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The World Bank Human Development Network – Education System Assessment for Better Education Results
SABER – SCHOOL HEALTH
Preliminary Assessment of School Health Policies in the Caribbean Community (CARICOM) ―
Dominica, Grenada, Guyana, Barbados, St. Lucia and St. Vincent and the Grenadines,
March, 2012
Summary of Findings Country Health-related
school policies Safe school
environment School-based health
services Health
Education
Barbados Emerging Established Established Advanced St. Lucia Latent Emerging Latent Emerging Guyana Latent Emerging Emerging Emerging Grenada Emerging Established Emerging Emerging Dominica Latent Established Advanced Advanced St. Vincent and the Grenadines
Latent Emerging Latent Latent
This is a report on the World Bank’s System Assessment for Better Education Results (SABER) pilot initiative in the Caribbean Community (CARICOM). It is a joint effort of the World Bank and CARICOM and is intended to lay the groundwork for a more comprehensive assessment of all the CARICOM countries in 2012. The report was prepared by Roshini Ebenezer (Consultant, World Bank) and Harriet Nannynonjo (Senior Education Specialist, World Bank).
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TABLE OF CONTENTS 1 INTRODUCTION .................................................................................................................. 4
2 THE IMPORTANCE OF SCHOOL HEALTH AND NUTRITION PROGRAMS .............. 4
2.1 The FRESH Framework: Building Blocks for a School Health Policy Framework ........ 5
3 SABER-SCHOOL HEALTH: A FRAMEWORK FOR ASSESSING SCHOOL HEALTH POLICIES ....................................................................................................................................... 5
3.1 Conceptual Framework for SABER-School Health......................................................... 6
3.1.1 Health-Related School Policies................................................................................. 6
3.1.2 Safe School Environment ......................................................................................... 7
3.1.3 School-Based Health Services .................................................................................. 7
3.1.4 Health Education ....................................................................................................... 8
3.2 Components and Scoring System of the SABER-School Health Framework ................. 8
4 APPLYING SABER-SCHOOL HEALTH IN THE CARIBBEAN .................................... 11
4.1 School Health in the Caribbean Context ........................................................................ 11
4.2 Objectives of the assessment .......................................................................................... 12
4.3 Methodology .................................................................................................................. 12
5 RESULTS ............................................................................................................................. 12
5.1 Summary of Results by Country .................................................................................... 12
5.2 DOMINICA ................................................................................................................... 13
5.3 GRENADA .................................................................................................................... 15
5.4 GUYANA....................................................................................................................... 16
5.5 ST. LUCIA ..................................................................................................................... 18
5.6 BARBADOS .................................................................................................................. 19
5.7 ST. VINCENT & THE GRENADINES ........................................................................ 21
5.8 Comparative results by Policy Domain .......................................................................... 22
5.8.1 Health-Related School Policies............................................................................... 22
5.8.2 Safe School Environment ....................................................................................... 23
5.8.3 School-Based Health Services ................................................................................ 23
5.8.4 Health Education ..................................................................................................... 24
6 CONCLUSION ..................................................................................................................... 24
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References Appendix Annexes
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ABBREVIATIONS CARICOM Caribbean Community EAC East African Countries ECOWAS Economic Community of West African States EduCan Caribbean Education Sector HIV and AIDS Coordinator Network FRESH Focusing Resources on Effective School Health HFLE Health and Family Life Education HDNED Human development Network, Education Department M&E Monitoring and evaluation NCD Non-Communicable Diseases SABER System Assessment for Better Education Results PCD Partnership for Child Development
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1 INTRODUCTION This report presents the findings of the 2012 pilot assessment of the school health policies for the following CARICOM countries:
Dominica Grenada Guyana St. Lucia Barbados St. Vincent and the Grenadines
The ultimate objective of this exercise is to help countries to identify the strengths and weaknesses in their school health policy frameworks, with the understanding that sound a policy framework is a critical component of effective school health programming. The result is a preliminary report on the status of development of the school health policy framework in the six countries listed above. The assessment itself is part of the System Assessment for Better Education Results (SABER)-School Health, which was created by the World Bank as part of its education strategy (World Bank, 2012). Section II of this report briefly discusses the importance of school health programs in contributing to education sector goals and the development of international consensus on the basic building blocks of effective school health programs. Section III discusses the conceptual framework of SABER-School Health, and introduces the components of the SABER-School Health framework and scoring system. Section IV provides the context for and objectives of this assessment as well the methodology used for data collection. Sections V presents the results for the six countries: first by individual country and then as a comparative analysis across each of four policy domains. A more detailed overview of the results for each country can be found in the Appendix.
2 THE IMPORTANCE OF SCHOOL HEALTH AND NUTRITION PROGRAMS
School health programs are now recognized as having a crucial role in improving the health, nutritional, and educational outcomes of school-aged children. For this reason, countries are increasingly integrating these programs into their national development policies and education sector plans. There is significant evidence that health-related factors, such as hunger and chronic illness, are underlying factors in low school enrollment, absenteeism, poor classroom performance, and early dropping out of school (Bundy 2011). The research also shows that schools can play a vital role in addressing these health-related factors and so improve the
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learning outcomes of school-aged children (Bundy 2011, Jukes 2008). The important role of the education sector in addressing poor health and malnutrition was acknowledged at the World Education Forum in Dakar, Senegal, in 2000, when a multi-agency initiative between UNESCO, UNICEF, WHO, and the World Bank was launched to provide guidance on the development and implementation of school health programs. Through this initiative, the FRESH (Focusing Resources on Effective School Health) framework was developed to provide a set of unifying principles to guide school health policies and programs.
2.1 The FRESH Framework: Building Blocks for a School Health Policy Framework
The FRESH framework suggests that the following four core components form the basis of an effective school health program:
1. Health-related school policies: including those that address HIV/AIDS and gender 2. A safe and supportive school environment: including access to safe water, adequate
sanitation, and a healthy psycho-social environment 3. School-based health and nutrition services: including de-worming, micronutrient
supplementation, school feeding, dengue prevention, and psycho-social counseling 4. Skills-based health education: including curriculum development, life-skills training, and
learning materials, including HIV
The FRESH framework also suggests that these components can only be implemented effectively when they are supported by strategic partnerships between the health and education sectors (Bundy, 2011). The FRESH approach promotes a shared framework that focuses on schools to promote health and learning. FRESH also seeks to involve the entire school community, including children, teachers, parents, and other community members, while linking schools to health services and integrating school health, hygiene, and nutrition as a strategic means of improving education outcomes.
3 SABER-SCHOOL HEALTH: A FRAMEWORK FOR ASSESSING SCHOOL HEALTH POLICIES
Recognizing school health as a key education sector sub-system, the World Bank’s Human Development Network, Education Department (HDNED) launched SABER-School Health as part of a larger exercise aimed at reviewing all education sub-systems. The main purpose of this initiative is to provide standards of good practice against which countries can rate themselves (World Bank, 2012). The primary focus of SABER-School Health is to gather systematic and verifiable information about the quality of policies, rather than about their implementation, on the premise that the foundation for effective implementation is a sound policy framework. As
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such, SABER-School Health is designed to provide a snapshot of the policy framework for school health and lay the groundwork for a deeper analysis of its implementation at a later stage. The essence of SABER-School Health as a tool for assessment is the SABER-School Health framework. This framework identifies the core policy domains (which serve as strategic goals) for school health programs, performance drivers that indicate progress towards realizing these goals, and concrete policy actions that governments can take towards establishing a strong policy framework for school health programs. Four developmental stages (latent, emerging, established, and advanced) are identified and standardized across each policy action that is introduced. The diagnostic tools developed for SABER-School Health can be used to determine a country’s progress in each policy area and can provide an overview of the developmental status of school health policy in the country.
3.1 Conceptual Framework for SABER-School Health The SABER framework identifies four core policy domains, aligned with the four pillars of the FRESH framework, as shown in Figure 1.
Figure 1: The four pillars of the FRESH framework
3.1.1 Health-Related School Policies Establishing health-related school policies is a vital aspect of ensuring effective school health programming. The process of setting school health policy provides an opportunity for national leadership to demonstrate a commitment to school health programing. School health policies also
FRESH School-
based health and nutrition
services
Health-related school policies
Safe school environment
Skills-based health
education
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play a role in ensuring accountability for quality school health programming by providing a clear basis for monitoring school health program implementation (PCD, 2012). Policies also provide the necessary guidance for a safe and gender-sensitive school environment. In many countries, girls are at a distinct disadvantage and must be mainstreamed in the education system, although in some countries, including much of the Caribbean, boys lag behind girls in educational performance. Thus, regardless of whether it is boys or girls who are lagging, such policies are intended to ensure support and structural guidance for gender mainstreaming.
3.1.2 Safe School Environment Ensuring a safe and supportive school environment is the second core policy goal for SABER-School Health. A safe and supportive school environment will provide adequate water and sanitation facilities but also includes a healthy psycho-social environment. Diseases related to poor sanitation and water scarcity can lead to illnesses, to which children are often the most vulnerable (PCD, FRESH resources 2012). Apart from the obvious health benefits of safe water and sanitation, the absence of safe and separate sanitation facilities for girls has been shown to be a factor in preventing girls from attending school and consequently, addressing this can improve girls’ attendance rates (PCD, FRESH resources 2011). There is also evidence that a positive psycho-social environment at school influences the overall behavior of students. Research has shown that factors such as “the relationships between teachers and students in classrooms, opportunities for student participation and responsibility, and support structures for teachers are consistently associated with student progress (WHO 2003)”. Conversely, there is a strong relationship between a negative psycho-social environment and health-compromising behaviors among students, such as smoking, teen sex, and alcohol misuse (WHO 2003). Ultimately, both the physical and psycho-social school environment have been shown to impact education and subsequently a safe and supportive school environment is a critical component in improving educational access and outcomes.
3.1.3 School-Based Health Services The third core policy goal of SABER-School Health is to ensure the delivery of school-based health services. School-based health and nutrition services include screening and referral for health problems as well as the provision of anthelmintic treatment for parasitic infections, micronutrient supplementation, and other simple treatments that are easily administered by teachers. This critical component of school health programs has an impact on the educational achievement of school-aged children among whom these diseases are highly prevalent (Jukes 2008). Diseases such as worm infection, malnutrition, and anemia have been shown to impact negatively on school attendance as well as on a child’s cognitive abilities, in turn affecting their
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educational performance. Also, these diseases are often preventable and treatable with simple, easily-administered treatments (Jukes 2008). School-based health and nutrition services provide a cost-effective means of addressing these diseases by utilizing the existing infrastructure of the school (including the skilled workforce of teachers and administrators), together with the resources of the health, nutrition, and sanitation sectors, to deliver substantial gains in health and education.
3.1.4 Health Education The implementation of a skills-based health education is the final policy goal of SABER-School Health. The school provides a crucial platform to impact the behavior and inform the choices of school-aged children and adolescents. However, there is increasing evidence that effective behavior change among children requires more than teaching health knowledge (WHO 2012). Behavior change requires a skills-based approach to health education that focuses on the development of the knowledge, attitudes, values, and skills (including life skills, such as inter-personal skills, critical and creative thinking, decision making, and self-awareness) that are needed to make positive health-related decisions and act on them (WHO 2012). A skills-based health education is critical to improving individual behavior, alleviating social and peer pressure, addressing cultural norms, and discouraging abusive relationships: all of which contribute to health and wellbeing and ultimately impact the educational opportunities and outcomes of school-aged children.
3.2 Components and Scoring System of the SABER-School Health Framework In addition to the core policy domains discussed above for achieving the strategic goals, there are eleven performance drivers (see Figure 2), which indicate progress. Linked to each performance driver are a set of policy actions that a government can take to improve its school health policy framework. For each policy action, four stages of development have been identified and standardized:
a. Latent: very little policy implementation b. Emerging: policy implementation falls between latent and established levels c. Established: minimum policy implementation d. Advanced: a comprehensive policy framework implemented
Identifying the stage of each policy action helps assess the status of each policy domain and ultimately the developmental status of the school health policy framework. The SABER-School Health framework used in this assessment is elaborated in Annex 1. The processes for data collection and analysis for SABER-School Health are being developed and piloted. As such, the
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data collection tools described in Section IV as well as the scoring system presented here are in a pilot stage. Figure 3 provides a sample of the scoring system for the SABER-School Health framework. Although the FRESH framework serves as the primary guiding principle for the SABER-School Health framework, other sources have informed the concept, including the core indicators of the monitoring and evaluation (M&E) framework for school health programs developed by FRESH partners; the experience from assessing other education sub-systems; advice from an Advisory Committee of experts;1 and previous surveys of education policies in various parts of the world, including the Caribbean in 2009.2 The framework-was validated by the school health stakeholders in 17 countries at a regional meeting of the Economic Community of West African States (ECOWAS) and in Sri Lanka. Figure 2: Core policy domains and performance drivers in school health (linked to each performance driver are a set of policy actions not shown here)
1 Including representatives of GlaxoSmithKline, International Food Policy Research Institute, London School of Hygiene and Tropical Medicine, Partnership for Child Development, Save the Children, UNICEF, World Bank, World Food Programme, and World Health Organization 2 Strengthening the Education Sector Response to School Health, Nutrition and HIV/AIDS in the Caribbean Region: A rapid survey of school health policies in 13 Countries, 2009
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Figure 3: Sample of the scoring system for the SABER-School Health assessment
POLICY GOALS POLICY LEVERS OUTCOME
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4 APPLYING SABER-SCHOOL HEALTH IN THE CARIBBEAN
4.1 School Health in the Caribbean Context School-aged children in the Caribbean face the burden of diseases of both prosperity and of poverty, in line with most emerging middle-income countries. Caribbean governments have identified the major risk factors for young people in the Caribbean as: (i) early sexual initiation; (ii) high and growing rate of HIV/AIDS infection among adolescents and youth – in some countries it is over three percent for the group aged 15 – 24 years; (iii) growing incidence of substance abuse among adolescents and youth; (iv) cultural practices that endorse social acceptance of physical and sexual abuse; (v) high incidence of crime and violence among adolescents and youth; and (vi) increasing prevalence of non-communicable diseases (NCD) such as diabetes, hypertension, and obesity that could be reduced by the establishment of healthy life styles during childhood and youth. Early efforts to address these issues, especially the HIV/ AIDS epidemic, were largely directed through the health sector. Initial activities in the education sector included the development of an HIV/AIDS education curriculum and guidance/counseling programs within schools. In the 1990s the Health and Family Life Education (HFLE) initiative was launched as a CARICOM multi-agency response to HIV/AIDS and other school health challenges (O’Connell et al. 2009). In 2006, in an additional response to these challenges, governments in the Caribbean committed to
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a broad health and nutrition program that specifically included HIV prevention by forming the Caribbean Education Sector HIV and AIDS Coordinator Network (EduCan). This network was established to promote information sharing and to build capacity for a national education-sector response to HIV/AIDS in the Caribbean. Operationally, this network has functioned as a mechanism for the coordination of broader school-health interventions, especially those related to NCDs (Bundy 2011). In 2009, to better understand the education sector response to school health and HIV/AIDS, EduCan undertook a rapid survey of school health policy and programming in 13 countries in the Caribbean. The survey provided a snapshot of school health programming in the region, providing one of the first cross-country comparisons of school health policies that laid the groundwork for the development of standardized tools for assessing the policy framework for school health.
4.2 Objectives of the assessment The ultimate objective of this assessment is to provide standards of good practice in school health for the Caribbean using the SABER-School Health framework. It would help the countries to identify the strengths and weaknesses in their school health policy framework, and to learn from each other’s practices.
4.3 Methodology A questionnaire for school health policies was developed in line with the SABER-School Health framework. This questionnaire is designed to be answered by focal points at the relevant ministries in collaboration with other school health stakeholders in the country. The questionnaire was first validated in Kenya and has been piloted in 10 countries in the regional network of East African Countries (EAC). They were sent to the HFLE focal points in 12 countries in the Caribbean. The HFLE coordinators were requested to complete the survey in collaboration with their counterparts in school health at the Ministry of Health and other relevant institutions. In cases where questions were left unanswered by the country, it was scored as latent.
5 RESULTS
5.1 Summary of Results by Country Below is a summary of the status of school health policies in Dominica (Figure 5), Grenada (Figure 6), Guyana (Figure 7), St. Lucia (Figure 8), Barbados (Figure 9), and St.Vincent and the
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Grenadines (Figure 10), which are assessed in terms of their stages of policy development as latent, emerging, established, or advanced (Figure 4). More details of the results are given in the Appendix.
Figure 4: Stages of policy development
Figure 5: Dominica scores on policy domains
Health-related school policies Dominica is latent in the area of health-related school policies. There is a poverty reduction strategy in place which includes school health, thus demonstrating some national recognition of the importance of school health; yet, to date, there is no national school health policy. Despite the absence of a school health policy, a national budget line for school health programs provides funding for “health promoting activities” through the health sector. A situation analysis has been undertaken for the school-feeding component of the school health program and program design, and implementation has been aligned with the needs identified in this situation analysis, but there remains a need for a broader and more comprehensive situation analysis. More attention should be paid to the quality assurance of programming as there is no formal M&E plan for the school health program. Gender mainstreaming has also not been addressed in the national education policy. Safe school environment
Latent
Established
Advanced Advanced
Health relatedschool policies
Safe schoolenvironment
School basedhealth and
nutrition services
Health education
Latent Emerging Established Advanced
5.2 DOMINICA
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Dominica is fairly advanced in the provision of a safe physical environment with enforced national standards for clean water, adequate sanitation facilities, and for regulating the safety of school infrastructure. Mechanisms are in place to update and monitor all schools to meet these standards and most stakeholders have been mobilized to maintain a healthy physical school environment. There is clear room for improvement in the psycho-social dimension of the policy framework. HIV/AIDS and physical and mental disability are all identified as sources of stigmatization but there are no systematic mechanisms in place to respond to these issues. Stigma is covered in the life-skills curriculum and teachers receive in-service training to cover these issues, yet without a strong policy framework in place, these responses do not appear to be sufficient to address bullying in schools due to stigma. There are national standards and guidelines on addressing institutional violence in schools but teachers do not receive in-service and pre-service training in addressing these issues. Trauma response in schools is addressed through psycho-social support for teachers and students who are affected by trauma. Both teachers and students have access to this support, “child-friendly” learning spaces have been established, and school-based, psycho-social services have been developed and implemented. School-based health and nutrition services All the necessary components for comprehensive implementation of school-based health and nutrition services are reported to be in place. The need for school-based screening and remedial action has also been captured in the situation analysis and outlined in national policy. Appropriate actions are being taken to address these needs and there is ongoing teacher training for referral of adolescent pupils to appropriate adolescent health services. Health education Dominica appears to be advanced in the area of health education. It has a fully-developed and fully-implemented health education and participatory approach to the life-skills curriculum; pre-and in-service teacher training; and coverage of health-related knowledge in school examinations.
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5.3 GRENADA
Health-related school policies As in Dominica, although school health has been included in the national poverty reduction strategy in Grenada, there is no formal school health policy in place to guide school health programming in the country. However, its mechanisms for quality assurance of the programming are advancing with an M&E system in place. A situation analysis has been conducted as part of this M&E plan although it is unclear how comprehensive it is. The gender dimension has been addressed in education policy and appears to be fairly advanced with a mechanism in place for monitoring gender mainstreaming. Safe school environment Grenada is advanced in the provision of a safe physical environment with standards for clean water and adequate sanitation facilities in place. There are standards for regulating the safety of school infrastructure and there are mechanisms to update and monitor all schools to meet these standards; the community has been mobilized to maintain a healthy physical school environment. Grenada is advanced in the attention paid to the psycho-social dimension of the school environment. HIV/AIDS, physical disability, and mental disability are all identified as sources of stigmatization and there are systematic mechanisms in place to respond to these issues. Stigma is covered in the life-skills curriculum, teachers receive in-service training to cover these issues, and there are support groups to help students and teachers deal with these issues. However, focal points for school health report that the policies to address bullying due to stigma are inadequate at the school-level. There are national standards and guidelines on addressing institutional violence in schools and also provision for psycho-social support for teachers and students who are affected by trauma; with both teachers and students having access to this support. “Child-friendly” learning spaces
Emerging
Established
Emerging
Emerging
Health relatedschool policies
Safe schoolenvironment
School basedhealth and
nutrition services
Health education
Figure 6: Grenada scores on policy domains
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have been established and school-based psycho-social services have been developed and implemented. School-based health and nutrition services The need for school-based interventions has been identified in a situation analysis and it appears that some interventions have been implemented and scaled up in a targeted manner. There has also been an assessment of school-based screening and referral services, but these needs have not been outlined in national policy, and no action has been taken to implement these services. Health education Grenada is emerging in the implementation of its national health education curriculum. Although it is fully developed and the material covered in its curriculum has been integrated into the school examinations, there is no pre- or in-service teacher training to teach this curriculum, nor have teaching materials been developed for it and thus the quality of this coverage is unclear. There are participatory approaches in place to teach age-appropriate and sex-specific life-skills for health behaviors and these have also been integrated into the national curriculum, but, once again, there is no teacher preparation to teach this curriculum.
5.4 GUYANA
Health-related school policies Guyana is latent in the area the implementation of health related school policies although it has an emerging national school health policy, published by the education sector. Most stakeholders have a copy of this policy and are being trained on its implementation. The other components of effective school health policy are latent. An incomplete situation analysis of school health and nutrition has also been undertaken, identifying some of the priority health and nutrition problems of school-aged children in the country. It is unclear where funding for school health comes from
Latent
Emerging
Emerging Emerging
Health relatedschool policies
Safe schoolenvironment
School basedhealth andnutritionservices
Healtheducation
Figure 7: Guyana scores on policy domains
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as there is no national budget line for school health. Mechanisms for monitoring and evaluation of school health programming have not been developed and gender mainstreaming of health policy in schools is latent. Safe school environment Guyana is on the borderline between emerging and established in the area of a safe school environment. Although formal national standards for the provision of safe water or clean sanitation facilities in schools appear to be absent, there is reported to be clean water and adequate sanitation facilities in most schools in the country with a system in place to monitor the quality of these facilities. There are, however, national standards regulating the safety of school infrastructure, and all schools in the country appear to adhere to these standards. There are also mechanisms in place to monitor the maintenance and safety of school infrastructure and the community has been mobilized to maintain a healthy school environment. HIV/AIDS and physical disability have been identified as the key sources of stigmatization in Guyana. Stigma is covered in the life-skills curriculum, pre- and in-service teacher training covers stigma issues and all teachers have been trained accordingly. Respondents to the questionnaire felt that the school-level policy to address stigma is sufficient in Guyana. There are no national standards or guidelines addressing institutional violence in schools, but teachers receive pre- and in-service training on addressing these issues. School-based health and nutrition services Some, but not all, school-based interventions identified in the situation analysis are being implemented and taken to scale. The situation analysis identified the need for school-based screening and referral to remedial services, and this has been outlined in the national policy. Action is being taken to implement these services and teachers are trained to refer adolescent pupils to appropriate adolescent health services. Health education Health education in Guyana is emerging. A national health education curriculum, as well as a participatory approach to the life-skills curriculum, has been fully developed. But not all schools have implemented these as yet, and it is unclear whether teachers are receiving training to teach the curriculum.
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5.5 ST. LUCIA
Health-related school policies The school health policy framework in St. Lucia is latent. There is no national school health policy in St Lucia; no national budget line for school health; and no situation analysis has been conducted to assess health-related school needs. The gender dimension of health is also not addressed in national education policy. Safe school environment St. Lucia is emerging in its policies to ensure a safe school environment for children. It is advanced in its attention to the physical school environment: national standards are in place for the physical school environment, there is clean water and adequate sanitation in most schools, and mechanisms are in place to monitor the quality of these facilities. There are also standards for the safety of school infrastructure, schools built after these standards were established follow these regulations and there are mechanisms in place to update old schools. In the area of psycho-social wellbeing, there is more room for growth. HIV and physical and mental disability have all been identified as sources of stigma and issues of stigma are covered in the life-skills curriculum, but there are no systematic mechanisms in place to respond to stigmatization in schools; and there are no support groups to address specific stigma issues faced by teachers or students. There are no national standards and guidelines on addressing institutional violence in schools, but teachers receive pre- and in-service training to teach this in the curriculum. There is, however, provision for psycho-social support for teachers and students who have faced trauma due to shock.
Latent
Emerging
latent
Emerging
Health related schoolpolicies
Safe schoolenvironment
School based healthand nutrition services
Health education
Figure 8: St . Lucia scores on policy domains
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School-based health and nutrition services School-based health and nutrition interventions have not been identified in a situation analysis and as such there is no provision for implementing these interventions. This is equally the case with school-based screening and referral services. There is also no provision for teacher training for the referral of adolescent pupils to the appropriate adolescent health services. Health education The national school health curriculum is partially developed and teachers are receiving pre- and in-service training to teach this curriculum but coverage is not universal. There are also participatory approaches for age-appropriate and sex-specific life skills for health, and these approaches have been integrated into the national curriculum. Pre- and in-service teacher training is provided for teaching this life-skills curriculum and it is being taught in most schools although the material is not covered in school examinations.
5.6 BARBADOS
Health-related school policies Barbados is emerging in its school health policy development. There is a national policy on school health and it has been published jointly by the health and education sectors. There is a national budget line for school health which comes through both the health and education
Emerging
Established Established
Advanced
Health related schoolpolicies
Safe schoolenvironment
School based healthand nutrition services
Health education
Figure 9: Barbados scores on policy domains
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sectors, and mechanisms are in place for smooth disbursement of this funding where needed at the implementation level. Quality assurance is also being addressed: an M&E plan is in place; a situation analysis has been conducted; and the gender dimension of health has also been addressed in the national education policy. Safe school environment Barbados is established in its policy to ensure a safe school environment. There are standards in place for clean water and adequate sanitation facilities, and these are available in all schools in the country. There are also national standards for the safety of school infrastructure and all schools meet these standards. There are mechanisms in place to monitor the maintenance of school infrastructure, and the community has been mobilized to ensure a physically safe and healthy school environment. As is the case with many other countries in the region, there is room for improvement in ensuring a safe psycho-social environment. HIV/AIDS and mental disability are identified as key sources of stigmatization but there are no systematic mechanisms in place to respond to these issues in schools, although stigma is addressed in the life-skills curriculum. It was reported that the response to bullying due to stigma in schools is insufficient. However, the country has mechanisms in place to respond to institutional violence in schools and provision of psycho-social support to teachers and students who are affected by trauma. School-based health and nutrition services Cost-effective and appropriate school-based health interventions have been developed on the basis of the situation analysis and these are being implemented and scaled up. The situation analysis also identified the need for school-based screening and referral to medical services. Although this has not been outlined in national policy, some action has been taken to implement the necessary measures, and teachers receive pre- and in-service training to ensure their smooth implementation. Health education There is a fully-developed curriculum that covers health, hygiene, nutrition, and HIV information. Teachers receive pre- and in-service training to teach this curriculum and it is integrated into national examinations and implemented in all schools. There are also participatory approaches in place to teach age-appropriate and sex-specific life skills for health, and these have also been integrated into the national curriculum. Teaching materials have been developed and teachers receive both pre- and in-service training for this curriculum. It is taught in most schools and there is systematic assessment of the impact of these health life-skills on health-learning outcomes; these skills are also assessed in school examinations.
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5.7 ST. VINCENT & THE GRENADINES
Health-related school policies St. Vincent is latent in the area of health-related school policies. There is a poverty reduction strategy which is in the process of being developed, yet school health is not included, and it is unknown if school health was discussed during the preparation of the document. There is no published national policy on school health and no national budget line for school health. A situation analysis has not been undertaken for the school health program and there is no formal M&E plan for the school health program. Gender mainstreaming has also not been addressed in the national education policy. Safe school environment St. Vincent is emerging in its policies to ensure a safe school environment for its school children. It is established in its attention to the physical school environment: national standards are in place for the physical school environment and there is clean water and adequate sanitation in all schools. Mechanisms are also in place to monitor the quality of these facilities. There are standards that apply to the safety of school infrastructure, and schools built after these standards were established follow these regulations. There are also systems in place to update old schools to safety standards, but currently, not all older buildings have been renovated. In the area of psycho-social wellbeing, there is room for improvement. HIV, and physical and mental disability have all been identified as sources of stigma, but pre-service and in-service training for teachers does not cover issues of stigma. While there is no official school-level policy in place to address bullying due to stigma, there are support groups to address specific stigma issues faced by teachers and students. There are no national standards or guidelines on addressing institutional violence in schools, and teachers do not receive pre- or in-service training regarding this subject matter. There is, however, provision for psycho-social support for teachers and students who have faced trauma due to shock.
Latent
Emerging
Latent Latent
Health relatedschool policies
Safe schoolenvironment
School based healthand nutrition
services
Health education
Figure 10: St. Vincent scores on policy domains
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School-based health and nutrition services School-based health and nutrition interventions have not been identified in a situation analysis and as such, there is no provision for implementing these interventions. This is equally the case with school-based screening and referral services. There is also no provision for teacher training for referral of adolescent pupils to the appropriate adolescent health services. Health education Insufficient information is available to make an assessment of St. Vincent’s national health education curriculum, although there is a national school curriculum in place.
5.8 Comparative results by Policy Domain The six countries in the region reveal positive trends in the development of school health policy (Figure 11) overall, but also indicate that there is still much room for improvement to ensure a sound policy framework for comprehensive school health.
Figure 11: SABER scoring overall SABER SCORING RUBRIC
Latent Emerging Established Advanced 0.0 - 0.3 0.31 - 0.59 0.6 - 0.79 0.8 - 1.0
5.8.1 Health-Related School Policies As Figure 11 shows, all six countries are either emerging or latent in the development and establishment of health-related school policies. Of the six countries surveyed, only Guyana and Barbados have school health policies in place and Barbados stands out as the only country where this policy was jointly published by both health and education ministries. In all countries except for Barbados there is a need for a national school health policy as a joint effort of both the health and education sectors, along with a national budget line for school health. All countries, including Barbados, lack a multi-sectoral steering committee to coordinate school health.
0
0.2
0.4
0.6
0.8
1
Dominica Grenada Guyana St Lucia Barbados St.Vincent
0.21 0.42
0.13 0.04
0.50
0.00
Figure 11: Scores on Status of Health-Related School Policies
23
The FRESH framework identifies collaboration between the health and education ministries as a prerequisite for effective school health programming. All six countries can benefit from greater collaboration between the education and health ministries, both in terms of developing school health policy as well as in managing the national funding stream for school health. A prerequisite for effective school health programming is a strong mechanism for the M&E of school health programs. These countries are at different stages of development of M&E plans and there is significant room for improvement in this area.
5.8.2 Safe School Environment As Figure 12 indicates, the six countries included show a clear move towards the established level in their policies to ensure a safe school environment. All countries are either established or advanced in the policies to support a safe physical school environment. The policy guiding the psycho-social dimensions of the school environment is far less developed in all countries. Although there are initiatives to address stigma and institutional violence in schools, most of the countries reported that mechanisms to address these issues are inadequate, and all but one of the respondents suggested that the policies are not effective in addressing bullying due to stigma at the school level.
5.8.3 School-Based Health Services As Figure 13 indicates, there is a wide variation in the status of policies supporting school-based health and nutrition services. This is largely because the situation analysis component is either missing or latent in most countries. To maximize the effectiveness of the school-based health and nutrition services, it is important that they are developed based on a
0
0.2
0.4
0.6
0.8
1
Dominica Grenada Guyana St Lucia Barbados St. Vincent
0.61 0.78
0.56 0.50
0.67 0.44
Figure 12: Scores on Status of Safe School Environment
00.20.40.60.8
1
Dominica Grenada Guyana St Lucia Barbados St.Vincent
1.00
0.56
0.33
0.00
0.67
0.00
Figure 13: Scores on status of School-based Health and Nutrition Services
24
comprehensive situation analysis, and targeted and scaled up according to the identified needs. This exercise suggests that in most of these countries there is a need for a more comprehensive alignment of the goals and priorities of school health services with the priorities identified in the situation analysis.
5.8.4 Health Education The HFLE program has laid a strong foundation for school health curriculum development and this is reflected in the results of the “Health Education” component of the policy framework. All of the six countries mentioned herein have either fully developed or partially developed skills-based health education curricula. However, as Figure 14 shows, Dominica and Barbados are the only countries that are advanced in this area. They not only have fully-developed curricula, but have fully implemented these across their territories, integrated the material into general school examinations, and made provision for pre- and in-service teacher training to teach the curricula. The other countries are still emerging, despite having either fully or partially developed curricula, because the curricula have not been fully implemented and/or there is still no provision for relevant teacher training.
6 CONCLUSION It is important to note that these results are pending validation through discussion with school health stakeholders in the respective countries. However, as intended, these results provide an initial snapshot of school health policy development in the Caribbean region. The results demonstrate the feasibility and value of school health policies and highlight the need for a more comprehensive exercise in the future. The questionnaire proved to be a valid and appropriate means of capturing the data needed to benchmark school health policy in the Caribbean but the process also revealed potential challenges to consider when scaling up this effort in the region. The major potential challenge is the high level of multi-sectoral coordination needed to complete the questionnaire. Although
00.20.40.60.8
1
Dominica Grenada Guyana St Lucia Barbados St.Vincent
1.00
0.33 0.33 0.33
1.00
0.00
Figure 14: Scores on status of Health Education
25
primary ownership of school health programming belongs to the education sector, effective school health programming is essentially a multi-sectoral effort and as such, the data on school health policies has to be provided jointly by all the sectors involved. When a country’s school health policy framework is advanced, the level of coordination between respective stakeholders is smooth. When its health policy framework is latent or emerging, this kind of coordination cannot be assumed and it is likely that it will require an extra effort on the part of the respondents. Many of the respondents noted the issue of multi-sectoral coordination as the most significant barrier to providing the information required for the exercise, and this resulted in unanswered questions and gaps in the data. Addressing this challenge will ensure the success of the future assessment of school health policy in the Caribbean. This might require rethinking the data collection methodology, including but not limited to issuing a questionnaire to each of the key sectors. Successful assessment should facilitate comparative policy dialogue, assist in disseminating good practice, and provide resources for future investment in school health in the region. References
Donald Bundy (2011). Rethinking School Health: A Key Component of Education for All. Washington, DC: World Bank; Directions in Development
Tara O’Connell, Venkatesh, M. and Bundy, D. March 2009. Strengthening the Education Sector Response to School Health, Nutrition and HIV/AIDS in the Carribean: A rapid survey of 13 countries. Coordinated by EduCan, EDC, PCD, the World Bank, and UNESCO
Matthew Jukes, Drake, L.J. and Bundy, D.A.P. (2008). School Health, Nutrition and Education for All: Leveling the Playing Field. Cambridge, MA: CABI Publishing
WHO Information Series on School Health. Document 10: Creating an environment for emotional and social wellbeing. Accessed at: http://www.who.int/school_youth_health/media/en/sch_childfriendly_03_v2.pdf WHO Information Series on School Health. Document 9: “Skills for Health”. Accessed at: http://www.who.int/school_youth_health/media/en/sch_skills4health_03.pdf The Partnership for Child Development (PCD) Schools and Health: FRESH homepage. Accessed at: http://www.freshschools.org/Pages/HealthRelatedSchoolPolicies.aspx World Bank SABER-School Health resources. Accessed at: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/0,,contentMDK:22845903~menuPK:282391~pagePK:148956~piPK:216618~theSitePK:282386,00.html
26
APPENDIX
27
28
29
30
31
32
33
34
35
36
37
-
Latent Emerging Established Advanced
School health included in national-level poverty reduction strategy or equivalent national policy
School health not yet included in national-level poverty reduction strategy or equivalent national policy
School health discussed by members and partners during preparation of PRSP but not included in final PRSP
School health included in the PRSP or equivalent national policy
School health included in national-level poverty reduction strategy or equivalent national policy, accompanied by targets and/or milestones set by the government
Published and distributed national policy covers all four components of FRESH[1] (health-related school policies, safe school environment, school-based health and nutrition services, and skills-based health education)
National recognition of the importance of school health exists but a national policy has not been published as yet
Published national policy that covers some but not all four components of FRESH (e.g. a policy on HIV in education only); some regional and school-level stakeholders have copies
Published national policy that covers some aspects of all four components of FRESH; almost all regional and school-level stakeholders have copies of the national school health policy and have been trained in its implementation
Comprehensive approach to all four areas promoting inclusion and equity; almost all regional and school-level stakeholders have copies of the national school health policy and have been trained in its implementation and written school-level policies exist that address school health
Published national policy involves a multisectoral approach
National recognition of the importance of a multisectoral approach to school health exists but a national policy has not been published as yet
Published national policy by the education or health sector that addresses school health
Published national policy by the education and health sectors that addresses school health
Published national policy jointly by both the education and health sectors that addresses school health and includes other relevant sectors (e.g. water, environment, agriculture)
Coordinated implementation of a national level policy that addresses school health
Multisectoral steering committee coordinates implementation of a national school health policy Any multisectoral steering committee
coordination efforts are currently non-systematic
Sectoral steering committee from education or health coordinates implementation of a national school health policy
Multisectoral steering committee from both education and health coordinates implementation of a national school health policy
Multisectoral steering committee from education, health, and one or more other relevant sectors (e.g. water, environment, agriculture) coordinates implementation of a national school health policy
Governance of a national school health policy
National budget line(s) and funding allocated to school health; funds are disbursed to the implementation levels in a timely and effective manner A national budget line or funding
does not yet exist for school health; mechanisms do not yet exist for disbursing funds to the implementation levels
National budget line and funding for school health exists in either the health or education sector; school health funds are disbursed to the implementation levels intermittently
National budget line and funding for school health exists in both the health and the education sectors; school health funds are disbursed to the implementation levels in a timely and effective manner
National budget line and funding for school health exists in health, education, and one or more other sectors; school health funds are disbursed to the implementation levels in a timely and effective manner and implementers have the capacity to plan and budget as well as request resources from the central level
A situation analysis assessess the need for the includsion of various thematic areas, informing policy, design, and implementation of national school health program such that it is targeted and evidence- based school
A situation analysis has not yet been planned to assess the need for the inclusion of various thematic areas and inform policy, design, and implementation of the national school health program
Incomplete situation analysis that assesses the need for the inclusion of various thematic areas; policy, design, and implementation of some thematic areas are based on evidence of good practice
Situation analysis conducted that assesses the need for the inclusion of various thematic areas; policy, design, and implementation of these thematic areas are based on evidence of good practice and are targeted according to situation analyses of what thematic area interventions to target in which
Situation analysis conducted that assesses the need for the inclusion of various thematic areas, along with costings; policy, design, and comprehensive implementation of these thematic areas are based on evidence of good practice and are targeted according to situation analyses of what
Monitoring and Evaluation (M&E)Systems are not yet in place for M&E of implementation of school health programming
A M&E plan exists for school health programming and data collection and reporting occurs intermittently especially at national level
The M&E plan for school health is integrated into national monitoring or information management systems and data collection and reporting occurs recurrently at national and regional levels
The M&E plan for school health is integrated into national monitoring or information management systems and data collection and reporting occurs recurrently at national, regional and school levels; baseline carried out and program evaluations occur periodically
Gender mainstreaming in the implementation of school health
Gender dimension of Health addressed in national education policy (e.g. pregnancy, sexual harassment, privacy and sanitation)
Gender dimension of Health is not yet formally addressed in national education policy
Gender dimension of Health addressed in national education policy but implementation is uneven
Gender dimension of Health is addressed in published education policy and is implemented nationally
Gender dimension of Health is addressed in published education policy, implemented nationally, and the M&E mechanism includes oversight of the gender mainstreaming
STAGE
National level policy that addresses school health
System Assessment and Benchmarking for Education Results - Benchmarks for St.Vincent on School Health Policy Framework
LATENT
OVERALL SCORE PER DOMAIN
Domain 1: Health-related school policies
Quality assurance of programming
PERFORMANCE DRIVER POLICY ACTION
38
Domain 2 - Safe school environment
Provision of safe water in schoolsThe need for provision of safe water is acknowledged, but standards are absent, and coverage is uneven
The need for safe water provision in all schools is recognised, standards have been established, but national coverage has not been achieved
Fresh potable water is available to students in most schools
Most schools have water that is accessible, of good quality and adequate supply; facilities are regularly maintained and monitored
Provision of sanitation facilities
The need for provision of sanitation facilities is acknowledged, but standards are absent, and coverage is uneven
The need for provision of sanitation facilities in all schools is recognised, standards have been established, but national coverage has not been achieved
Sanitation facilities are available to students in most schools
Most schools provide adequate sanitation facilities and these facilities are regularly monitored and maintained
Provision of sounds school structures( including accessibility for children with disabilities) and school safety
Construction and maintenance of school buildings is unregulated and national standards are lacking on what constitutes sound school structures and school safety
New schools being built have sound structures and school safety issues are taken into account, but coverage is not universal among older schools
Sound school structure standards are set – both national and local and coverage is universal for new builds and an update program is in place for older buildings; teachers, schoolchildren, families and other local stakeholders are mobilized to achieve and sustain a healthy school environment
National and local standards for sound school structures are fully implemented and coverage is universal; building structures are regularly monitored and maintained
Issues of stigmatisation (e.g. HIV, disability) are recognized and addressed by the education system
Any responses to issues of stigmatisation in schools are currently non-systematic
Some schools are effectively responding to stigma issues, but coverage is not universal; in-service teacher training on stigma issues is being provided
Stigma is covered in life skills education, pre- and in-service teacher training are being provided universally, and bullying as a result of stigma is effectively dealt with at the school level
Stigma is covered in life skills education, pre- and in-service teacher training are being provided universally, bullying as a result of stigma is effectively dealt with at the school level, and support groups responding to specific stigma issues are in place for both learners and teachers
Protection of learners and staff from violence ( including corporal punishment, fighting, physical assualt, gan activity, bullying, sexual harrassment and gender based violence)
National standards on how to address violence in schools are lacking
National standards on how to address some forms of institutional violence in schools are in place, guidelines are being developed, and in-service training is being provided
National standards and guidelines on how to address some forms of institutional violence in schools are published and disseminated; pre- and in-service teacher training are being provided universally
Mechanisms are in place to respond to all forms of institutional violence in schools
Provision of psychosocial support to teachers and students who are affected by trauma due to shock (e.g. conflict, orphaning, etc.)
Provision of psychosocial support for learners and teachers affected by trauma due to shock is non-uniform
Some psychosocial support is available to learners and teachers either in school or through referrals but coverage is not universal
Available psychosocial support for learners and teachers is mobilised (either in school or through referral services) and there is provision of appropriate psychosocial support activities for teachers and students in temporary learning spaces and in child-friendly spaces for young children and adolescents
Effective school-based intervention for supporting students’ psychosocial well-being is developed and there is provision of appropriate psychosocial support activities for teachers and students in temporary learning spaces and in child-friendly spaces for young children and adolescents; impact on psychosocial wellbeing and cognitive function is being monitored
School-based delivery of health and nutrition services
The school based health and nutrition services identified in the situation analysis and outlined in the national policy are being implemented (e.g. deworming, first aid, malaria contro, micronutrients, school feeding, vaccination etc.)
A situation analysis has not yet been undertaken to assess the need for various school-based health and nutrition services
Situation analysis has been undertaken that assess the need for various school-based health and nutrition services but systematic implementation is yet to be underway
Situation analysis has been undertaken, identifying cost-effective and appropriate school-based health and nutrition interventions, some of which are being implemented and taken to scale in a targeted manner in the available budget
All of the school-based cost-effective and appropriate health and nutrition services identified in the situation analysis and outlined in the national policy are being implemented and taken to scale in a targeted manner in the available budget
Remedial services (e.g. refractive erros, dental , etc.)
A situation analysis has not yet been undertaken to assess the need for school-based screening and referral to various remedial services
Situation analysis has been undertaken that assess the need for school-based screening and referral to various remedial services but implementation is uneven
Situation analysis has been undertaken, identifying those cost-effective and appropriate school-based screening and referral to various remedial services that are being taken to scale in the available budget; in-service teacher training is being provided
All of the school-based cost-effective and appropriate screening and referral to remedial services identified in the situation analysis and outlined in the national policy are being implemented and taken to scale in the available budget; pre- and in-service teacher training are being provided
Adolescent health servicesAny referrals of pupils to treatment systems for adolescent health services occur non-systematically
Teacher training for referral of pupils to treatment systems for adolescent health services
Teacher training for referral of pupils to treatment systems for adolescent health services with referral ongoing
Pre- and in-service training of teachers for referral of pupils to treatment systems for adolescent health services with referral ongoing
EMERGING
Domain 3: School based health and nutrition services
LATENT
Physical school environment
Psychosocial school environment
School-based screeing and referral to health systems
AN
NEX
1
Perf
orm
ance
D
river
Po
licy
Actio
n La
tent
Em
ergi
ng
Esta
blis
hed
Cut
ting-
edge
Dom
ain
1: H
ealth
-rel
ated
sch
ool p
olic
ies
Nat
iona
l lev
el p
olic
y th
at a
ddre
sses
sc
hool
hea
lth
Sch
ool h
ealth
in
clud
ed in
na
tiona
l-lev
el
pove
rty re
duct
ion
stra
tegy
or
equi
vale
nt n
atio
nal
polic
y
Sch
ool h
ealth
not
ye
t inc
lude
d in
na
tiona
l -lev
el
pove
rty re
duct
ion
stra
tegy
or
equi
vale
nt n
atio
nal
polic
y
Sch
ool h
ealth
di
scus
sed
by
mem
bers
and
pa
rtner
s du
ring
prep
arat
ion
of
PRSP
but
not
in
clud
ed in
fina
l PR
SP
Sch
ool h
ealth
in
clud
ed in
the
PRSP
or e
quiv
alen
t na
tiona
l pol
icy
Sch
ool h
ealth
in
clud
ed in
nat
iona
l-le
vel p
over
ty
redu
ctio
n st
rate
gy o
r eq
uiva
lent
nat
iona
l po
licy,
acc
ompa
nied
by
targ
ets
and/
or
mile
ston
es s
et b
y th
e go
vern
men
t
Publ
ishe
d an
d di
strib
uted
nat
iona
l po
licy
cove
rs a
ll fo
ur c
ompo
nent
s of
FR
ESH
3 (hea
lth-
rela
ted
scho
ol
polic
ies,
saf
e sc
hool
en
viro
nmen
t, sc
hool
-bas
ed
heal
th a
nd n
utrit
ion
serv
ices
, and
ski
lls-
base
d he
alth
ed
ucat
ion)
Nat
iona
l rec
ogni
tion
of th
e im
porta
nce
of
scho
ol h
ealth
exi
sts
but a
nat
iona
l pol
icy
has
not b
een
publ
ishe
d as
yet
Publ
ishe
d na
tiona
l po
licy
that
cov
ers
som
e bu
t not
all
four
com
pone
nts
of
FRES
H (e
.g. a
po
licy
on H
IV in
ed
ucat
ion
only
); so
me
regi
onal
and
sc
hool
-leve
l st
akeh
olde
rs h
ave
copi
es
Publ
ishe
d na
tiona
l po
licy
that
cov
ers
som
e as
pect
s of
all
four
com
pone
nts
of
FRE
SH
; alm
ost a
ll re
gion
al a
nd s
choo
l-le
vel s
take
hold
ers
have
cop
ies
of th
e na
tiona
l sch
ool
heal
th p
olic
y an
d ha
ve b
een
train
ed in
its
impl
emen
tatio
n
Com
preh
ensi
ve
appr
oach
to a
ll fo
ur
area
s pr
omot
ing
incl
usio
n an
d eq
uity
; al
mos
t all
regi
onal
an
d sc
hool
-leve
l st
akeh
olde
rs h
ave
copi
es o
f the
na
tiona
l sch
ool
heal
th p
olic
y an
d ha
ve b
een
train
ed in
its
impl
emen
tatio
n an
d w
ritte
n sc
hool
-le
vel p
olic
ies
exis
t th
at a
ddre
ss s
choo
l he
alth
Publ
ishe
d na
tiona
l po
licy
invo
lves
a
Nat
iona
l rec
ogni
tion
of th
e im
porta
nce
of
Publ
ishe
d na
tiona
l po
licy
by th
e Pu
blis
hed
natio
nal
polic
y by
the
Publ
ishe
d na
tiona
l po
licy
join
tly b
y bo
th
3 F
RES
H o
r Foc
usin
g R
esou
rces
on
Eff
ectiv
e Sc
hool
Hea
lth is
a c
omm
on fr
amew
ork
for s
choo
l hea
lth p
rogr
amm
es w
hich
was
inte
rnat
iona
lly a
gree
d up
on in
A
pril
2000
at t
he W
orld
Edu
catio
n Fo
rum
in D
akar
, Sen
egal
. The
FR
ESH
par
tner
s inc
lude
man
y in
tern
atio
nal o
rgan
izat
ions
incl
udin
g C
hild
-to-C
hild
Tru
st,
EDC
, Edu
catio
n In
tern
atio
nal,
FAO
, IR
C, P
CD
, RB
M P
artn
ersh
ip, S
ave
the
Chi
ldre
n, U
NA
IDS,
UN
ESC
O, U
NIC
EF, U
NO
DC
, WFP
, WH
O a
nd th
e W
orld
B
ank.
2 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
mul
tisec
tora
l ap
proa
ch
a m
ultis
ecto
ral
appr
oach
to s
choo
l he
alth
exi
sts
but a
na
tiona
l pol
icy
has
not b
een
publ
ishe
d as
yet
educ
atio
n or
hea
lth
sect
or th
at
addr
esse
s sc
hool
he
alth
educ
atio
n an
d he
alth
sec
tors
that
ad
dres
ses
scho
ol
heal
th
the
educ
atio
n an
d he
alth
sec
tors
that
ad
dres
ses
scho
ol
heal
th a
nd in
clud
es
othe
r rel
evan
t se
ctor
s (e
.g. w
ater
, en
viro
nmen
t, ag
ricul
ture
) C
oord
inat
ed
impl
emen
tatio
n of
a
natio
nal l
evel
pol
icy
that
add
ress
es
scho
ol h
ealth
Mul
tisec
tora
l st
eerin
g co
mm
ittee
co
ordi
nate
s im
plem
enta
tion
of a
na
tiona
l sch
ool
heal
th p
olic
y
Any
mul
tisec
tora
l st
eerin
g co
mm
ittee
co
ordi
natio
n ef
forts
ar
e cu
rren
tly n
on-
syst
emat
ic
Sec
tora
l ste
erin
g co
mm
ittee
from
ed
ucat
ion
or h
ealth
co
ordi
nate
s im
plem
enta
tion
of a
na
tiona
l sch
ool
heal
th p
olic
y
Mul
tisec
tora
l st
eerin
g co
mm
ittee
fro
m b
oth
educ
atio
n an
d he
alth
co
ordi
nate
s im
plem
enta
tion
of a
na
tiona
l sch
ool
heal
th p
olic
y
Mul
tisec
tora
l st
eerin
g co
mm
ittee
fro
m e
duca
tion,
he
alth
, and
one
or
mor
e ot
her r
elev
ant
sect
ors
(e.g
. wat
er,
envi
ronm
ent,
agric
ultu
re)
coor
dina
tes
impl
emen
tatio
n of
a
natio
nal s
choo
l he
alth
pol
icy
Gov
erna
nce
of a
na
tiona
l sch
ool
heal
th p
olic
y
Nat
iona
l bud
get
line(
s) a
nd fu
ndin
g al
loca
ted
to s
choo
l he
alth
; fun
ds a
re
disb
urse
d to
the
impl
emen
tatio
n le
vels
in a
tim
ely
and
effe
ctiv
e m
anne
r
A n
atio
nal b
udge
t lin
e or
fund
ing
does
no
t yet
exi
st fo
r sc
hool
hea
lth;
mec
hani
sms
do n
ot
yet e
xist
for
disb
ursi
ng fu
nds
to
the
impl
emen
tatio
n le
vels
Nat
iona
l bud
get l
ine
and
fund
ing
for
scho
ol h
ealth
exi
sts
in e
ither
the
heal
th
or e
duca
tion
sect
or;
scho
ol h
ealth
fund
s ar
e di
sbur
sed
to th
e im
plem
enta
tion
leve
ls in
term
itten
tly
Nat
iona
l bud
get l
ine
and
fund
ing
for
scho
ol h
ealth
exi
sts
in b
oth
the
heal
th
and
the
educ
atio
n se
ctor
s; s
choo
l he
alth
fund
s ar
e di
sbur
sed
to th
e im
plem
enta
tion
leve
ls in
a ti
mel
y an
d ef
fect
ive
man
ner
Nat
iona
l bud
get l
ine
and
fund
ing
for
scho
ol h
ealth
exi
sts
in h
ealth
, edu
catio
n,
and
one
or m
ore
othe
r sec
tors
; sc
hool
hea
lth fu
nds
are
disb
urse
d to
the
impl
emen
tatio
n le
vels
in a
tim
ely
and
effe
ctiv
e m
anne
r and
im
plem
ente
rs h
ave
the
capa
city
to p
lan
3 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
and
budg
et a
s w
ell
as re
ques
t re
sour
ces
from
the
cent
ral l
evel
Q
ualit
y as
sura
nce
of p
rogr
amm
ing
Situ
atio
n an
alys
is
asse
sses
nee
d fo
r th
e in
clus
ion
of
vario
us th
emat
ic
area
s4 , inf
orm
ing
polic
y, d
esig
n, a
nd
impl
emen
tatio
n of
th
e na
tiona
l sch
ool
heal
th p
rogr
am
such
that
it is
ta
rget
ed a
nd
evid
ence
-bas
ed
A si
tuat
ion
anal
ysis
ha
s no
t yet
bee
n pl
anne
d to
ass
ess
the
need
for t
he
incl
usio
n of
var
ious
th
emat
ic a
reas
and
in
form
pol
icy,
de
sign
, and
im
plem
enta
tion
of
the
natio
nal s
choo
l he
alth
pro
gram
Inco
mpl
ete
situ
atio
n an
alys
is th
at
asse
sses
the
need
fo
r the
incl
usio
n of
va
rious
them
atic
ar
eas;
pol
icy,
de
sign
, and
im
plem
enta
tion
of
som
e th
emat
ic
area
s ar
e ba
sed
on
evid
ence
of g
ood
prac
tice
Situ
atio
n an
alys
is
cond
ucte
d th
at
asse
sses
the
need
fo
r the
incl
usio
n of
va
rious
them
atic
ar
eas;
pol
icy,
de
sign
, and
im
plem
enta
tion
of
thes
e th
emat
ic
area
s ar
e ba
sed
on
evid
ence
of g
ood
prac
tice
and
are
targ
eted
acc
ordi
ng
to s
ituat
ion
anal
yses
of
wha
t the
mat
ic
area
inte
rven
tions
to
targ
et in
whi
ch
geog
raph
ic a
reas
Situ
atio
n an
alys
is
cond
ucte
d th
at
asse
sses
the
need
fo
r the
incl
usio
n of
va
rious
them
atic
ar
eas,
alo
ng w
ith
cost
ings
; pol
icy,
de
sign
, and
co
mpr
ehen
sive
im
plem
enta
tion
of
thes
e th
emat
ic
area
s ar
e ba
sed
on
evid
ence
of g
ood
prac
tice
and
are
targ
eted
acc
ordi
ng
to s
ituat
ion
anal
yses
of
wha
t the
mat
ic
area
inte
rven
tions
to
targ
et in
whi
ch
geog
raph
ic a
reas
M
onito
ring
and
Eva
luat
ion
(M&
E)
Sys
tem
s ar
e no
t yet
in
pla
ce fo
r M&E
of
impl
emen
tatio
n of
sc
hool
hea
lth
prog
ram
min
g
A M
&E
pla
n ex
ists
fo
r sch
ool h
ealth
pr
ogra
mm
ing
and
data
col
lect
ion
and
repo
rting
occ
urs
inte
rmitt
ently
The
M&
E p
lan
for
scho
ol h
ealth
is
inte
grat
ed in
to
natio
nal m
onito
ring
or in
form
atio
n m
anag
emen
t
The
M&E
pla
n fo
r sc
hool
hea
lth is
in
tegr
ated
into
na
tiona
l mon
itorin
g or
info
rmat
ion
man
agem
ent
4 T
hem
atic
are
as m
ay in
clud
e: C
hild
ren
with
Spe
cial
Nee
ds; D
ewor
min
g; D
isas
ter R
isk
Red
uctio
n/Em
erge
nces
; Edu
catio
n fo
r Sus
tain
able
Dev
elop
men
t; G
ener
al
Life
Ski
lls/S
ocia
l and
Em
otio
nal L
earn
ing;
HIV
/AID
S; H
ygie
ne, W
ater
and
San
itatio
n; M
alar
ia; S
choo
l Fee
ding
; Nut
ritio
n; O
ral H
ealth
, Vis
ion
and
Hea
ring;
Ph
ysic
al A
ctiv
ity; P
reve
ntio
n an
d R
espo
nse
to U
nint
entio
nal I
njur
y; S
exua
l and
Rep
rodu
ctiv
e H
ealth
(SR
H);
Subs
tanc
e A
buse
; and
Vio
lenc
e in
the
Scho
ol
Setti
ng.
4 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
espe
cial
ly a
t na
tiona
l lev
el
syst
ems
and
data
co
llect
ion
and
repo
rting
occ
urs
recu
rrent
ly a
t na
tiona
l and
re
gion
al le
vels
syst
ems
and
data
co
llect
ion
and
repo
rting
occ
urs
recu
rrent
ly a
t na
tiona
l, re
gion
al
and
scho
ol le
vels
; ba
selin
e ca
rrie
d ou
t an
d pr
ogra
m
eval
uatio
ns o
ccur
pe
riodi
cally
G
ende
r H
ealth
dim
ensi
on o
f ge
nder
add
ress
ed
in n
atio
nal
educ
atio
n po
licy
(e.g
. pre
gnan
cy,
sexu
al h
aras
smen
t, pr
ivac
y an
d sa
nita
tion)
Hea
lth d
imen
sion
of
gend
er is
not
yet
fo
rmal
ly a
ddre
ssed
in
nat
iona
l ed
ucat
ion
polic
y
Hea
lth d
imen
sion
of
gend
er a
ddre
ssed
in
nat
iona
l ed
ucat
ion
polic
y bu
t im
plem
enta
tion
is
unev
en
Hea
lth d
imen
sion
of
gend
er is
add
ress
ed
in p
ublis
hed
educ
atio
n po
licy
and
is im
plem
ente
d na
tiona
lly
Hea
lth d
imen
sion
of
gend
er is
add
ress
ed
in p
ublis
hed
educ
atio
n po
licy,
im
plem
ente
d na
tiona
lly, a
nd th
e M
&E m
echa
nism
in
clud
es o
vers
ight
of
the
gend
er
mai
nstre
amin
g D
omai
n 2:
Saf
e sc
hool
env
ironm
ent
Phy
sica
l sch
ool
envi
ronm
ent
Prov
isio
n of
saf
e w
ater
in s
choo
ls
The
need
for
prov
isio
n of
saf
e w
ater
is
ackn
owle
dged
, but
st
anda
rds
are
abse
nt, a
nd
cove
rage
is u
neve
n
The
need
for s
afe
wat
er p
rovi
sion
in
all s
choo
ls is
re
cogn
ised
, st
anda
rds
have
be
en e
stab
lishe
d,
but n
atio
nal
cove
rage
has
not
be
en a
chie
ved
Fres
h po
tabl
e w
ater
is
ava
ilabl
e to
st
uden
ts in
mos
t sc
hool
s
Mos
t sch
ools
hav
e w
ater
that
is
acce
ssib
le, o
f goo
d qu
ality
and
ad
equa
te s
uppl
y;
faci
litie
s ar
e re
gula
rly m
aint
aine
d an
d m
onito
red
Prov
isio
n of
sa
nita
tion
faci
litie
s
The
need
for
prov
isio
n of
sa
nita
tion
faci
litie
s is
ack
now
ledg
ed,
The
need
for
prov
isio
n of
sa
nita
tion
faci
litie
s in
all
scho
ols
is
Sani
tatio
n fa
cilit
ies
are
avai
labl
e to
st
uden
ts in
mos
t sc
hool
s
Mos
t sch
ools
pr
ovid
e ad
equa
te
sani
tatio
n fa
cilit
ies
and
thes
e fa
cilit
ies
5 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
but s
tand
ards
are
ab
sent
, and
co
vera
ge is
une
ven
reco
gnis
ed,
stan
dard
s ha
ve
been
est
ablis
hed,
bu
t nat
iona
l co
vera
ge h
as n
ot
been
ach
ieve
d
are
regu
larly
m
onito
red
and
mai
ntai
ned
Prov
isio
n of
sou
nd
scho
ol s
truct
ures
(in
clud
ing
acce
ssib
ility
for
child
ren
with
di
sabi
litie
s) a
nd
scho
ol s
afet
y
Con
stru
ctio
n an
d m
aint
enan
ce o
f sc
hool
bui
ldin
gs is
un
regu
late
d an
d na
tiona
l sta
ndar
ds
are
lack
ing
on w
hat
cons
titut
es s
ound
sc
hool
stru
ctur
es
and
scho
ol s
afet
y
New
sch
ools
bei
ng
built
hav
e so
und
stru
ctur
es a
nd
scho
ol s
afet
y is
sues
ar
e ta
ken
into
ac
coun
t, bu
t co
vera
ge is
not
un
iver
sal a
mon
g ol
der s
choo
ls
Soun
d sc
hool
st
ruct
ure
stan
dard
s ar
e se
t – b
oth
natio
nal a
nd lo
cal
and
cove
rage
is
univ
ersa
l for
new
bu
ilds
and
an
upda
te p
rogr
am is
in
plac
e fo
r old
er
build
ings
; tea
cher
s,
scho
olch
ildre
n,
fam
ilies
and
othe
r lo
cal s
take
hold
ers
are
mob
ilized
to
achi
eve
and
sust
ain
a he
alth
y sc
hool
en
viro
nmen
t
Nat
iona
l and
loca
l st
anda
rds
for s
ound
sc
hool
stru
ctur
es
are
fully
im
plem
ente
d an
d co
vera
ge is
un
iver
sal;
build
ing
stru
ctur
es a
re
regu
larly
mon
itore
d an
d m
aint
aine
d
Psy
chos
ocia
l sc
hool
env
ironm
ent
Issu
es o
f st
igm
atis
atio
n (e
.g.
HIV
, dis
abilit
y) a
re
reco
gnis
ed a
nd
addr
esse
d by
the
educ
atio
n sy
stem
Any
resp
onse
s to
is
sues
of
stig
mat
isat
ion
in
scho
ols
are
curr
ently
non
-sy
stem
atic
Som
e sc
hool
s ar
e ef
fect
ivel
y re
spon
ding
to
stig
ma
issu
es, b
ut
cove
rage
is n
ot
univ
ersa
l; in
-ser
vice
te
ache
r tra
inin
g on
st
igm
a is
sues
is
bein
g pr
ovid
ed
Stig
ma
is c
over
ed in
lif
e sk
ills e
duca
tion,
pr
e- a
nd in
-ser
vice
te
ache
r tra
inin
g ar
e be
ing
prov
ided
un
iver
sally
, and
bu
llyin
g as
a re
sult
of s
tigm
a is
ef
fect
ivel
y de
alt w
ith
at th
e sc
hool
leve
l
Stig
ma
is c
over
ed in
lif
e sk
ills e
duca
tion,
pr
e- a
nd in
-ser
vice
te
ache
r tra
inin
g ar
e be
ing
prov
ided
un
iver
sally
, bul
lyin
g as
a re
sult
of s
tigm
a is
effe
ctiv
ely
deal
t w
ith a
t the
sch
ool
leve
l, an
d su
ppor
t gr
oups
resp
ondi
ng
6 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
to s
peci
fic s
tigm
a is
sues
are
in p
lace
fo
r bot
h le
arne
rs
and
teac
hers
P
rote
ctio
n of
le
arne
rs a
nd s
taff
from
vio
lenc
e (in
clud
ing
corp
oral
pu
nish
men
t, fig
htin
g, p
hysi
cal
assa
ult,
gang
ac
tivity
, bul
lyin
g,
sexu
al h
aras
smen
t, an
d ge
nder
-bas
ed
viol
ence
)
Nat
iona
l sta
ndar
ds
on h
ow to
add
ress
vi
olen
ce in
sch
ools
ar
e la
ckin
g
Nat
iona
l sta
ndar
ds
on h
ow to
add
ress
so
me
form
s of
in
stitu
tiona
l vio
lenc
e in
sch
ools
are
in
plac
e, g
uide
lines
ar
e be
ing
deve
lope
d, a
nd in
-se
rvic
e tra
inin
g is
be
ing
prov
ided
Nat
iona
l sta
ndar
ds
and
guid
elin
es o
n ho
w to
add
ress
so
me
form
s of
in
stitu
tiona
l vio
lenc
e in
sch
ools
are
pu
blis
hed
and
diss
emin
ated
; pre
- an
d in
-ser
vice
te
ache
r tra
inin
g ar
e be
ing
prov
ided
un
iver
sally
Mec
hani
sms
are
in
plac
e to
resp
ond
to
all f
orm
s of
in
stitu
tiona
l vio
lenc
e in
sch
ools
Prov
isio
n of
ps
ycho
soci
al
supp
ort t
o te
ache
rs
and
stud
ents
who
ar
e af
fect
ed b
y tra
uma
due
to
shoc
k (e
.g. c
onfli
ct,
orph
anin
g, e
tc.)
Prov
isio
n of
ps
ycho
soci
al
supp
ort f
or le
arne
rs
and
teac
hers
af
fect
ed b
y tra
uma
due
to s
hock
is
non-
unifo
rm
Som
e ps
ycho
soci
al
supp
ort i
s av
aila
ble
to le
arne
rs a
nd
teac
hers
eith
er in
sc
hool
or t
hrou
gh
refe
rral
s bu
t co
vera
ge is
not
un
iver
sal
Avai
labl
e ps
ycho
soci
al
supp
ort f
or le
arne
rs
and
teac
hers
is
mob
ilised
(eith
er in
sc
hool
or t
hrou
gh
refe
rral
ser
vice
s)
and
ther
e is
pr
ovis
ion
of
appr
opria
te
psyc
hoso
cial
su
ppor
t act
iviti
es fo
r te
ache
rs a
nd
stud
ents
in
tem
pora
ry le
arni
ng
spac
es a
nd in
chi
ld-
frien
dly
spac
es fo
r yo
ung
child
ren
and
Effe
ctiv
e sc
hool
-ba
sed
inte
rven
tion
for s
uppo
rting
st
uden
ts’
psyc
hoso
cial
wel
l-be
ing
is d
evel
oped
an
d th
ere
is
prov
isio
n of
ap
prop
riate
ps
ycho
soci
al
supp
ort a
ctiv
ities
for
teac
hers
and
st
uden
ts in
te
mpo
rary
lear
ning
sp
aces
and
in c
hild
-fri
endl
y sp
aces
for
youn
g ch
ildre
n an
d ad
oles
cent
s; im
pact
7 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
adol
esce
nts
on p
sych
osoc
ial
wel
lbei
ng a
nd
cogn
itive
func
tion
is
bein
g m
onito
red
Dom
ain
3: S
choo
l-bas
ed h
ealth
and
nut
ritio
n se
rvic
es
Sch
ool-b
ased
de
liver
y of
hea
lth
and
nutri
tion
serv
ices
The
scho
ol-b
ased
he
alth
and
nut
ritio
n se
rvic
es id
entif
ied
in th
e si
tuat
ion
anal
ysis
and
ou
tline
d in
the
natio
nal p
olic
y ar
e be
ing
impl
emen
ted
(e.g
. dew
orm
ing,
fir
st a
id, m
alar
ia
cont
rol,
mic
ronu
trien
ts,
scho
ol fe
edin
g,
vacc
inat
ion,
etc
.)
A s
ituat
ion
anal
ysis
ha
s no
t yet
bee
n un
derta
ken
to
asse
ss th
e ne
ed fo
r va
rious
sch
ool-
base
d he
alth
and
nu
tritio
n se
rvic
es
Situ
atio
n an
alys
is
has
been
un
derta
ken
that
as
sess
the
need
for
vario
us s
choo
l-ba
sed
heal
th a
nd
nutri
tion
serv
ices
bu
t sys
tem
atic
im
plem
enta
tion
is
yet t
o be
und
erw
ay
Situ
atio
n an
alys
is
has
been
un
derta
ken,
id
entif
ying
cos
t-ef
fect
ive
and
appr
opria
te s
choo
l-ba
sed
heal
th a
nd
nutri
tion
inte
rven
tions
, som
e of
whi
ch a
re b
eing
im
plem
ente
d an
d ta
ken
to s
cale
in a
ta
rget
ed m
anne
r in
the
avai
labl
e bu
dget
All o
f the
sch
ool-
base
d co
st-e
ffect
ive
and
appr
opria
te
heal
th a
nd n
utrit
ion
serv
ices
iden
tifie
d in
th
e si
tuat
ion
anal
ysis
and
ou
tline
d in
the
natio
nal p
olic
y ar
e be
ing
impl
emen
ted
and
take
n to
sca
le in
a
targ
eted
man
ner
in th
e av
aila
ble
budg
et
Sch
ool-b
ased
sc
reen
ing
and
refe
rral
to h
ealth
sy
stem
s
Rem
edia
l ser
vice
s (e
.g.,
refra
ctiv
e er
ror,
dent
al, e
tc.)
A si
tuat
ion
anal
ysis
ha
s no
t yet
bee
n un
derta
ken
to
asse
ss th
e ne
ed fo
r sc
hool
-bas
ed
scre
enin
g an
d re
ferr
al to
var
ious
re
med
ial s
ervi
ces
Situ
atio
n an
alys
is
has
been
un
derta
ken
that
as
sess
the
need
for
scho
ol-b
ased
sc
reen
ing
and
refe
rral
to v
ario
us
rem
edia
l ser
vice
s bu
t im
plem
enta
tion
is u
neve
n
Situ
atio
n an
alys
is
has
been
un
derta
ken,
id
entif
ying
thos
e co
st-e
ffect
ive
and
appr
opria
te s
choo
l-ba
sed
scre
enin
g an
d re
ferra
l to
vario
us re
med
ial
serv
ices
that
are
be
ing
take
n to
sca
le
in th
e av
aila
ble
budg
et; i
n-se
rvic
e te
ache
r tra
inin
g is
be
ing
prov
ided
All o
f the
sch
ool-
base
d co
st-e
ffect
ive
and
appr
opria
te
scre
enin
g an
d re
ferr
al to
rem
edia
l se
rvic
es id
entif
ied
in
the
situ
atio
n an
alys
is a
nd
outli
ned
in th
e na
tiona
l pol
icy
are
bein
g im
plem
ente
d an
d ta
ken
to s
cale
in
the
avai
labl
e bu
dget
; pre
- and
in-
serv
ice
teac
her
8 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
train
ing
are
bein
g pr
ovid
ed
Ado
lesc
ent h
ealth
se
rvic
es
Any
refe
rrals
of
pupi
ls to
trea
tmen
t sy
stem
s fo
r ad
oles
cent
hea
lth
serv
ices
occ
ur n
on-
syst
emat
ical
ly
Teac
her t
rain
ing
for
refe
rral
of p
upils
to
treat
men
t sys
tem
s fo
r ado
lesc
ent
heal
th s
ervi
ces
Teac
her t
rain
ing
for
refe
rral
of p
upils
to
treat
men
t sys
tem
s fo
r ado
lesc
ent
heal
th s
ervi
ces
with
re
ferr
al o
ngoi
ng
Pre-
and
in-s
ervi
ce
train
ing
of te
ache
rs
for r
efer
ral o
f pup
ils
to tr
eatm
ent
syst
ems
for
adol
esce
nt h
ealth
se
rvic
es w
ith re
ferra
l on
goin
g D
omai
n 3:
Sch
ool-b
ased
hea
lth a
nd n
utrit
ion
serv
ices
. Too
ls fo
r mor
e de
taile
d an
alys
is o
f foc
us a
reas
(ful
l lis
t ava
ilabl
e fro
m
____
__).
B
rook
er, S
. 200
9. M
alar
ia C
ontro
l in
Sch
ools
: A T
oolk
it on
Effe
ctiv
e E
duca
tion
Sec
tor R
espo
nses
to M
alar
ia in
Afri
ca.
Was
hing
ton,
DC
: Wor
ld B
ank;
Lon
don:
Par
tner
ship
for C
hild
Dev
elop
men
t.
Dix
on, R
., J.
Kih
ara,
A. T
embo
n, S
. Bro
oker
, K. N
eese
r, K.
Lev
y, A
. Fis
hban
e, A
. Mon
treso
r, D
. A. P
. Bun
dy, a
nd L
. J. D
rake
. 20
10. S
choo
l-bas
ed D
ewor
min
g: A
pla
nner
s’ g
uide
to p
ropo
sal d
evel
opm
ent f
or n
atio
nal s
choo
l bas
ed d
ewor
min
g pr
ogra
ms.
” C
onfe
renc
e Ed
ition
. Was
hing
ton,
DC
: Dew
orm
the
Wor
ld.
G
loba
l Atla
s of
Hel
min
th In
fect
ion.
ww
w.th
isw
orm
ywor
ld.o
rg
W
orld
Ban
k. 2
003.
Edu
catio
n an
d H
IV/A
IDS:
A S
ourc
eboo
k of
HIV
/AID
S P
reve
ntio
n Pr
ogra
ms.
Was
hing
ton,
DC
: Wor
ld B
ank.
Wor
ld B
ank.
200
8. E
duca
tion
and
HIV
/AID
S: A
Sou
rceb
ook
of H
IV/A
IDS
Pre
vent
ion
Prog
ram
s; V
olum
e 2:
Edu
catio
n S
ecto
r-w
ide
App
roac
hes.
Was
hing
ton,
DC
: Wor
ld B
ank.
Wor
ld B
ank,
UN
ICE
F, a
nd W
ater
and
San
itatio
n Pr
ogra
m. 2
005.
“Too
lkit
on H
ygie
ne, S
anita
tion,
and
Wat
er in
Sch
ools
.” W
orld
Ban
k, W
ashi
ngto
n, D
C.
W
orld
Ban
k. 2
011.
“Sys
tem
Ass
essm
ent a
nd B
ench
mar
king
for E
duca
tion
Res
ults
(SAB
ER),
Scho
ol F
eedi
ng S
ub-S
yste
m.”
Dra
ft Fr
amew
ork
Rub
rics.
27
Apr
il 20
11.
Dom
ain
4: H
ealth
edu
catio
n Kn
owle
dge-
base
d he
alth
edu
catio
n P
rovi
sion
of b
asic
, ac
cura
te h
ealth
, H
IV, n
utrit
ion
and
hygi
ene
info
rmat
ion
in th
e sc
hool
cu
rric
ulum
that
is
rele
vant
to
beha
viou
r cha
nge
Som
e sc
hool
s ar
e te
achi
ng s
ome
heal
th, H
IV,
nutri
tion
and
hygi
ene
info
rmat
ion,
but
co
vera
ge is
not
un
iver
sal n
or is
the
Som
e he
alth
, HIV
, nu
tritio
n an
d/or
hy
gien
e in
form
atio
n is
incl
uded
in th
e cu
rric
ulum
, but
it
may
not
be
com
preh
ensi
ve; i
n-se
rvic
e te
ache
r
Cur
ricul
um
com
preh
ensi
vely
co
vers
hea
lth (l
inke
d to
the
heal
th is
sues
id
entif
ied
in th
e si
tuat
ion
anal
ysis
), H
IV, n
utrit
ion
and
hygi
ene
know
ledg
e;
Cur
ricul
um
com
preh
ensi
vely
co
vers
hea
lth (l
inke
d to
the
heal
th is
sues
id
entif
ied
in th
e si
tuat
ion
anal
ysis
), H
IV, n
utrit
ion
and
hygi
ene
know
ledg
e;
9 Pe
rfor
man
ce
Driv
er
Polic
y Ac
tion
Late
nt
Emer
ging
Es
tabl
ishe
d C
uttin
g-ed
ge
info
rmat
ion
prov
ided
tra
inin
g is
bei
ng
prov
ided
, and
the
maj
ority
of s
choo
ls
are
teac
hing
the
curr
icul
um c
over
ed
heal
th in
form
atio
n,
but c
over
age
is n
ot
univ
ersa
l
pre-
and
in-s
ervi
ce
train
ing
is b
eing
pr
ovid
ed; a
nd a
ll sc
hool
s ar
e te
achi
ng
the
curr
icul
um
pre-
and
in-s
ervi
ce
train
ing
is b
eing
pr
ovid
ed; a
ll sc
hool
s ar
e te
achi
ng th
e cu
rric
ulum
; and
the
know
ledg
e is
co
vere
d in
sch
ool
exam
s A
ge-a
ppro
pria
te
and
sex-
spec
ific
life
skills
edu
catio
n fo
r he
alth
Parti
cipa
tory
ap
proa
ches
are
pa
rt of
the
curr
icul
um a
nd a
re
used
to te
ach
key
age-
appr
opria
te
and
sex-
spec
ific
life
skills
for h
ealth
th
emes
5
Som
e lif
e sk
ills
educ
atio
n is
taki
ng
plac
e in
som
e sc
hool
s us
ing
parti
cipa
tory
ap
proa
ches
, but
it
is n
on-u
nifo
rm a
nd
does
not
cov
er a
ll of
the
life
skills
for
heal
th th
emes
Parti
cipa
tory
ap
proa
ches
are
par
t of
the
natio
nal
curr
icul
um; s
ome
of
the
key
life
skills
for
heal
th th
emes
are
co
vere
d in
the
curr
icul
um; i
n-se
rvic
e tra
inin
g is
be
ing
prov
ided
; and
te
achi
ng o
f the
pa
rtici
pato
ry
appr
oach
es is
ta
king
pla
ce in
the
maj
ority
of s
choo
ls,
but i
s no
t uni
vers
al
Parti
cipa
tory
ex
erci
ses
to te
ach
life
skills
for h
ealth
be
havi
ours
are
par
t of
the
natio
nal
curr
icul
um; p
re- a
nd
in-s
ervi
ce tr
aini
ng is
be
ing
prov
ided
; and
m
ater
ials
for
teac
hing
life
ski
lls
for h
ealth
in s
choo
ls
are
in p
lace
and
m
ade
avai
labl
e an
d te
achi
ng is
ong
oing
in
mos
t sch
ools
Parti
cipa
tory
ex
erci
ses
to te
ach
life
skills
for h
ealth
be
havi
ours
are
par
t of
the
natio
nal
curr
icul
um; p
re- a
nd
in-s
ervi
ce tr
aini
ng is
be
ing
prov
ided
; m
ater
ials
for
teac
hing
life
ski
lls
for h
ealth
in s
choo
ls
are
in p
lace
and
m
ade
avai
labl
e an
d te
achi
ng is
ong
oing
in
mos
t sch
ools
; and
sc
hool
cur
ricul
a gu
idel
ines
iden
tify
spec
ific
life
skills
for
heal
th le
arni
ng
outc
omes
and
m
easu
rem
ent
5 E
ssen
tial l
ife sk
ills (
soci
al a
nd e
mot
iona
l lea
rnin
g); B
asic
nut
ritio
n an
d he
alth
y lif
e st
yles
(nut
ritio
n, sc
hool
gar
dens
, and
phy
sica
l act
ivity
); B
asic
hea
lth is
sues
(m
alar
ia, h
elm
inth
s, in
fluen
za o
utbr
eaks
– th
ese
shou
ld b
e lin
ked
to th
e he
alth
issu
es id
entif
ied
in th
e si
tuat
ion
anal
ysis
); B
asic
safe
ty is
sues
(roa
d sa
fety
, saf
ety
at h
ome
and
at sc
hool
, firs
t aid
, em
erge
ncy
prep
ared
ness
); Pe
rson
al h
ealth
and
hyg
iene
issu
es (h
ygie
ne, o
ral h
ealth
, vis
ion
and
hear
ing)
; Phy
sica
l, em
otio
nal a
nd
soci
al d
evel
opm
ent a
nd se
xual
and
repr
oduc
tive
heal
th; H
IV a
nd A
IDS;
Sub
stan
ce a
buse
; Vio
lenc
e pr
even
tion;
Sus
tain
able
dev
elop
men
t (cl
imat
e ch
ange
, re
sour
ce m
anag
emen
t, en
viro
nmen
tal p
rote
ctio
n, d
isas
ter r
isk
redu
ctio
n); G
ende
r iss
ues
10
Perf
orm
ance
D
river
Po
licy
Actio
n La
tent
Em
ergi
ng
Esta
blis
hed
Cut
ting-
edge
stan
dard
s, in
clud
ing
exam
inat
ions
N
ote:
Ann
exes
1 a
nd 2
are
cont
aine
d in
a se
para
te d
ocum
ent,
atta
ched