Health Related School Policies

The FRESH framework, an intersectoral partnership to Focus Resources on Effective School Health, provides the context for effective health related school policies.  School policies, promoting good health and a non-discriminatory, safe and secure physical and psychosocial environment, are most effective when supported by other reinforcing strategies such as provision of safe water and sanitation, skills based health education, provision of health and other services, effective referral to external health service providers and links with the community.  The FRESH framework provides this context by positioning health related school policies among its four core components, that should be made available together for all schools:

Health related school policies
Safe water and sanitation
Skills based health education
Access to health and nutrition services

Ensuring that children are healthy and able to learn is an essential component of an effective education system. This is especially relevant to efforts to achieve education for all in the most deprived areas. Good health increases enrolment, reduces absenteeism and brings more of the poorest and most disadvantaged children, many of whom are girls, to school. It is these children who are often the least healthy and most malnourished, who have the most to gain from improved health, and who need health related school policies that, when effectively endorsed, can lead to better educational outcomes.

1. Why health related school policies?

Health policies in schools, including skills-based health education and the provision of some health services, can help promote the overall health, hygiene and nutrition of children. But good school health policies should go beyond this to ensure a safe and secure physical environment and a positive psychosocial environment. Such policies, should address issues of abuse of students, sexual harassment, health-related practices of teachers and students, school violence, bullying, and guaranteeing the further education of pregnant schoolgirls and young mothers, to help promote inclusion and equity in the school environment.

Policies that help to prevent and reduce harassment by other students and even by teachers, also help to fight against reasons that girls withdraw or are withdrawn from schools.  Policies regarding the health-related practices of teachers and students can reinforce health education: teachers can act as positive role models for their students, for example, by not smoking in school. The process of developing and agreeing upon policies draws attention to these issues.  The policies are best developed by involving many levels, including the national level, regional and district level, and the school level – including the teachers, children, parents and the wider community. 

2. Why School health policies are necessary for effective school health and nutrition programs.

  • School health policies can provide highly visible opportunities to demonstrate commitment to equity, non-discrimination, gender issues and human rights and be a positive model for the whole society.
  • Policies are necessary for and can give a clear structure to a safe, protective and inclusive school environment.
  • Policies, when clearly communicated to the school population and the whole society, can give rules on how to behave and what is accepted or not in the school setting.
  • Policies that are actively accepted and endorsed by the PTA and the community can be followed more effectively. In cases when policies are not followed there will be a demand for change and stricter monitoring will be possible.
     

School health and nutrition policies must be developed and supported by key stakeholders at all levels.  At the national level, for example, this involves an agreed framework of responsibility, policies and action between the key government ministries (such as Health and Education ministries) and other institutions and organizations with an input and responsibility for school health programming.  At district and school levels, policies should be clearly understood, implemented and supported by all those responsible for the education, health and well being of the children.  Policies should cover a broad spectrum of areas critical for the health and development of school age children.  Examples given here include policies relating to: early pregnancy and exclusion from school; tobacco and tobacco free schools; sanitation in the school environment; HIV and reproductive health education; sexual harassment and abuse of students; the role that teachers can play in delivering simple health services through schools; and the public-private partnerships for delivery of school food services.

To be effective, school policies need resources for their implementation.  This means that adequate resources must be made available at the national, regional, district and local levels.  Such resources include government financing, but may also include contributions from other donors such as NGOs, and ultimately, to ensure long term sustainability of effective implementation of school health and nutrition policies, support from parents and the local community.

3. Content of school health policies


Strong intersectoral cooperation is required to plan, implement and monitor a sustainable school health program. It should be clearly defined and inscribed in a common statement, describing who is responsible for the interventions planned and who will be implementing those interventions.  This cooperation and communication strategy should be written down in a ‘protocol d’accord’ or ‘memorandum of understanding’ between the education and health sectors.

The Ministry of Health (MoH) is responsible for the health of school age children, but this age group is rarely a priority for the health sector. Delivery of health services to children under 5 and pregnant women – the typical priority groups for the MoH – frequently leaves few resources left for the school children.  The education of school children is the priority of the Ministry of Education and if “improved learning and education achievement by improving health and nutrition” is adopted, then it also becomes their priority to assure the health of the school-aged child. Thus the protocol d’accord needs to make transparent the tasks to be shared between the two ministries. This is the first step towards a successful school health program.

MAURITANIA Memorandum of understanding between Ministry of Education (MEN) and Ministry of Health (MSAS). (English translation)


Foreword: The Quality Education for All program in MEN has a School Health (SH) component with the objective to improve learning by improving health and nutrition of the pupils.


In this setting the MEN and MSAS have agreed:


Article 1: Form a National Technical Committee in school health regrouping all the services from the two departments that are active in the domain.
Article 2: Creation of a national coordination with MEN for the SH program.
Article 3: The MEN give the necessary funds (via contract) to MSAS (CAMEC) for availability of medicine and micronutrients (disbursement, quality control, transportation, storage…)
Article 4: Establish a tight collaboration between the two departments whatever the hierarchy level: central and peripheral.
Article 5: The MEN is responsible for all the activities in the school environment


1)  Planning the activities in school :

  • Implement
  • Sustain
  • Evaluate
  • Supervise

2)  Mobilization of the necessary resources (human and financial)
3)  Coordination of all the activities in school
4)  Management of the financial activities in relation to SH.
5)  Curriculum revision and elaboration of guidelines, manuals, modules, pedagogical and  didactic support
6)  Teacher training of professional teaching staff (teachers, inspectors, directors) PTA and NGO’s in the domain.
7)  The professional teaching staff is responsible for the distribution of medicine and micronutrient in the schools under the supervision of health personnel (doctors, nurses…)


Article 6: The MSAS is responsible for:


1)  Curative aspects:

  • Therapeutic protocol, (dose and frequency of treatment).
  • Availability of medicines (disbursement, quality control, storage, transport, delivery)

2)  School Health  aspects

  • The scientific content of health education adopted for schools.
  • Training of teachers in the issues of School health.
  • Technical supervision of PTA and NGO’s operating in the domain.

Participating in the elaboration of the manuals, guidelines, modules and pedagogical and didactic support.

 

4. Examples of policies

  • Unwanted early pregnancy and exclusion from schooling

Adolescents (The term “adolescent” refers to people between the age of 10-19, according to a 1998 joint statement by WHO, UNICEF and UN Population Fund.), children 10-19 years old, are not physiologically mature for childbearing; early childbearing is associated with high levels of maternal mortality and morbidity, low birth weight and higher risk of infant mortality. In addition, there are many socio-economic benefits to delaying early childbearing with better opportunities to improved education, avoidance of repetition, reduction of drop-out rates and an increased chance to acquire skills and knowledge for her and her family’s future life.

As access to education has increased and the benefits of postponing childbearing have become more widely known, unwanted pregnancies have declined in most countries. The use of contraceptives and demand for access to contraception have increased in equal measure, particularly among unmarried women in many parts of the world. Still, the proportion of unsafe abortions with extreme health risks remains high. Survey data indicate that the proportion of young mothers with unwanted pregnancies varies widely within and between regions. In Sub-Saharan Africa around 11-13 % of pregnancies are unwanted in Niger and Nigeria, compared to 50% or more in Botswana, Ghana, Kenya, Namibia and Zimbabwe.

Female children are underrepresented in primary level enrolment. Globally 46% of enrolled children are females with more differences to be found in the poorest countries. Some two thirds of females are not enrolled in secondary school and those that are enrolled often drop out. The reasons for drop out are many including the involvement in waged labor, the high direct and opportunity cost of schooling, gender biased curriculum, and teaching practices including discrimination of girls and premature fertility.  Young women with low levels of educational and economic attainment often experience restricted ability and motivation to regulate their fertility, resulting in higher rates of early pregnancy. The cycle is further perpetuated as young women who are in school are forced to discontinue their education when they become pregnant, thereby greatly restricting their economic opportunities.

In Jamaica adolescent pregnancy has long been a serious concern. In 1977 the proportion of births to teen-age mothers rose to 31% of all births, often following a pattern of 3-4 children before the age of 20. Since 1977 the Women’s Center of Jamaica Foundation have started a quality program with the objective of motivating young mothers to choose education instead of continuous motherhood. They have since helped over 22,000 mothers return to the school system. Figures for 1997 show that the program reached 51% of the 3,016 mothers under 16 who gave birth in the country. The achievement include:
* A decrease in negative societal attitudes displayed towards the teen mother
* The breakdown of the barriers within the ministry of education and the changes in the education code to allow teenage mothers to return to the school system
* A decline in the teen pregnancy rate from 31% in 1977 to 23% in 1997
Other important outcomes are that all children to mothers in the intervention group are in school and that no pregnancies have occurred in the adolescent children of women who participated.

There is a need to prevent unwanted early pregnancies through policies in schools that include family life education and family planning in secondary school curriculum. Reduction of risk behaviors through a skills based health education is the most effective approach. Young women with higher levels of education are more likely to postpone marriage and childbearing. Fertility levels among the least educated and the most educated women in Peru differ by 5 children. In Guatemala adolescent birth rates are higher among those with no schooling. Adolescents who postpone childbirth are five times more likely to finish their secondary education.

Case studies from Guinea and Cote d’Ivoire show that for a girl, an unplanned pregnancy could mean shame for the family, an end to her education and rejection by the baby’s father. Often she is blamed by her friends and is discriminated against.

Health related policies, supported by the community, PTA, and schoolchildren that will ensure that a pregnant girl can stay in school and continue her education, are essential to improve girls’ educational outcome and fight exclusion and discrimination.

Policy :

  • Do not exclude pregnant girls from school.
  • Encourage students to come back to school after childbirth.
  • Include family life education in the curriculum
  • Prohibit all kinds of discrimination based on gender
     

Tobacco and the tobacco free school

Tobacco use is one of the chief preventable causes of death in the world. The adverse health effects of tobacco use among smokers are well described. Tobacco use generally begins during adolescence and continues through adulthood sustained by addiction to nicotine. Recent trends indicate an earlier age of initiation and rising smoking prevalence rates among children and adolescents. If the trend continues tobacco use will result in the deaths of 250 million of the people who are children and adolescents today.

In recent years many health agencies have called for concerted action against tobacco use among young people and for more data and information on tobacco use among school children. To supply the data the Global Youth Tobacco Survey project was conducted in 12 countries in 1999 to provide more information on tobacco use among school children and enhance the capacity of countries to design, implement and prevent their own tobacco control and prevention programs. The survey showed that among children 13-15 years old among 10-33% smoked, more frequent among boys than girls. One fifth or more of young people begin smoking before the age of 10 years. There is a higher risk of being addicted, or become heavy smokers when you initiate smoking so young. The survey also showed that laws restricting the sale of tobacco to young people are seldom enforced

Evaluation studies of 10 US located prevention programs in schools have shown sustained reduce in tobacco and alcohol use. Evaluation of Life skills training targeting 4,466 7th graders showed 50-70% reduced tobacco and alcohol use with significant impact after three years. The Star program similar reduced tobacco, alcohol and marihuana use by 30% in 4,978 6th and 7th graders. The conclusion of this study is  that prevention in schools is most effective when school lessons are reinforced by a clear, consistent social message that teen, alchohol, tobacco and drug use is harmful, unacceptable and illegal. Involving families and communities, as many of these curricula do, is very important

The vast majority of children exposed to tobacco smoke (ETS) do not choose to be exposed. Given that more than a thousand million adults smoke worldwide, WHO estimates that around 700 million or almost half of the world’s children breathe air polluted by tobacco smoke.

The large number of exposed children and the evidence that environmental (ETS) causes illness in children constitutes a substantial public health threat. Governments have a responsibility to legislate to control exposure to tobacco smoke in public spaces such as schools. Educational strategies, including effective education on health risks to children are likely to be more effective when cultural specific public policy is in place. The overall goal is to protect this vulnerable group from exposure and support and help them avoid starting unhealthy smoking habits and addiction .

Policy:

  • No smoking in schools by teachers and students
  • No selling of cigarettes to children.
  • No tobacco advertising and promotion.
  • Higher tobacco prices and no possibility to purchase cigarettes one by one. 
     

Sanitation, gender and privacy, as well as maintenance of facilities by the community.

Lack of facilities and poor hygiene affect both girls and boys, although poor sanitation conditions at schools have a stronger negative impact on girls. All girls should have access to safe, clean, separate and private sanitation facilities in their schools. If there are no latrines and hand washing facilities at school or if they are in a poor state of repair, then many children would rather not attend than use the alternatives. In particular girls who are old enough to menstruate need to have adequate facilities at school that are separate from those of boys. They may miss school every month and find it hard to catch up, which makes them more likely to drop out of school altogether.

There is a need to develop a national sanitation policy and an implementation strategy in collaboration with all key stakeholders. Local level collaboration is required to develop commitment and support maintenance of the facilities in schools by the community.

“Lack of latrines, especially separate latrines for girls was identified as the worst school experience for girls. This draws attention to the special conditions and experience, which prevent girls from fuller participation and achievement. Privacy issues relating to sanitation are a major factor forcing girls out of school.” Dr Crispus Kiyonga, Minister of health , Uganda

n January 1997 an action plan was made to raise the profile of sanitation in Uganda. A concept paper was written and published using existing data including: Socio-economic effects, environmental effects, educational effects: number of girls who drop out , lack of privacy, health effects and nutritional effects. A working group with four specific subgroups was appointed : legislation, Policy, Planning and Organisation of a national forum with members from each district. In addition:
* An environmental Health Policy was drafted
* An environmental health act was drafted
* Two national sanitation plans were drafted

Lessons learned from a DPHE-UNICEF study in 1994 and 1998 in Bangladesh showed that provision of water and sanitation facilities in schools increased girl’s attendance by 15%. Interaction with family and demand for sanitation facilities at home were seen in 80% of children where those practices were acquired at school.

Policy:

  • Separate latrines for teachers, boys and girls
  • Safe water in all schools
  • Active commitment from PTA for maintenance of water and sanitation facilities.
     

 HIV and exclusion, the content of sex education and access to condoms.

HIV infection is one of the major problems facing school-age children today. They face fear if they are ignorant, discrimination if they or a family member or friend is infected, and suffering and death if they are not able to protect themselves from this preventable disease.  It is estimated that 40 million people, worldwide, are living with HIV or have AIDS, at least a third of these are young people aged 15-24. In 1998 more than 3 million young people worldwide became infected including 590,000 children under 15. More than 8,500 children and young people become infected with HIV each day. In many countries over 50% of all infections are among 15-24 years old, who will likely develop AIDS in a period ranging from several months to more than 10 years. In Sub Saharan Africa, girls are frequently becoming infected in their early teens.

Studies have shown the enormous impact HIV and AIDS have on the education sector and the quality of education provided, particularly in certain regions of the world such as Sub Saharan Africa. Consequences of the AIDS epidemic include a probable decrease in the demand for education, coupled with absenteeism and an increase in the number of orphans and school drop out, especially among girls. Girls are socially and economically more vulnerable to conditions that force people to accept risk of HIV infection in order to survive. A decrease in education for girls will have serious negative effects on progress made over the past decade toward providing an adequate education for girls and women. Reduced numbers of classes or schools, a shortage of teachers and other personnel, and shrinking resources for educational systems all impair the prospects for education.

Effective, skills based HIV/STD/reproductive health education and prevention is needed in all schools for all children so that no one is left ignorant. Yet in many places schools are apprehensive about providing sex education or discussions of sexuality because of cultural demands to protect adolescents from sexual experience. Women often lack skills needed to communicate their concerns with their sexual partners and to practice behaviors that reduce their risk of infection, such as condom use, which is often controlled by men.

The school can either be a place that practices discrimination, prejudice and undue fear or one that demonstrates society’s commitment to equity. School policies need to ensure that every child and adolescent has the right to skills based life education; particularly when that education is necessary for survival and avoidance of HIV infection.

A UNAIDS review (1997) of 53 studies which assessed the effectiveness of programs to prevent HIV infection and related health problems among young people concluded that sex education programs do not lead to earlier or increased sexual activity among young people, in fact the opposite seems to be true. 22 reported that HIV and/or sexual health education either delayed the onset of sexual activity, reduced the number of sexual partners or reduced unplanned pregnancies and STD rates. 27 studies reported that HIV/AIDS and sexual health neither increased nor decreased sexual activity, pregnancy or STD. The review concluded that school based interventions are an effective way to reduce risk behaviors associated with HIV/AIDS/STD among children and adolescents.

A WHO review of studies on sexuality education found that access to counseling and contraceptive services did not encourage earlier or increased sexual activity.In Europe and Canada where comprehensive sexuality education and confidential access to condoms are more common, the rates of adolescent sexual intercourse are no higher than in the United States and teen-age pregnancy rate is lower.

In South Africa , until late in 1999 the department of education had no policy on HIV/AIDS. In August 1999 the Departments Corporate Plan 2000-2004 identified action on HIV/AIDS as one of the five priorities.  The main objectives 1) raising awareness about HIV/AIDS among educators and learners 2) integrating HIV/AIDS into the curriculum, and 3) developing models for analyzing the impact of HIV/AIDS on the system.
Education’s HIV/AIDS policy is consistent with the priorities of the Department of Health’s strategic plan but goes further to provide guidance on discrimination in schools and institutions. It specifies that:·
* The constitutional rights of learners and educators must be protected equally
* There should be no compulsory disclosure of HIV/AIDS status
* No HIV positive learner or educator may be discriminated against.     
* Learners must receive education about HIV/AIDS and abstinence in the context of life-skills education as part of the integrated curriculum.
* Educational institutions will ensure that learners acquire age and context appropriate knowledge and skills to enable them to behave in ways that will protect them from infection.
* Educators need more knowledge of , and skills to deal with HIV/AIDS and should be trained to give guidance on HIV/AIDS
(Carol Coombe  CICE, December 2000, Managing the impact of HIV/AIDS on education in South Africa)

Policy:

  • Skills based health education focusing on HIV/AIDS prevention
  • Stimulate peer support and HIV/AIDS counseling in schools
  • No discrimination of HIV positive teachers or students
  • Access to condoms
     

 Sexual harassment and abuse of students including by teachers.

Sexual abuse and violence are serious problems that transcend racial, economic, social and regional lines. Violence is frequently directed toward females and youth, who lack the economic and social status to resist it.  Adolescents and young women in particular may experience abuse in the form of domestic violence, rape and sexual assault and sexual exploitation. Accurately estimating the prevalence of sexual abuse and violence in the developing world is difficult due to limited amount of research done on the subject, and the fact that cultural acceptance prevents it from being reported.

Violence against women is a widespread problem in Sub-Saharan Africa. Surveys conducted reveal that 46% of Uganda women, 60% of Tanzania women, 42% of Kenyan Women and 40% of Zambian women report regular physical abuse. Studies have shown that children who witness violence, particularly within an abusive household, may experience many of the same emotional and behavioral problems that physically abused children experience such as depression, aggression, physical health complaints and poor school performance.

Worldwide 40-47% of sexual assaults are perpetrated against girls age 15 or younger, most often by a male relative, neighbors or a male teacher.  Young girls frequently report that their early sexual experience were coerced often due to lack of economic power or the need to be approved to pass from one grade to the next in school. Young women are vulnerable to coercion into sexual relationship with older men, “sugar daddies”, who take advantage of their lack of economic resources and promise to help pay for expenses, such as, school fees in exchange for sex. In South Africa 30% of girls reported that the first sexual encounters were forced, and in rural Malawi, 55% of adolescent girls surveyed reported that they were often forced to have sex. In Kenya, 50% of adolescent girls admit receiving gifts when engaged in sex, and in Uganda 22% of primary school children anticipate receiving a gift or money in exchange for sex.

An effective school system requires clear policies and strict laws that ensure children a safe and secure school environment without sexual assault and harassment by teachers and older classmates.  The policies must be well known and accepted by everyone, including school children, and effectively enforced by the community and PTA.

Policies may be in place in many countries, but the threat of social stigma often prevents young women from speaking out about rape and abuse, and the laws are commonly not enforced.

All Anglophone countries in Africa have enacted laws which directly address sexual offence against minors. The age at which young people are protected by rape laws varies in these countries from under 13 years in Nigeria to under 16 years in Zimbabwe.

Workshops (one for teachers and one for pupils) were the final stage of the research on “The Abuse of girls in Zimbabwean Junior Secondary Schools.” The workshop gave the following recommendations for strategic actions:
* The key to addressing the issue is breaking the silence at all levels, among girls, teachers, school heads, parents and Ministry officials , open a dialogue, information sharing and co-operation.
* Girls can support each other and act as a group, refuse to see a teacher alone, move around the school and walk home together with other girls. Report cases, as a group. Make clear to the teachers that they are aware of the code of conduct of teacher behavior and that misconduct is a punishable offence.
*  Teachers can create a more friendly and supportive environment, avoid verbal abuse and act as positive role models for both boys and girls at all times. Teachers can also take the schools Guidance and Counseling lessons more seriously, make them more participatory, encourage girls to speak about difficult issues, and using drama, drawings and writing to include everyone.
*  School management can change the school culture of violence by enforcing effective disciplinary measures against teachers and pupils who indulge in abusive behavior. Provide a forum for pupils especially girls to talk about issues of abuse in a non-threatening environment possibly with individuals outside the school. Teach pupils greater self esteem and establish an effective pupil representation system (student council). School management can ensure that Guidance and Counseling is taught only by qualified, trained teachers. Ensure that teachers know that they will be reported if they transgress the regulations and that all rules are enforced regarding pupil behavior. Ensure that parents know what the school regulations are and involve parents in the formulation of the school policy on teacher and pupil management. Work closely with parents and the community.
*  The Ministry of Education can ensure a rigorous selection of trainee teachers and head teachers and provide a gender awareness component in all in-service training courses and workshops
(Fiona Leach et al. Department for International Development, Education Research, Serial no 39, 2000)

Policy:

  • Ensure by law that sexual harassment and violence is prohibited in the school environment by teachers and pupils.
  • Make the law well known and accepted by everyone, empower adolescents to report cases, and enforce effective disciplinary measures for those who abuse.
     

 Role of teachers in delivering a simple health package through schools.

Schools can effectively deliver some health and nutritional services provided that the services are simple, safe and familiar and address problems that are prevalent and recognized as important within the community.
School health policies that allow teachers to deliver a simple health package (including anthelmintics and micronutrient supplements) have been shown to be effective, inexpensive and acceptable to teachers and parents. The impact of these school based control programs show tremendous promise for reducing morbidity and increase learning of school age children. (WHO 1999).  Teachers need to be trained well to monitor and deal with any side effects of treatment, in cooperation with local health workers.

Large scale school-based health and nutrition programmes in Ghana, Tanzania, India and Indonesia (50,000 to 3 million children) have shown that with training and supervision teachers can administer anthelmintic drugs (albendazole for intestinal nematodes and praziquantel for schistosomiasis) and micronutrient supplements to children at school.  Teachers and the community perceived this as an acceptable role for teachers

Policy:

  • Training and use of teachers to deliver simple health interventions, in collaboration with health sector workers and with involvement of the local community.

Food vendors – nutrition and hygiene.


Policy development and setting the objectives of school nutrition provides the framework for implementing all the other recommendations aimed at improving education through better health and nutrition. Analyzing the nutrition and health situation of school children with focus on causes of energy and micronutrient deficiencies has become a way to engage governments in the problems of that age group and the necessary content of the policy for school nutrition programming and provision of school food services.

Many governments have given private enterprises the responsibility for preparing and delivering a ready to eat meal or snack. It is argued  that governments should encourage small local enterprises. Some school canteens in Lesotho, for example, are run by former local vendors who successfully bid on the privatized service. In Nigeria state and local governments train and license vendors who sell to schoolchildren. In Indonesia school principals use their power to choose the vendors who serve their schools.

Another problem to tackle with policies are quality and hygiene of the food served. Governments need to regulate what is sold by commercial vendors and regulate the standards of sanitation. Even in the United States, concern for the nutritional quality of foods provided by private vendors has made the move to privatization slow; yet where it has occurred, the benefits appear to be substantial.

Cohen M. (1991) ‘Use of Microenterprises in the delivery of Food programs to School children” World Bank
The author discusses the significant contribution street food trade makes in some areas to the diet of school-age children and argues for using this part of the food distribution system when considering school nutrition programming. Project experiences suggest that the informal institution of street food vendors have been effectively used to deliver nutrition/food assistance to schoolchildren. Working with street vendors to improve the nutritional quality and safety of these foods involves an approach that considers not only the needs of children but also the financial viability of the enterprise and the training and management needs of the individual vendor. It is suggested that the success of using this approach for school nutrition programming depends on involving all institutions which may affect the legitimacy of this economic activity, i.e., municipal and local government, ministries of education and health, and non-governmental organizations which represent vendors’ interests.

Converting from a Government supplied to a privately supplied school lunch program in Rhode island has lead to cheaper yet tastier and more nutritious lunches in the public schools there. The state government recently terminated its twenty-five year old program of centrally planned and purchased lunches for the public schools and hired private contractors to take over the program. The annual cost of the program plummeted from US$11 million to US$ 200,000 and federal and state subsidies fell almost one half. An expressed concern at the time of the conversion was that privately run program would emphasize profit over nutritional quality, but the new program delivers higher nutritional value than the old program did and student participation in the program have soared. Glass,Stephen. 1995 Incredible yet Edible; How Rhode island beefed up its school lunch program. Washington Post. (September 3)

Policy:

  • Regulation of vendors and the quality, hygiene and standard of the food provided.
     

4. The way forward

The Convention of the Rights of the Child, now ratified by most countries of the world give  Governments the political responsibility to endorse and monitor clear  health related  policies. School health policies can provide highly visible opportunities for the Governments and the whole society to demonstrate commitment to equity, non-discrimination, gender issues and human rights in all the schools in their countries. School policies should be clearly communicated to the school population and  actively monitored by the PTA and the community. In the new FRESH framework school policies  providing a safe, inclusive and non-discriminatory environment is one of the four core interventions. These policies are most effective when supported by other reinforcing strategies such as provision of safe water and sanitation, skills based health education and provision of basic health and other services. Implemented together those four interventions will lead to better learning outcomes  and health of  school children in the 21 century.


References:
2. WHO (1996) Improving School Health programmes: Barriers and Strategies. 1996

3. Bundy, D.A.P. & Guyatt, H.L. (1996). Schools for health: Focus on health, education and the school-age child. Parasitology Today 12: 1-16.

4. WHO (1999) International Consultation on Environmental Tobacco Smoke and Child health. Tobacco Free Initiative.

5. Warren, C.W.  et al., (2000) Theme Papers. Tobacco use by youth: a surveillance report from the Global Youth Tobacco Survey project.

6. WHO (1999) Tobacco Use Prevention: An Important Entry Point for the Development of Health Promoting Schools. Information series on School Health, document five.

7. UNICEF/IRC Global workshop on school Sanitation and hygiene education. Workshop report March 2000

8.  WHO (2000) Local Action. Creating Health Promoting Schools . Information series on School Health.

9.  WHO (1999) Violence Prevention: An Important Element of a Health Promoting School. Information series on School Health, document three.

10. WHO (1999) Preventing HIV/AIDS/STI and Related Discrimination: An Important Responsibility of Health Promoting Schools. Information series on School Health, document six.

11. Sexual Abuse and Violence in Sub Saharan Africa, 1998, Advocates for Youth  fact sheets. http://www.advocatesforyouth.org

12. The impact on early pregnancy and childbearing on adolescent mothers and their children in Latin America and the Caribbean, 1997 Advocates for Youth  fact sheet. 

13. Adolescent sexual and reproductive health in Sub-Saharan Africa, 1998. Advocates for Youth fact sheet.

14. School Condom Availability. 1998, Advocates for Youth Fact sheet

15. The World’s  Youth 2000, Population Reference Bureau, Measure Communication. http://www.measurecommunication.org

16. Senderowitz, J. (2000) A Review of Program Approaches to Adolescent Reproductive Health, Poptech Assignment Number 2000.176.

17. WHO (1999) Monitoring helminth control programs. A guide for Managers of Control Programs.

 

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