1. WASH IN SC H OOLS:
Healthy to Learn and Learn to be
Healthy
Natalie Roschnik, School Health and Nutrition Advisor, Save the Children
GRF, Davos, One Health Summit, 18 November 2013
2. Save the Children: Where we work
Health and
Nutrition
Education &
Child
Development
Child
Protection
& HIV AIDS
Hunger and
Livelihoods
Humanitarian
response In 2012, Save the Children helped more than
125 million children in nearly 120 countries
3. WASH in schools
in 29 countries
(School Health and Nutrition)
Tajikistan
Armenia
Afghanistan
United States
(Domestic Programs)
Egypt
Pakistan
Haiti
Dominican Republic
Guatemala
Mali
Sudan
Yemen
China
Nepal
Bangladesh
Philippines
El Salvador
Burkina
Faso
S. Sudan Ethiopia
Vietnam
Kenya
Malawi
Bolivia
Mozambique
Indonesia
4. Outline
School age children and the education system
WASH situation in schools
WASH and girls education
The international FRESH Framework:
Healthy to learn, learn to be Healthy
Case study Mali
Menstrual Hygiene Management
Conclusion
5. Why focus on school age children?
They suffer from some of the
highest burdens of diseases
80% have
malaria
School age children represent
26% of the population in Africa
Which prevent them from
learning and contribute to
disease transmission in the
population
School children are great
agents of change within the
community
They are the parents and
leaders of tomorrow
65% are anemic
40% have hookworm
7. What schools have to offer
There are more schools than
health centers
A paid professional (usually)
workforce in daily contact with
school children and the
community
Children with willingness and
potential to bring change within
their households and capacity
School Management
Communities
Linkages with the health sector
7
10. Discrepancies within and between countries
and high drop out rates
69 million primary school-age
children out of school (UNESCO)
75-101 million children in school
are likely to drop out before
completing primary school
(UNESCO)
272 million school days lost each
year due to diarrhoea alone
(WHO)
2 out of 3 schools lack decent
toilets in the developing world
(UNICEF)
11. WASH situation in schools in Mali
Results from Dubai Cares funded WASH
in schools project in 6 regions
80% of schools have
latrines but only 12% have
separate latrines that meet
norms
48% have a water point but
only 7% are functional and
meet norms
32% have handwashing
facilities but only 8% have
water and soap
Only 5% of students were
observed washing hands
after leaving the toilet
21. FRESH Framework: an international framework
Focusing Resources on Effective School Health
At the World Education
Forum, Dakar, 2000
International Agencies
agreed that
School Health and
Nutrition is essential for
reaching Education For
All goals
and learning outcomes
22. The Four Pillars of
FRESH
Equitable School
Health Policies
WASH in
schools
(in 4 pillars)
Safe
Learning
Environment
Healthy to learn
and learn to be healthy
School based
School Based
Health and Nutrition
health and
nutrition services
Services
Skills based health
education
23. WASH in schools in Mali
• 1 400 schools
• 6 regions
• > 560 000 schoolchildren
24. Partnership and coordinator for scale up
Interagency
Steering
Committee
Coordination
Unicef
Care
Oxfam
- Interangency project coordinator
- interagency MEL coordinator
Save
WaterAid
- Project coordinator
- Project coordinator
- Project coordinator
- Project coordinator
- Project coordinator
- Focal point ‘hard’
- Focal point ‘hard’
- Focal point ‘hard’
- Focal point ‘hard’
- Focal point ‘hard’
- Focal point ‘soft’
- Focal point ‘soft’
- Focal point ‘soft’
- Focal point ‘soft’
- Focal point ‘soft’
- Focal point ‘MEL’
- Focal point ‘MEL’
- Focal point ‘MEL’
- Focal point ‘MEL’
- Focal point ‘MEL’
25. Common infrastructure norms
FAC ADE PR INCIPALE
Norms:
Distance to the classrooms (20-30m), to waterpoint (minimum
15m) etc.
31. Conclusions
School Health and Nutrition = Healthy to Learn
and Learn to be Healthy
WASH in schools is part of School Health and
Nutrition
It’s a partnership between education and health
sector
SHN important for Education and Health
It is especially important for girls education
Let’s not forget Menstrual Hygiene
Management (MHM), part of WASH in schools
I am going to talk to you about WASH in schools, and School Health and Nutrition more generally which is a partnership between the health and the education sector to help advance the goals of both sectors.
But before that let me tell you about Save the Children and why I am here today:Save the Children which used to be made up of 29 separate organisations is now one organisation with a common mission and strategies, reaching 125 million children in nearly 120 countries with multisectoral programs which aim to bring positive lasting change to children and their families.Our strategy to bring lasting change (our theory of change ) is to build evidence, use the evidence to advocate for and then support scale up through partnership with governments and other implementing and research agencies
The reason Save the Children was asked to speak today is that we are one of the leading international agencies supporting the implementation of School Health and Nutrition programs. WASH in schools is one key element of School Health and Nutrition. Our SHN programs now reach nearly 30 countries around the world.Today I will talk to you about health programming within the education sector (SHN), specifically WASH in schools to show why it is important for both the health and education sector, yet is often not prioritized. And why it is important for girls education most importantly
School age children are not typically a priority for the health sector because they are less at risk of dying.. Yet they do representat a School age children represent a large portion of the population, which is mostly ignored by the health sector because they are not at a high risk of dying. They are the survivors.Yet they have amongst the highest burdens of disease (often invisible) which is preventing them from participating and learning in school and is contributing to disease transmission in the community. For example, school age children have the highest rates of intestinal worms, bilharzia and malaria, and high rates of anemia. They are least likely to seek and get treatment because they have developed immunity and are not ‘visibly’ sick. Here is a primary school class in Mali. Based on survey results in this area, in this class, 80% are likely to have malaria parasites in their blood (with no symptoms), 40% hookworm and 65% anemia. Many will also have diarrhea or may be hungry because they came to school without breakfast. All of which are not “visible’ But are preventing them from concentrating and learning.
Schools have a paid (usually) professional workforce and there are more schools than health centers. Schools therefore provide a great opportunity to bring behavior change amongst school chidlren and their non enrolled peers and families.
Bearing in mind a few challenges e.g. this first grade class in Malawi, wih 450 children enrolled and 200 present on this day – with one teacher!
Here is the situation in a country like Mali. These are the results from a baseline survey for the Dubai Cares funded WASH in schools project which is being implemented by 5 agencies, including Save the Children. The map shows the percent of schools with separate improved latrine facilities by region. Most schoolsactually have latrines, water points and evenhandwashingfacilities but they are inadequate. (seebullets)
Kids, especially small ones are often scared of using the latrines for different reasons e.g. the hole is too big and they are scared of falling in. There is nothing to hold onto, the latrine rooms are smelly and dirty
The impact on girls is particulary bad, especially when they are menstruating. Impact on education (notes from Brad Kerner Sarah Bramley presentation)Adolescent girls face particular challenges in the school environment. Poor water supply and inadequate sanitation facilities to allow girls to handle their menstruation with dignity, can all contribute to an uncomfortable learning environment for girls. Inadequate sanitary protection materials may lead to blood leaking and staining clothes causing stress and the fear of teasing by boys. Teachers, particularly male teachers, may not be aware of how to support girls to manage menstruation, and may even refuse girls’ requests to visit the latrine and making them stand up when answering questions. A number of studies report that such factors result in girls missing school during their menstrual periods and can even be a contributing factor to some girls dropping out of school. Recent studies have also indicated that child survival is more closely linked to their mother’s education level than their poverty level, so contributing factors which reduce educational opportunities for girls potentially have wide ranging implications to my sector, the health sector Gakidou, E, Cowling, K, Lozano, R, Murray, C.J.L (2010) Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis, Lancet 2010, 376: 959–74
53 seconds: Tadala Interview explaining how she misses around 5 days per month of school when she menstruates
So what is the solution? How can the health and education sector work better together to improve the health situation in schools.At the World Education Forum in Darak in 2000, international agencies agreed that School Health and Nutrition (which includes WASH in schools) is essential for achieving education for all goals and improving learning outcomes.
The Dubai Cares funded WASH in schools program is a great example of a partnership to improve WASH in schools at national level. It reaches 6 out of the 9 regions of mali, 1400 schools and over half a milion children
With a strong community component through Community Led total sanitation, a highly effective method to get community commitment and action to improve the WASH situation both at school and community level. This has been particularly successful in Mali.