© 2013 Save the Children 1

Dear Colleagues,

Save the Children and the School Health and Nutrition (SHN) community demonstrated remarkable progress this year in achieving maximum impact for children In 2012, SHN programming reached nearly 3.5 million school-age children, directly and indirectly, with crucial health and nutrition services and, at the time of this update, SHN programs are currently in 32 countries.

There are many key innovations and SHN program results to highlight in 2012 and 2013 as country offices complete their transitions to Save the Children International. This year we completed the FRESH (Focusing Resources on Effective School Health) Monitoring and Evaluation (M&E) Guidance, providing global leadership on how to monitor and evaluate SHN programs. This published document is a culmination of effort extending over five years by Save the Children and its partners (listed on page 3), as well as participation of select Save the Children Country Offices who piloted the guidelines. The publication of these guidelines clearly demonstrates Save the Children’s ability to work in partnership with international organizations to produce global solutions and to ensure that children’s rights and needs are met.

SHN programs also provided noteworthy examples of evidence-based innovations in the field, such as: the school-based malaria

control programs in Mali and Malawi; the efforts to measure the sustainability of WASH in schools in Bangladesh and the Philippines; the exploration of Menstrual Hygiene Management in the Philippines; the development of toolkits incorporating SHN in Early Childhood Development programs; and the use of new technologies in SHN teaching methods in Asia. These innovative programs demonstrate Save the Children’s continued exploration of new and improved, evidence-based methods to provide solutions to problems facing children around the world.

As we continue this exploration, the renewed commitments from critical donors such as the Procter & Gamble Fund, Wrigley Jr. Foundation and SC’s Individual Child Sponsorship Programs allowed and will continue to allow us to grow in order to create sustainable improvements for children through our SHN programs.

As I approach my 10-year anniversary with Save the Children, I want to recognize the incredible dedication of all the staff in the field who have worked so tirelessly to implement and improve SHN programs, all the while juggling the ever-changing requirements from headquarters (be it SC US or SCI or a donor). I can never fully emphasize our deep appreciation for their great efforts and dedication. Thanks.

Seung Lee, Senior Director for SHN, September 2013

TABLE OF CONTENTS

I. Introduction and Program Highlights…………. 2-7

What is School Health and Nutrition? ………………... 2

What makes WASH in Schools Sustainable? …………. 2

What does SHN Cost?: A case study in Bangladesh…... 2

FRESH M&E Guidance Published………………………. 3

Malaria Control in Schools: Mali and Malawi…………... 4

Integrating SHN in Early Childhood Development……. 5

Very Young Adolescents……………………………….. 5

Growing Relationships with Corporate Partnerships…. 6

Working with Child Sponsorship……………………… 6

II. Country Updates………………………………… 8-18

Africa…………………………………………………… 8

Asia……………………………………………………. 11

Latin America and the Caribbean…………………….. 15

Middle East and Eurasia……………………………….. 17

North America and Europe…………………………... 18

III. Thought Leadership……………………………..19-21

IV. Where We Work………………………………….. 22

Cover photo: Van Thi Trang and her classmates raise their hands in their primary school class in Vietnam. Photo by: Karin Kuhns / Save the Children

School Health and Nutrition: Program Update

ISSUE 9 | YEAR 2012-2013

Supporting school-age children to be healthy to learn and to learn to be healthy

 

© 2013 Save the Children 2

What is School Health and Nutrition?

School Health and Nutrition (SHN) programs contribute to the quality of education by addressing fundamental health and nutrition needs that keep children out of school and reduce their ability to learn effectively while in school. The essential elements of an effective SHN program, as outlined in the Focusing Resources on Effective School Health (FRESH) Framework agreed at the 2000 World Education Forum in Dakar, Senegal aim to:

Ensure equitable health-related school policies

Increase access to safe and hygienic learning environments

Promote life-long healthy behaviors through skills-based and child-focused health (including HIV) education

Increase access to health and nutrition services for school-age children

The success of Save the Children’s SHN programs also hinges on effective partnerships between education, health, and other sectors, as well as with government actors, communities, and children. All programs require support at all levels, from schools and communities to the national level.  

What makes WASH in Schools Sustainable?

In 2012, the Philippines and Bangladesh country offices undertook studies to determine the key factors for ensuring sustainable WASH in Schools. Understanding these factors will help Save the Children prioritize its support to schools and communities so that WASH facilities remain functional long after the intervention is complete. The studies, led by Christie Chatterley from the University of Colorado at Boulder, evaluated a sample of schools in impact areas in the Philippines and Bangladesh using an approach called qualitative comparative analysis (QCA). QCA is a systematic technique for studying causality that (1) allows for rich, contextual data by using a small number of cases; (2) evaluates necessity and sufficiency to help reduce the large number of conditions suggested in the literature; and (3) provides multiple sufficient solutions to increase flexibility.

The analyses from both Bangladesh and the Philippines found that financial support from government or community sources is necessary to ensure well-managed schools and WASH structures in schools; however, financial support alone is insufficient. The QCAs showed that the presence of a school champion—who could be

either a teacher or an active member of the school management committee dedicated to maintaining the facilities— is as important as the financial support itself. The results of the QCA studies in Bangladesh and the Philippines indicate that programs should be sure to emphasize advocacy and partnership with the Ministry of Education, local government, and the school community to encourage ongoing management support to WASH infrastructure. Additionally, it is essential that schools, and especially their champions, are active during WASH construction, ongoing monitoring, and leadership and management of the program. Save the Children hopes to share these lessons learned with other Country Offices to encourage long-lasting results of WASH in Schools.

What does School Health and Nutrition Cost? A case study in Bangladesh Since 2002, Save the Children in Bangladesh has run low-cost, school-based health and nutrition (SHN) programs. These programs aim to prevent and treat health issues that affect children’s ability to learn while creating a safe and supportive school environment that promotes healthy behaviors and contributes to children’s participation in quality education.

In 2011, Save the Children conducted a costing study of the four SHN interventions of school-based delivery of health and nutrition services, water and sanitation services, health education, and community support from the Sponsorship-funded Shishunder Jonno (meaning “For Children”) program. The program takes place in Meherpur Sadar, a sub-district of Meherpur in Bangladesh. The study analyzed the costs associated with four SHN interventions using data from FY2009-2010, in order to help inform the scale-up of SHN activities for Save the Children’s other education programs in Bangladesh.

Introduction and Program Highlights

Migrant students wash hands by reading the health message on the wall in China. Photo by: Save the Children China field staff

 

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Figure 1: Total SHN Intervention Costs per Student/Year

 

Save the Children’s analysis in Bangladesh found that SHN interventions are very low-cost:

Annual cost of SHN per student for all SHN activities is US$29.49, of which Save the Children covered 98% of costs and the Government of Bangladesh covered 2%. The financial contribution of the Government of Bangladesh included teacher opportunity cost and the logistic costs of the deworming program by providing medicines twice per year. Because the government investment in Save the Children’s SHN program is small, it makes it an attractive option for supporting investment in education.

To carry out all SHN activities in 112 schools for one year, reaching 21,101 students and 30,000 households, a total amount cost of US$622,227 was required. This included Save the Children’s implementation funding for 95% of costs, 3% of overhead costs, and the 2% contribution from the Government of Bangladesh.

Overall, Save the Children provided 98.3% of the implementation costs for SHN services, health education, water and sanitation, and community support services in schools.

While the costs of some WASH activities, such as arsenic treatment plants, latrines, and urinals are higher due to the large capital investment needed for the hardware, these additions will last for many years. The low cost nature of SHN interventions makes them an attractive investment for both Save the Children and the Government, ultimately helping to ensure that children are healthy to learn and that they learn to be healthy while in school.

Published FRESH M&E Guidance

As part of ongoing efforts to provide internationally-agreed guidance on how to monitor and evaluate school health programs, the Focused Resources of Effective School Health (FRESH) partners have developed and released the Monitoring and Evaluation (M&E) Guidance for School Health Programs. This guidance has been produced with the support, advice, and insights of numerous professional

health experts and organizations over the past five years, including: American Institutes for Research (AIR), Child-to-Child Trust, Education Development Center (EDC), Education International, International School Health Network (ISHN), London School of Hygiene and Tropical Medicine (LSHTM), Partnership for Child Development (PCD), Roll Back Malaria (RBM) Partnership, Save the Children, Schools for Health in Europe (SHE) Network, UNESCO, UNICEF, UNODC, WFP, WHO, and the World Bank, among others. The guidance has also been refined based on country-level feedback and experiences from government and development partners, including pilot testing with Save the Children’s programs in El Salvador, Ethiopia, Nepal, and the Philippines.

With its set of recommended indicators, the FRESH M&E Guidance intends to help programs in low- and middle-income countries ensure their implementation is more standardized and evidence-based. Additionally, it is hoped that the FRESH M&E Guidance will help lead to better coordination between programs and the priorities they address as well as to ultimately contribute to better health and education outcomes for children in school.

As this guidance is intended to be a living document, feedback from further review and implementation is most welcome. Additionally, please further disseminate these guidance materials to partners and networks. To read the full FRESH M&E Guidance, please visit: http://bit.ly/1c6ssHX located on www.schoolsandhealth.org.

Interventions Taka USD

Health and Nutrition Services 123.02 $1.62

WASH 1802.70 $23.72

Health Education 108.93 $1.43

Community Support 206.39 $2.72

Total 2241.04 $29.49

A girl in Nepal demonstrates proper hand washing techniques. Photo by: Seung Lee / Save the Children

 

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Malaria Control in Schools: Mali and Malawi Save the Children, the London School of Hygiene and Tropical Medicine (LSHTM), and our valued national partners in Mali and Malawi continue to work together to build evidence for malaria control in schools in these two very different malarial contexts. This research is funded by Child Sponsorship, with additional funding from International Initiative for Impact Evaluation (3IE) and the Wellcome Trust.

Mali

In Mali, the Cluster Randomized Control Trial began in November 2010 and ended in May 2012. This study of 80 schools in Sikasso Cercle, Southern Mali, showed impressive results for both malaria control and school health education. Dissemination of results and recommendations at the national level occurred on April 25, 2013, World Malaria Day.

The results of the study were broadcast on the national evening news as well as in newspapers. Results were also disseminated at regional and local levels. Save the Children is now working with the National Malaria Control Program in Mali to include school-age children in the national malaria control strategy and has plans to scale the interventions up, starting in the current impact area.

The FRESH M&E Guidance encompasses three documents, which can be found at http://bit.ly/1c6ssHX located on www.schoolsandhealth.org:

Monitoring and Evaluation Guidance for School Health Programs: Eight Core Indicators to Support FRESH1: The eight Core Indicators focus on national-level and school-level efforts to implement comprehensive school heath programs as defined in the international FRESH framework. Collecting the eight Core Indicators will allow country governments to identify the strengths and weaknesses of their school health programming. Using this information, countries can strengthen policy and implementation and monitor progress over time.

Monitoring and Evaluation Guidance for School Health Programs—Appendices2:   These appendices include data collection tools to support the collection and compilation of the eight Core Indicators.

Monitoring and Evaluation Guidance for School Health Programs—Thematic Indicators3 : The Thematic Indicators focus on program-level M&E of school health and contain a menu of around 250 indicators, largely drawn from existing M&E guidance or developed by thematic expert groups, covering 15 school health topics for researchers and program staff to choose from, including: Water, Sanitation and Hygiene; Worms; Food and Nutrition; Physical Activity; Malaria; Oral Health; Eye Health; Ear and Hearing; Immunization; Injury Prevention; HIV and AIDS; Sexual and Reproductive Health; Substance Use; Violence in Schools; and Disaster Risk Reduction. References: 1 h p://bit.ly/1aSGMkd; 2 h p://bit.ly/1cgIjm3; 3 h p://bit.ly/1c6ssHX

Key Findings from Mali:

At baseline, 80% of school children had malaria parasites and 65% were anemic. Less than 5% of children infected with malaria had fever. This means that the majority of cases were asymptomatic, going undetected and untreated. Only 42% of children reported sleeping under a mosquito net.

Children who benefited from school based malaria prevention education reported using mosquito nets for a longer period of time than those who did not take part in the comparison group. Over 90% of children were still sleeping under a net at the end of the rainy season (November) and 88% three months after the end of the rainy season (February), compared to 62% and 58% respectively in the comparison group.

One course of malaria treatment at the end of the malaria season and the beginning of the school year cleared children of malaria parasites and reduced their risk of anemia for six months (until the end of the school year). In May (6 months after the treatment), less than 10% of children in the intervention group were infected compared to 75% in the untreated group. The percentage of children with anemia was 35% in the intervention group versus 49% in the untreated group.

For more details, read the full report Malaria Control in Schools in Mali—links below in English and French:

(English) http://www.schoolsandhealth.org/Documents/Malaria%20control%20in%20schools%20in%20Mali%20(English).pdf

(French) http://www.schoolsandhealth.org/Documents/Malaria%20Control%20in%20Schools%20in%20Mali%20(French).pdf

A school boy in Mali learning how mosquitoes transmit malaria. Photo by: Natalie Roschnik / Save the Children

 

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Malawi

In Malawi, Save the Children, in partnership with the London School of Hygiene and Tropical Medicine, the Malaria Alert Center, and the National Malaria Control Program is conducting a Randomized Control Trial in 58 schools in Chikowi, Zomba District to evaluate the feasibility and impact of school-based malaria diagnosis and treatment. The trial was delivered through a Pupil Treatment Kit (a First Aid Kit with treatments for other common health problems) and is the first time, globally, that teachers will be trained to use Rapid Diagnostic Tests and provide malaria treatment to children. This intervention contributes to the Government of Malawi’s goal to ensure universal coverage of key health services, including prompt diagnosis and treatment of malaria. It is also expected to improve school attendance as children are more likely to get treatment, get treated earlier, and be absent for fewer days.

The study is funded by Child Sponsorship and the International Initiative for Impact Evaluation (3IE). A needs assessment, conducted in April 2011 found that 65% of children were infected with malaria, mostly asymptomatic cases and 35% were anemic. Since April, Save the Children began Phase 2 of the intervention by starting an Intermittent Parasite Clearance (IPC) that was followed by a second School Survey follow-up that assessed the impact of the IPC on reported net use, malaria, anemia as well as cognitive and educational tests. In 2012, there was a comparison between schools that received Long-Lasting Insecticide Nets (LLINs), malaria prevention education, and parasite clearance as well as a School Survey and a Community Survey to evaluate community and school perceptions of school-based interventions and how improvements in health status in schools might last. The end-line for this study is expected to be conducted in mid-2014 with results at the end of next year.

Integrating SHN in Early Childhood Development Programs At Save the Children, we have begun to explore the most effective ways of integrating health and nutrition activities into Early Childhood Development (ECD) programs. For example, the Lancet series on “Maternal and Child Nutrition” published in June 2013, recommends nutrition-sensitive interventions and programs, which can serve as a delivery platform for nutrition-specific interventions, potentially increasing their scale, coverage, and effectiveness. ECD programs are one of those platforms; however, there is currently little evidence or documented experience to guide ECD program managers for integration of key health and nutrition interventions into programming.

In December 2012, the SHN team hired a consultant using Sponsorship Funding to draft a toolkit for ECD program managers to provide guidance on how to integrate recommended health and nutrition interventions into their programs without duplicating the roles and responsibilities of the local health service. The toolkit has been reviewed by members of the Save the Children US teams in School Health and Nutrition, Early Childhood Development, and Child Survival, and it is now being revised. Save the Children hopes to share the next draft with country offices and to finalize the toolkit by the end of 2013. In the meantime, Save the Children will continue documenting lessons and experiences from ongoing programs and studies in Bangladesh, Bolivia, El Salvador, Indonesia, Malawi, Mali, Pakistan, and Zambia for broad dissemination.

Very Young Adolescents Program

Children ages 10-14 are considered “Very Young Adolescents.” This group of children, who are sometimes in primary school and who are sometimes entering secondary school, have a special set of needs that are different than younger children in primary school and older children in secondary school. Save the Children’s SHN and Adolescent Sexual and Reproductive Health (ARSH) teams are partnering to develop a package of services that will address the special needs of these children. This package of services seeks to improve educational attainment for children in this age group, while also equipping them with the skills and knowledge necessary to navigate their changing bodies and the world around them.

Through programs addressing the needs of 10-14-year-olds, we also hope to encourage positive and healthy sexual and reproductive attitudes throughout their lives in order to inspire lasting behavior change and long-term positive health outcomes. Save the Children has engaged Douglas Stagnaro,

The planning workshop for the Pupil Treatment Kit Study in Liwonde, Malawi with district, national and international research partners. Photo by: Save the Children

 

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a Fellow from GlaxoSmithKlein (GSK) working on a PULSE Volunteer Partnership through GSK’s skills-based volunteering initiative, to help identify the components of a package of services for VYAs. We anticipate that this package will be available for circulation in 2014.

Growing Relationships with Corporate Partnerships Corporations and corporate foundations continue to be a major funding source for Save the Children’s School Health and Nutrition programs around the globe. Coca-Cola, GlaxoSmithKline, Green Mountain Coffee, IKEA, Procter & Gamble, TOMS Shoes, and the Wrigley Company Foundation have all been significant funding partners for many country office SHN programs, and in recent years, corporate interest for these programs has continued to increase.

Sustaining this trend, Save the Children was awarded two major multi-country grants from corporations in early 2013. The Wrigley Company Foundation awarded Save the Children US$3.6 million for SHN programs in China, Indonesia, Kenya, the Philippines, Tajikistan, and Vietnam. This two-year award provides expansion funds to Wrigley’s US$3 million award for 2011-2013. The Wrigley Company Foundation funds comprehensive SHN programming with a focus on oral health.

Save the Children has benefitted from Procter & Gamble (P&G) funding for many years, including, for example, its funding for SHN programs in China and Kenya as well as Adolescent Sexual and Reproductive Health programs in Ethiopia and South Africa. With a grant of US$2 million, Save the Children has established a global partnership, which brings together many of the P&G brands, including

Safeguard, Oral-B, Crest, Always/Whisper, and Gillette to expand comprehensive SHN programming in China and Mexico and to establish a new SHN program in Nigeria.

With their award, Procter & Gamble has also made an incredible investment in the expansion of Save the Children’s thought leadership, allowing us to lead globally with critical tools and learning opportunities related to SHN programs. These opportunities include, among others, the drafting and development of a toolkit/guidelines on how to measure cognitive change as a result of SHN programs, the global SHN Program Learning Group meeting in Nepal in December 2013 (page 19), and the rollout of the FRESH M&E guidelines (page 3).

As an example of corporate donors expanding their role beyond traditional philanthropy, the Wrigley and P&G partnerships also focus on employment engagement activities within the respective countries related to these SHN programs.

These opportunities exemplify the shared values of Save the Children and the private sector contributing to the overall positive impact for children. Through multi-country support, these partnerships also encourage cross-country innovations, which offer increased program learning gains and the opportunity for deeper, more comprehensive research in SHN interventions and impact. In keeping with Save the Children’s Theory of Change, the SHN team will continue to pursue partnerships in order to share knowledge, influence others and build capacity to achieve immediate and lasting change in the lives of children.

Eleven-year-old Anielka shows her five-year-old brother Lenier how to wash his hands in the remote farming community of Cacao Minitas, in the El Sauce municipality of León province, Nicaragua. Photo by: Brent Stirton / Save the Children

Children participating in Global Hand Washing Day in Tajikistan. Photo by: Khairinisso Akhmedova / Save the Children

 

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Working with Child Sponsorship

Child Sponsorship Funding remains a core source of support for Save the Children’s School Health and Nutrition technical leadership and for programs globally, supporting programs in 14 countries. Child Sponsorship Funding recently expanded to Zambia and is expanding to Indonesia and Vietnam in 2013. All of these countries will include a SHN program. Support from other Save the Children members, including Save the Children Italy and Save the Children Korea, has enabled much of the growth in Sponsorship-funded programming and will secure a foundation of funds for SHN in the future.

SHN is one of the four core Sponsorship-funded programs at Save the Children along with Basic Education, Early Childhood Development, and Adolescent Development, with HIV as a cross-cutting core program area. Child Sponsorship Funding supports community-based programs that serve all children in impact areas. These programs run for approximately 10 years in each impact area and offer an opportunity for long-term, comprehensive education and health programming.

Child Sponsorship Funds also serve as an excellent canvas for innovation in SHN programs. Interventions and programs initiated and piloted with Child Sponsorship Funding are frequently used to leverage additional funding from other

sources to take these programs and interventions to scale, which have been proven to work in country contexts.

In 2012, Child Sponsorship Funding enabled the SHN team to produce important capacity building materials and activities, including the completion of a Health Education Manual, which has been an ongoing request from field offices. The manual includes a set of 23 critical lessons to be used by programs and countries in order to teach children crucial healthy behaviors. Other key documents completed or drafted with support from Child Sponsorship in 2012 that are critical to improving the quality of SHN programming are: Guidelines on Vitamin A and Iron Supplementation for School age Children; Cost Analysis of the Sponsorship-funded SHN program in Bangladesh (page 2); Quality Comparative Studies of Water, Sanitation and Hygiene (WASH) interventions by SHN to understand the sustainability in Philippines and Bangladesh (page 2); and the FRESH M&E Guidance (page 3).

SHN programming, through Child Sponsorship Funding, exemplified Save the Children’s Theory of Change by being the voice for better practices and policies, achieving results at scale through support for effective implementation of best practices, and by being the innovator through the use of evidence-based and replicable solutions. See our results contributing to the four pillars of this theory below.

Be the Innovator:

Results from the Malaria in Schools project showed an 80% drop in the rate of malaria to just 3%.

In Afghanistan, 85% of children reported washing their hands with soap and water after using the toilet.

In Egypt, SHN programming reduced the anemia rate to 42% and decreased the rate of trachoma to 20%.

In the U.S., the Healthy Choices program is piloting PAC-ER (Progressive Aerobic Cardiovascular Endurance Run ) to measure children’s fitness.

Be the Voice:

In Ethiopia, the government has adopted a national SHN policy as a result of years of advocacy by Save the Chil-dren and other organizations.

In Mali, results of the Malaria Control in Schools study are used to advocate for the inclusion of school age chil-dren in the national malaria control strategy.

In Bolivia, the SHN program empowers boys and girls through hygiene clubs where they share best practices with their peers.

Build Partnerships:

In Ethiopia, the SHN program in impact areas have initiat-ed the establishment of district level SHN coordination committees, which bring together several sectors in the dis-trict government.

In Haiti, a campaign of mass deworming was conducted by the Ministry of Health in partnership with the SHN team.

In Nepal, Save the Children is a founding member of the national SHN network and supports it annually to ensure collaboration among partners.

Achieve Results at Scale:

In Egypt, Save the Children collaborated with the Direc-torate of Education, the Health Insurance (HI) depart-ment, and four partner community development associ-ates to expand the coverage of HI services and conduct medical check-ups for 100% of ECD children in primary schools in Grades 1, 4, and 7.

In Nepal, Save the Children implemented a Sponsorship-funded SHN program for district wide implementation of the basic SHN package in 1,214 schools.

SHN Program Results through Child Sponsorship Funding and the Theory of Change

 

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Country Updates

Africa Save the Children currently has SHN programming in 11 countries on the continent of Africa.

Ethiopia

Save the Children has been actively involved in assisting the Federal Minister of Education to draft a National Health and Nutrition Policy plan since the introduction of its first SHN program in Woliso, Ethiopia in 2001.

Save the Children has also carried out a national SHN baseline survey on behalf of the Federal Ministry of Education, has assisted in drafting policy legislature, and has worked as an advocate for the adoption of a SHN policy. In October 2012, all of this hard work paid off; the National Health and Nutrition Policy was officially signed. Through ongoing SHN Sponsorship-funded work in West Showa and Tigray, Save the Children will continue to support the government to roll-out the new SHN policy in Ethiopia in the years to come.

Working with an emphasis on sustainability, we developed active District SHN Committees that help to implement and monitor the program. The committees include representatives from six district government offices. The program is also testing innovative approaches, including the school-based production of soap to address the chronic challenge of keeping schools supplied.

The comprehensive SHN program is currently being implemented in 102 schools in West Showa and 70 Schools in Tigray. In 2013, activities in both Tigray and West Showa are expanding to additional schools to support more children.

Kenya

In 2012, Save the Children’s Wrigley-funded SHN programs in Kiambu and Nairobi reached 18,862 students with health education focused on oral health and hand washing. The program reached 7,200 students with deworming medication and 683 students with Vitamin A supplementation while delivering water and sanitation improvements in 25 schools, including the development of hand washing facilities. Save the Children reached an additional 15 non-formal education schools in Nairobi with programs focused on hand washing, improved water supply and sanitation, and deworming using funds from P&G.

In the upcoming year, Save the Children will strengthen the capacity of School Health Clubs as well as reinforce the knowledge, attitudes, and practice improvements made during 2012. Special emphasis will be made to continue the improvement of the ongoing management of WASH facilities in Kiambu and Nairobi. In Nairobi, school communities have expressed the desire for real and lasting improvement in WASH infrastructure. To achieve that result, Save the Children’s programs in Kenya work with students, communities, school management, the Nairobi County Council, and other stakeholders to encourage sustained improvements of WASH in Schools.

The SHN program in Kenya will continue its focus on oral health and WASH, but will also incorporate needed health and life skills of Very Young Adolescents (ages 10-14) in schools. These needs will be addressed through school administrators and School Health Clubs in addition to developing teaching and learning materials that address puberty and gender norms.

Malawi

Over the past year, Malawi’s SHN program mainly focused on advancing the Malaria Control in Schools study . We recruited Allison Verney, a SUPER (Save the Children University Partnership for Education Research) Fellow, to support the analysis and dissemination of the baseline survey and to support the overall SHN program in order to develop the research protocol and submit to the ethical review board

Third graders, nine-year-olds, Kotek Alemu, Siake Toddesse and Higawi Belachew sitting together during class at Sengota Primary School, West Showa, Ethiopia. Photo by: Susan Warner / Save the Children

Though not all of our SHN country programs are featured in the ‘Country Updates’, they are all working to strengthen the relevance and effectiveness of SHN programming in order to meet the changing needs of children around the world.

 

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in Malawi. Through her fellowship, she has also supported the country office team to conduct an acceptability study with local communities to assess whether they felt comfortable having teachers diagnose and treat malaria. Finally, she has supported the country office to draft the Pupil Treatment Guide.

The London School of Hygiene and Tropical Medicine (LSHTM) was also awarded a grant from 3IE to support the research-related costs of Save the Children’s study, which will complement programs funded by Child Sponsorship.

The SHN program in Malawi continued to improve the water and sanitation situation in schools using innovative approaches piloted the previous year, while also supporting both district and national level deworming activities. These activities included filling both financial and technical gaps to ensure that teachers and district health staff were adequately trained and supervised. In 2012, the program reached 21,316 children (10,442 boys and 10,874 girls), showing an increase from 19,598 in 2011.

Through continued SHN support, programs in Malawi increased access to child-friendly, school-based health, hygiene, and nutritional services through health- and nutrition-driven interventions. As a result of Child Health Days, referrals enabled 18,501 children to access health and nutrition services while also supporting the training of 302 parenting group leaders in positive parenting practices.

Mali

The Dubai Cares and Sponsorship-funded SHN program in Mali now reaches 254 communities, 66,806 school children and 13,893 out-of-school children in Sikasso and Yorosso Cercles with comprehensive SHN programming. The Dubai Cares WASH in Schools project is in its fourth and final year and has reached most of its WASH in Schools targets. At baseline, only 17% of schools had a water point, 59% had latrines, and 3.5 % had hand washing facilities.

Today almost all of the 130 target schools have all three facilities meeting the WASH in Schools standards. Community-Led Total Sanitation (CLTS), an approach which leads communities to discourage open air defecation, has been implemented in 30 communities with great success; 232 family latrines and hand washing facilities have been built by the communities themselves at their own cost following the CTLS sessions. The team is planning to scale-up this work eventually to all 254 Sponsorship-funded schools. Additional funding was identified by UNICEF to extend the program to another 113 schools in Sikasso from 2013. In March 2013, Save the Children received a grant from UBS Optimus

Foundation, with matched funding from Save the Children Switzerland and Child Sponsorship Funds to conduct a cluster randomized control trial in 90 communities and 60 ECD centers. This study will evaluate the feasibility and impact of a combined malaria and nutrition package targeting children 0-5 years using the ECD centers as the main platform for delivery. This study will be conducted in partnership with the LSHTM and Institute of Education in London, Sight and Life, the Institut National de Recherche en Sante Publique (INRSP), Malaria Research Training Center (MRTC), and the Ministry of Education in Mali.

Mozambique

In the past year, Save the Children progressively phased its Sponsorship-funded programs from Gaza to Nampula Province. The Phase-Out from Gaza and Phase-In to Nampula is expected to be completed by December 2015. In Gaza Province, the SHN programs mainly focus on building capacity to ensure that improvements in the communities, with which we have worked for the past decade, are maintained after Save the Children’s support ends. Our SHN programs also support the rehabilitation of boreholes and school WASH facilities; peer education training in hygiene and nutrition; the establishment of water committees and the training of 156 School Committee members and primary school teachers; and support for deworming activities and IEC in 52 schools, reaching 37,000 children per year for SHN programs as a whole.  

An endline survey was conducted in April 2012 in 20 schools to evaluate the impact of the Sponsorship-funded programs

Girl learning to write in a community-based child development center in Mali. Photo by: Natalie Roschnik / Save the Children

 

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over their 10-year lifespan. The results are currently being processed. It is expected that a new SHN program will begin in 2014 in Nampula Province. A situation analysis and baseline are expected in the latter part of 2013 or the early part of 2014. The program will be designed to meet school children’s needs based on these studies.

South Africa

The Reducing Maternal and Child Mortality through Strengthening Primary Health Care (RMCH) Program in South Africa improves delivery of school health services. These activities support the achievement of the Integrated School Health Program’s (ISHP) goal to: improve the general state of children’s health in school, improve the environmental conditions in schools, and to address barriers to learning that arise when children or their environments are unhealthy. Fundamental to this approach is the National Basic Educational Department’s framework and the Care and Support for Teaching and Learning (CTSL), which is a coordinated multi-sectorial response to address barriers to teaching and learning.

Instead of solely targeting school communities for service delivery, the program aims to mobilize children and community members for the promotion and preservation of school health services. The program also targets key actors including local duty bearers responsible for delivery of essential health services, social workers, members of the South African Police Service, municipal role players, ward councilors, mayors, and community workers. Save the Children wants to emphasize the shift from the routine habit of persuasion and transmission of information from outside technical experts and district authorities to support dialogue, debate, and negotiation on issues that resonate with those most affected. An important strength of this type of approach

is that it shifts the emphasis on outcomes from individual behavior to social norms, policies, culture, and creation of a sustainable supporting environment. RMCH is working within 25 priority districts where 400 schools will be selected to support the strengthened delivery of school health services.

Zambia

The recently launched Sponsorship-funded program in Lufwanyama, Zambia began implementation of Early Childhood Development (ECD) and Basic Education (BE) programs. In 2013, we are completing program design, increasing staff capacity, and growing community engagement to enable the launch of a full SHN program in early 2014. We collected data on SHN in the Sponsorship-funded baseline survey in May 2013 that is informing the program design. We look forward to identifying the positive impacts our programs have had on school children in Zambia in 2014.

Zimbabwe

The Oprah Winfrey Foundation and Save the Children are partnering to provide a child-friendly education environment in the community of Matau, in the Hurungwe District of Zimbabwe. This three-year commitment of $1.5 million helped us improve access to and the quality of early childhood development activities; to introduce our Literacy Boost reading program for children to help them improve this gateway skill; train teachers to improve their skills; and construct classrooms, latrine blocks, administrative offices, and teacher housing.

Through this partnership, Save the Children supported 64 community health and nine school health clubs, empowering their focus on hygiene promotion through training and capacity building of the communities in disaster response. As a result of this support, 518 members of school and community health clubs benefitted and these members formed six operational wards in an effort to increase the sustainability of these programs.

Happy Parent-Teacher Association (PTA) partners in Nacala, Mozambique. Photo by: Seung Lee / Save the Children

Rebecca and Philasande sharing lessons they learned through Save the Chil-dren’s programming in South Africa. Photo by: Karen Siegel / Save the Children

 

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Asia In Asia, Save the Children’s SHN programming is currently implemented in 9 countries.

Afghanistan

In 2012, Save the Children’s SHN programs reached over 70,000 children and contributed to the improvement of children’s behaviors and knowledge on health, nutrition, and hygiene in Afghanistan. These programs took place in four provinces where we provided lessons on hand washing and the importance of safe water; demonstrated how to treat diarrhea; dewormed children who were both in and out of school; and supplemented these children with vitamin A.

Through our Child Focused Health Education (CFHE) program, we promoted hygiene, sanitation, health, and nutrition education through role play, games, and stories. We also trained local community volunteers to teach young adolescents ways in which to stay healthy and active in their day-to-day lives. In Afghanistan, 85% of children reported washing their hands with soap after using the toilet in Faryab, which increased from 72% in 2011.

Save the Children’s programs will continue to provide children with access to safe and child-friendly water, sanitation, and hygiene facilities, as well as education on subjects like proper hand washing to prevent diarrhea.

Bangladesh

Save the Children in Bangladesh saw a great expansion of programs from 2011-2012 and continues to support SHN practices throughout participating schools. In the past year alone, Sponsorship-funded SHN activities reached approximately 89,000 children (133% higher than 2011).

We also established hand washing facilities in 182 schools, which was an 11% increase from previous years. To improve school sanitation, we provided a running water supply for latrines in 37 schools. Additionally, field staff trained 705 teachers on how to provide health education sessions and distribute deworming tablets.

Further SHN achievements of the Sponsorship-funded program include:

Deworming 88,518 school children (99%) and 230 out-of-school children

Distributing Vitamin-A to 87,369 children (98%)

Providing iron supplementation to 81,272 school children (91%)

Improving 210 schools’ access to safe water

Increasing the number of schools with functional latrines to 184

In addition to the Sponsorship-funded program, other Save the Children education initiatives that included SHN activities were the USAID-funded Proteeva program that reached 350,003 children and the SHIKHON program that reached 84,882 children. In total, Save the Children reached 524,380 pre-primary and primary-school children with SHN services in Bangladesh in 2012.

China

To promote good health practices in schools, Save the Children trained 450 head teachers and health teachers from 19 privately-run migrant-child elementary schools in Shanghai and Guangzhou. In partnership with experts from Shanghai Theatre Academy and Guangzhou Shandao Social Work Service Center, we developed drama performance and educational theatre activities focused on child health education. To further engage children, Save the Children also designed a series of health education materials which focus on participatory lessons for children to learn skills needed for healthy living.

Save the Children has been implementing SHN programs in Yunnan Province for three years. During that time, we have trained over 700 rural teachers in Mojiang County. Such promotional activities were also developed throughout eight rural schools in Jinping County and Malipo County. In Tibet, we helped construct hand-dug wells, latrines, and waste treatment facilities for eight schools in the agricultural and pastoral areas.

Together in 2012, we helped 78,831 children and 40,711 adults by boosting school health promotion in Guangzhou, Shanghai, Tibet, and Yunnan.

Grade 2 students using drama for SHN education to learn ways to stay healthy. Photo by: Jinping Guo / Save the Children

 

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Indonesia

In partnership with The Wrigley Company Foundation and Dubai Cares, Save the Children cooperated with important stakeholders to provide comprehensive health and hygiene education (including oral health), to foster supportive environments and policy changes for WASH in schools and to scale-up SHN services in Indonesia. We have implemented the WASH in School Empowerment (WISE) project in three provinces in Eastern Indonesia. To date, it has reached 225 schools with nearly 40,000 students. Other WISE achievements include distributing toothpaste and toothbrushes to 19,106 students, training 3,443 community members in oral health and good practices, conducting 219 school visits by dentists and nurses, and incorporating SHN into the primary school curriculum in two districts.

Save the Children and The Wrigley Company Foundation, through the WISE program, have also:

Provided more than 30,000 school children in 57 schools with improved access to water and sanitation facilities

Trained 439 teachers from 180 schools in hygiene promotion

Created a program that trained 653 students as “little doctors” for hygiene promotion

Hosted 6,385 adults (mainly parents) in hygiene education sessions in the community in an effort to support children in the area with good hygiene behavior

Nepal

In Nepal, Save the Children, through Child Sponsorship Funding, is a founding member of the national SHN network and continues to support it every year to ensure collaboration among partners. Save the Children worked with other organizations several years ago, such as Japan International Cooperation Agency (JICA), CCS Italia, and Plan International to create this SHN network to coordinate and

assist the Departments of Education and Health for implementation of the national SHN program. Save the Children implements the SHN program in partnership with District Public Health Offices and District Education Offices for district-wide implementation of the basic SHN package in 1,214 in schools in Kapilvastu, Pyuthan, and Siraha districts in 2012. The team in Nepal continues to work hard in preparation for this year’s SHN Program Learning Group, December 3-10.

Pakistan

One of the greatest achievements of the Pakistan office has been its ability to integrate SHN into larger Education and Child Development programs. As such, SHN is now being implemented in five programs across seven districts reaching 1,431 schools and 748,000 children.

In 2012, a new AUSAID-funded Early Childhood Care and Education (ECCE) program was initiated in Khyber Pakhtunkhwa (KP) province targeting Kaachi (preschool) and first through third grade primary classes in Abbottabad, Battagram, Bruner, and Peshawar. A baseline survey conducted in March-April 2012 found that children were suffering from high rates of malnutrition and morbidity: 41% were anemic, 50% were infected with worms, 42% showed iodine deficiency, and 26% were stunted. To address these problems, Save the Children provides annual deworming in schools and communities through home-based child care centers and parent groups. In addition, an extensive health education program has been launched in all target schools and ECCE homes to help teachers and parents educate children on health issues and healthy practices through stories, puppet shows and demonstrations. SHN activities cover all children in impact schools and communities. 

Children participate in a Global Hand Washing Day activity in Belu, Indo-nesia supported by the WISE project. Photo by: Save the Children

Boys combing their hair at a hand washing station in Nepal. Photo by: Seung Lee / Save the Children

 

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In 2012, the Pakistan office also successfully integrated SHN into the Dutch Embassy (EKN)-funded Balochistan Education Program with a similar package of interventions to those already described. We conducted a SHN baseline survey in March 2012 and found that 24% of children were anemic, 40% were infested with worms, 52% were iodine deficient, and 47% were stunted. The program reaches 340 schools in three districts: Killa Abdullah, Mastung, and Quetta.  

The Program for Establishing Partnership and Stability (PEPAS) in Battagram is another five-year project funded by the Dutch Embassy (EKN), which was launched in March 2012. It reaches 260 schools and 40 madaris (religious schools) in total in the Battagram district of KP. The goal of the project is to improve resilience among fragile communities through increased learning and development opportunities in education and livelihood environments. One of the objectives of the project is to improve quality of and access to ECCE, primary schools, and secondary schools, especially for girls. SHN is critical to ensure quality education and offers a unique opportunity to evaluate the ‘added value’ of SHN implemented alongside an education program.

Philippines

Save the Children, with support from The Wrigley Company Foundation, implemented the Kids SHINE (School Health Involvement and Empowerment) and Kids SHINE MORE (Mainstreaming Oral Health in Education) projects for the past two years. These projects support the Sponsorship-funded program by ensuring the delivery of health, nutrition, and hygiene services; improving water and sanitation facilities; and encouraging children’s active participation in School Health and Nutrition. Save the Children in the Philippines supports continued advocacy for the implementation of

national policies and programs with a focus on health and nutrition. We aim to create sustainable application of the SHN Program through the support of local partners as well as the meaningful participation of school children. Going forward, focus areas include oral health education, systemization and sustainability of SHN activities in schools, and scaling-up the Child Health Promoter program.

Some of the key achievements, with Wrigley’s support in the Philippines, consist of:

Constructing, rehabilitating, and maintaining water supply systems, sanitary toilets, and hand washing facilities in 110 schools

Training 3,171 Child Health Promoters (CHPs) who reached approximately 130,539 school children through Child-to-Child activities, including lessons on how to brush your teeth

Building strong working partnerships with the Department of Education, local government units, parents, and communities around SHN and oral health

Developing a CHP Activity Logbook, SHN Score Card, and WASH Observation Checklist, all of which facilitated recording, reporting and monitoring of SHN-related activities and projects

Eleven-year-old Angel wears her Bulilit (“little” in Tagalog) vest, symbolizing that she is a little health worker and promoter in a rural village in South Cen-tral Mindanao in the Philippines. Photo by: Seung Lee / Save the Children

Children presenting a theatrical demonstration about cleanliness in a Child Friendly Space in Mirpur Khas district in Pakistan. The elder boy advised the younger children to always wash their hands before eating after they got sick from eating food without cleaning their hands first. Photo by: Save the Children / Pakistan field office

 

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Tajikistan

In 2012, Save the Children, supported by The Wrigley Company Foundation, reached 100 schools across Khatlon Region and Rasht Valley with School Health and Nutrition interventions. These interventions were originally designed to benefit 26,464 primary school children, but as a result of Child-to-Child replication influenced by Child-Led Organizations (CLO), they nearly tripled this number and reached 75,864 in 2012. This program provides education and health training to school teachers, students, and community members.

In the coming year, Save the Children will build on its programming in these 100 schools by continuing to help institutes facilitate CLO, expand Save the Children’s health curriculum to include menstrual hygiene management, improve water quality at schools, and increase the coverage of our oral hygiene curriculum. Additionally, we will expand to 50 more schools. Tajikistan’s SHN program further contributions to positive health outcomes include:

Trained 1,600 children using the Child-to-Child training approach for hygiene and health issues, including hand washing and tooth brushing techniques, diarrhea prevention, and food safety

Provided micro-grants for Parent-Teacher Associations to make SHN improvements in the areas of water, sanitation, and hand washing infrastructure

Distributed 769,800 water purification sachets to 28 schools that tested positive for water contamination

Developed a cartoon on hygiene and oral health that was broadcast on local TV

Disseminated 24,355 solar lamps to primary school children in the target schools of SHN, improving the conditions of school children for preparing their homework during electricity shortage in winter and autumn seasons and preventing eye strain while children do their homework

Vietnam

The Vietnam program has made significant strides to incorporate School Health and Nutrition in 30 schools throughout three program areas of Hanoi, Hai Phong, and Ho Chi Minh City. In 2012, we reached 27,039 students with activities that promote oral health and health education. In addition, Save the Children developed a 170-page health education manual with lesson plans on oral health, nutrition, adolescent development, personal hygiene, and drug abuse prevention education. In addition to these interventions, Save the Children also:

Educated 20 master trainers, 300 teachers, and 30 school health officers on extracurricular activities and SHN

Improved hygiene systems in the 30 project schools including toilets and/or hand washing stations

Implemented 1,433 interactive extracurricular health sessions and 35 interactive, experiential activities that benefited roughly 27,000 school-aged children (6-14 years)

Reached about 700 teachers and parents in 14 communities and parent associations through dialogues and workshops

In the upcoming year, we will continue to improve children’s knowledge on, attitudes about, and practice of oral health and hygiene, nutrition, and hand washing through health education and policy improvements at schools. Save the Children will further emphasize the importance of improving school lunches and will expand its focus on the health and life skill needs of adolescents through training school administrators, creating child-to-child clubs, and concentrating on menstrual hygiene management.

Peer-to-Peer performance about prevention of diarrhea by Child-Led Or-ganization members on Global Hand Washing Day in Tajikistan. Photo by: Khairinisso Akhmedova / Save the Children

Students participate in group work to illustrate SHN messages in Nguyen Trai Primary School, Hanoi, Vietnam. Photo by: Hoang Thi Tay Ninh / Save the Children

 

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Latin America and the Caribbean Save the Children currently has SHN programming in 6 countries in Latin America and the Caribbean.

Bolivia

Save the Children’s SHN programs in Bolivia effectively contributed to the reduction of the prevalence of iron deficiency and the improvement of hygiene practices. In an effort to continue these improvements, Save the Children expanded the program from Oruro to other areas in the country, such as the municipality of Caracollo.

In the Oruro municipality, we implemented the SHN program in 18 schools. Save the Children also later applied direct coverage of SHN programs in 16 additional schools. In partnership with the Portuguese Civic Association and the Department of Health, we also implemented an advocacy plan focused on good hand washing practices that reached 54,554 students, 2,750 teachers, and 5,596 community inhabitants, totaling 62,900 persons. As a result, the prevalence of anemia decreased in primary school students in Oruro to 5.6% and boys’ and girls’ knowledge and practices regarding hand washing before eating improved 83.1% in 2012.

After this experience in Oruro and Caracollo, we are extending the program to new schools in other municipalities (Oruro, Caracollo, La Paz, and El Alto), with support from the Karlsson Family Foundation and Unilever. In addition, we are rolling out SHN programs in Cochabamba with full implementation planned for late 2013. This new experience will allow for more children to improve their health in future programs.

El Salvador

Throughout the schools where Save the Children is currently working in El Salvador, we adopted the innovative Child-to-Child methodology for implementing our SHN program. The program includes “School Brigades” where the Child-to-Child methodology promotes child participation and ensures schools reach their desired health and nutrition goals. The brigadiers also lead the M&E processes and develop accountability sessions in their districts. There are 45 School Brigades (one for each school) and currently 475 student brigadiers between them. A study conducted by an external research team from Toronto University in early 2013 documented the experience and the results indicate that:

“Children are the primary project decision-makers and receive strong guidance and support from adults in their school and Save the Children’s El Salvador office. The brigadiers’ participation brings them increased understanding of democratic processes, improved confidence, communication and leadership skills, and leads to improved student health and academic performance.”

Since implementation of the first SHN program in 2008, the brigades directly affected 24,970 individuals and indirectly impacted an additional 24,235. The program successfully changed key practices at the schools; for instance, the number of students washing their hands with proper technique on a regular basis increased from four out of every 10 students to eight out of every 10 students. In all of the participating schools, students practice hand washing before all school snacks are served. In addition, now half of the school snack stores in participating schools have been qualified as “Healthy Stores,” meaning they no longer sell junk food and instead offer a variety of highly nutritional options for students.

Guatemala

In 2012, Save the Children’s SHN program in Guatemala reached 100% of the schools in its Education Initiative funded by Starbucks and Child Sponsorship. This work served approximately 8,000 children directly and more than 51,000 people indirectly and largely worked to improve school performance in coffee-farming families. This program strengthens the basic health norms related to coffee producing activities. School governments actively participate to teach children to wash their hands and brush their teeth. Save the Children implements the Child-to-Child peer education approach, which improves leadership skills and self-esteem while simultaneously promoting health messages.

Save the Children coordinates with local health authorities and service-providers at the municipal level to provide deworming medication and Vitamin A supplementation.

Boys and girls participating in a Health Fair in Bolivia. Photo by: Gilmer Ticlla / Save the Children

 

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Communication and coordination with relevant stakeholders in Guatemala was essential to gain commitment to provide deworming services and Vitamin A supplementation in the 2013 school year.

Haiti

Save the Children’s interventions in Haiti took place in Maissade, Dessalines, and Leogane and were centered on training school stakeholders, reinforcing the capacities of health staff in schools, identifying needs (such as materials, training, and best hygiene practices), and providing hygiene kits. As a result of our SHN programming in Haiti, 39,024 children benefited from improved health, WASH, and nutritional status in 152 schools (14,943 children in 72 schools in Maissade, 11,037 children in 40 schools in Dessalines, and 11,672 children in 40 schools in Leogane). An additional 472 teachers and school principals improved their level of competency through trainings in school health and hygiene, thus enabling them to better respond to the needs of children.

Child Sponsorship funded our SHN programs in Maissade and Dessalines, which saw many additional improvements in the health and nutritional status of children throughout the year in Haiti:

Trained 411 teachers and school directors on protocols for deworming children and micro-nutrient distribution

Educated 7,744 parents and community leaders and 20,772 students on hygiene practices and health in schools

Supported best hygiene practices in 40 schools throughout Dessalines and 72 schools in Maissade

Phased-out of the Maissade impact area in early 2013

Honduras

The Sponsorship-funded program in Honduras implemented SHN activities in two municipalities: Intibucá and El Valle. These SHN activities focused on promoting key sanitation, hygiene, and nutritional practices—mainly hand washing, latrine use, hygienic practices for food handling, water treatment, and garbage disposal. Funds to further support the Sponsorship-funded program’s activities were leveraged from donors like USAID’s EduAccion project.

Mexico

In 2012, Procter & Gamble and Save the Children’s hand washing and health interventions reached 200,000 children nationwide during World Hand Washing Day. In 2013, we delivered a workshop on the same topic where we reached around 80,000 children and, in the coming months, we plan to highlight our activities around the next World Hand Washing day by promoting cartoons aimed toward children. Throughout the country, we conducted SHN activities that create awareness around personal hygiene in 140 schools in 10 states. In the past year, these programs directly benefited 35,400 children, parents, and teachers (whereas some 46,100 others were indirectly benefited) by implementing our FRESH framework. In the upcoming year, Save the Children aims to conduct SHN activities in 29 model schools, resulting in a combined reach of 128 schools with significant support for 108 schools and 20 model schools in the cities of Mexico City, Quintana Roo, and Tabasco. We look forward to reaching at least 30,000 primary-school-aged children, parents, and others in the school community through our SHN activities.

Nicaragua

During the year, Save the Children presented its commitment to health and nutrition through the Race for Survival, in which approximately 420 children participated. Throughout Nicaraguan impact schools, Save the Children helped 17 schools attain improved water and sanitation facilities benefiting 2,092 children; developed protection codes in 20 schools that establish norms for ensuring emotionally and physically safe environments; and revised the curriculum for early childhood education centers for children with disabilities.

Tooth brushing training activity in Escuela Oficial Rural Mixta Huica municip-io de la Libertad, Huehuetenango, Guatemala. Photo by: Lilia Cifuentes / Save the Children

 

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Middle East and Eurasia

In the Middle East and Eurasia, Save the Children has SHN programming in 4 countries.

Armenia

Save the Children continued to improve school health and hygiene services and practices through the delivery of the Action for Child Health and Education (ACHE) project in four rural communities within Aragatsotn province. Through the ACHE project, in tandem with the WFP-funded Healthy Lifestyle Education project, Save the Children promoted healthy nutrition practices and behaviors among primary school children.

Within the scope of the ACHE project, Save the Children enhanced the quality of school hygiene facilities by improving the infrastructure of eight bathrooms in four rural schools in Aragatsotn province. We renovated all bathrooms, in which we supplied sanitary appliances and provided 24-hour running water and functioning sewer systems.

Two hundred sixty-three school students of different grades engaged in student council groups in an effort to raise awareness and advocate for better health, hygiene, and nutrition practices in their schools, homes, and communities. One hundred parents of school-age children from four communities participated in health seminars and 95 school teachers and managerial staff attended a one-day training on SHN. In an effort to promote this hard work, Save the Children developed, published, and distributed the Healthy Nutrition Manual to participating schools.

Egypt

Save the Children’s Sponsorship-funded programs continue to ensure that children and adolescents are educated and healthy through the delivery of sustainable interventions for children, their families, and communities. Save the Children’s SHN program reached 100% of Abnoub district’s 103 primary and preparatory schools, directly affecting 63,226 children (29,598 girls and 33,630 boys). The program also reached 11,445 adults, including social workers, the Board of Trustees, school officials, inspectors, headmasters, community leaders, and CDA (Community Development Association) members. The SHN program likewise scaled-up the implementation of its Health Education Manual and messages, reaching 551,424 students directly and 14,130 adults indirectly.

The SHN Egypt program also:

Decreased the rate of anemia from 55% in 2008 to 42% in 2012

Decreased the rate of parasitic infection from 4% to 1%

Increased the percentage of teachers who are capable of demonstrating nutrition sessions from 80% to 90%

Promoted extra-curricular activities that improved the school health environment for 65,000 children

Trained 850 social workers and teachers on health education

In addition, we made joint efforts with the Ministry of Education, utilizing Save the Children’s health education manual, to build capacity of social workers and disseminate health messages to primary school students. The program reached 100% of the 740 Assiut primary schools with health education messages regarding anemia, hygiene, and prevention of common childhood illnesses.

Iraq

An OFDA-funded WASH program focused on the rehabilitation of sanitation facilities and water supply systems in 53 schools. Additionally, the program supported information-sharing and training for relevant school personnel to maintain and repair their own facilities and systems. In tandem with these programs, Save the Children aimed to facilitate complementary, participatory child-friendly hygiene promotion and school clean-up campaigns. We trained Ministry of Education trainers, as well as Save the Children community mobilizers, to deliver key health messages to students with the following objectives:

Knowledge of how to prevent and manage diarrhea increased by 24%

Diarrhea prevalence reduced by 24%

Community awareness about safe water increased by 26%

Knowledge of proper water storage increased by 40%

Improper household solid waste management reduced by 24%

Good hand washing practices significantly increased to 68% of the beneficiary community

One of Save the Children’s facilitators leads a health education training on skin/cleaning hands in Iraq. Photo by: Seung Lee / Save the Children

 

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Yemen

In 2012, Save the Children, through WASH programs funded by UNICEF and CIDA, responded to emergency situations which were the result of an influx of IDPs from Abyan, Aden and Lahj. Through these programs, Save the Children reduced the rate of disease related to the lack of adequate WASH services and practices, specifically aimed toward children. We implemented the programs throughout eight schools in Aden and eight schools in Lahj for a total reach of 16 schools. In addition, IDPs and hosting communities from ten-quarters of Alhota city and Alsjoedeif village in Tuban district in Lahj also benefitted from these programs.

The Save the Children and UNICEF programs, which included the rehabilitation of WASH facilities throughout the 16 schools, reached 812 IDP households (894 women, 900 men, 636 girls, and 989 boys) as direct beneficiaries and an additional 18,592 schools students (1,075 boys and 1,082 girls) as indirect beneficiaries.

Under this program, other activities included:

Formation of 16 WASH committees consisting of men and women

Distribution of basic hygiene kits and monthly hygiene kits to IDP households

Conducting training courses on WASH, health education, and problem solving for WASH committees and Community workers

Holding weekly awareness sessions and cleaning campaigns for IDP children and their families

Building water points, hand washing facilities, and laundry accommodations for schools in need

Rehabilitation of latrines in schools while taking into consideration persons with disability needs

North America and Europe Italy

Save the Children implements a major program in Italy aimed at preventing the effect of poverty on children’s daily lives. One of these initiatives is “Ready, Set,

Go!” (2011-2013), a three-year program funded by Kraft Food Foundation, which focuses on reduction and prevention of obesity. The program targets 32,000 children between 6-10 years old in 10 cities with activities including promotion of healthy lifestyles and children’s rights to play, regular physical activity, and access to healthy food.

The “Ready, Set, Go!” Program has two parts:

To promote educational activities for children and their families in schools that stress the importance of healthy eating and physical activity as key factors for good general health

To renovate sport centers and playing fields in underserved areas close to schools, including parks, playgrounds, roller parks, and gyms. Access to activities organized in these facilities is free of charge. There are also summer camps with educators and trainers.

An impact evaluation of the program’s results will be conducted by the University of Rome to promote a large-scale strategy for rethinking urban spaces and making them child friendly.

United States

“Healthy Choices” is the physical activity and nutrition component of Save the Children’s afterschool and summer programs in the U.S., which also address

literacy and family engagement. Healthy Choices provides children with a healthy snack and 30 minutes of moderate-to-vigorous physical activity daily as well as a weekly nutrition education lesson. The goal of the program is to increase physical activity and healthy eating among participating children and their families. Healthy Choices uses the evidence-based Coordinated Approach to Child Health (CATCH) curriculum. The child-level outcomes measured are the aerobic capacity (fitness) and nutrition knowledge.

Save the Children began this health program in U.S. schools in 2005. Today, Healthy Choices operates in the afterschool environment in 15 states and the District of Columbia, serving more than 15,000 children in poor rural communities.

Save the Children staff member Lauren Faelh leads a group of students through a series of games and activities as part of the Save the Children Healthy Choices program at Augusta Elementary School in Augusta, Arkan-sas. Photo by: Susan Warner / Save the Children

 

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Using Mobile Technology in Interventions

In 2012-13, multiple projects used mobile technology to support implementation and evaluation. The purpose of using mobile technology was to make interventions more effective and make evaluations faster and more efficient. In 2012, the Bangladesh country office implemented an innovative school health project, in which teaching assistants (para-teachers) used portable mini-projectors to conduct weekly health education sessions for children in school.

This innovation made sessions more visual and more engaging. Other participatory activities supplemented the sessions to ensure the sanitation of school premises as well as sharing of health messages with the community. Evaluation of this project will take place in 2013.

Additionally, in 2013, the end-line evaluation of a WASH in Schools project in Indonesia and mid-term evaluation of the Sponsorship-funded program in Bangladesh used Tablet PCs to support data collection from students. In Bangladesh, the SHN program efficiently used resources by borrowing Tablets and enumerators from the Literacy Boost program to collect student Knowledge, Attitudes and Practice (KAP) information.

Program Learning Group, Nepal 2013

Save the Children’s SHN program is thrilled to announce our upcoming Program Learning Group (PLG) in Nepal, December 3-10. To maintain our continued level of quality programming, Save the Children regularly conducts PLG workshops on health and nutrition themes and sub-themes. PLGs provide opportunities to share best practices, explore challenges, and learn about innovative approaches. In 2013, our goal is to ensure that our SHN programs are the most effective by sharing top procedures and state of the art SHN implementation among program implementers, TA providers, Members, key partners, and donors.

Cognitive Toolkit Workshop

As the education sector and donors focus on improving learning outcomes of children, the need to highlight the importance of health and nutrition in improving children’s capacity to learn and its link to future learning outcomes becomes ever more important. Save the Children, in partnership with the Institute of Education in London and the London School of Hygiene and Tropical Medicine, with support from USAID and funding from Procter & Gamble, organized a two-day workshop where experts gathered from around the world to a) share their experience with cognitive assessments; b) recommend a set of cognitive tests based on agreed criteria; and c) recommend next steps to support the broader use of these tests in program design, monitoring, and evaluation. We look forward to participating in further cognitive tool workshops in the future.

SHN Community of Practice Save the Children focuses on growing a strong SHN community of practice. This community is dedicated to sharing experiences, expanding knowledge about school health and nutrition, and enhancing programming around the world. In 2012 and 2013, we have continued to strengthen our Facebook Group and our monthly webinar series. 

Facebook Group: The SHN Program Managers Facebook Group serves as a platform for SHN managers and other Save the Children employees interested in SHN living across continents and time zones to get to know each other and ask questions, give advice, or simply to share about their daily activities. Our membership has grown to over 100 people and continues to grow monthly. There are frequent posts of photos from events around the world, including SHN policy conferences and school health days. Other conversations revolve around sharing recent publications and observations of best practices for school WASH programs.  

Monthly Webinar Series: The webinar series has continued to enjoy success in 2012 and 2013. This series is open to the global School Health and Nutrition community, and provides opportunities to learn about current SHN topics as well as to share experiences and learning from ongoing programs. In 2013, we have alternated webinars about current SHN topics with Save the Children Country Office staff presenting the successes and challenges of their programs. Participants are also encouraged to continue the conversation after the webinar through the Facebook group.  

Thought Leadership

Participants at the SHN Program Learning Group in Tanzania, 2010. Photo by: Save the Children

 

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Partnership and Networking Events

Save the Children is part of a global network where our SHN practitioners are experts in many different fields. In an effort to disseminate knowledge, discuss complex challenges, and find sustainable solutions, the SHN team often attends health and nutrition events worldwide. Here are some of the events we took part in during 2012-2013:

School Health and Nutrition Short Course (Laos) Key staff from Save the Children International in China, Indonesia, Laos, Vietnam, and Bangladesh and each country’s respective government counterparts from participated in the Training Course on School Health & Nutrition Programs in Southeast Asia held in Vientiane, Lao PDR, 13-20 February 2013. The course was coordinated by the Partnership for Child Development, Mahidol University, and the Japan Consortium for Global School Health Research and hosted by the Government of Lao PDR.

Water and Health Conference, Chapel Hill, North Carolina, October/November 2012 Although Hurricane Sandy did not have a huge impact on North Carolina, it did prevent many participants and presenters from attending the 2012 Water and Health Conference: Science, Policy and Innovation, jointly organized by the Institute for the Environment and the Water Institute at University of North Carolina (October 29-November 2, 2012). However, the turnout was still significant. UNICEF led the WASH in Schools group with a special day dedicated to “WASH for All Schools – Maintaining the Momentum on the Call to Action for WASH in Schools” on October 29. Neera Sharma and Yadav Mainali from the SHN team in Nepal attended the

conference and presented on Nepal and Save the Children’s experience in scaling-up SHN programming to a packed audience, demonstrating the collaboration between UNICEF at headquarters and in the field.

Education Global Initiative Meetings: Jordan, December 2012 and Colombia, May 2013 The Education Global Initiative has been circling the globe with regional strategy meetings (Africa in November 2011 and Asia Pacific in March 2012) where SHN managers from the field represented programs. December 2-6, 2012, the Middle East and Eurasia Regional Education meeting was jointly hosted by Save the Children International Country Office in Jordan and the Education Global Initiative and attended by 53 participants from 18 countries, representing five different Save the Children members in Jordan. Presentations on SHN explained SHN’s role as a crucial sector in development and highlighted links to SHN’s role in education for children with disabilities.

May 6-10, 2013, Save the Children International Country Offices in Colombia and the education Global Initiative (EGI) Core Team jointly hosted the Latin America and Caribbean (LAC) Regional Education Meeting. Forty-eight participants attended the meeting (excluding external speakers and partners) from Save the Children country offices and members in 18 countries.

Neglected Tropical Diseases Meetings in Atlanta (February 2013 – STHAC), Geneva (July 2013 – WHO), and Bogota (May 2013 – PAHO) Seung Lee, Senior Director for SHN, was nominated to be a member of the Soil-Transmitted Helminthiasis (intestinal worms) Advisory Committee (STHAC) and attended her first STHAC meeting in February 2013 at the Task Force for Global Health in Decatur, Georgia, USA. STHAC is funded by Johnson & Johnson and GlaxoSmithKline, with Children Without Worms being the secretariat, working to maximize the use of pharmaceutical donations to control cases of Soil-Transmitted Helminthiases.

Natalie Roschnik, SHN Advisor, presented on behalf of the Nepal Country Office at a World Health Organization organized meeting on “Development and roll-out of a standardized district level Management NTD Training” on July 17-19, 2013. She highlighted the scaling-up of deworming in Nepal through various levels of training as well as the important role of NGOs.

Seung also made a presentation on the efficacy of using SHN as a platform for the delivering of SHN treatments at

Children present the importance of World Oral Health Day in Tajikistan. Photo by: Khairinisso Akhmedova / Save the Children

 

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a Pan American Health Organization organized conference in Bogota, Colombia from May 16-17, 2013. The second day’s meeting was titled “Intensifying Integrated Efforts for Control of Soil-Transmitted Helminthiasis in the Region of the Americas” followed by a 3-day workshop (May 13-15) to formulate country action plans.

Menstrual Hygiene Management (MHM) Consultations in New York (September 2012 – UNICEF), Geneva (March 2013 – WHO), and Kenya (July 2013, UNESCO) There are growing efforts around the world to address adolescent girls’ menstrual hygiene management (MHM) needs and SHN is a critical piece supporting these efforts. Save the Children shares its experience and collaborates with different partners to address this need. Seung Lee, Senior Director SHN, was a presenter on a panel titled “Approaches to addressing MHM for girls” at the MHM Virtual Conference organized by UNICEF & Columbia University on September 27, 2012 in New York. She discussed how the four pillars of SHN answer the needs of MHM. On March 8th, Natalie Roschnik shared the point of view of NGOs at the UN’s MHM Conference organized by WHO in Geneva.

Save the Children can pilot MHM activities to demonstrate and provide evidence for further scale-up of MHM programs. Seung Lee and Sarah Bramley, Senior Specialist SHN, participated in the UNESCO consultation at the International Technical Consultation on Menstruation Education (ME) and Menstrual Hygiene Management (MHM) and the Education Sector July 16-18, 2013 in Nairobi, Kenya. During the consultation, they visited a school supported by SC and its partners where girls spoke about their experience with MHM. At the UNESCO consultation, they also shared Save the Children’s early work in the Philippines (conducted with Emory University).

UNAIDS Inter-Agency Task Team (IATT) on Education As a steering committee member of the UNAIDS Inter-Agency Task Team (IATT) on Education, Seung Lee attended the Association of African Universities (AAU) and UNAIDS Inter-Agency Task Team (IATT) organized Symposium on: HIV and Tertiary Education: Prevention, Protection and Scholarship - A symposium on HIV education policy development and implementation in higher education institutions on February 4, 2013 in Accra, Ghana. She also chaired several sessions during the meetings following the symposium and spoke about the FRESH M&E framework.

Condolences On July 13, 2013, Save the Children’s country office in Honduras tragically lost three of its education team members in a fatal car accident. Their dedication and sacrifice to their work will always be remembered and revered by Save the Children’s global community.

Diana Rosario Ordoñez was born in Tegucigalpa, Honduras. Diana became part of Save the Children’s family as Education Program Director in November 2005. She had such a passion for her work—which has been highlighted by those she worked with—whether through trainings, exchanges,

field visits, or meetings. She enjoyed sharing the experiences that helped her grow both professionally and personally and was committed to educational development for children. Her greatest pride was her family; her children Gustavo, Ilyane and Josué, and her husband Gustavo Moreno. Diana was best known for spreading joy wherever she went; she was an exemplary member of Save the Children and her smile and energy will be truly missed.

Arles Wilberto Linares was born in Olanchito, Yoro, Honduras. Arles joined Save the Children’s family in October 2012 as a Training Facilitator on the “Teacher and Citizen Participation – EducAcción” Project. He loved being with his family and his goal was to give

the best to his children José and Karla, and to his wife María Mejía. Arles provided the best of the best to his colleagues. His desire to contribute to the improvement of quality education, his dedication to his work, and his dreams for his family are the character traits that will be remembered most about Arles.

Alma Iracema Flores was born in Orica, Francisco Morazán, Honduras. Alma joined Save the Children’s family in October 2012 serving as Community Facilitator on the “Teacher and Citizen Participation – EducAcción” Project. She was a selfless and dedicated member of her community who loved her children

Andres Eduardo and Carmen Daniela. She always encouraged her colleagues to approach their work with enthusiasm and dedication. She enjoyed her work and her commitment to protect the most vulnerable populations in Honduras will continue to be an inspiration. She will be remembered fondly for her strength, joy and courage.

 

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Save the Children’s School Health and Nutrition Program

Where We Work

Save the Children is the world’s leading independent organization for children, working in over 120 countries around the world. Our mission is to inspire breakthroughs in the way the world

treats children and to achieve immediate and lasting change in their lives.

Seung Lee Senior Director for SHN slee@savechildren.org

Sarah Bramley SHN Senior Specialist sbramley@savechildren.org Jacquelyn Haver SHN Specialist jhaver@savechildren.org Caroline Hilari SHN Senior Specialist chilari@savechildren.org

Jeanne Long SHN Specialist jlong@savechildren.org

Natalie Roschnik SHN Advisor nroschnik@savechildren.org

Mohini Venkatesh SHN Senior Specialist mvekatesh@savechildren.org

For more information about School Health and Nutrition programming at Save the Children, please contact:

54 Wilton Road, Westport, Connecticut 06880 www.savethechildren.org