School Health and Nutrition

Investments in school health are a strategic win-win for a country’s education and health sectors - and more critically - a win for children and adolescents.

Girls washing hands — Photo: Madagascar, Crystal Thompson, USAID

For the health sector, schools represent a cost-effective platform for reaching school-aged children with the interventions they need to achieve their human capital potential. For the education sector, delivery of health services and health sector investments ensures that a child’s poor health is not a bottleneck to learning, growth, and cognitive formation. For these reasons, investments in school health and nutrition are synergistic and essential to other educational investments focusing on quality and access. Moreover, school health sets the stage for children to thrive and become transformative agents in their communities.

Screenshot of video (click to read more)

Check out our toolkit on school health and nutrition: a set of multimedia microlearning products for health and education policymakers, practitioners and donors.

Go to the toolkit

What is School Health?

Broadly we can think about school health in terms of what is required for children to be healthy. One of the most well-known frameworks for making school health concrete and parsing it into major component areas is UNESCO’s Focusing Resources on Effective School Health (FRESH) framework. In this framework, there are four pillars of school health:

Policies. Are there national, sub-national as well as school policies that make children safe and signal a commitment to every child’s health?
School environment. Is the school environment safe and free from hazards? Is there clean water and other sanitation services?
Services. What sort of routine health services are offered at the school to students and are those appropriate and adequate for the students’ needs? Services vary and examples include school feeding, deworming, HIV/AIDS prevention education, treatment for malaria and routine screenings for vision and hearing, among others.
Education. Are students provided with age-appropriate information to empower them to take ownership over their health and well-being?

Illustration of a school in the center of a community — © Partnership for Child Development. Used with the permission of Partnership for Child Development. Further permission required for reuse.

What We Know About the Benefits of Strong School-Health Programs

Quite simply, healthy children learn better. For instance, certain conditions that are prevalent among school-age children and adolescents can impair cognition, attention span, and learning. To take one example, the average IQ loss for children with untreated worm infections is estimated to be 3.75 IQ points per child, and the average IQ points lost due to anemia is even higher. The good news is that most of these conditions are easily treatable. School-based health interventions in areas where these conditions are prevalent could result in 2.5 additional years of schooling for affected children.

Although the relationship between healthy children and able learners has been well-established, in practice many children remain inadequately supported. Prior estimates in low- and lower-middle income countries have found annual public spending for health for ages 5-20 is less than 3 billion USD. In comparison, public expenditure for education during the same age range is estimated to be more than 200 billion. Because health is a prerequisite for learning, these substantial educational investments likely fail to realize their true dividends as inadequate health serves as a constraint to learning and development.

The inadequacy of health investments for school-age children is being recognized more broadly. Furthermore, interest in SHN is more pronounced due to COVID, and school health has become a major priority action for building back schools, and not only in low- and lower-middle income countries.

Practitioner Spotlight

Kenya

Ministry of Public Service, Youth and Gender Affairs

In 2017 and 2018, the Ministry of Public Service, Youth and Gender Affairs established a national program to procure and deliver sanitary towels to 3.7 million girls in primary, special primary and secondary schools. The motivation for this large-scale effort came from the Republic of Kenya’s Constitution which enshrines a commitment to gender equality as well as the country’s Basic Education Act and Goal 4 of the SDGs. Research conducted by the World Bank estimated that adolescent girls in low and middle-income settings may be absent up to four school days out of every 28 days due to inadequate menstrual hygiene management (Mooijman et al., 2005). Not all research has found a clear link between provision of sanitary towels and school days missed. However, when attendance data are missing from school registries, simply excluding the missing data incorrectly minimizes any program effects. A recent randomized controlled trial that corrected for these problems in data collection from Kenya estimated a reduced effect while nonetheless confirming that provision of sanitary towels reduces absenteeism among adolescent girls by more than 5%. Despite some dispute on the magnitude of the effect, this program is clearly critical to to improving school attendance.

School Health and Nutrition in the News

March 2023 | Special Update

International School Meals Day: Launch of New Animated Video

Learning while hungry is nearly impossible. In honor of International School Meals Day, the Child Health Task Force developed a new animated video on the benefits of school feeding programs for children. School meals are one of the most effective non-teaching interventions to improve learning. They encourage children to attend school regularly and foster equitable opportunities to learn. Making these programs effective requires the support and input of many sectors, including education, health, and agriculture.

February 2023 | Webinar

Ready to Learn and Thrive: Sharing the School Health and Nutrition Global Status Report

The Child Health Task Force, UNESCO, and LSHTM co-hosted a webinar to mark the publication of the report Ready to Learn and Thrive: School Health and Nutrition around the World. Listen to the recording and access the presentation slides here on the website.

October 2022 | Webinar

School Health and Nutrition: Reach and Relevance for Adolescents

The Global Financing Facility (GFF) is hosting a webinar to launch a suite of tools designed to guide program planners through some of the key questions that arise in program development and investment prioritization to support adolescents in achieving their full potential. The event will engage the World Bank Task Team Leaders, technical bodies, and external funding agencies to discuss how these tools can be widely applied in practice. The programmatic briefs and Zoom link are available on the GFF website.

FAQ

Where can I read more about school health and nutrition?

There are many publications that succinctly describe the benefits of using the school as a platform for routine health service delivery, including the 2017 Disease Control Priorities, Third Edition chapter entitled Schools as platform for addressing health in middle childhood and adolescence and the 2011 World Bank Rethinking School Health publication.

USAID has produced two white papers examining the evidence and impact of school health interventions on human capital formation:

Operationalizing Health and Education Coordination, published in 2021, addresses the question: How do countries, practitioners, and development partners bridge the gap between knowing ‘what to do’ and ‘how to do it’ when it comes to school health. The report offers a menu of practical recommendations that can be applied across the programmatic cycle.
Human Capital Investments: The Case for Education and Health in Sub-Saharan Africa, published in 2020, specifically considers opportunities to reach school-age children and adolescents in Africa given the young demographic profile of the region.
Maximizing Human Capital by Aligning Investments in Health and Education, published in 2018, takes a global perspective in its analysis. It introduces human capital, its relevance to the Journey to Self-Reliance, and draws upon the Disease Control Priorities, Third Edition to provide examples of human capital interventions across the first two decades of life, spanning from early childhood to job entry.

The GFF developed a series of briefs to guide practitioners with designing, implementing, and monitoring school health and nutrition programs targeted to adolescents. The briefs include:

The World Food Program Regional Offices in Central/East, West, and Southern Africa commissioned three reports reviewing school-based interventions addressing the health and nutrition of school-aged children in each region.

Save the Children organizes a monthly webinar related to school health and nutrition. Learn about upcoming webinars and access past recordings here.

The Child Health Task Force Resource Library compiles relevant literature here.

What are the current key frameworks for the design, implementation, and monitoring of school health and nutrition programs?

Over the past two decades, international technical bodies have developed frameworks to support governments and partners to design, implement, and monitor holistic and integrated school health and nutrition programs at the national and sub-national levels.

The most commonly referenced frameworks include:

These frameworks can be applied at all points across the program cycle, meaning that implementers and funders do not need to develop standalone tools to design, implement, and monitor a school health and nutrition program. The use of these frameworks ensures that the program is cohesive, comprehensive, and equitable.

Where can I find guidance about delivering school-based health services during prolonged school closures?

In September 2020, WHO, UNICEF, and UNESCO summarized considerations for school-related public health measures in the context of COVID-19. This UNICEF document provides clear and actionable guidance for safe operations through the prevention, early detection, and control of COVID-19 in schools and other educational facilities. Guidance is also available in French, Spanish, and Arabic.

UNICEF, the World Health Organization and the International Federation of Red Cross and Red Crescent Societies published Guidance for COVID-19 Prevention and Control in Schools, with a series of supplemental content with practical guidance across domains ranging from implementation to the development of child friendly materials. These resources are also available in French, Portuguese, and Spanish.

Building on experience gained during the first year of the pandemic, the Global Financing Facility published an overview of approaches to sustain the delivery of school health and nutrition services in periods of school closures, while presenting considerations for the resumption of school-based service delivery upon reopening. The brief is also available in French.

For additional references on adapting service delivery to children during the current global pandemic, please cross-reference the Child Health Task Force toolkit on Understanding Child Health in the Context of COVID-19.

Stay up to date!

Join the Re-imagining the Package of Care for Children subgroup by subscribing to the Child Health Task Force to stay abreast of current initiatives related to school-age children and adolescents. In addition, refer to the WHO for the latest global guidance on health interventions targeted to school-age children and adolescent health and for global guidance on health promoting schools.

Have a spotlight to suggest? Want to ask a Question? Contact: childhealthtaskforce@jsi.com