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Indonesia // Fit for SchoolProgram Assessment StudyFIT-PAS 2012–2014-2016

List of Tables, Figures and Acronyms 2

Summary 5

1. Introduction 6 Fit for School Programm 6 Fit for School Assessment Study 7

2. The Water, Sanitation & Hygiene Survey // WASH 9 Handwashing Facilities 10 Toilet Facilities 11

3. The Health Outcome Study 12 Parasitological Status 14 Nutritional Status 15 Oral Health Status 16 School Attendance and Performance 17

4. Discussion and Conclusions 18 Discussion 18 Conclusions and Outlook 21

References 22

Acknowledgements // Imprint 23

Annex 24 Annex 1 // List of Schools Surveyed 25 Annex 2 // WASH Survey Form 26 Annex 3 // Description of WASH indicators 30 Annex 4 // HOS Survey Form 31

Table of Content

Tables

Table 1 Access to handwashing facilities in schools at baseline, 2012

10

Table 2 Access to handwashing facilities with water and soap at follow-up, 2014

10

Table 3 Access to toilets at baseline, 2012 11

Table 4 Number of FIT-HOS participants in FIT model and control schools

13

Table 5 Dental caries and PUFA experience in permanent dentition in FIT model and control schools, 2014

17

Table 6 School attendance and school performance of all children in the school year 2012-2013 and 2013-2014

17

Figures

Figure 1 The FIT Program Assessment Study Framework

7

Figure 2 Condition of toilets at follow-up, 2014 11

Figure 3 Prevalence of STH infection in FIT model and control schools

14

Figure 4 Nutritional status of children in FIT model and control schools

15

Figure 5 Prevalence of dental caries and PUFA in permanent dentition in FIT model and control schools

16

Figure 6 Independent handwashing after leaving the latrine, Cambodia, 2014

19

Figure 7 STH Prevalence per country, 2014 19

Figure 8 Prevalence of thinness and overweight/obesity per country, 2014

20

Figure 9 DMFT Increment: Country Differences, 2014 20

Acronyms

BLK Balai Laboratorium Kesehatan

BMI Body Mass Index

DMFT or dmft

Decayed, Missing, Filled Teeth (permanent/deciduous)

EHCP Essential Health Care Package

FIT Fit for School

FIT-HOS Fit for School Health Outcome Study

FIT-PAS FIT Program Assessment Study

FKG UNPAD Facultas Kedokteran Gigi, Universitas Padjadjaran (Padjadjaran University Faculty of Dentistry)

GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit

HWWS Individual handwashing with soap

Lao PDR Lao People’s Democratic Republic

LabKes Laboratorium Kesehatan

MoE Ministry of Education

PEO Provincial Education Office

PUFA or pufa

Pulp involvement, Ulceration, Fistula, Abscess (permanent/deciduous)

SEAMEO-INNOTECH

Southeast Asian Ministers of Education Organization Regional Center for Educational Innovation and Technology

STH Soil-transmitted helminth

UKS Usaha Kesehatan Sekolah (School Health Program Team)

UNESCO United Nations Educational, Scientific and Cultural Organization

UNICEF United Nations Children’s Fund

WASH Water, Sanitation and Hygiene

WHO World Health Organization

2 FIT FOR SCHOOL FIT FOR SCHOOL 3

4 FIT FOR SCHOOL FIT FOR SCHOOL 5

The Regional Fit for School (FIT) program is a joint school health program of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, the Southeast Asian Ministers of Education Organization Regional Center for Educational Innovation and Technology (SEAMEO INNOTECH), and relevant government agencies in four partner countries in the region – Indonesia, Lao People’s Democratic Republic (Lao PDR), Cambodia and the Philippines. The regional FIT program aims to improve access to water, sanitation and hygiene (WASH) facilities in schools, and to initiate positive change in hygiene behaviour through the implementation of daily group handwash-ing with soap, daily group toothbrushing with fluoride toothpaste and school-based bi-annual deworming as part of the integrated national deworming program. In Indonesia, the regional FIT program started on Regional level in November 2011 and implementa-tion in West Java by the Provincial Education Office (PEO) and the Usaha Kesehatan Sekolah (UKS) started in October 2012. During the research and development phase, 12 primary schools in Bandung City and Indramayu district were selected as official model schools of the program covering around 7,000 school children. Replication and scale up initiatives in West Java and other parts of Indonesia are under way.

To assess the effect of program interventions, a comprehensive FIT Program Assessment Study (FIT-PAS) was conducted with three major compo-nents: a WASH survey, which assessed the status of water, sanitation and hygiene resources in schools, a behavior study in Cambodia, which investigated independent handwashing practices and social norms of primary school children, and a Health Outcome Study. In 2012, baseline data was collected by a trained local research team from nine schools that implemented the FIT interventions in Bandung City and Indramayu district, and the same number of control schools, defined the nearest same size school, that implemented the existing government school health programs. The follow-up survey was done two years after.

The FIT-PAS showed that two years after program implementation, the FIT program improved access to handwashing facilities, water and soap in schools, as well as access to clean and functional toilets in schools. There was a clear impact of the daily group tooth-brushing on oral health. The progression of dental caries on permanent teeth was 24 % lower among FIT schoolchildren than control schoolchildren. There was a very low prevalence of STH infection in both FIT and control schoolchildren at baseline and follow-up, which indicated that the national de-worming program is working well. The percentage of thin children (1 in 4 children being thin) did not significantly differ between FIT model and control schools, nor between baseline and follow-up. On the other hand, prevalence of childhood obesity increased in intervention and control schools which indicates that childhood obesity is becoming a public health problem in the Indonesia. The study also built research capacity and improved the collaboration between education and health sectors, and with academia. This intersectoral approach is necessary to effectively address public health issues for children in the South-east Asian Region.

Summary

HANDWASHING TOOTHBRUSHING DEWORMING

SCHOOL HEAD

TEACHERS STUDENTS

ACTIvITIES

SCHOOL MANAGEMENTSTAKEHOLDERS

MONITORING

MAKING CHILDREN FIT FOR SCHOOL // TRANSFORMING SCHOOLS INTO HEALTHY PLACES

CLEANING & MAINTENANCE

STAKEHOLDERINvOLvEMENT

ROUTINE

WATER FACILITIES

TOILETSGROUP WASHINGFACILITIES

INFRASTRUCTURE & MATERIALS

PLANNING & BUDGETING

SUPPLIES

BRINGING DRINKING WATER TO SCHOOL

PARENTS COMMUNITy EDUCATION OFFICE

FIT FOR SCHOOL 23

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References

22 FIT FOR SCHOOL

Acknowledgements // Imprint

The Indonesia Fit for School Program Assessment Study was conducted by the following research team:

Principal InvestigatorDr. Martin Hobdell,visiting Professor in Dental Public Health, Department of Epidemiology, University College London.

Chief InvestigatorPantjawidi Djuharnoko,Public Health Subdivision Head, Social Basic Services Bureau of West Java Governor’s Office

Co-InvestigatorsSri Susilawati,Lecturer of Dental Public Health Department Faculty of Dentistry, Universitas Padjadjaran

Dewi Kartini Sari,Standardization Section Chief, Ministry of Health

Sitti Ganefa Fakki,Guidance and Evaluation Section Chief, Ministry of Health

Contributors: Dr. Maria Carmela Mijares-Majini, Consultant; Dr. Bella Monse, Coordinator for Research and International Relations and Ms. Jed Dimaisip-Nabuab, Research Coordinator, GIZ Fit for School; Dr. Denise Duijster, Research Consultant, University College London; Dr. Robert Dreibelbis, Assistant Professor, University of Oklahoma; Dr. Katrin Kromeyer-Hau-schild, Assistant Professor and Dr. Roswitha Heinrich-Weltzien, Professor, University Hospital, Friedrich-Schiller-University Jena; Dr. Habib Benzian, Adjunct Professor, New york University; Ms. Nicole Stauf, Policy Analyst and Project Manager, Health Bureau; Mr. Philip Purnell, Manager, Education and Innovation Office, SEAMEO INNOTECH.

The research was made possible through the support and cooperation of the Provincial Education Office of West Java, the Ministry of Health, West Java School Health Team, Bandung City Health Office. Thanks are given to Indramayu District Health Laboratory who coordinated and conducted the survey in field and laboratory. Thanks go to the principals, teachers, parents, and children in the participating schools who gave their consent and time for the research activities.

Immense gratitude go to officials of Universitas Padjajaran specifically, Dr. Med. Setiawan, Vice-Rector in the field of research, community and cooperation, Dean Dr. Nina Djustiana and Dr Dudi Aripin, vice Dean of Academic Affairs and the rest of the Health Research Ethics Committee of Universitas Padjajaran.

Acknowledgment go to Bella Monse (GIZ), Wim van Palenstein Helderman (Radboud University, Nijmegen, The Netherlands), and Habib Benzian (New york University) who contributed to the design of the study, Mitch Mijares-Majini, Jed Dimaisip, Nicole Siegmund, Rigil Munajat, Sunarno, and Katrina Javier of the GIZ Fit for School Program team who provided technical, adminis-trative, and logistical support, and to Douglas Ball (consultant), Hanna Satyawati (consultant), Rodgelyn Amante (Fit for School Inc.), Ella Cecilia Naliponguit, Ma. Rosalia vivien Maninang, Melanie Hora (Department of Education, Philippines), vicente Belizario (Department of Health, Philippines), Denise Duijster (University College London) and Katrin Kromeyer-Hauschild and Roswitha Heinrich-Weltzien (University of Jena, Germany), Robert Dreibelbis (University of Oklahoma) for their expertise and contributions.

Special thanks go to the in-country research team members : Prima Andisetyanto, Fidya Meditia Putri, Nidhal Syarifa, Khairunnisa Lubis, Tenny Setiani D., Arlette Suzy S, E. Fitriana Sari, Rahmi Alma Farah Adang, Sri Tjahayawati, Indra Mustika, yurika Ambar , Hening, Riana Wardani, Gilang yubiliana, Aldilla Miranda, Fajar Fatriadi, Ame Suciati, Indra Primathena, Indah Suasani W, Nikita Irzana Utami, Annisa Rosalina, Esti Sunyaruri, Dita Hofinesia, M.Yusuf Yasin, Marini Sundari, Erwina Maya Astari, Lilis Nurliyanasari, Cut Meutia Hanief, Widi Maretha, Revini Nuita, Tansza Setiana Putri, Hannie Rohani, Eulis yulia, Lilis Candra Dewi, Ngaisah, Marina Dewani Tanjung, Mira Karmila, yana Kusdiana, Dyah Erani Restorika, Eti Rohaeti, Nina yudiansih, Mardiastuti, Mokh.Iing Syafei, Martaulina Sinaga, tita Juita and encoders Cucu Zubaedah and Anne Agustina.

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