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© 2011 Save the Children 1
Dear Colleagues,
In review, 2010 was a significant year for Save the Children’s School Health and Nutrition (SHN) program. Our SHN program reached 5,260,859 children in 19 countries in 2010, nearly double the number of children reached in 2009. This expansion could not have been achieved without the dedication of Save the Children staff and partners from around the globe. Many children’s health and education outcomes have been achieved because of your efforts.
This program update provides a snapshot of the various SHN activities implemented by country offices in 2010. It details Save the Children’s role in the global push to promote water, sanitation and hygiene (WASH) in schools; combat neglected tropical diseases (NTDs); and develop evidence and good practices for malaria and anemia control in schools. It also outlines key resources that were developed in 2010 to be shared with the SHN community.
A key highlight of the year was the 2010 SHN Program Learning Group (PLG) in Zanzibar, Tanzania in December, which provided the opportunity for over 40 SHN program managers, technical assistance providers, outside technical experts and other Save the Children member staff to share best practices and receive in-depth training. Expert guest speakers included representatives from the Zanzibar AIDS Commission, Save the Children’s Child Protection Initiative and the Helminth Control Programme in Zanzibar.
As we look forward to 2011, Save the Children will build on its knowledge sharing efforts and expand its SHN portfolio to several new countries. This will happen against the backdrop of our transition to Save the Children International, which holds new opportunities for us as a global organization striving to address the health and education needs of children worldwide.
Seung Lee Senior Director for SHN April 2011
School Health and Nutrition Program Update I s s ue No . 7 , 2010 : A Yea r i n Re v i ew
Supporting school-age children to be healthy to learn and to learn to be healthy
Children and Schools Reached by Save the Children’s SHN Programs
In this issue:
What is School Health and Nutrition? WASH in Schools = SHN Save the Children Combats Global Burden of NTDs Building the Evidence for Malaria Control in Schools Results from Studies Key Materials Produced Country Updates
Asia Africa Middle East/Eurasia Latin America/Caribbean North America
Looking Forward Partnerships and Networking Events Contacts Where We Work
Source: Reports from SHN programs and Global Education Indicators
2 2 3 3 4 5
5-13 5-8
8-10 11
11-13 13 13 14 15 16
© 2011 Save the Children 2
Water, Sanitation and Hygiene (WASH) in Schools = SHN
In 2010, there was a major Call to Action for WASH in Schools to ensure that every child learns in a safe and hygienic environment and is protected from illnesses that limit their growth and development. The Call to Action is a collaboration among partners—including Save the Children and UNICEF—that urges decision-makers to increase investments and prioritize WASH in Schools, and for stakeholders to plan and act in cooperation. Throughout 2010, Save the Children presented at events on a global scale to promote the Call to Action and to share our successes in providing school-age children with clean water for drinking and handwashing, education on good hygiene, appropriate treatment for parasites and gender-specific toilets as part of quality SHN programming.
On September 9th, Save the Children shared results and lessons from over ten years of SHN programs in Sweden during World Water Week. The story of Sarita, a 15-year old girl who benefited from Save the Children’s SHN program in Nepal, was an integral element at Bathroom Pass, a kid-friendly exhibit that showcased WASH in Schools through the stories of children around the world. The exhibit was co-sponsored by H2O for Life, an important partner of Save the Children, and hosted at the Academy for Educational Development (AED) in October and November 2010. On October 7th, Save the Children moderated and presented at a Congressional Briefing in Washington, DC sponsored by Water Advocates and Basic Education Coalition titled Water, Sanitation and Hygiene for Schools in the Developing World.
The partnership with the WASH sector is a critical element in the expansion of SHN; and in the coming year, Save Children will continue to advocate for more WASH in schools with its partners.* SHN programs will continue to support days such as Global Handwashing Day, World Toilet Day and World Water Day that highlight the importance of water and sanitation. We will work with Emory University and London School of Hygiene and Tropical Medicine, among others, to explore the impact of hygiene, water and sanitation on children’s health and education, with a special emphasis on the impact on girls’ education.
*WASH in Schools partners include: Alliance of Religions and Conservation, AED, CARE, Children Without Worms, Catholic Relief Services, Dubai Cares, Ecological Management Foundation, Emory University, Global Water Challenge, H2O for Life, IRC International Water and Sanitation Centre, International Rainwater Harvesting Alliance, Millennium Water Alliance, UNICEF, United Nations Secretary-General’s Advisory Board on Water & Sanitation, WaterCan, Water Advocates, WaterAid, Water For People and the World Health Organization (WHO).
What is School Health and Nutrition?
School Health and Nutrition (SHN) addresses the critical health and nutrition factors that keep children out of school and reduce their ability to learn effectively while in school. The essential elements of an effective SHN program, as outlined in the Focusing Resources on Effective School Health (FRESH) framework agreed at the 2000 World Education Forum in Dakar, Senegal aim to:
• Increase the use of health and nutrition services at school.
• Increase access to safe WASH facilities in schools.
• Promote life-long healthy behaviors through skills-based and child-focused health (including HIV) education.
• Ensure health-related school policies and support at all levels, from schools and communities to the national level.
The success of a program also hinges on effective partnerships between education, health, and other sectors, with communities and with children.
Students wash their hands with soap and water in Pakistan. Photo by Pakistan CO.
Front Cover: School children in Malawi raising their clean hands. Photo by Natalie Roschnik.
© 2011 Save the Children 3
Save the Children Combats the Global Burden of Neglected Tropical Diseases
Neglected tropical diseases (NTDs) are a group of 13 parasitic and bacterial infections that affect over 1.4 billion people—including 400 million school-age children throughout the developing world—that can result in malnutrition, anemia, disability, illness and death. The health consequences of NTDs have an effect on children’s mental development and school attendance rates, which are directly linked to children’s learning outcomes. According to the Global Network for Neglected Tropical Diseases (GNNTD), treating NTD-infected children is one of the most important strategies for ensuring universal access to education; and deworming is the single most cost-effective means of improving school attendance. Further benefits are achieved by integrating nutrition interventions with deworming, in particular, micronutrient supplementation to address anemia.
Save the Children is a committed partner in the global effort to control NTDs, reaching in- and out-of-school children around the world through its SHN programs. In 2010, Save the Children’s SHN programs dewormed children in 16 countries including more than 800,000 children in Ethiopia alone. This effort included capacity building of district- and school-level health and education partners to implement the deworming and community mobilization to support the activity. At Save the Children, deworming is rarely conducted without longer-term activities to prevent transmission of NTDs, including improvements to school WASH facilities and the promotion of hygiene practices.
Save the Children collaborated closely with global partners of the NTD community in 2010. Save the Children participated and presented at global meetings and contributed to the guidelines for deworming school-age children in the second edition of the WHO’s Helminth control in school-age children: a guide for managers of control programmes. Save the Children will continue to foster partnerships with key allies in combating NTDs such as Deworm the World, Helen Keller International, International Trachoma Initiative, USAID, GlaxoSmithKline, Children Without Worms, ORBIS, GNNTD and others.
Building the Evidence for Malaria Control in Schools
Save the Children is working with the London School of Hygiene and Tropical Medicine, the Kenya Medical Research Institute-Wellcome Trust Research Programme, the Institut National de Recherche en Santé Publique in Mali and the Malaria Alert Center in Malawi to develop the evidence base on malaria control in schools. (See results from operational research studies on page 4).
Most national malaria programs have so far ignored school-age children, who represent up to 26 percent of the population in Africa, because of their lower risk of dying from malaria. However, school-age children are most likely to harbor malaria parasites, yet are the least likely to sleep under bed nets or seek appropriate treatment. Despite low mortality risks experienced by school-age children, malaria still accounts for 50 percent of all deaths in school-age children in Africa and is a major cause of anemia, affecting around 50 percent of school-age children. Malaria and anemia reduce children's ability to concentrate and learn in school and contributes to about 50 percent of all preventable absences and between 4 and 10 million lost school days per year.
At present, the evidence needed to guide national policy and strategy development on malaria control in schools is weak. The evidence that does exist suggests that malaria control interventions can reduce the prevalence of malaria and anemia amongst school children and improve children’s ability to learn. The recently published toolkit entitled Malaria Control in Schools: A toolkit on effective education sector responses to malaria in Africa is an excellent resource for all those wishing to address malaria in schools. It lists the arguments (from both health and education point of views) for malaria control in schools, presents the range of malaria control interventions which schools can implement and highlights the existing evidence.
Left: Students receive deworming tablets at Muqueluene School in Mozambique. Photo by Mozambique CO.
A school boy receives a long lasting insecticidal net during a distribution day at school. Photo by Mali CO.
© 2011 Save the Children 4
Results from Studies
Malaria in Mali and Malawi To contribute to the evidence base for malaria control in schools, Save the Children is conducting operational research studies in Mali and Malawi.
In Mali, a randomized control trial in 80 schools was initiated in November 2010 to evaluate the impact of school-based distribution and promotion of long lasting insecticidal nets (LLINs) on school children’s health (malaria and anemia prevalence), education (attention, numeracy and literacy) and use of LLINs. Preliminary results from the baseline survey show that 75 percent of school children had malaria parasites in their blood, 65 percent were anemic and only 41 percent reported sleeping under a LLIN the night before the survey (see graph below). Only five percent of children had fever, which means that most cases were asymptomatic. Results also show a strong association between malaria and anemia, whereby children with high levels of malaria parasitaemia were substantially more likely to be anemic.
A similar survey will be conducted in 50 schools in Malawi in May 2011. Our thanks to our numerous colleagues around the globe for their guidance and support of these studies.
Multiple-Micronutrient Supplementation: a Randomized Controlled Cluster Trial in Bangladesh Save the Children, in partnership with Nutrition Works, Westminster and Harvard Universities and the International Center for Diarrhoeal Disease Research, Bangladesh, with funding from Sight and Life, completed a three year study to evaluate the impact of school based multiple-micronutrient supplementation on the health and nutritional status, growth, and educational achievement of school children. One hundred schools in Gangni Upazilla in Meherpur district, Bangladesh were randomly allocated to two groups. The first group received a multiple-micronutrient tablet three times a week and
the control group received a placebo containing B group vitamins only. All children in both groups were dewormed twice a year. A baseline survey was conducted from March-July 2008 and was repeated in November-December 2010 to assess the change over time and between the two groups on a range of health and educational indicators. Results from the study are expected in August 2011.
Our thanks to our donors, partners and colleagues providing technical support, research and coordination of this trial. Improving Handwashing with Soap in Malawi In November 2010, Save the Children conducted an assessment of handwashing facilities and supporting activities in 20 schools in Zomba, Malawi to identify the most effective way to improve handwashing practices at school. Each school received four plastic buckets with taps, 49 soap tablets and handwashing promotion posters developed by the Malawian government. Each school was then asked to come up with their own creative method of promoting use of soap for handwashing, preventing misuse or theft of the soap and a system to replace the water.
Overall, the handwashing facilities were very well received by both teachers and children and schools were able to find effective ways to improve handwashing practices. The average number of soap bars used by school per week was fairly small: three (range = 2-4) for an average school size of 800 children. To minimize theft, most schools decided to cut the soap into four pieces, thread it and tie it to the plastic bucket (see picture below). Duty rosters for refilling the buckets of water, and morning assemblies and in-class instruction for promoting and demonstrating handwashing with soap were also identified as effective ways to improve handwashing practices at school. One unexpected outcome mentioned by teachers was improved punctuality as children used the facilities available at the school to both drink and wash their hands, removing a reason for children to leave the school compound and return late to class.
Percentage of Children with Malaria, Anemia and Who Report Sleeping Under a Bed Net the Night Before, n=2,000
A school girl washes her hands using soap tied to a string. Photo by Natalie Roschnik.
65%
41%
75%
0%
20%
40%
60%
80%
100%
Malaria Anemia Reported use ofbednets
Note: Hemoglobin levels (to estimate anemia prevalence) and malaria parasitaemia were measured using through finger prick blood samples and analyzed using a HemoCue Photometer and thick blood smears.
© 2011 Save the Children 5
Key Materials Produced
In 2010, several key documents for the design, monitoring and evaluation of SHN programs were produced. As part of the revision of the Common Approach to Sponsorship Programs guidance, the SHN module was updated. The revised SHN module is a comprehensive guide on designing SHN programs for any country program staff. It provides detailed background on SHN, including Save the Children’s strategy and links with other programs. The module goes through each program-cycle step with specific guidance on SHN and includes key action points for community mobilization.
Operational manuals for two countries, Bangladesh and Malawi, were also produced. These manuals, which are based on Save the Children’s experience implementing SHN with the Ministries of Education and Ministries of Health and other partners at district level, go beyond program design to provide more detailed guidance on implementing individual interventions. These are meant to be ready references on program implementation for country program managers, as well as field staff and implementing partners.
Also in 2010, a Knowledge Attitudes and Practice (KAP) survey tool was compiled with model questions on most topics addressed by SHN programs. This tool is typically used during program evaluations (e.g. baseline and end line surveys), to assess change in children’s health-related KAP following the introduction of a health education activity. The questions in the KAP tool are drawn from a range of different sources and they focus on practice-related outcomes and reported behaviors as opposed to knowledge alone.
Save the Children also released a series of fun videos on YouTube, taking on four dirty words: germs, toilets, worms and dirty water. Through the “Dirty Word” videos, we are highlighting the WASH conditions at schools in developing countries, and simple solutions that are helping children stay healthy so they can stay in school and learn. The video clips come from our successful program in Nepal. Read more and watch the videos narrated by SHN Senior Director Seung Lee on Save the Children’s web site.
Country Updates
Asia Afghanistan Save the Children’s Sponsorship SHN programming in Afghanistan continued in 2010, reaching approximately 39,000 in and out-of-school children across Faryab and Sar-i Pul provinces. Building on program successes since 2006, the program impact area expanded SHN into six new schools in Faryab province in 2010 and now covers a total of 52 schools. Highlights from 2010 include child-focused health education (CFHE) trainings and health campaign days. The country office conducted first aid refresher trainings for 418 students in 13 schools and conducted trainings on all CFHE modules for 180 adult SHN committee members. In addition, students participated in campaign days for raising awareness on the health benefits of vitamin A and deworming in their communities. Students walked in their neighborhoods carrying vitamin A rich foods, handed out educational pamphlets and announced health education messages via a megaphone. In school, the children engaged in role playing, singing songs and reciting poetry relevant to the campaign messages.
SHN activities funded by Bulgari, a Save the Children corporate partner, took place in an additional 22 schools in Faryab province and 20 schools in Sar-i-Pul provinces. This included vitamin A supplementation and deworming, CFHE, first aid and the construction of handwashing stations. These activities will continue in 2011.
Meanwhile, SHN activities funded by the Khalifa Foundation provided deworming tablets and vitamin A supplementation to 32,140 and 20,692 children respectively in Kabul and Parwan provinces. Throughout 2010, school children participated in SHN campaigns focused on various key health topics, including handwashing, vaccinations, safe drinking water, diarrhea and iodized salt. The Afghanistan country office also engaged community members in promoting SHN messages by training 300 CFHE volunteer facilitators on the principles of the United Nations Convention on the Rights of the Child, 348 CFHE volunteer facilitators on a flies module and 300 CFHE volunteer facilitators on a diarrhea module. In addition, 298 students were trained on child-focused first aid.
Students in Afghanistan learn about nutritious foods. Photo by Afghanistan CO.
© 2011 Save the Children 6
Bangladesh The Shishuder Jonno sponsorship project continues to increase access to health and nutrition services and quality of WASH infrastructure at school and promote behavior change among its beneficiaries. In 2010, the program reached 37,951 children.
SHIKHON, an informal education program funded by the European Commission and Dubai Cares, reached 154,587 children in 2010 with bi-annual deworming, vitamin A supplementation and annual vision screenings in 5,180 schools. Iron supplementation was also conducted in the 1,670 Dubai Cares-funded schools.
Commencing in 2010, a USAID-funded education project, Promoting Talent Through Early Education (PROTEEVA), reached 183,310 children in 630 primary schools and 1,260 pre-primary schools across 21 districts and 49 sub-districts with its SHN, Basic Education and Early Childhood Development activities. As a result, Save the Children trained 329 PROTEEVA staff and local partner-NGO staff on SHN and supported them during school-based deworming in November. A media highlight was a Skype video call between children at a PROTEEVA school and children at a school in Virginia, USA, which aired on ABC News late last year. This communication was part of a partnership with H2O for Life.
As highlighted in the Key Materials section on page 5, the Bangladesh country office released its SHN operational manual, a guide for program planning and implementation and for setting some basic programming standards, in early 2010. The country office also played an important role in working with development partners to develop a national health education curriculum called “Better Health, Better Education,” which the Department of Primary Education released last year. The country office is an active member of the national SHN technical working group and has raised a strong voice in advocating for SHN priorities for the government’s strategic plan for education for 2011-2016.
China In 2010, Save the Children reached 24,173 migrant children in 13 schools in Beijing and Shanghai. Migrant children are a focus of SHN programming in China because there are an estimated 20 million migrant children living in urban areas in China, the majority of whom fail to qualify for residency permits, and therefore have limited or no access to local services such as health, education and municipal water supply or sanitation. In Shanghai, health checks were conducted for 18,135 primary school migrant children; and school health clinics were either set up or furnished with appropriate equipment and better supplies. In addition, the first health records for migrant students were created.
Save the Children also continued to improve health facilities and health and hygiene practices in remote rural areas of China. In Tibet, low-cost, safe drinking water supply systems and environmental sanitation facilities were installed in 12 schools, as well as the construction of gender-specific latrines. A total of 20,050 rural primary school children have benefited directly from improved health education curriculum, as well as 1,614 school teachers and staff. Many health clinics were either renovated or established, and health records were completed for all children in project schools.
Across all program locations, health promotion activities were celebrated on Global Handwashing Day and World Health Day. In Beijing and Shanghai, thanks to the use of child-friendly communication materials, these activities contributed to improving the health and hygiene behaviors of 15,600 children as well as raising the awareness of local authorities, parents and community members. Similarly, in Tibet, child-friendly and culturally-sensitive posters, brochures and pamphlets on HIV/AIDS and STI prevention and awareness were distributed widely, contributing to improving the health of children and raising awareness in the community. Children reached by the SHIKHON program participate in a
handwashing demonstration. Photo by Bangladesh CO.
Migrant children in Xingzhi School in China receive vision screening. Photo by China CO.
© 2011 Save the Children 7
Nepal Based on years of program learning experiences in three districts, Save the Children has been providing technical support to the Ministries of Education (MoE) and Health and Population (MoHP) to implement a national SHN Strategy, which was devised in 2006. The strategy emphasizes the implementation of a comprehensive and standardized package of SHN interventions, as outlined in the FRESH framework, while building the capacity of teachers, health workers and school management committees in order to sustain programs. The School Health and Nutrition Network, comprised of the MoE, MoHP, Japan International Cooperation Agencies, Centro Cooperazione Sviluppo (CCS) Italy, Helen Keller International, Plan International and Save the Children, is responsible for finalizing the comprehensive package of SHN interventions. The purpose of the SHN Network is also to advocate and lobby for implementation and scaling-up of SHN programs. In Nepal, the SHN Network launched a national SHN website in 2009, which features an annual newsletter.
Save the Children began sponsorship-funded SHN programs in 1999 in three districts of Nepal: Kanchanpur, Kailali and Siraha. Save the Children phased the programs out of Kanchanpur and Kailali, but continues to coordinate with district education and public health officials to manage deworming and iron supplementation in those districts. Sponsorship programs are currently being carried out in the districts of Siraha, Kapilvastu and Pyuthan. Key SHN activities include semi-annual deworming and iron supplementation; screening for vision, hearing and dental problems; provision of safe drinking water and gender-specific latrines; and provision of health education. The programs reach 337 schools, with 94,986 children receiving a 13-week course of iron supplements and 103,059 children receiving deworming tablets semi-annually in 2010. Save the Children also provides health education materials and technical support to schools in seven districts, including Achham, Bajura, Doti, Bardia, Rukum, Rolpa and Sunsari.
Philippines Three partner schools in Paranaque City under the Metro Manila Program, which has implemented SHN programming under sponsorship since 2005, started to phase activities out in 2010. A parasitologic assessment was conducted in February 2011, serving as an endline survey. SHN will be introduced in two new partner schools in the city of Caloocan, north of Metro Manila in June 2011. A situational analysis of the target barangays (villages) was conducted in August 2010. A key finding of the analysis was that available toilets in schools were insufficient to meet the needs of large student populations, and most of them were poorly maintained.
In South Central Mindanao, hot nutritious snacks were served to all school children (preschool to Grade 6) in 25 partner schools to improve daily school attendance especially during the lean months (July to September). Partner schools have registered a high absenteeism rate of 45 percent due to short-term hunger brought about by seasonal household food insecurity. This intervention is a joint undertaking by the PTAs, schools and communities. Aside from the regular deworming and vitamin A supplementation, school children also received iron supplements for 10 weeks provided in partnership with local government units. In 2010, Save the Children continued its partnership with H2O for Life to support water and sanitation interventions in Metro Manila and South Central Mindanao.
In addition, Save the Children began preparations for piloting SHN interventions in five schools in Talipao, Sulu province, as part of its USAID-funded Sustainable Health Improvements through Empowerment and Local Development (SHIELD) project. The project, which is being implemented in communities that lack health facilities, is an opportunity to showcase the extent to which schools can link up with the community to improve children’s health and nutritional outcomes.
Pakistan SHN is now reaching 475 schools and nearly 150,000 children in Pakistan through a range of education and SHN programs in 7 districts. In 2010, a new IKEA-funded project, Improving the Lives of the Children in Cotton Growing Districts of Pakistan, was launched with multiple program components, including the implementation of SHN activities in 350 schools.
In early 2010, Save the Children continued its pilot SHN project in 100 schools with support from Procter & Gamble (P&G). 270 latrines and 106 handwashing facilities have been constructed so far in the target schools. Additionally, bi-annual
Save the Children, in partnership with H2O for Life, provided support for building latrines in schools in 2010. Photo by Philippines CO.
© 2011 Save the Children 8
school health days have been organized to provide deworming treatment and vitamin A supplements to more than 24,000 in- and out-of-school children. Hygiene kits have been developed and provided to all target schools and Child Health Clubs have been formed in 84 schools.
In 2010, SHN activities in the Afghan Refugee Education Program continued since the program began in 2008. Child-focused health education (CFHE) has been an integral part of the program, with Save the Children training 414 teachers on CFHE and all 25 target schools conducting monthly CFHE sessions. The program has provided health education, vitamin A supplementation and deworming to 15,139 in-school and 992 out-of-school children.
Meanwhile, the SHN program in the Batagram and Allai sub-districts (Batagram district) in the North-West Frontier Province continues to provide essential SHN interventions. In the Batagram sub-district, the program has reached 40,000 in- and out-of-school children in 100 schools and communities; and in Allai sub-district, the program has reached 18,000 children in 150 schools. The program, which began in 2008 with funding from the Canadian International Development Agency, ended in early 2011. The results from the endline study will be available in spring 2011.
The Pakistan country office conducted three studies in 2010 that assessed the effect and impact of SHN interventions in schools and communities. Results from an iron supplementation study showed that there was an increase in the hemoglobin levels both in the single dose and double dose group compared to the control group, but the increase was not significant. Results from a KAP study on CFHE to see the effectiveness of health education showed that there was an increase in knowledge from 33 percent at pre-test to 90 percent at post-test. Results from an endline study assessing the effect of iodized oil capsule supplementation and iodized salt campaign showed in the Batagram that iodine deficiency decreased to 18 percent from 66 percent. Based on these results, Save the Children will investigate how to improve iron
supplementation; and will continue its efforts on CFHE and reducing iodine deficiency among children.
Africa
Ethiopia The USAID-funded Community-School Partnership Program (CSPP), which began in 2008, is supporting more than 1.1 million children across eight regions of Ethiopia. Among the 1,800 CSPP schools, 95 percent (1706 schools) have gender-specific latrine facilities—up from 23 percent at baseline—and 52 percent (937 schools) have potable water sources—up from 14 percent at baseline. The Program’s School Incentive Awards stimulated the majority (58.5 percent) of the cost of constructing WASH infrastructure through community contributions (cash, labor and in-kind), which help ensure community ownership of the program and school improvements. In addition to WASH activities, the program dewormed 803,340 children in 2010. CSPP is scheduled to end in 2011.
In 2010, Ethiopia continued SHN sponsorship-funded programming in 27 schools in Tigray and West Shoa with an objective to increase primary education completion rates through addressing health and nutrition issues. The program reached 12,743 children in Tigray, where a mid-term evaluation is scheduled for 2011. SHN programming in West Shoa reached 47,747 children across 72 schools in 2010. During 2010, the sponsorship-funded programs strengthened coordination and collaboration with government Health Extension Workers to support activities and health education in school. Linking to these local health workers is an important approach for ensuring sustainability in the program.
Additionally, the Ethiopia country office participated in a National Workshop on NTDs to launch the Ministry of Health’s new NTD plan. Save the Children was invited to be a member of the National NTD Task Force. Children receive health and nutrition services during a school health
day at a school in Pakistan. Photo by Pakistan CO.
Students receive access to safe drinking water with support from the CSPP program in Ethiopia. Photo by Ethiopia CO.
© 2011 Save the Children 9
Malawi After over 10 years implementing SHN in Mangochi district and supporting the roll out of the national SHN strategy, Save the Children has now moved its focus to Zomba district. In 2010, a situation analysis was conducted to identify the key health needs for school-age children in the Zomba program. The results show high levels of school absenteeism and drop out, many of which are due to health-related issues; malaria and micronutrient deficiencies; students going to school on empty stomachs; inadequate water and sanitation facilities; and school-based violence. In addition, the situation analysis showed that a low percentage of students practice key health behaviors, such as handwashing and sleeping under insecticide-treated nets.
Save the Children has begun to address these issues in Zomba. The first activity involved mobilizing communities around SHN, supporting the Ministry of Health-led school-based deworming in Zomba and piloting handwashing facilities (see results on page 4). Since malaria is one of the most commonly reported health problems affecting school-age children in Malawi and there is very little local experience on school-based malaria control, Save the Children has decided to focus on this disease and help build the evidence base on the role of schools in controlling malaria (see pages 3 and 4).
Lastly, Save the Children has written an operational manual for implementing SHN in Malawi, based on the Mangochi experience, which has been used as a reference for program planning in the new impact area. The Ministry of Education has welcomed this guidance and will look to adapting it for use by all partners in the country.
Mali In 2010, a new four-year WASH in Schools project funded by Dubai Cares was launched, targeting 130 schools and 29,000 children in Sikasso district, in Sikasso region. This project is part of the larger partnership for WASH in Schools (see page 2) in Mali involving five agencies (UNICEF, CARE, Oxfam, WaterAid and Save the Children) that will reach 726 schools across five regions of Mali. This program complements Save the Children’s Sponsorship-funded SHN program which now reaches 37,143 children in 181 schools in Sikasso and Yorosso districts.
Save the Children continues to support school-based deworming, vitamin A and iron supplementation, combined with capacity building of teachers and school management committees within a broader community mobilization effort. Sixteen thousand long lasting insecticidal nets have been provided to school children in 40 schools and teachers have been trained to conduct malaria prevention lessons and
activities as part of the randomized control cluster trial described on page five. At the national level, Save the Children continues to work with the Ministries of Education and Health and UNICEF to agree on and eventually support the implementation of a common SHN strategy.
Mozambique In 2010, the sponsorship-funded Ku-Bunhetana program reached more than 31,000 children in 52 schools across the districts of Manacaze, Chibuto, Bilene and Xai-Xai in Gaza Province with its SHN, Basic Education and Early Childhood Development (ECD) activities. SHN activities, which include deworming and vitamin A supplementation, were also extended to 2,850 children in ECD centers supported by Save the Children.
Access to safe water and sanitation facilities in schools continues to improve as Save the Children works with the communities and partners provide sustainable child-friendly latrines and urinals, water pumps and handwashing facilities. Forty-four latrines and 22 urinals were constructed in 11 schools in 2010; and sanitation and hygiene materials, such as buckets, soap and drinking water containers, were also provided. Save the Children also trained 48 water committees, 48 school councils, 103 teachers and 17 children’s groups on the effective management of WASH facilities to promote program sustainability, and sanitation and hygiene awareness. Disease prevention—including malaria, diarrhea and HIV/AIDS—and nutrition were key topics for health education lessons within the schools. The iodine content of salt from student’s homes was tested and among 6,894 samples, 32 percent of salt was not iodized. Save the Children has therefore reinforced its promotion of iodized salt in homes, alongside the importance of eating fruits and vegetables.
A school teacher in Mali teaches students about the health benefits of deworming tablets prior to administration. Photo by Mali CO.
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In conjunction with the agriculture sector, students in 21 schools received training in agriculture, which included the distribution of seeds and a small agricultural tool. In addition, six agro-nutritional fairs were held for students, teachers and parents to learn about growing nutritious foods.
South Sudan In 2010, SHN activities in South Sudan continued to reach refugees through the Reintegration, Support and Empowerment Through Lifesaving and Education (ReSETLE), Phase II project. The year-long project, funded by the U.S. Department of State, Bureau of Population, Refugees and Migration, follows the ReSETLE, Phase I project, which began in 2008 and ended mid-year in 2010.
Sudan For most of 2009, Save the Children’s programs were suspended in Sudan, following the Government’s decision in March 2009 to revoke the licenses of 13 international development agencies, including Save the Children. In March 2010, Save the Children resumed the implementation of the American Idol-funded SHN activities in South Kordofan under a sub-granting mechanism with Save the Children Sweden. In 2010, the program distributed deworming tablets and micronutrient supplements to 17,911 school children in all of the 40 schools targeted by the project. School awareness-raising activities that addressed issues of malaria and personal hygiene were conducted; sanitation facilities were installed; and educational materials and 40 first aids kits were distributed throughout the project period.
Save the Children conducted several workshops and trainings over the course of 2010, including: one three-day refresher training courses in each of the two program localities—Dilling and Talodi—in collaboration with the Ministry of Health’s Expanded Program on Immunization (EPI); one nine-day first aid training course in collaboration with the Sudan Red Crescent Society for one teacher from each of the 40 target
Successes of Burkina Faso The Fondation pour le Développement Communautaire (FDC), a local NGO that was launched from Save the Children’s efforts in Burkina Faso, continues to implement the national SHN program alongside Helen Keller International (HKI) and Catholic Relief Services (CRS). In 2006, the Ministry of Education (MoE) contracted these three NGOs to roll out SHN in 25 of Burkina's 40 provinces. In 2010, the program reached 918,729 children in 5,020 schools with a package of SHN interventions, which included deworming, micronutrient supplementation, health education and capacity building of schools and communities to implement and sustain activities.
This is a unique model of a government handing over responsibility to NGOs to coordinate a program which it doesn't have the capacity to implement. The three NGOs had previous experience implementing SHN in Burkina Faso and are able to avoid the administrative bottlenecks faced by the government, and roll the program out more rapidly through the MoE and Ministry of Health structures, building their capacity at the same time. Thus far, the main challenge is the lack of funding to improve the water and sanitation facilities in schools, which in turn prevents children from adopting healthy behaviors and staying healthy at school. The consortium—Save the Children/FDC, HKI and CRS—is currently planning a final evaluation of the program which will assess amongst other things, improvements in children’s health status since the start of the program.
Save the Children conducts a teacher training on SHN in South Kordofan, Sudan. Photo by Sudan CO.
Students learn about nutritious foods during an agro-nutritional fair. Photo by Mozambique CO.
schools; two workshops on Integrated Management of Childhood Illnesses in collaboration with education offices in Dilling and Talodi along with State and Federal Ministries of Health; and one training for school head teachers, representatives of the Parent Teacher Association (PTA) and health workers on basic school health and nutrition issues. The results of pre- and post-training tests among the 106 participants at the latter workshop showed an increase in awareness of SHN issues from 49 percent to 80 percent.
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Middle East/Eurasia
Egypt In Egypt, the sponsorship-funded SHN program in Minia Governorate has been phasing out since 2007 and a sponsorship program started to phase in to the new impact of area of Abnoub district in Assiut Governorate in 2008. As of March 2010, 95 percent of impact schools in Minia had functioning latrines and 75 percent had handwashing facilities, up from 25 percent and less than one percent in 2002, respectively. In addition, annual program monitoring results show a decrease in the prevalence of anemia from 40 percent to 10 percent and trachoma from 22 percent to 5 percent among students in Minia compared to baseline results in 2004.
In 2010, the Egypt country office conducted a joint initiative to prevent swine flu among school children with the Ministry of Health, Ministry of Education, Ministry of Social Affairs and Insurance and the Red Crescent Society. The initiative used the Child-to-Child approach to distribute health and hygiene messages to raise awareness of swine flu in all 249 target schools. The country office also engaged community members in key SHN messages. These community members often became supporters and advocates for national policies benefiting children, such as a policy forbidding teachers from smoking in front of students. Save the Children also trained 252 doctors, nurses and social workers on health insurance policy and quality services in Minia and Assiut Governorate; and assisted 45,650 school children in receiving their health insurance cards, which enables them to access to low-cost health services.
In 2011, Save the Children will continue to collaborate with government partners to integrate its health education manual into the primary school curriculum on a national level. The SHN program will also provide further training to healthcare providers, school teachers and civil society organizations to improve the quality of healthcare available to students.
Yemen In the Dubai Cares-supported program in Yemen in 2010, Save the Children expanded its activities in health education by including child-focused health education (CFHE) in 35 schools in Aden, Abyan and Lahj Governates. A total of 1,060 students were trained in a first aid module, which focused on developing life skills and positive behaviors for managing risk; and a total of 1,538 children, 173 boys and 139 girls, were trained in a nutrition module. The health education topics were reinforced to students through the distribution of first aid kits in each school and nutrition campaigns in three schools.
In addition to promoting CFHE, improving WASH facilities was a focal point for the Yemen country office in 2010. Two latrine banks—each containing four latrines, including one for disabled children—were constructed and 105 latrines were repaired. Further, 21 schools benefited from the receipt of handwashing sinks, water tanks and small electrical pumps. The water tanks, both on the ground and overhead, are needed at schools due to the interruption of water from the main water network for hours or sometimes for days in some areas, especially rural areas. Due to weak water pressure, the small electrical pumps are used to transport water to the overhead tanks, ensuring that school children have access to water for drinking and handwashing.
In 2010, the Yemen country office connected with Deworm the World and the national deworming program in order to secure deworming drugs for program areas in conflict zones.
Latin America and the Caribbean Bolivia In 2010, the national Improving Our Lives SHN program supported by USAID, GlaxoSmithKline, the SODIS Foundation, Vitamin Angels, Sight and Life and Save the Children’s sponsorship funding came to an end. The comprehensive SHN program improved the health and nutrition of 194,289 children in 634 schools in La Paz, El Alto, Oruro, Caracollo, Cochabamba, Santa Cruz and Beni.
Students raise their clean hands in Assiut, Egypt on Global Handwashing Day. Photo by Egypt CO.
Students participate in a nutrition drama activity. Photo by Yemen CO.
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An endline study conducted in 2010 showed an important reduction in anemia rates in Cochabamba from 23 to 2 percent; in La Paz from 11 to 2.2 percent; in Oruro from 58 to 23.6 percent; and in El Alto from 24.5 to 9.7 percent over the project period. Program staff worked with communities and schools to design age-appropriate hygiene materials for children to use at home with their siblings and parents; and held fairs on health, nutrition and hygiene in each school. As a result of these health education interventions, students could more readily identify healthy and nutrient-rich foods, as well as health consequences of not receiving these vital nutrients. Improving Our Lives demonstrated successful, replicable approaches to children’s nutritional and health concerns. By its conclusion, four out of five municipal authorities had allocated funding in their annual operating plans to implement activities in children’s health and nutrition. The La Paz and Oruro municipalities, for example, implemented this program in all of their schools—beyond the planned coverage area—with plans to continue activities without the presence of the Improving Our Lives alliance. In 2011, the Bolivia country office will begin new sponsorship- funded programs, including SHN in Cochabamba.
Dominican Republic The Dominican Republic’s SHN program is part of the Batey Community Development Project, a USAID-funded project which works in former sugar cane work camps known as bateys. Based on positive results from the first two years of implementation, the original two-year project timeline has been extended for an additional two years and the target population has been expanded into new areas and bateys in the eastern and southern part of the country. The community development project now reaches 1,500 students in nine primary schools, up from 800 students in five primary schools in the previous year. The project has improved WASH facilities in schools and communities, including building handwashing stands in schoolyards to facilitate easy access for handwashing after latrine use and designating a ‘hygiene corner’ in each classroom. These corners include at least one
ceramic water filter to ensure access to safe drinking water for all students as well as a bucket, soap, jerry can and towels.
The program has also provided deworming tablets and vitamin A supplementation to all students, and trained teachers and students in key health and hygiene messages, including nutrition, oral hygiene, handwashing and solid waste management. In 2011, the current SHN activities will continue alongside other community development activities.
El Salvador El Salvador increased the number of schools with SHN activities in high-poverty municipalities in the department of Ahuachapán from 14 schools in 2009 to 37 in 2010. The implementation activities respond to critical SHN issues in the target schools, including poor hygiene practices, poor environmental sanitation on school grounds and lack of nutritional snacks sold at school snack shops. Using the Child-to-Child approach, Save the Children promotes handwashing among school children; and substantial improvements have been reported, with 85 percent of students observed washing their hands before eating and after latrine use compared to a baseline rate of 10 percent. The garbage management systems at schools have shown great improvement as well, with nearly 75 percent of schools reporting cleaner school grounds. Finally, the quality and safety of food sold at school snack shops has also improved. Seventy-nine percent of snack shops now sell healthier snacks, such as fruits and vegetables, and staff have adopted safe food handling practices, such as keeping food covered to prevent contamination by flies.
Student brigades were established and trained on SHN. They completed diagnostics of critical SHN issues at their schools and, based on the findings, identified key changes that needed to be made and made action plans to address those. Save the Children provided some of the cleaning supplies and other needed materials as identified in each school’s plan.
Save the Children has developed close collaboration with the Ministry of Agriculture, the Ministry of Education and other key institutions that promote SHN initiatives.
Guatemala In 2010, Guatemala commenced a SHN pilot project in Xexac that reached 3,726 children. With participation from the community, the project seeks to improve health and hygiene practices through heath education and improved WASH infrastructure. On Global Handwashing Day, students at the schools demonstrated their enthusiasm for WASH activities by drawing health promotion posters, creating signs for latrine facilities and receiving face-painted tattoos.
Guatemala continued its school-based WASH projects in the Nebaj region with support from Frito Lay. The project has
A new latrine in Nueva Llallagua community. Photo by Bolivia CO.
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improved access to safe drinking water in schools for 3,058 children in 12 schools. Sanitation and hygiene awareness is being carried out using the Child-to-Child approach to promote proper latrine usage and handwashing and tooth brushing techniques.
Haiti In January 2010, a 7.0 magnitude earthquake shook Haiti. Since then, the international community, including Save the Children, has been assisting the government and the people of Haiti’s recovery efforts. Rebuilding from the destruction caused by the earthquake and unrest of elections has been slow, but our sponsorship-funded SHN program in Maissade, which began in 2003, continued to provide key SHN interventions in Haiti. In 2010, the program reached 20,107 school children in 108 schools and 2,421 out of school children, including children who were displaced by the earthquake. In addition to providing deworming, vitamin A supplementation and iron supplementation, Haiti continued its work to improve WASH facilities and the quality of drinking water in schools. All of the 108 target schools are equipped with handwashing facilities.
Water treatment was critical in Maissade in 2010 because of a cholera outbreak, which gripped the country in October. In addition to providing low-cost water purification kits to schools and to families in the community in partnership with Klorfasil, Save the Children responded to the cholera outbreak by training 430 teachers in cholera prevention and by promoting health messaging in schools on the importance of handwashing and hygiene. In one community where schools were closed due to the high prevalence of cholera, the country office’s WASH and health teams worked together to hold two community education health education sessions to sensitize the community on how to prevent cholera from spreading. The schools have since reopened. Capacity building was a focal point for Haiti in 2010. Save the Children trained 147 teachers in health behavior change topics, 123 teachers in conducting vision screenings, 322 teachers in vitamin A distribution and deworming, and 139 children on HIV/AIDS.
A teacher administers deworming tablets in Maissade. Photo by Haiti CO.
Looking Forward In 2011, Save the Children will expand its SHN activities to school-age children in China, Indonesia, Kenya, the Philippines, Tajikistan and Vietnam through a grant from the Wrigley Foundation. The two-year grant is expected to reach 260,000 of the poorest and most marginalized children in these countries.
Save the Children will also a launch a new Dubai Cares-funded project in Indonesia that will complement the work funded by Wrigley. Dubai Cares is an important supporter of WASH in schools and of SHN activities at Save the Children. Ongoing dialogue promises increased support from Dubai Cares and new and renewed partnership with PepsiCo, GlaxoSmithKline and Procter & Gamble, among others.
In 2011, Save the Children will also scale up its arsenic mitigation activities in Bangladesh, following successful funding secured from Stemcor through the Long Island Council and the Global Education Advisory Board. Arsenic mitigation in the drinking water supplies is a major public health concern in South Asia, especially Bangladesh, affecting the health and cognitive ability of school-age children.
This year also marks the start of a three-year project in Armenia, Action for Child Health and Education, which delivers SHN and Early Childhood Development interventions to children in three provinces. The project, funded by Medicor Foundation and Save the Children-Switzerland, addresses the numerous problems Armenia has had maintaining infrastructure in public schools since the collapse of the former Soviet Union. Save the Children’s SHN activities will provide children with access to renovated toilets in 12 rural schools, as well as provide training for children and teachers on proper maintenance of these facilities and critical health education.
North America USA Save the Children’s Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) Program provides children in rural America with support to improve health outcomes and learn lifelong healthy eating habits. The CHANGE Program includes 30 minutes of non-competitive, moderate to vigorous physical activity, healthy snacks and nutrition and energy balance education. Based on findings from Save the Children’s groundbreaking March 2005 study, Nutrition and Physical Activity Field Assessment of Children in Rural America, CHANGE is helping to promote and increase access to physical activity and healthy diets at school, in after-school and summer programs, at home and in the community. This year, the CHANGE program is reaching more than 14,000 children in 13 states.
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Partnership and Networking Events
Royal Society of Tropical Medicine and Hygiene (RSTMH) Biennial Meeting Liverpool, England, September 8-10, 2010
Natalie Roschnik gave a presentation titled Integrating Micronutrients with Deworming in Schools: Save the Children’s Experience with School Health and Nutrition Programs at the RSTMH biennial meeting in Liverpool in September 2010. The presentation focused on the importance of providing micronutrients, especially iron and vitamin A, following deworming to address anemia, which affects about 40 percent of school-age children.
EDUCAIDS Consultative Meeting on HIV/AIDS and Education Indicators Paris, France, October 25-27, 2010
In late October, Seung Lee attended a consultative meeting convened by UNESCO on behalf of EDUCAID as an invited member for consultation on identifying internationally-recognized indicators capable of measuring the process and outcomes of education sector programs to address HIV and AIDS. These indicators were adopted by the UNAIDS Inter-Agency Task Team for Education during their December meeting to be used in the global monitoring and evaluation (M&E) framework on Education and HIV and AIDS.
Meeting of FRESH Partners for the Development of an M&E Framework for School Health Paris, France, October 28-29, 2010 In October 2010, Focusing Resources on Effective School Health (FRESH) members, including Save the Children, met in Paris to review the first draft of an M&E framework for school health. Partners first met in September 2008 at the WHO in Geneva to agree on the need for and next steps for developing this framework. Save the Children has played a leading role over the past three years to move the development of the framework forward.
Transition to SCI As part of Save the Children US’s efforts to work with various members and provide technical assistance to ensure quality programming during the transition to Save the Children International (SCI), the SHN team engaged with other Save the Children members in 2010. The Regional Technical Advisors Forum in Bangkok in January 2010 served as an opportunity for Save the Children members in Asia to learn about the different programs and discuss the shift to SCI where Mohini Venkatesh met counterparts from different Save the Children members. At the invitation of Save the Children Italy, Seung Lee traveled to Save the Children Italy’s office in Rome in September to meet with their international program
staff. She provided two days of in-depth training on the basics of Save the Children US’s programming principles and program cycle as it relates to SHN programming and sponsorship funding. Save the Children Italy expressed their interest in continued support of quality programming and SHN. The 2010 SHN Program Learning Group (PLG) in Tanzania in December also provided an opportunity for engaging with Save the Children member staff. Staff from China mingled with staff from Haiti, Kenya and others to discuss best SHN practices to benefit more children.
For more information about School Health and Nutrition programming at Save the Children, please contact:
Seung Lee Senior Director for SHN [email protected]
Natalie Roschnik SHN Advisor [email protected]
Daniel Abbott, Senior Specialist, Water, Sanitation and Hygiene [email protected]
Mohini Venkatesh SHN Specialist [email protected]
Sarah Bramley SHN Specialist [email protected]
Above: Participants at the SHN PLG in Tanzania. Below: Courtyard and water point of a Save the Children-supported school toured during the PLG.
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Country SHN Representative E-mail Afghanistan Sohail Azami [email protected]
Armenia Iren Sargsyan [email protected]
Bangladesh Ikhtiar Uddin
Ataur Rahman
Bolivia Ccoya Sejas [email protected]
Burkina Faso Maria Kere [email protected]
China Le Wang
Lu Liu
Dominican Republic Raul Del Rio [email protected]
Egypt Mohamed Zanati [email protected]
El Salvador Gersande Chavez [email protected]
Ethiopia Getachew Mekonnen
Haftay Tesfay
Chaltu Yasin
Guatemala Lilia Cifuentes [email protected]
Haiti Nélie Jeantillon [email protected]
Indonesia Jennifer Rosenzweig
Wiwied Trisnadi
Kenya Jane Rita Meme [email protected]
Malawi Mpumulo Jawati [email protected]
Mali Seybou Diarra [email protected]
Mozambique Joaninha Abudo [email protected]
Nepal Ashish KC
Kedar Shah
Pakistan Badar Uzaman [email protected]
Philippines Amado Parawan [email protected]
South Sudan Loro Fredrick [email protected]
Sudan Naji Fadul [email protected]
Tajikistan Shakhlo Yarbaeva [email protected]
United States John Farden [email protected]
Vietnam Lisa Sherburne [email protected]
Yemen Farida Mashgary [email protected]
Please note: As Save the Children moves towards Save the Children International, some of these contact email addresses are likely to change.
School Health and Nutrition Programs and Contacts
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Save the Children’s School Health and Nutrition Program
Where We Work
54 Wilton Road Westport, Connecticut 06880 www.savethechildren.org
Save the Children is the world’s leading independent organization for children, working in over 120 countries around the world. Our mission is to inspire breakthroughs in the way the world treats children, and to achieve immediate and lasting change in their lives.
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