cooperation, and mentoring) must be improved for education and health workers.
Much is known about the effectiveness of various school health and nutrition programs. Research findings could have a much greater impact if they were accessible to more people. We must try to extract key findings from the many excellent technical documents that exist and make them available in simple, clear formats and multiple languages for practitioners. There is a need for ongoing professional development and technical know-how for education and health workers about how to identify, select, and implement the most effective strategies for their needs. A creative use of the Internet and online training must be applied to the field of school health and nutrition on a global scale.
6. Multiple targeted and coordinated strategies are needed to improve desired behavior patterns and health outcomes.
Research in public health, the foundation of most approaches to school health, has demonstrated that multiple strategies coordinated to address a few common goals are more effective in producing desired behavior changes and health outcomes than single-track approaches. Such strategies may include coordinated policy, supportive environments, community action, personal skills, and health services targeted to a few selected conditions (WHO/Ministry of Health Indonesia, 1997).
7. Indicators that provide universal measures of progress are needed to focus efforts and report changes that are possible to achieve by 2015.
While there has been tremendous progress since Jomtien, it is impossible to tell the full story of what has happened globally without common indicators of progress. Such indicators could provide information about national capacities and infrastructure to implement school health programs. Measures could include the availability of school policies and budgets with line items dedicated to health, mechanisms for collaboration, and the health-related training of teachers and health workers. Beyond measures of capacity, indicators of children's health status could include height and weight data, rates of anemia and other micronutrient deficiency diseases, and number of meals or fruit and vegetable servings per day. At the national and local level, too, more and better program planning and evaluation tools are necessary.
8. Model programs should be developed for different levels of investment because countries vary in what they can afford.
We should identify the best package of inputs and services at different investment levels (e.g., $2, $5, and $10 per child). For each "model package," we should also identify the expected benefits as precisely as possible. Such an approach will enable countries to launch school health initiatives that are both efficacious and affordable.
Another observation must inform our efforts in the future. In many countries, people who are very poor and disenfranchised have reported that their participation in addressing health issues in schools has made a difference in their lives. The opportunity to have a voice and role in creating change to improve the quality of life for their children, themselves, and their community has transformed their world. In his book Development as Freedom, the Nobel Prize-winner for economics Dr. Amartya Sen argues that reductions in poverty and progress in economic development are possible only when citizens have the freedom or opportunity to receive basic education and health care. With the participation of allūthe education and health sectors, parents, teachers, and community membersūpeople everywhere can make gradual improvements in their quality of life.
As we consider the changes that policy makers, practitioners, and citizens can bring about in the future, it is good to reflect on developments in the past. The following chapters look back at the status of school health leading up to Jomtien in 1990; describe conceptual frameworks that were developed in the 1990s; and highlight major trends that took place in the field of school health and nutrition since Jomtien.
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