Partnerships for Promoting Health and Education Donald Bundy Human Development Network The World Bank Vancouver, Canada, June 7, 2007

Partnerships for Promoting Health and Education

Donald BundyHuman Development Network

The World Bank

Vancouver, Canada, June 7, 2007

0

20

40

60

80

100

0 10 20 30 40 50 60

Age (years)

Perc

enta

ge infe

cte

d

Ascaris Trichuris Hookworm

0.6

0.65

0.7

0.75

0.8

0.85

0 2 4 6 8 10 12 Months Since Baseline

Attendance Rate

Untreated

Schools

Treated

Schools

Treatment 1 Treatment 2

Miguel & Kremer, 2000

Condition Prevalence/ No. Cases

IQ loss: Per Child

Total IQ loss/mentalretardation

Years ofschooling lost

Stunting 52%/292m 3 points 877(21.6m)

284m

Anaemia 53%/298m 6 points 1788(45.6m)

524m

Worms 30%/169m 3.75 points 633(15.8m)

201m

IQ and schooling losses avoidable by school based SHN programs

Comparing returns to education

Add years schooling Cost US$ p.a.SHN Programs 1.2 – 2.5 < 4Textbooks 1.1 60Cash transfer – Nicaragua 0.45 77 Cash transfer – Progresa 0.66 136 School Feeding 0.4 – 1.2 22 -151

A FRESH Start: Focusing Resources on Effective School

Health, Hygiene & Nutrition

• Child Friendly Schools ….UNICEFChild Friendly Schools ….UNICEF

• Health Promoting Schools…WHOHealth Promoting Schools…WHO

• Education for All…UNESCOEducation for All…UNESCO

• Food for Education…WFPFood for Education…WFP

• School Health Initiative…World School Health Initiative…World

BankBank

A FRESH Start: Focusing Resources on Effective School

Health, Hygiene & Nutrition

Core intervention activities• Effective health, hygiene and nutrition policies for

schools

• Sanitation and access to safe water facilities for all schools

• Skills based health, hygiene & nutrition education

• School based health & nutrition services

• Policies in schools …that ensure well maintained sanitation and specific agreement that teachers can deliver treatment • Healthy environments in schools ….with effective sanitation and safe water to reduce transmission • Skills based health education …that promotes hygiene and healthy behaviors • School based delivery of anthelmintics by teachers …that follows WHO guidelines

FRESH framework for action against worms

FRESH Framework (UNESCO, UNICEF, WHO, World Bank,

others)

Health-Promoting Schools (WHO)

Child-Friendly Schools (UNICEF)

PopEd (UNFPA) Global School Feeding Campaign (World Food

Program)

Policy Respects and recognizes the rights of the individual

Respects and recognizes the rights of the child

Creates an enabling environment for reproductive health and HIV education

Focuses on those most at risk (girls, poorest communities, AIDS affected and infected)

School Environment Healthy environment with opportunities for physical education and recreation

Healthy, safe, secure. Is protective emotionally and psychologically

Protects young people from unwanted pregnancy, STIs, sexual abuse and violence

Serves as platform for other interventions

Education Life skills education Promotes quality learning outcomes, provides skills based health education

Strengthens HIV and reproductive health education programs

Supports learning through good nutrition and promotes access to education

Services Provides services, nutrition and food safety programs, counseling and social support programs and health promotion programs for schools. Includes community outreach components

Promotes physical and mental health

Ensures access to youth-friendly sexual and reproductive health services

Provides food and promotes and supports deworming

Supportive Partnerships Engages health and education officials, teachers, students, parents, health providers, community leaders

Is child centered, family focused and community based

Targets young people in and out of school and ensures participation from parents, youth, community leaders and organizations

Promotes community and school partnerships

FRESH Partnership

• Launched at the World Launched at the World

Education for All Forum in Education for All Forum in

Dakar, Senegal April 2000Dakar, Senegal April 2000

• WHO, UNICEF, UNESCO, WHO, UNICEF, UNESCO,

World Bank & OthersWorld Bank & Others

Directory of School Based

Health and Nutrition Programmes:

Findings from a surveyof organisation support

Partnership for Child DevelopmentPartnership for Child Development

Jan W de Lind van WijngaardenJan W de Lind van Wijngaarden

Celia MaierCelia Maier

Lesley DrakeLesley Drake

Updated Survey – October 2006Updated Survey – October 2006

Comparison of integrated SHN programmes in 2006 with 2000

The move towards Intergrated Programming

16

29

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5

10

15

20

25

30

35

2000 (n=41) 2006 (n=38)

Nu

mb

er

of

org

an

isati

on

s

Finding 2: Since FRESH, most agencies are moving towards Integrated SHN

Programmes

0

5

10

15

20

25

30

35

1 2 3 4

Num ber of pillars

Nu

mb

er

of

org

an

isa

tio

ns

Number of organisationssupporting 1, 2, 3 or 4 pillars ofFRESH

Number of organisations explicitlysupporting the FRESH f ramew ork

Comparison of SHN activities in 2006 with 2000

(N=41) % (N=38) %Policy 22 54% 36 95%SHN policy - - 24 63%Gender poicy/ Policies to increase girls' school attendance & participation 22 54% 29 76%HIV/AIDS policy - - 22 58%Skills based health education 40 98% 36 95%HIV prevention & reproductive health 27 66% 29 76%Malaria 10 24% 16 42%Health & nutrition 38 93% 30 79%School based health services 27 66% 33 87%Screening 11 27% 11 29%Deworming 21 51% 27 71%Nutritional interventions 24 59% 22 58%Water and sanitation 25 61% 32 84%Safe water 25 61% 26 68%Latrines 25 61% 27 71%School environment 11 27% 25 66%

2006Areas

2000

Finding 3:Increasing partnerships between agencies

The move towards increased partnerships

22

36

0

5

10

15

20

25

30

35

40

2000 (n=41) 2006 (n=38)

No

. o

rgan

isat

ion

s

Accelerating the Education Sector Response to School Health and

HIV&AIDS: Four Years On

A Working Group of the UNAIDS Inter-Agency Task Team for

Education and HIV/AIDS.

Education Sector Funding of the Response to HIV/AIDS: Review of 38 Education projects in

Africa Region 1997-2004

• Only 42% specified a sectoral school health and HIV&AIDS program and budget

• 33% did not mention school health and HIV&AIDS at all

Allocation of Multi-sectoral Health Resources to the Education Sector (survey

of 22 projects)

• 60% did not disburse to education

• 18% disbursed >5% of budget to education

Key Correlates with an Effective Education Sector Response:

• Strong education sector leadership

• Inclusion of school health in the education sector plan

• Support from a mix of resources – education and health sector

• Technical assistance to the education sector in developing this new area

The Process

Regional Analytical Work

Sub-Regional Workshop

Establishment of National Development Partners Group

National Workshop and Follow Up

Fast FactsSince 2002:37.....the number of African countries in the Accelerate networks 76.....the number of agencies, NGOs and development partners that have participated in the process 60..... the average number of days between training events 120......the total number of training days to date 1,350....the number of education sector staff that have participated in training events 162,000......the number of person training days conducted

Objective 1: To promote leadership by the education sector and create sectoral demand for an HIV/AIDS response.

Participation of countries in the Accelerate Initiative since 2002

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5

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2001 2002 2003 2004 2005 2006

Year

Nu

mb

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f C

ou

ntr

ies Sub-Regional Activities

National Level Activities(including workshops,technical supportmissions etc)

Accelerating the Education Sector Response to HIV and AIDS:

Sub-Regional Workshops

█ East Africa

2002

█ East Africa█ Nigeria


Sub-Regional Workshops2003

█ East Africa█ Nigeria█ Central Africa



█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa





█ East Africa█ Nigeria█ Central Africa█ Anglophone West Africa█ Francophone West Africa

(Madagascar observer)

2004




(Madagascar observer)█ Lusophone Countries

2004




(Madagascar observer)█ Lusophone Countries


Sub-Regional Workshops and National Follow-up

2006

█ Sub-regional participation only█ Countries with National Follow-up

Objective 2: To harmonize support among development partners, in order to better assist countries and reduce transaction costs.

Level of representation of UN agencies, bilaterals and civil society organizations at the sub-regional and national level workshops and Network meetings held since 2002

43

57

8

54

7 7 7 7

2 23

23

4

8

23 3

5

86

5

3

2

33

25

6

9

57

2 22

22

2

2

24

4

25

8

1

3

4

8

2

5

6

4

8

7

13

2 44

4

11

2

1

2

12

4

1

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25

East Africa

East Africa Meeting

Nigeria (2) Nigeria (1)

Central AfricaNigeria (3)

Zambia

Anglophone W Africa

Ethiopia

Francophone Africa Lusophone AfricaEA Network Launch

Nigeria (5)

Curriculum Workshop

Nigeria (6)Nigeria

Burkina Faso Sierra LeoneSenegal

EACEthiopia

Central Africa The Gambia

United Republic of TanzaniaCivil society

Bilateral donors

UN agencies

2004 2005 200620032002

Degree of participation of development partners in in sub-regional and national level workshops held since 2002

21

2

23

5

7

5

10

23

23

7

7

6

24

18

12

21

5

12

11

0 2.4 4.8 7.2 9.6 12 14.4 16.8 19.2 21.6 24

Teacher Associations

Save

PCD

MTT

Action Health

Action Aid

USA

UK

Norway

Ireland

Canada

WFP

WB

UNICEF

UNFPA

UNESCO

UNDP

UNAIDS

ILO

Pa

rtn

ers

Percentage Workshops Attended

0 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Objective 3: To promote coordination with the National AIDS Authorities, and enhance access to HIV&AIDS funds.

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2001 2002 2003 2004 2005 2006

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s Sub-Regional levelActivities

National Level Activities

Initiation ofDisbursement of NACFunds to MoE

Chronology of the initiation of MoEs accessing funds from their NACs

Objective 4: To enhance availability and sharing of information on HIV and AIDS that is of specific relevance to the education sector.

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20000

40000

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tota

l no

. hit

s e

ac

h m

on

th

Total number of website hits on www.schoolsandhealth.org each month, January 2003 – December 2006

Additionally, To date, approximately 250,000 hard copies of 95 titles have been distributed in at least the three main languages.

The sub-Regional Networks of HIV and AIDS Education Focal Points

• West Africa Network (ECOWAS and Mauritania) 16 countries: launched in 2004

• Eastern Africa Network 7 countries: launched in 2006

• Lusophone Africa (PALOPS)5 countries: launched in 2006

• Central Africa Network (ECCAS/SEMAC)7 countries: launched in 2006

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2002 2003 2004 2005 2006

Year

Nu

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Education SectorPolicies

Education SectorStrategic Plan

Sub-Regional LevelActivities


Progress made in the implementation of some activities in the area of policy against the number of activities carried out under the Accelerate Initiative.

0

5

10

15

20

25

30

35

40

2002 2003 2004 2005 2006

YearN

umbe

r of C

ount

ries

HIV Prevention Initiatedin Schools

Teacher TrainingInitiated

Sub-Regional LevelActivities


Progress made in the implementation of some activities in the area of prevention against the number of activities carried

out under the Accelerate Initiative.

Objective 5: To strengthen the technical content and implementation of the education sector response to HIV&AIDS.

Key changes since EFA 2000

• More holistic approaches to school health, and increasing recognition of the need to work across the whole school

• More harmonization among sectors and development partners – more cost-effectiveness, lower transaction costs and less confusion

• More partnerships across sectors and among development partners around School health programs in low and middle income countries

Key issues going forward

• FRESH framework does not reflect developments, eg, in health promotion, addressing violence etc…needs to be RE-Freshed

• Accountability and monitoring of health issues by the education sector often the weakest part of the program…need for a common set of indicators

• Focus on low income countries has missed opportunities for cross learning with high and middle income countries….need for information sharing among networks

For more information, please visit:

www.schoolsandhealth.org

Documents

Partnerships for Promoting Health and Education Donald Bundy Human Development Network The World Bank Vancouver, Canada, June 7, 2007