FRESH Pillars

The FRESH Framework identifies four key pillars as the basis for school health responses: equitable school health policies, safe learning environment, skills-based health education, and school-based health and nutrition services. It is through these four mutually reinforcing components that an effective school health response can be implemented within each school.

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School-based health and nutrition services

Many common health problems which students face in school can be managed effectively, simply, and inexpensively through school-based health and nutrition services. Treatment services such as deworming and micronutrient supplementation are simple, easy, safe and cheap to administer by teachers and can immediately improve children’s health and nutritional status. This in turn helps them to concentrate and learn in school. School-based counselling services can help identify and support children and young people during difficult times and prevent school absenteeism and drop-out. A strong referral system to health service providers, child protection services and community support groups is also essential to ensurethat children with more serious health problems which cannot be dealt with at school are referred to the appropriate services.  

While the school system is rarely universal, coverage is often superior to health systems, and it has an extensive skilled workforce in daily contact with children and the community. Schools are therefore in a unique position to promptly and cost-effectively address common health problems which prevent children from attending and participating in school and to improve follow-up with existing health and social services.

Further information on school-based health and nutrition services.

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Equitable school health policies

National- and local (school)-level school health policies are necessary to promote effective school health programming.  

At school level: School health-related policies set priorities, objectives, standards and rules to protect and promote the health and safety of both students and staff. School health policies should address physical safety issues such as ensuring that the school has adequate water and sanitation facilities as well as a safe environment to protect students and staff from abuse, sexual harassment, discrimination, and bullying. School health policies should respond to local priorities and the needs of all, including marginalized children. In addition, the process of developing and agreeing upon policies draws attention to the issues that need to be addressed.

At national level: School-level health policies are most effective when supported by a national level policy framework that articulates expectations for schools across the country. For example, the national school health policy may recommend where appropriate, that all schools have safe and separate water and sanitation facilities for girls and boys, that all children are dewormed at least once a year and that child health clubs are set up in every school to improve child participation in school health. Both national- and school-level policies are best developed by involving as many stakeholders as possible: teachers, students, health care providers and the community.

Further information on school health policies


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A safe learning environment

The school environment refers to aspects of the school or learning space that affect both the physical and psychosocial well-being of students, teachers, and other school staff. With regards to psychosocial well-being, the school should be a place where all are free from fear, exploitation, and where codes against misconduct exist and are enforced. With regards to physical well-being, the school should be a place where all individuals are free from danger, disease, physical harm or injury; where sufficient water and sanitation facilities are provided and where physical structures (buildings, paths and latrines) are sound, welcoming and secure. 

Provision of safe water and sanitation are essential first steps towards a healthy physical learning environment. The school environment can potentially damage the health and nutritional status of students, if it exposes them to hazards such as infectious diseases carried by an unsafe water supply, lack of hand washing facilities or unsanitary latrines. In order for hygiene education to be effective, clean water and adequate sanitation facilities must be made available. These in turn can reinforce the health and hygiene messages, and act as an example to both students and the wider community. They also make the school more welcoming and can increase school attendance, especially amongst girls who require the privacy of single sex toilets (particularly during their menses).

Further information on safe learning environment


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Skills-based health education

Skills-based health education uses participatory exercises to assist students to acquire knowledge and develop the attitudes and skills required to adopt healthy behaviors. The skills developed can include cognitive skills such as problem-solving, creative and critical thinking, and decision-making; personal skills such as self-awareness, anger management and emotional coping; and interpersonal skills such as communication, cooperation and negotiation skills. For example, skills-based health education can clarify students’ perceptions of risk and vulnerability, which can help them avoid becoming infected with HIV, malaria or other diseases, increase their understanding of the importance of washing hands after going to the latrine or before eating, or realize their own role in the use of resources and their impact on the environment. Skills-based health education thus has the potential to empower individuals to protect and improve their own and others’ health, safety and well-being, which can in turn lead to better health and educational outcomes for children and their communities now and in the future.

Further information on skills based health education  


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