Y E AR 2 01 1 - 201 2
ISSUE 8
WHAT IS SCHOOL HEALTH AND NUTRITION?
UNAIDS IATT ON EDUCATION S YMPOSIUM
MALARIA IN SCHOOLS IN MALI AND MALAWI
FRESH MONITORTING AND EVALUATION
PARTNERSHIP WITH WRIGLEY FOUNDATION
WORKING WITH SPONSORSHIP …………….
SAVE THE CHILDREN’S SHN COMMUNITY OF
PRACTICE..…………………………………
SHN AND ECD T OOLKIT…………………….
COUNTRY UPDATES………………………….
ASIA………………………………………...
AFRICA……………………………………..
LATIN AMERICA……………………………
MIDDLE EAST………………………………
NORTH AMERICA…………………………..
LOOKING FORWARD………………………….
PARTNERSHIP AND NETWORKING EVENTS…
WHERE WE WORK .... ……………………….
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School Health and Nutrition: Program Update
Supporting school-age children to be healthy to learn and to learn to be healthy
Dear Colleagues,
It has been another year of growth and changes for Save the
Children and the School Health and Nutrition (SHN)
community. In 2011, Save the Children reached over 4 million
children directly and an additional 7 million children indirectly
with critical health and nutrition services for school-age children.
There are many key issues and programs to highlight in 2011 and
2012. The global health sector has been focusing its attention on
Neglected Tropical Diseases (NTDs) for many years, which has
led to commitments from GlaxoSmithKline (GSK) and Johnson
& Johnson (J&J) to provide free deworming tablets (albendazole
and mebendazole) to treat all children in need. Save the Children
and our partners will work to ensure that all children who we
serve and need to be treated, will be able to take advantage of
the global commitment to conquer NTDs.
This year Save the Children and our partners in the education
sector also looked at how HIV/AIDS is addressed in the sector
and recognized the critical structure that SHN can provide for
HIV/AIDS prevention and services in schools.
As Save the Children continues to lead in SHN, we are
constantly looking to improve interventions to address critical
needs. In 2011, school-based malaria control and oral health
(including tooth-brushing and anti-smoking) activities were
introduced to several countries with support from Sponsorship
funding and Wrigley Foundation. Our work with WASH in
schools partners, especially UNICEF, was also strengthened
through continued collaboration.
In addition to primary school-age children, we are working with
key partners to increase and improve health and nutrition
services for children in Early Childhood Development (ECD)
programs and secondary schools, especially for adolescent girls.
The SHN and ECD teams are supporting countries to pilot new
approaches combining ECD and SHN. We are also working with
the Adolescent Reproductive and Sexual Health (ARSH) Team
for Very Young Adolescent (VYAs) and Menstrual Hygiene
Management (MHM). This program update will give you a
chance to learn more about these topics and activities in our
countries. Hope that it is useful.
Seung Lee, Senior Director for SHN, October 2012
Cover photo: Tirunesh Sisay in her classroom in Jemjem, Ethiopia. Photo by Susan Warner.
© 2012 Save the Children
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What is School Health and Nutrition?
School Health and Nutrition (SHN) addresses the critical
health and nutrition factors 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 environment.
 Promote life-long healthy behaviors through skills-based and
child-focused health (including HIV) education.
 Increase access to health and nutrition services for schoolage children.
Students collecting water for hand washing in Tajikistan. Photo by
Chris Martin.
The success of a SHN program also hinges on effective
partnerships between education, health, and other sectors, as
well as with communities and with children. All programs
require support from all levels, from schools and communities
to the national level.
The day was fruitful and contained many insightful discussions
on the different linkages between HIV & AIDS and education
and SHN and how to strengthen them to be more effective.
The symposium report can be found on the UNESCO website
(http://www.unesco.org/new/fileadmin/MULTIMEDIA/HQ/
ED/pdf/IATT%20Symposium%20report_Final.pdf)
UNAIDS Inter-Agency Task Team (IATT) on
Education Symposium
On November 30, 2011, the American Institutes for Research,
FHI360, the Global Partnership for Education, Save the
Children and the World Bank co-hosted the UNAIDS InterAgency Task Team (IATT) on Education Symposium on HIV
& AIDS and education and school health and nutrition (SHN)
in Washington, D.C.
Malaria in Schools in Mali and Malawi
Children under the age of five and pregnant women are the
primary targets for most malaria control programs. These
populations experience the most acute symptoms of malaria,
and cases are more likely to result in mortality. However,
school-aged children are the highest carriers of malaria
parasites. They may not suffer as frequently from acute
symptoms, however, malaria in this age group may result in
anemia and poor cognition leading to lower education
outcomes than healthy children. As national governments
move towards universal coverage of malaria control strategies
and malaria elimination, school-age children who represent
around 25 percent of the population in Africa, can no longer
be ignored by national malaria control programs.
The symposium, “Can We Be More Effective? Strengthening
Linkages between HIV & AIDS and Education and School
Health and Nutrition,” convened members of the IATT to
review, identify and discuss existing practices, opportunities
and challenges for improving the efficiency and effectiveness
of education sector responses to HIV & AIDS by
strengthening linkages with school health and nutrition.
Symposium participants:
 Explored the conceptual and practical synergies between
With support from the London School of Hygiene and
Tropical Medicine (LSHTM) and Kenya Medical Research
Institute (KEMRI), in partnership with national research
institutes and Ministries of Health and Education, Save the
Children is conducting studies in Mali and Malawi to build the
evidence for malaria control in schools. The research will
contribute to a small but growing evidence base showing
benefits on both health and educational levels and will guide
national malaria and school health policies.
HIV & AIDS programming and SHN programming;
 Shared experiences of integrating HIV & AIDS-related
activities and SHN into education systems;
 Discussed how to measure impacts and outcomes of SHN
and HIV and AIDS programming;
 Learned how existing policy priorities and frameworks
support the integration of HIV & AIDS activities and
SHN into education systems.
© 2012 Save the Children
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Mali
The baseline survey conducted in November 2010 showed
that a staggering 80 percent of children had malaria (mostly
asymptomatic) and 65 percent were anemic. Meanwhile, only
42 percent reported sleeping under a bed net the night before
the survey. To address the incredibly high rates of malaria and
anemia in this age group, Save the Children, in collaboration
with LSHTM and KEMRI Welcome Trust and in partnership
with the Institut National de Recherche en Santé Publique
(INRSP, National Research Institute for Public Health), the
National Malaria Control Program, and Ministry of Education
in Mali, conducted a study (a cluster randomized trial) to
evaluate the impact and cost effectiveness of three schoolbased malaria control interventions: 1) a school based
distribution of Long-Lasting Insecticide Treated Nets (LLINs);
2) malaria prevention education using participative teaching
approaches to link learning at school with action at home; and
3) Intermittent Parasite Clearance (IPC) treatment of all school
children regardless of infection once a year during peak malaria
season.
Save the Children staff member and a nurse examining 14-year-old
Lonney Steven who is sick with malaria in Malawi. Photo by Michael
Bisceglie.
Teachers provide mass treatment for malaria
In November 2011, the end of the peak season for malaria and
the beginning of the school year in Mali, all children in the
intervention schools were given a full course (one treatment
per day for three days) of Artemisinin Combination Therapy
(Artescope) to clear all the malaria parasites from their blood.
This exercise was the first time teachers were responsible for
providing the treatment and the experience showed that they
are not only capable (if adequately trained), but they have the
trust of the community and children to do so. Preliminary
results show that children remained clear of malaria until the
end of the school year (May-June) and the prevalence of
anemia is substantially reduced following treatment, which
suggests that IPC is potentially a highly cost-effective
intervention for schools in this region.
Schools distribute and promote the use of mosquito nets
In April 2011, a school mosquito net distribution campaign
was conducted in 40 intervention schools. Teachers and
children prepared songs, role plays and demonstrations for the
entire community to make the day a ceremonious one and take
the opportunity to promote the use of mosquito nets by all
community members. Each schoolchild received two LLINs,
providing, in effect, mosquito net protection to at least 4
children, since the nets were large. The school-based campaign
coincided with the roll out of the universal mosquito net
distribution campaign organized by the National Malaria
Control Program across the study communities, thereby
minimizing the comparison group effect. Nonetheless, results
from a household survey conducted in August 2011 and the
mid-term survey in November 2011 suggest that the school
can play an important role in promoting use of nets alongside
a national mosquito net campaign, and distribute nets where
no national campaign is planned.
The full results of the Mali study will be available at the end of
2012 and shared with partners in Mali and the sub-region to
help guide future malaria control and school health
programming in the Sahel.
Malawi
Save the Children is conducting a similar study in Malawi in
partnership with the LSHTM, KEMRI Welcome Trust, the
Malaria Alert Center, the National Malaria Control Program
and the National School Health program under the Ministry of
Education to evaluate the impact and cost effectiveness of
school based diagnosis and treatment of malaria. A needs
assessment/baseline survey conducted in April 2011 in 50
schools in Zomba district found that 60 percent of children
had malaria (mostly asymptomatic) and 32 percent were
anemic. These results were presented in a national
Left: 4-year-old Lasana and Boubacar Sandougou wash their hands
before lunch at a school in Ifola, Mali. Photo by: Joshua Roberts.
© 2012 Save the Children
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stakeholder’s meeting in May 2012 and the recommendation
was to reintroduce Pupil Treatment Kits (PTKs), a school
health kit to treat common health problems, including malaria,
at the school.
FRESH Monitoring and Evaluation Framework
The Save the Children SHN team has been working for the
past several years with other Focusing Resources on Effective
School Health (FRESH) partners to develop an internationally
agreed monitoring and evaluation guidance for school health.
The guidance is based on the international FRESH Framework
launched at the Dakar World Education Forum in 2000. The
guidance has two main parts:
Teachers will diagnose and treat malaria
PTKs were originally piloted by Save the Children in 100
schools in Mangochi District and scaled up nationwide by the
national School Health program in 2006. Unfortunately, when
the malaria drugs changed from Sulfadoxine Pyrimethamine
(SP) to ACT and became prescription only, teachers were no
longer allowed to provide treatment and malaria drugs were
removed from the PTKs. Malaria diagnosis and treatment has
now become more acceptable to non health professionals and
the national malaria control and school health programs are
keen to reintroduce PTKs training teachers to diagnose and
treat malaria in schools. Unlike Mali, mass treatment of malaria
without diagnosis is not a feasible solution in Malawi where
malaria transmission is year round. PTKs will not address
asymptomatic malaria but will provide immediate treatment to
Part 1 recommends eight core FRESH indicators (two per
FRESH pillar (see page 2) to assess national-level progress
towards the achievement of a comprehensive school health
program. The core indicators allow countries to score
themselves in relation to internationally agreed standards for
school health (based on the principles of FRESH), identify
strengths and weaknesses in their national school health
programming which in turn can help identify areas to
strengthen and improve in future. These eight core indicators
were developed by FRESH partners and will be pilot tested by
FRESH partners in the field during 2012-2013.
Part 2 is a menu of school health-related indicators organized
by health topic drawn largely from existing guidance or
developed by technical working groups. The purpose of this
menu of indicators is to facilitate project-level selection of
monitoring and evaluation indicators across health topics. For
example, if a broader education program with elements of
SHN (e.g. WASH and deworming) is seeking indicators
specifically focusing on these school health concerns, this
guidance can be used to select relevant indicators from the
WASH and deworming indicator pages. It will avoid searching
through general WASH and deworming-specific guidance to
find the relevant indicators. The health topics covered in this
guidance include: HIV/AIDS; sexual and reproductive health;
water, sanitation, and hygiene; worms; malaria; food and
nutrition; physical activity; oral health; eye health; hearing;
substance abuse; disaster risk reduction and sustainable
development; violence in schools; prevention and response to
unintentional injuries; and immunization. In each case, a
reference for more information is provided.
First graders wash up as part of school health program in Bolivia.
Photo by Michael Bisceglie.
children at school and thereby reduce the number of days they
are absent from schools due to malaria.
The research design is a cluster randomized trial, whereby 50
schools will be allocated to either receive PTKs or not for one
school year and both groups will be compared on health and
educational outcomes as well cost effectiveness.
A draft version of the guidance will be posted on the
UNESCO website by the end of 2012 to undergo a broader
review and pilot testing of the core indicators. Save the
Children has been actively involved throughout the
development of this guidance, alongside other FRESH
partners, including American Institutes for Research (AIR),
Child-to-Child Trust, Education Development Center (EDC),
Education International (EI), Partnership for Child
Development (PCD), UNESCO, UNICEF, UNODC, WHO,
World Bank.
In October 2012, teachers from 25 intervention schools will be
trained to implement the PTK, which means identifying,
treating or referring children with health problems directly at
school. This will include using Rapid Diagnostic Tests to test
children for malaria and then provide a full treatment course.
Focus group discussions conducted amongst teachers, parents
and community members in August 2012 found that there was
great support for this intervention and general acceptability for
teachers to take on this role.
© 2012 Save the Children
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Partnership with the Wrigley Foundation
In 2011, Save the Children and the Wrigley Foundation
launched its partnership with a $3,000,000 grant to fund
School Health and Nutrition programs in six countries. This
exciting partnership provides funding for two and a half years
to expand SHN programs in China, the Philippines, Indonesia
and Tajikistan, and to start two new programs in Vietnam and
Kenya. The Wrigley-funded programs provide comprehensive
school health and nutrition activities to over 260,000 children
in approximately 478 schools. These programs also have a
special focus on oral health, which is a growing priority for the
Save the Children’ School Health and Nutrition programs
globally.
Sponsored girl, Delwara with her mother and younger brother. Photo
by Bangladesh CO.
A special component of the partnership is the Wrigley
Company’s commitment to employee engagement. Wrigley
staff associates are volunteering their time and special skill sets
to help Save the Children expand our reach. For example,
some Save the Children programs are calling on associates to
paint key health messages in school compounds. Other
associates are volunteering and providing funding to expand
water and sanitation services in schools.
scale. Sponsorship program have recently supported
innovative approaches to addressing malaria through SHN
programs. Both the Mali and Malawi country offices have
elected to use some of their Sponsorship funding to help
develop, implement and evaluate these potentially highly cost
effective interventions (see page 2 for details).
A Sponsorship conference was held in Antalya, Turkey in
October, 2011 and included participants from all countries
with Sponsorship-funded programs as well as from Save the
Children members supporting Sponsorship. This was an
excellent opportunity for countries to share their experience
and successes, including the innovations around malaria
treatment in schools which generated significant interest.
Save the Children and the Wrigley Foundation are committed
to providing high quality programming to improve students’
health and well-being. By working together, we hope to
leverage the special skills from both organizations to enhance
program quality and scope.
As all the country offices move into Save the Children
International (SCI) in 2012, Save the Children US will retain
leadership with Sponsorship-funded programming. However,
the move to SCI offers the potential to leverage additional
funds and support more programming. Save the Children Italy
and Save the Children Korea have both become active
supporters of Sponsorship programming by identifying
sponsors in their home countries with funds used to support
core programming. This additional support enabled a new
Sponsorship program to launch in Zambia in 2012. This
program will include SHN in the near future.
Working with Sponsorship
Child Sponsorship funding remains a core source of support
for School Health and Nutrition programs globally, supporting
programs in 17 countries. SHN is one of the four core
Sponsorship programs at Save the Children, along with Basic
Education, Early Childhood Development and Adolescent
Development, with HIV as a cross-cutting core program area.
Sponsorship funding supports community-based programs
that serve all children in impact areas. While a limited number
of children participate directly as sponsored children who
communicate with sponsors in the US or other donor
countries, all the children in the impact area benefit from the
programming.
Save the Children’s School Health and Nutrition
Community of Practice
Sponsorship programs run for approximately 10 years in each
impact area and offer an opportunity for long term,
comprehensive education and health programming, and are an
excellent source for innovation within our programs.
Interventions and programs initiated and piloted with
Sponsorship funding are frequently used to leverage additional
funding from other sources to take these programs and
interventions which have been proven to work in country to
© 2012 Save the Children
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 2011, with the increased reach of new media
platforms, we aimed to develop conversations rather than only
pushing information out. In addition to listservs, we have
added both a monthly webinar series and a Facebook group,
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SHN team contracted an SHN expert to develop a clear set of
lessons with objectives and teaching methods. When finished,
this compilation will be available for country offices to adapt
and use in their programs. The lessons will exemplify childcentered activities and focus on key health behaviors such as
hand washing, latrine use or sleeping under a mosquito net.
These lessons will be a critical element of the SHN
Implementation Toolkit which includes: The SHN Common
Approach Module; the SHN Operational Manual; and the
Model KAP Questionnaire.
Micronutrient Supplementation Guidelines for Schools
Vitamin A and iron are two of the most important
micronutrients needed for optimal physical and mental wellbeing, and have been administered to school
children alongside deworming by Save the Children for nearly
15 years. Until recently there were no internationally
recognized guidelines for supplementation in the school-age
group. This gap has been a barrier to successful
implementation. To address this gap, Save the Children
contracted two lead nutritionists in the school health field, to
review the existing evidence and make recommendations for
vitamin A, iron and multi-micronutrient supplementation for
school-age children. The paper is in its final stages and will be
peer reviewed and then published through the United Nations
Standing Committee on Nutrition (UN/SCN) working group
for school-age children electronic-group. In 2011, WHO also
published a guideline recommending intermittent iron
supplementation in preschool and school-age children where
the prevalence of anemia is 20 percent or higher. This
guidance is based on a Cochrane review of intermittent
supplementation studies amongst children under 12 years of
age. Both are available on: www.who.int/nutrition/
micronutrients/guidelines.
Students danced, recited poems and gave performances to
demonstrate their knowledge of health and hygiene practices.
Khuroson, Tajikistan. Photo by Chris Martin.
with the intent of promoting dialogue about SHN.
Facebook Group
The School Health and Nutrition Program Managers Group
provides a safe space for program managers and other Save
the Children staff interested in School Health and Nutrition to
engage in conversations about their programs. It serves as a
platform for members 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. Recent
conversations included comparing notes on how to test for
iodine deficiency in school children and sharing photos of staff
members’ dedication to work through floods.
Monthly Webinar Series
The School Health and Nutrition team in DC launched a
monthly webinar series in the fourth quarter of 2011. The
webinar series responds to program managers’ desire for a
learning platform, as expressed at the 2010 Program Learning
Group meeting in Zanzibar. Each hour-long webinar features
an expert speaker and highlights two Save the Children
programs. The webinar series is open to the global School
Health and Nutrition community, and provides opportunity to
learn about current SHN topics, as well as to share experiences
and learning from ongoing programs. Participants are
encouraged to continue the conversation after the webinar
through the Facebook group. Past webinars are recorded and
housed at: www.schoolsandhealth.org.
SHN and ECD Toolkit
As Early Childhood Development (ECD) programming gains
momentum, the need to address the health and nutrition
aspects of ECD is required. Save the Children, with its
extensive experience in SHN, Maternal and Child Health and
ECD often implemented concurrently, is in a unique position
to develop a health and nutrition package for ECD programs.
The SHN, ECD and child survival teams are supporting a
number of countries to develop and pilot health and nutrition
interventions within the ECD context. These include Pakistan,
Mali, Malawi, Zambia, Indonesia, El Salvador, Bolivia and
Bangladesh. A comprehensive health and nutrition strategy for
ECD was drafted for Malawi, which can be adapted to other
countries. Lessons and recommendations from each of these
countries will be gathered and used to develop a generic toolkit
for integrating health and nutrition in ECD, Meanwhile the
ECD team is working with the Child Survival team to integrate
Participatory Health Education Curriculum in
Development
A key element of SHN programming is skills-based,
participatory health education, which is delivered by trained
teachers to students. In the past, countries have implemented
health lessons by adapting and using existing curricula. Based
on these lessons and the latest on child participation methods,
as well as to responding to requests from country offices, the
© 2012 Save the Children
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152 more CFHE groups in Kabul and Parwan. Along with
receiving trainings on diarrhea, cough and cold, intestinal
worms, hand washing and safe water, the CFHE groups also
organized campaigns after completion of each module and
through these campaigns 14,145 students and out of school
children, both boys and girls, received deworming pills. The
SHN team also established “Health Walls” in 28 schools
through which the health messages were disseminated to all
children.
Bangladesh
In Bangladesh, the SHN program has been expanding by:
increasing access to school-based health services and practices;
creating a healthy school environment by providing separate
toilets for boys and girls; and providing safe drinking water
and water for hand washing. In 2011, through three projects,
the SHN program reached 347,921 children (out of 351,590,
ECD concepts into maternal and child health programming.
Country Updates
Asia
Afghanistan
Afghanistan continues to be a challenging environment for
children, with widespread drought and ongoing conflict. In
2011 and 2012, Save the Children continued implementing
SHN programs in Faryab, Sar-i Pul, Jarwzjan, Bamyan, Kabul
and Parawan Provinces. In total, the programs reached over
60,000 with a broad spectrum of funding sources. Funding
sources include: Sponsorship, Bulgari, Japan Platform (JPF),
and Al-Khalifa.
SHN programs in Afghanistan address all four SHN pillars.
Health education is accomplished through Child-to-Child
methodology in schools and with Child Focused Health
Education (CFHE) working through community-based
groups. Child-to-Child classes and CFHE groups were
expanded in Saripul and Faryab. Important school-based first
aid and vision and hearing screening programs were added to
eight more schools in the Sponsorship-funded program in
Faryab. Wells and latrines were also constructed or
rehabilitated in key schools through Sponsorship.
The SHN program funded by Bulgari also covered 22 schools
in Faryab, 20 schools in Saripul and 18 schools in Jawzjan
provinces. Both in-school and out-of-school children attended
51 Child Focused Health Education (CFHE) groups and
learned about nutrition, diarrhea, vaccination, cough and cold
and intestinal worms.
The SHN program supported by the Japanese Platform
funding in Bamyan province covered six schools with the
entire SHN package. Al-Khalifa Foundation-funded SHN
programs also continued until June 2011 and helped establish
A group of primary school-age boys tussle over a slippery bar of soap while
washing their hands as part of the School Health and Nutrition program in
Bangladesh. Photo by Jeff Holt for Save the Children.
i.e. 99 percent coverage) with at least twice a year deworming
and vitamin A supplementation; annual iron supplementation
and vision screening; and increased awareness on hand
washing with soap.
In 2011, the Shishuder Jonno Sponsorship-funded project
reached 48,298 children by expanding services to one more
sub-district, thus increasing coverage by 27 percent. Nutrition
education/counseling using nutrition chart for stunted and
wasted children and their parents was a new initiative.
PROTEEVA (Promoting Talent Through Early Education), a
USAID-funded education project, reached 153,526 children in
630 primary schools and 1,260 pre-primary schools across 21
districts and 49 sub-districts. Along with the Meiji Gakuin
University from Tokyo, Japan, the project also launched a
Randomized-Controlled Intervention and Evaluation of an
Children act out the importance of drinking water from safe and
trusted water sources. Kabul Province in Afghanistan. Photo by:
Shakirullah Akhtar.
© 2012 Save the Children
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workshops were organized through parents associations in
schools, and child-led health promotion activities among peers,
siblings and community members were organized around key
global moments such as Global Hand Washing Day, World
Health Day, and Children’s Day.
Innovative School Health and Nutrition Education (ISHNE)
project for Primary Schools in rural Bangladesh in June 2011.
The study collaborates with the Ministry of Primary and Mass
Education and the Directorate General of Health Services.
SHIKHON, a non-formal education program funded by the
European Commission and Dubai Cares, reached 146,097
children in 2011 in 5,180 schools. Iron supplementation was
also conducted in 1,670 Dubai Cares-funded schools. In
addition, 131,789 participants (children and adults) from
SHIKHON project areas observed Global Hand Washing
Day.
Field experiences have been successfully leveraged wherever
possible to achieve results at scale. Save the Children
In addition to its activities in schools, the SHIKHON program
worked in communities to mobilize parents and families for
ensuring children are dewormed, and that they have access to
safe water and sanitation in school. Video showingsfor health,
nutrition and hygiene awareness took place at 100 locations
reaching over 5,000 people; four water treatment plants were
installed in four highly contaminated villages to provide arsenic
-free water to 800 children and families; and five billboards
with arsenic messages placed in five locations in Meherpur
using funds from Stemcor. The SHN program also
successfully led a process of country mapping for WASH in
schools along with Government of Bangladesh and UNICEF.
P&G volunteer Karwin Lau serves lunch to migrant school children
in Shanghai, China. Photo by Lynn Spreadbury.
collaborated with leading universities in Beijing and Shanghai
to publish and widely disseminate a national school health
education teaching reference book, as well as a teaching aid
book on participatory school health education.
The Bangladesh office completed a randomized control trial
which evaluated the effect of multiple micronutrient
supplements on health and educational outcomes, a study cofunded by Save the Children and Sight and Life, with technical
support from Nutrition Works and Harvard University. The
results have been submitted for publication in a peer reviewed
journal.
Save the Children also celebrated its successful advocacy
efforts in Shanghai that brought about a new policy issued by
the local government in June 2011 to implement free school
health services for 162 migrant schools. 150,000 children now
benefit from improved health education and health facilities in
Shanghai as a result. A national forum on school health
promotion for migrant children also took place in June 2011 to
promote Shanghai’s successes in other parts of China.
China
In 2011, Save the Children’s SHN projects in China directly
reached 28,804 children in migrant communities of Shanghai
and Guangzhou, as well as in rural areas of Tibet and
Yunnan. Migrant children have continued to be an important
target group for SHN programming because China has over 27
million migrant children, the majority of whom don’t qualify
for residency permits in urban areas, and therefore have
limited access to local basic services.
Indonesia
In 2011, Save the Children commenced a WASH in Schools
project called WASH in Schools Empowerment (WISE) in
eastern Indonesia. Funded by Dubai Cares, the project is
implemented by a consortium of three development agencies
(Save the Children, CARE and UNICEF), together with the
Government of Indonesia. Over a two year period the project
is expected to reach 450 schools in four poor and remote
provinces—West Papua, Papua, Nusa Tingarra Timor, and
South Sulawesi. The overall objective of the project is to
contribute to the well-being of children through sustainable
and scalable integration of water and sanitation facilities and
promotion of hygiene in primary schools. This objective was
achieved through: design and construction of cost-efficient,
Key health education and promotion activities were delivered
both in urban and rural settings, and were not only focused on
improving the knowledge of students, their schools and
families, but also on building teachers’ capacity to improve the
quality of health education. In 2011, 480 primary school
teachers received training on participatory health education
methods, and 50 school health teachers received training to
provide better services for children. Promoting healthy and
hygienic behaviors for caregivers has also been a focus in 2011:
© 2012 Save the Children
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low-technology sanitation facilities in schools; hygiene
promotion in schools and communities; improving the
capacity of school and community to create an enabling
environment for improving sanitation; systematizing support
for school health and hygiene from the national government;
and monitoring, evaluation, learning, and sharing of best
practices. In 2011, Save the Children conducted a Knowledge,
Attitudes, and Practices (KAP) baseline survey in the first
batch of 225 schools; developed training dissemination plans;
developed hygiene education modules for in-class sessions as
well as peer-led “little doctor” sessions; selected and trained
master trainers in school health and hygiene from six districts;
and built local government capacity in school hygiene.
with national level stakeholders to define the basic package for
SHN and advocate for the incorporation of SHN in
Multisectoral Nutrition Plan (MSNP) led by National Planning
Commission. Save the Children has been actively involved in
the development of joint action plan of department of health
service and department of education for scaling up of SHN all
over country in phases. In addition Save the Children is
planning to develop integrated (with DoHS and DoE) districtwide implementation plan for three the sponsorship funded
areas—Siraha, Kapivastu and Pyuthan. Save the Children is
also an active participant of the Nepal’s SHN network: http://
schoolhealth.org.np/
Finally, Save the Children leveraged Dubai Cares funds to
receive funding from the Wrigley Foundation which is being
used to conduct oral hygiene activities (including daily tooth
brushing, and regular visits from nurses/dentists) in the 225
Save the Children-supported schools.
Pakistan
Since the 2005 earthquake when Save the Children first started
implementing SHN in 30 government primary schools and
communities in Tehsil Allai, District Battagram, SHN has
grown tremendously and now targets 12 districts across the
country, reaching over 765,500 children in 1,455 schools. This
growth was made possible by including SHN as a sub-theme in
all existing and upcoming child education and development
projects.
Nepal
Save the Children has been implementing School Health and
Nutrition Program in partnership with the Department of
Education (DoE) and Department of Health Services (DoHS)
at National level and with partners (PNGOs) at district level in
close collaboration and coordination with and District Public
Health Office (DHO) and District Education Office (DEO).
In 2011, the program successfully achieved the key indicators
of the strategic objectives. The schools including the School
Management Committee (SMC), are the main structure that
Save the Children supported to achieve improvements across
the four SHN/FRESH pillars (safe school environment,
school-based health and nutrition services, skills-based health
education and school health-related policies).
The international FRESH framework is used as a basis for all
SHN programming and Child Focused Health Education
A total of 377 schools in the impact areas implemented SHN
components in 2011. A total of 102,644 children received
deworming tablets and 74,694 children received full course of
iron supplementation. A total of 80,654 children received
vision, hearing and dental screening and minor treatment
services in the impact area, in coordination with the school
management committees, school teachers, health facility and
NGOs’ staff. A total of 77,739 children have participated in
the health education/demonstration session focused on
personal hygiene, hand washing, and prevention of worm
infestation, anemia and Vitamin A deficiency. Similarly, in 327
of 377 schools, SMCs held quarterly meeting and discussed
SHN issues and 59 percent of the SMCs reviewed and
incorporated SHN program in their annual school
improvement plan. Coordination with district level SHN
committees and program monitoring by the committee was
highly encouraged in all districts. Save the Children worked
© 2012 Save the Children
Snakes and ladders games designed to educate school children into
the practice of good hygiene as part of Save the Children's WASH in
Schools program in Pakistan. Photo by CJ Clarke.
(CFHE) is the main approach to reach both school and nonschool going children with key health messages using
participative, skills building teaching methodologies. The
Pakistan country office is currently developing six new
modules to add to the existing eight modules to make the
CFHE more comprehensive. This package will be made
available to other countries where appropriate. Save the
Children works in partnership with several local NGOs and
government institutions to conduct trainings of master trainers
9
The SHN team in Pakistan has a clear advocacy plan to
increase SHN uptake by the government. They have been
particularly successful at using broader advocacy events to
raise awareness of SHN issues and engaging partners by
sharing Save the Children’s SHN experience in Pakistan and
elsewhere.
in CFHE who in turn train school teachers and peer educators.
This approach improves sustainability and integration of SHN
into the government system.
In September 2011, a new early childhood care and education
(ECCE) project funded by AUSAID was launched in four
districts of Khyber Pakhtunkhwa Province, expected to reach
around 120,000 children aged 3-8 years and 80,000 family
members from 400 primary schools and catchment
communities. SHN is integral to this project and will provide
valuable experience on how to integrate health and nutrition
into both school- and community-based early childhood care
and development programming in Pakistan and elsewhere. The
SHN component includes a health education component
Philippines
With funding support from Sponsorship, local partner
support, and the implementation of two Wrigley Foundationfunded projects, the Kids SHINE (School Health Involvement
and Empowerment) and Kids SHINE MORE (Mainstreaming
Oral Care in Education), reached more than 130,000 school
children in 108 partner schools (28 in Metro Manila and 80 in
South Central Mindanao). Appreciative community
mobilization, integration, capacity building and partnership
were the strategies to achieve more outcomes and
sustainability.
Pakistan’s SHN Growth Comparison:
Year 2009 vs. 2011
2009
2011
No. of districts
7
12
No. of schools
475
1455
Direct beneficiaries
150,000
765,500
With funding from Kraft Foods, four schools in Paranaque
City, Metro Manila benefitted from a supplemental feeding
program primarily to improve school attendance during lean
periods. Vegetable gardens and the construction of a
delivered through parenting sessions; preschool classes
(Kachi); and for children 3-4 years of age, at community level,
through early childhood development homes run by
Community Learning Workers (CLW). Following the results of
the baseline survey, a package of health and nutrition services
will be identified and provided across the communities as well.
Iron Supplementation in Northwest Pakistan
The Pakistan country office conducted a study comparing different schedules of iron supplementation in 30
schools in northwest Pakistan, suffering from the aftermath of the devastating 2005 earthquake. One group of
schools received once-weekly iron tablets for 24 weeks;
the second group received twice-weekly iron tablets for
12 weeks and the third group received no iron tablets.
Surprisingly, the iron supplements, regardless of the
treatment schedule, had very little impact on hemoglobin levels. This may be due to the relatively low prevalence of anemia at baseline (33 percent) and/or other
factors being the main cause of anemia in this population (other micronutrient deficiencies or parasitic infections). This study is a useful reminder that intermittent
iron supplementation in schools, now recommended by
WHO where the prevalence of anemia is above 20 percent, may not always be sufficient.
© 2012 Save the Children
Primary school celebrating Global Hand Washing Day in the
Philippines. Photo by Gloria Remoblas Ramat.
mushroom house expanded the sources of food in the school
and offered a healthy menu for children in the school canteen.
The project also developed a hand sanitizer made from
mushroom as an income generating activity for the school.
This project garnered local and international recognition for
the significant corporate social responsibility extended by
Kraft Foods to public schools and communities.
The SHN program intensified the promotion of proper
hygiene practices as a project baseline survey showed that 70
percent of the children wash their hands at key times.
Children’s active and sustained participation was highlighted in
the implementation of SHN activities by the organized
“Bulilit” (Children) Health Promoters (BHPs) in each school.
10
to improve school water and sanitation infrastructure, such as
water systems and latrines using community contributions and
challenge grants.
The SHN program in Tajikistan has also utilized lessons
learned from the previous GlaxoSmithKline (GSK)-funded
PHASE project in Tajikistan.
Vietnam
Save the Children in Vietnam started its SHN program in mid2011 in three urban cities: Ha Noi, Hai Phong and Ho Chi
Minh City. Save the Children, with support from the Ministry
of Education and Training and in partnership with Provincial
Departments of Education and Training, is currently
implementing the program in 30 schools. The program focuses
on behavior change communication activities on health and
nutrition, including oral health. It aims to improve ageappropriate, school-based hygiene facilities and supplies
according to school needs. Save the Children organized a large
-scale event in each of the three cities to celebrate Global
Hand Washing Day in October 2011. More than 2,000
children participated in the event in each city. The Global
Hand Washing Day Celebration attracted the media and there
were 11 news articles posted in local newspapers and on
websites. During the events, the local authorities shared their
appreciation of the school health and nutrition program. They
also expressed their commitment to project implementation.
School children washing their hands on Global Hand Washing Day.
Photo by Vietnam country office.
The BHPs actively managed the Nutrition Month (July)
activities, Children’s Month (October) and Global Hand
Washing Day (October 15).
Oral health was given emphasis in 2011 which included regular
dental check-up, education sessions (e.g., proper tooth
brushing) and the provision of Dental Kits to children in
grades 2, 3 and 4 in selected partner elementary schools.
Tajikistan
Since April 2011, Save the Children in Tajikistan has been
implementing a two-year SHN program targeting 100 schools
in Khuroson, Vakhsh, Bokhtar, Sarband, Rasht and Tojikibod
districts of Khatlon and Rasht provinces. This Wrigley
Foundation-funded project aims to improve the health
behaviors, health status and oral health of schoolchildren. in
Save the Children is the only organization in Tajikistan
working on oral health schools and the need is great. The
University of Tajikistan is a supporter of this project. Child-toChild trainers and community mobilizers are carrying out long
term, behavior changing activities using active learning
methodologies. The project has helped 15,073 children
increase their knowledge of waterborne diseases, diarrhea
prevention and other vital health issues. Participatory rural
appraisal techniques are used to encourage and empower
schoolchildren and communities to identify problems in their
schools and villages and become active agents of change.
Africa
Ethiopia
After over four years of implementation, the USAID-funded
Community-School Partnership Program (CSPP) came to a
successful completion in July 2012. The program benefitted
over 1.2 million children in 1,800 schools across the country.
Over 1 million children were dewormed and provided with
health, hygiene and
HIV/AIDS education.
Schools also benefitted
from improved water,
sanitation and hygiene
services (see graph on page
12). The program
achieved these results by
ensuring strong links
between communities,
schools and health and
government education
staff, which continue to
ensure improved health
and educational
Additionally, Save the Children and government technicians
tested the water in 74 schools. The tests showed that over a
quarter of the school water systems were infected with fecal
matter. Children were frequently absent from school with
diarrhea as a result of drinking the water. To address these
problems, in addition to health and hygiene training, Procter &
Gamble’s (P&G) PUR water purification sachets are being
distributed in schools to promote safe water use.
Save the Children is also partnering with the local NGO Oshti
Milli, PTA’s, child-led organizations and government officials
© 2012 Save the Children
Honche Bite Community-Based School in Dendi District, West Showa,
Ethiopia. Photo by Susan Warner.
11
outcomes for children.
Ethiopia’s Sponsorship-funded programs continue providing a
comprehensive SHN program in over 100 schools in Tigray
and West Showa. A mid-term evaluation was completed in
Tigray in June 2012 and showed strong results in improved
knowledge as well as improvements in nutritional status. The
evaluation also provided direction to areas that need additional
focus to translate knowledge into practice in the remaining
period of project implementation. The program in West
Showa continues to strengthen coordination and joint
planning and implementation with the government Health
Students learn about nutritious foods in school. Photo by Kenya
country office.
Project activities include supporting biannual deworming and
micronutrient supplementation, hygiene and sanitation
improvement taking into consideration the special needs for
girls and children with various challenges, provision of safe
water, building teachers’ capacity to recognize signs and
symptoms of common childhood illnesses including oral
health and promptly refer them to the hospital for further
management, provision of health education and creation of
school health clubs, school health open days, inter/intra
school health competitions and advocacy forums to inform
the National School Health policy of 2009.
Extension Workers as well as the district-level health and
education government offices, utilizing sustainable approaches
throughout the program cycle. As part of access to health and
nutrition services, 29,000 students were screened for vision
and hearing problems in West Showa. Hearing and vision
screening helps teachers to design strategies for class
management for children with hearing and vision problems.
In 2011, the project trained 18 government trainers on SHN
and reached 495 pupils during the Global Hand Washing Day
and celebration. The project will reach 14,500 pupils and 860
teachers, SMC members and support staff directly with
various project interventions. Indirectly, the project will reach
150,000 community members in the two years of
implementation.
Save the Children remains very active in supporting national
SHN efforts through the Federal Ministry of Education’s
School Health and Nutrition Task Force as well as the Federal
Ministry of Health’s Neglected Tropical Disease Task Force.
Malawi
The Sponsorship-funded SHN program is currently reaching
all 58 schools in the Traditional Authority (TA) Chikowi in
Zomba district, with more intensive piloting of interventions
in 20 schools. In the 20 schools, improved metal hand
washing and drinking water facilities were introduced, which
can easily be pushed around like a wheelbarrow, and have a
bigger capacity of 100 liters compared to the previous plastic
20 liters containers. Hand washing with soap is promoted with
a climax during Global Hand Washing Day celebrations. At
the district level, Save the Children provides ongoing support
to the district level school health team under the district health
and education authorities to implement school health
activities. This has included supporting the training of teachers
to do school-based deworming (with albendazole and
praziquantel) across all 212 schools in Zomba district. Save
the Children is planning to pilot the school health booklet, a
health screening tool developed by the national SHN program
Kenya
Save the Children initiated an SHN project in Kenya in
January 2011 with funding from the Wrigley Foundation. The
program aims to improve health, nutritional and educational
status of school-age children in marginalized parts of Nairobi
and Kiambu Districts. The project is being implemented in
partnership with Girl Child Network in 25 schools. This
program is the first time Save the Children is working in urban
areas in Kenya. It seeks to complement the government’s
efforts in strengthening the implementation of
Comprehensive School Health Program in Kenya through the
Ministry of Education and the Ministry of Public Health
Services.
© 2012 Save the Children
12
health problems at the CBCC, quality daily meals provided by
the community, growth monitoring and promotion and
nutritional surveillance, and promotion of existing health
services (deworming, vitamin A, etc.). This package is currently
being piloted in 10 CBCCs, after which the package will be
scaled up.
(MoE) and support the national schistosomiasis control
program to develop a teacher guide and IEC materials to
accompany the deworming.
The main highlights for the year included presenting the
results of the malaria control in schools baseline survey
conducted in April 2011 at a national stakeholders’ meeting in
May 2012. The results emphasized the urgent need for
addressing malaria in the school-age population since over 50
percent of the school children were found to be infected and
36 percent were anemic. (More details are on pages-3-4.)
In December 2011, the Conrad Hilton Foundation funded
Save the Children to implement a package of health and
nutrition services alongside a larger World Bank-funded Early
Child Development study, called Protecting Early Childhood
Development (PECD). The study aims to evaluate three
quality improvement strategies on early child development
using a cluster randomized control design across 200
Community-Based Childcare Centers (CBCCs) in four districts
of Malawi. The package of services will include intermittent
iron supplementation, treatment and referral of common
Ireen Vincent, age 10, takes an eye test given by a Save the Children
trained teacher in Malawi. Photo by Michael Bisceglie..
Local Beliefs on Latrines and Soap Use in Mali
A qualitative study conducted in August 2011 in rural communities in Sikasso region Mali, by Dr. Younoussa Touré, a Malian
Anthropolist
hand
washing
expert,
some fascinating beliefs about latrine and soap use:
Students
raise theirand
clean
hands
in Assiut,
Egypthighlighted
on Global Hand
washing Day. Photo by Egypt CO.
Latrines are a relatively new concept in these rural parts of Mali. One villager recalled the first latrine being built in his village
in 1959, for the visit of a high ranking official. For many years and to this day, people continue to view latrines as being for
the use of external visitors or for the sick, disabled and elderly who are unable to walk to find a bush. “Latrines are not for
us”, “they are dirty and cumbersome” and “we farmers who are always in the field do not have time to build latrines.” Some
even believe that latrines are responsible for the disappearance of some plants. However, as populations grow and the
availability of bushes decrease, and with pressure from development partners and authorities, the need for latrines are
becoming more obvious even to the village elders whose influence is very strong.
Soap. “The only time we use soap is when we’ve used toxic substances (fertilizers or pesticides)” says one villager, a sentence
which summarizes the situation in these villages. Washing hands with soap was viewed with suspicion, as an imported habit
or an imitation of ‘toubabs’ (white people). The most common time mentioned for washing hands is before meals and it
follows a hierarchical order whereby each family member starting with the eldest rinses their hands in a common bowl of
water. The youngest come last and the water must not be changed. Adding soap to this routine would imply breaking with
family tradition and disrespecting the elders. Many also believe that dirt makes a person stronger and is a snobbery. “Dirt
doesn’t kill a farmer. On the contrary, dust on a farmer’s hands strengthens him.” Common myths reinforce the reticence to
use soap. For example: “ washing hands with soap impoverishes you” or “ it will remove men’s protection.” Soap is mostly
used by women for washing clothes or dishes, some (but a minority) mentioned washing hands with soap after contact with
their children’s feces but many myths surrounded this practice too “my child does not eat, his feces do not smell, so they are
clean.”
With support from Dr. Younoussa Touré, Save the Children is currently developing strategies and messages in Mali to
counteract some of these beliefs, which go back generations and are so harmful.
Reference: Touré Younoussa. Recherche formative sur le lavage des mains au savon et sur l’utilisation des latrines en milieu scolaire. Save the
Children, Dubai Cares, September 2011
© 2012 Save the Children
13
mechanism to improve child participation in school (including
WASH) management and improvement. The Dubai Cares
WASH team also piloted Community Led Total Sanitation
(CLTS) with great success in a small number of villages in
Sikasso and is planning to scale it up in 2012-13. A formative
study led by a local anthropologist was conducted in 20 villages
in Sikasso to identify the main barriers and motivations for
latrine use and hand washing with soap and has laid the
foundation for the development of a behavior change
communication strategy for schools and communities, which
will reinforce the work of school governments and CLTS (see
box on page 3). Save the Children continues to support schoolbased deworming and micronutrient supplementation across
all target schools.
A student washing hand from a wheel barrow hand washing and
drinking water facilities Photo by Malawi CO.
In April 2012, a workshop was held in Lilongwe bringing
together, SHN and Early Childhood and Development (ECD)
staff and led by the ECD and SHN technical advisors to
develop a health and nutrition strategy for Save the Children
ECD’s programs across the country. The strategy provides a
framework for action and describes potential Health and
nutrition interventions and strategies to integrate into current
and future ECD programs. Save the Children’s ECD programs
span across eight districts. In 2011, the Sponsorship funded
ECD and SHN programs in Zomba worked together to
provide vitamin A supplements to all children attending
schools and CBCCs in TA Chikowi. A total of 648 teachers,
ECD caregivers and Health Surveillance Assistants were
trained to administer the vitamin A using the government
guidelines. Primary schools registered a coverage of over 80
percent while the ECD centers had a coverage of over 90
percent. The vitamin A supplementation went along with
education on the importance of vitamin A and its deficiencies;
additionally, posters were developed and used during the
exercise and are still being used in schools.
Meanwhile at the national level, Save the Children supported
the Ministry of Education to finalize the national SHN policy
through a multi-stakeholder meeting, which was about to be
validated by the Cabinet when the coup d’etat happened, and
has stalled for the time being. The Dubai Cares consortium led
by UNICEF has also been working on a health education
teacher training manual, which was then validated by the MoE
and will be used by the Dubai Cares partners from October
2012.
Amongst the great achievements of the Mali office has been
the implementation of a large malaria in schools study with
support from the London School of Hygiene and Tropical
Medicine (details on page 3).
Mozambique
After nearly 20 years of programming in Gaza province, the
Sponsorship-funded Ku-Bunhetana program, which includes
Basic Education (BE), Early Childhood Development (ECD),
Adolescent Reproductive Sexual Health (ARSH) and SHN has
begun the process of phasing over to a new impact area. In
2011, the program reached 37,168 children in 52 schools
across the districts of Manjacaze, Chibuto, Bilene and Xai-Xai,
but funding and programming is gradually being transferred to
Nampula Province in the north of Mozambique. Over the past
year, the Mozambique country office has been focusing on
community and partner mobilization and capacity building to
provide and maintain sustainable child-friendly latrines and
urinals, water pumps and hand washing facilities. Sixty-two
latrines and urinals were constructed in 31 schools in 2011;
and sanitation and hygiene materials, such as buckets, soap and
drinking water containers, were also provided. Save the
Children trained 16 water committees, 52 school councils, 104
teachers and school manager and 18 children’s groups on
effective management of WASH facilities to promote program
sustainability, and sanitation and hygiene awareness.
Information, education and communication (IEC) materials
Mali
Despite the political upheaval which the country has faced
since the coup d’etat in March 2012, Save the Children’s
sponsorship- and Dubai Cares-funded SHN program in
Sikasso region has been largely unaffected since it is in the
south of the country. In 2011, the program reached 51,393
children and 253 schools in the cercles of Yorosso and
Sikasso.
The Dubai Cares WASH in Schools project continues to make
tremendous progress in improving WASH in schools and
communities. In 2011, 122 latrines, 35 water points and 88
hand washing stations were constructed in 35 schools and the
remaining 95 schools targeted by the Dubai Cares project are
expected to benefit from these same facilities in the coming
year. Child governments continue to be a very popular
© 2012 Save the Children
14
provide health, hygiene and nutrition education. The program
will target approximately 10,000 students in the first five years
of implementation.
for nutrition, disease prevention and other SHN topics were
distributed in all schools. Save the Children has also reinforced
its promotion of iodized salt in homes, along with the
importance of eating fruits and vegetables. Students also
received training in agriculture, which included the distribution
of seeds and a small agricultural tool. Students, teachers and
community members participated in agro-nutritional fairs,
where they learned about growing nutritious foods and eating
a balanced diet.
Zimbabwe
Save the Children in Zimbabwe received over $1 million to
establish an education project in Matau Primary School. In
2011, the project started with hardware (school and borehole
construction) and is now moving onto ECD, Literacy and
SHN programming in 2012. Although Matau Primary School
is the focus of the project, it is in a cluster of five other
“satellite” schools and nine ECD centers. Save the Children’s
programs will work with all children and community members
being served through these institutions.
In April 2012, Save the Children Mozambique country office
in partnership with CISM (Centro de Investigação em Saúde
de Manhiça, Mozambique), CRESIB (Centre de Recerca en
Salut Internacional de Barcelona, Spain), and the Ministries of
Health and Education conducted a major endline survey. The
results of this survey will be used to identify successes and
lessons learned to guide future programming in Nampula,
Gaza province and elsewhere in Mozambique. The
Mozambique country office has also been working to identify
a new impact area for Sponsorship-funded programs and
identified Nampula Province as the most in need of health,
education and child protection initiatives. Mozambique
country office plans to begin programming in 2013 in Nacala
Porto and Nacala Velha.
Latin America
Bolivia
In 2011, through WASH programs, Save the Children had the
opportunity to work in eleven schools in the Cochabamba
municipality using a behavior change methodology that relied
Zambia
In 2011, Zambia was selected as the site of a new Sponsorshipfunded program. This new program began its activities in 2012
in Lufwanyama district in the Copperbelt Region, starting with
ECD activities and then SHN and BE activities in the near
future. The Sponsorship SHN program will strengthen an
existing SHN policy and program implemented through the
Ministry of Education and will address key health and nutrition
Students in the health and nutrition program at a school in Bolivia. Photo
by: Michael Bisceglie.
on: 1) teacher training, 2) dissemination of classroom
materials, 3) training student leaders, 4) capacity building for
school officials, 5) and sanitary infrastructure improvement.
The training and materials focused on water, hygiene and
sanitation to improve health outcomes so that children are in a
better physical state to learn. Save the Children involved
municipal authorities, training them in nutrition and hygiene
activities, working with them so that they will adopt the
methodology and expand them to other schools. The “School
Health and Hygiene for a Better Life” project was
implemented in Districts 8 and 9, in the southern part of
Cochabamba.
In the Oruro and Caracollo municipalities the “Improving Our
Lives” program, which was in 71 schools and reached 14,000
students and 600 teachers, is being phased out and
Sponsorship funding is being phased over to Cochabamba.
Save the Children staff checking on a water pump at a public school in
Zambia. Photo by: Seung Lee.
issues, including malaria, diarrhea, intestinal parasites and
anemia as well; improve WASH facilities in schools and
© 2012 Save the Children
15
The municipalities decided to continue the SHN program by
allocated funding in their annual operating plans to implement
these activities in May 2012.
El Salvador
El Salvador’s School Health and Nutrition program reached 73
percent more children in 2011 than in 2010, directly reaching
more than 14,000 children in the areas of Sonsonate,
Ahuachapán, and San Pedro Masahuat. The program responds
to issues in the target schools, including poor hygiene
practices, poor environmental sanitation on school grounds,
and lack of nutritional snacks sold at school snack shops. The
El Salvador program uses a Child-to-Child approach to map
children’s priorities in schools and address those priority issues
systematically. Student brigades were established and trained
Haiti schoolchildren have a lesson on safe water as part of the SHN program. Photo by Haiti CO.
in gifts in kind from TOMS Shoe Company. Save the Children
worked through local health posts and schools to distribute
shoes to school-age children. The shoe donation provided a
bridge for students who had not received or had outgrown
their government-provided shoes, allowing them to attend
school, and protect their feet from soil-transmitted helminthes.
Haiti
Save the Children has implemented an SHN program in the
commune of Maissade since 2003. In 2011, this program
provided a full package of services to 108 of 110 schools in the
district. More than 20,035 school children received mass
deworming, iron and Vitamin A supplementation. (9,913 girls
and 10,122 boys); and 1,723 out of school children (927 girls
and 796 boys) were also dewormed. The program is helping to
improve health and nutritional of children, so they can better
learn. Working with partners is a top priority for delivering the
SHN package of service, especially since the announcement of
the phase out of Sponsorship funding from Maissade. For this
reason, 1,334 education actors (teachers, directors, parents,
students and cooks) were trained with support from Ministry
of Public Health and Population (MSPP) on the modules
related to deworming, nutrition, hygiene and HIV/AIDS.
Young girl demonstrating what she learned in school in El Salvador.
Photo by Seung Lee
on SHN. Students completed diagnostics of critical SHN
issues at their schools and based on the findings, identified key
changes that needed to be made and made action plans to
address those. Save the Children provided some of the
cleaning supplies and other needed materials as identified in
each school’s plan. Additionally, the program has partnered
with the Ministry of Education to achieve national television
and newspaper coverage for Global Hand Washing Day
celebrations. The media coverage was estimated to have
reached 122,000 beneficiaries indirectly. Save the Children has
also developed close collaboration with the Ministry of
Agriculture, the Ministry of Health and other key institutions
that promote SHN initiatives.
A campaign to monitor the quality of drinking water was
launched in 744 households and 40 schools with support from
the Association of Health Personnel of Maissade (ASPM). The
number of schools with school canteen increased 60 percent
with financial support from the World Bank, la CORDAID
and World Food Program Bureau of Nutrition and
Development (BND). Save the Children partnerships have
helped achieve many of the program objectives making the
departure from Maissade easier. Phase out of Maissade is on
its way and many activities have started in the new impact area
of Marchand Dessalines: including situation analysis; program
development; schools selection and dissemination of
information to communities and partners. The model SHN
program from Maissade has been replicated in Léogane,
thanks to funding from Coca-Cola.
As part of the School Health and Nutrition program in El
Salvador, Save the Children received approximately $700,000
© 2012 Save the Children
16
Save the Children is implementing a school health and
nutrition program in 40 schools in Léogane, which began in
late 2011. The program includes conducting a baseline and
endline on current health and nutrition knowledge and
practices by students and staff in the 40 schools, training of
teachers, school administrators and parents in hygiene and
nutrition.
the support committees for implementation of child-friendly
spaces.
In 2011, SHN programming was incorporated in emergency
response work. Community-based organizations were
strengthened to rebuild damaged water and sanitation
infrastructure at community level schools in the departments
of Valle and Choluteca. The water system directly impacted
28 primary schools, with a population of 5,942 children.
Services such as deworming, vitamin supplementation,
mosquito fogging/spraying were also performed at schools.
Mexico
Since 1973, Save the Children has served in 14 of Mexico’s 31
states and the Federal District through programs in education,
health and hygiene, nutrition, violence prevention, eradication
of child labor and exploitation, environmental education and
rapid response in emergencies. By 2011, Save the Children
reached more than 234,000 children across Mexico. Programs
were delivered through 363 public schools, 142 communitybased Early Childhood Development centers (Centros de
Bienestar Infantil), 16 interactive learning spaces (bibliotecas
lúdicas), three agricultural centers for migrant farm workers
and their families and 26 community spaces.
Since 2007, Save the Children has also supported community
volunteers and staff working in centers to obtain certification
in order to qualify under the government’s new early
childhood registration initiative. Through schools, Save the
Children introduces hygiene and nutrition education to
children and helps schools to improve the quality of their
water and sanitation services. Save the Children’s guide on
nutrition education has been approved by the National
Institute of Nutrition. In rural communities, Save the Children
is helping children to access digital learning opportunities by
establishing digital classrooms and training teachers.
Children at an ECD center practicing good hygiene. Photo by Seung
Lee .
Honduras
Save the Children Honduras uses a comprehensive community
-focused development methodology. Program focus areas
include: sustainable agriculture and natural resources
management; education; strengthening of local development;
and health, population and nutrition. Children’s rights, gender
and risk management are cross-cutting themes that are
addressed in all program areas. The SHN program works
through partnership. Save the Children has cooperative
agreements to provide technical support to the different
Government Ministries, and it forms strategic partnerships at
national level with NGOs that enable coordinated responses
to rights violations and emergency issues.
Nicaragua
The Save the Children Nicaragua country program is
implementing a project to guarantee water and sanitation
coverage and quality in 15 rural communities in the
municipalities of Waslala, Siuna and Mulukuku in the North
Atlantic Autonomous Region (RAAN) with funding from
COSUDE (Swiss Development Cooperation). In addition to
benefiting 7,800 people, this project has improved health and
hygiene conditions in 15 schools (one in each community), so
far benefitting 1,500 children. Schools have safe water 24
hours a day and each has installed bathrooms. Using a creative
methodology to promote behavior change, children participate
in determining hygiene and cleanliness standards, and also
identify where the toilets will be built, their size, and the colors
to be used. Local municipal governments and the Ministry of
Education (MINED) are the partners in this project.
The establishment of these partnerships has given Save the
Children a leading role in responding to natural disasters and
in managing external and internal resources. It also helped in
the implementation of programs such as “Pinta y Aprende con
Quique” (Paint and Learn with Quique), a Field Epidemiology
Survey Team initiative at the University of Miami and the
Honduran Institute of Social Security. Through work with
teachers and volunteer, this program works with school
children on issues such as: health, security and community
reconstruction, and also encourages group work in the midst
of adversity, to be prepared during natural disasters and
recover after the event. Education and training is also given to
© 2012 Save the Children
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councils to ensure they were planning and implementing CtC
and other SHN activities. A Knowledge, Attitude and Practices
(KAP) survey conducted among school children before and
after the project’s intervention showed 50 percent increase in
average in all four communities. Save the Children organized
parent education classes for parents of children aged 6-18 with
community health providers (nurses and doctors) in order to
increase their knowledge about the issues and topics discussed,
and ensure continued counseling of parents through provision
of day-to-day services. Overall, 320 parents participated at the
seminars and demonstrated 80 percent knowledge increase.
Simultaneously, the project conducted SHN training for 95
teachers and school management staff.
Municipal governments and communities guarantee the
construction of infrastructure projects and Save the Children
oversees the project and provides technical assistance to
communities and other actors involved.
Families United in Health project (FAMISALUD), funded by
USAID, in the municipalities of Siuna, Rosita and Bonanza is
also being implemented in the RAAN. This project uses a
methodology called “Coloring for Health,” which promotes
hygiene and sanitation practices to first through third grade
students and teachers, and includes environment and gender as
cross-cutting themes. In 2011, 15 schools and 1,187 children
participated. A total of 38 adults were trained in this
methodology: 28 from MINED, five from the Ministry of
Health (MINSA), and five project technical staff. Materials
were donated to the schools, including crayons and coloring
books, and assessments were carried out with students to
identify their hygiene practices (if they wash their hands, brush
their teeth, and use the latrine), to determine the safety of
water sources, and to establish if there were any recent cases of
diarrhea.
Egypt
In Egypt, the Sponsorship-funded SHN program in the Minia
Governorate phased out by the end of 2011 and a new
Sponsorship-funded SHN program was started in the Abnoub
district in the Assiut Governorate since 2008. As of January
2011, 97 percent of the impact schools in Minia had
functioning latrines and 80 percent had hand washing facilities,
up from 25 percent and less than 1 percent in 2004,
respectively. In addition, annual program monitoring results
show a decrease in the prevalence of anemia from 40 percent
to 9 percent and trachoma from 22 percent to 4 percent
among students in Minia, compared to baseline results in 2004.
Middle East and Eurasia
Armenia
In January 2011, the Save the Children Armenia country office
started its three year Action for Child Health and Education
(ACHE) project targeting 12 rural communities in the
Armavir, Aragatsotn and Gegharkunik provinces of Armenia.
ACHE’s objectives focus on increasing children’s participation
in quality early childhood development programs and
improving the use of key school-based health and nutrition
services, practices and behaviors.
In 2011, the Egypt country office established the anemia
control initiative for basic education schools in 100 percent of
Save the Children applied Child-to-Child (CtC) methodology
to mobilize school-age children around health, nutrition and
hygiene issues. Save the Children trained eight CtC facilitators
and 12 CtC groups were created and facilitated in Maisyan,
Shahumyan, Musaler and Jrashen communities, with three
different age groups per school directly reaching 292 school
children. Children focused on health, hygiene and nutrition
practices, conducted research, proposed solutions to improve
the situation and implemented child-led actions. Activities
varied by community and CtC groups and included celebration
of Global Hand Washing Day through community awareness
raising events, School Hygiene Poster competition,
development of maintenance plans for school bathrooms and
the development of school hygiene rules and guidelines.
10-year-olds Amira Abd El-Hamid and Israa Mohamed Rashad in SHN
class in Minya, Egypt. Photo by: Ahmed El-Nemr.
Abnoub schools in partnership with Assiut Directorate of
Education, Health Insurance and partner NGOs. Annual
program monitoring shows a decrease in the prevalence of
anemia from 55 percent in 2008 to 45 percent in 2011 and
reduced rates of schistosoma from 4 percent to 1 percent in
2011. Restrooms and water pipes in 307 primary and
preparatory schools in Assiut and El-Minya Governorates have
An assessment conducted after completion of the CtC
activities revealed that 89 percent of children demonstrated 60
percent increase of knowledge and practices on healthy
behaviors. Save the Children worked closely with the students
© 2012 Save the Children
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were conducted at schools with 288 participants including
teachers, students and both mothers and fathers. The
campaign was implemented with the support of the Ministry
of Education and Ministry of Health offices in Lahij by trained
health staff and school teachers and the mass administration of
deworming was based on the WHO guidelines.
a system for maintenance now and the SHN curriculum has
been disseminated.
Save the Children also engaged community members in key
SHN messages. These community members often became
supporters and advocates for national policies benefiting
children, such as a policy forbidding teachers from smoking in
front of students. Save the Children trained 400 doctors,
nurses and social workers on health insurance policy and
quality services; and assisted 95 percent school children in
receiving their health insurance cards, which enables them to
access to low-cost health services.
North America and Europe
Italy
In Italy, 25 percent of children are at risk of poverty, and there
are about 2.5 million children and adolescents living in
conditions of material poverty and often cultural, social, and
relational deprivation. Save the Children is implementing two
major projects related to child poverty in Italy aimed at
preventing the effect of poverty on children’s the daily life.
One of which is the three-year program (2011-2013) funded by
Kraft Food Foundation, Ready, Steady, Go!, focused on obesity.
32,000 children (6-10 years old) in 10 cities are targeted with
activities including promotion of healthy life style and
children’s rights to play, regular physical activity, and access to
healthy food.
Yemen
With the support of the Ministry of Education offices in both
Aden and Lahij, Dubai Cares-supported program in Yemen is
working to raise health awareness among children through
health education activities in schools. It also aims to train
health workers and teachers on a comprehensive package of
health education sessions through formation of health clubs in
schools and organizing festivals. During October 10-17, 2011,
The Ready, Steady, Go! program has two parts:
Children participating in school health program in a school in Yemen.
Photo by: Yemen country office.
Promoting 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;

Renovating 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.
Save the Children organized two events for Global Hand
washing Day in both the Lahij and Aden governorates, which
included exhibition of children's drawings on the importance
of washing hands, songs, plays and interviews carried out by
the children. 301children, 72 teachers, 58 parents and 3
managers from the Ministry of Education, with a total of 434
people participating. In addition, 26 schools and 3 satellite
rooms were provided with first aid box and cleaning materials.
USA
Save the Children’s Healthy Choices program provides
children in the United States living in poverty support to
improve health outcomes and learn lifelong, healthy eating
habits. Save the Children began this health program in US
schools in 2005. Today, Healthy Choices operates in the
afterschool environment in 12 states and the District of
Columbia, serving more than 13,000 children. Save the
Children provides children with 30 minutes or more of daily,
moderate-to-vigorous physical activity that teaches life-long
movement skills and combines fun and fitness. Children also
try healthy foods that expose them to new fruits, vegetables
In January 2012, deworming campaign was conducted in Lahij
governorate as part of the activities for the Inclusive
Education Program. The campaign targeted students from six
schools in Tuban district in Lahij. A total of 5,290 students of
school-age were de-wormed (1,800 boys and 3,490 girls).
Awareness sessions on personal hygiene and environment
© 2012 Save the Children

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and grains that encourage making better food choices.
Looking forward
In 2011, Save the Children introduced two new elements to
Healthy Choices: the “Healthy Habits” nutrition and physical
activity education; and the “Fitnessgram” fitness assessment to
evaluate progress of those children receiving regular physical
activity through our after-school programs.
Linking SHN to Adolescent Sexual and Reproductive
Health through work with Very Young Adolescents
Save the Children is an emerging global leader in the health of
Very Young Adolescents (VYA), children ages 10-14 years old.
Almost invisible in global health programs, Save the Children
will focus on this age group by ensuring comprehensive
sexuality education, strengthening menstrual hygiene
management, delaying early marriage and pregnancy,
decreasing anemia and supporting the formation of positive
gender norms which fills a critical gap in equipping adolescents
with the ability to navigate the challenges and opportunities
during their transition through puberty. As an interagency
collaboration, the health of very young adolescents will be
addressed by our School Health and Nutrition team and the
Adolescent Reproductive and Sexual Health (ARSH) team to
ensure that all children, despite their school-going status, have
their health needs met and that state-of-the-art technical
approaches in sexual and reproductive health are utilized.
Related to, and as part of this package, Save the Children is
looking at Menstrual Hygiene Management (MHM) activities
with its WASH partners as well as Human Papillomavirus
(HPV) vaccinations with the health community in general.
Save the Children is pairing its Healthy Choices program with
policy initiatives and campaigns including the Campaign for
Healthy Kids and the Targeted Coordinated School Health
initiative to build the success of our existing school-based
health program, expand our anti-obesity strategy to connect
home, school and community, and support long-term
sustainability in elementary schools by reaching out to entire
school districts.
Condolence
Lucienne Maas, an esteemed colleague and friend of many
SHN staff around the world, passed away in late July 2012
after several years battling cancer. She worked for children in
Sustainability of School WASH Studies
In 2012, the SHN team supported the Philippines and
Bangladesh country offices to conduct research studies to
identify key factors affecting the sustainability of their WASH
in School interventions. The studies used an analytical
technique called Qualitative Comparative Analysis (QCA)
which combined qualitative and quantitative methods of
research. A better understanding of factors such as those
affecting the proper use and maintenance of latrines or hand
washing facilities will help these country programs take
appropriate actions to ensure better returns on their
investments in WASH in future programming.
Partnership and Networking Events
WASH in Schools Course by UNICEF and Emory
University
Save the Children continues to be a key partner in the WASH
in Schools Network led by UNICEF. Many countries offices
contributed to the mapping of WASH in Schools including
leading the process in Bangladesh. Results are available at
www.washinschoolsmapping.com. Furthermore, several Save
the Children offices took part in a WASH in schools ecertificate course offered by Emory University to UNICEF
staff.
Lucienne visiting a market in Sanaa. Photo by Seung Lee.
need, side by side with many of us, in Egypt, Palestine,
Afghanistan and for the past several years in Yemen.
Lucienne demonstrated her dedication to children to her last
days; on July 16, she even called in from her hospital bed to
share her experience with Child Friendly Health
Education during a SHN Webinar. Her endless energy and
enthusiasm for her work will continue to inspire us in our
own efforts and she will remain with us always in our hearts.
© 2012 Save the Children
SHN Short Course
Save the Children’s SHN, education and health managers
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education strategy.” The SHN marketplace stand was great
interest.
continue to participate and contribute to the Partnership for
Child Development (PCD)’s SHN Short course offered to
government implementers and their partners. Participants
from Africa attended the course in Nairobi in October 2011
and in May 2012 and from Asia to the course in Bangkok in
February 2012
International Conference on Schools in Montréal
On November 28 and 29, 2011 SCUS participated at the
International Conference on Schools that promotes health,
wellbeing and educational success in Montréal, Québec,
Canada. The conference stems from collaboration between the
consortium of the Annual Public Health Days/Journées
annuelles de santé publique (JASP) and the International
Union for Health Promotion and Education (IUHPE). The
Institut national de santé publique du Québec (INSPQ), the
Canadian Association for School Health (CASH) and the
International School Health Network (ISHN) jointly chaired
the event. Seung Lee facilitated a panel session with
presentations from various countries
2011 ISID-NTD Neglected Tropical Diseases Meeting
The International Society for Infectious Diseases held a special
conference on NTDs in Boston, Massachusetts, USA, from
July 8 to 10, 2011. Save Children was a member of the
program committee and contributed to the school-based NTD
presentation which can be found at http://ntd.isid.org/.
University of North Caroline (UNC) Water and
Health Conference
In October, 2011 Save the Children staff attended the Water
and Health Conference hosted by the University of North
Carolina. The conference was attended by researchers,
implementers, policy makers and funders in the WASH and
health areas. Dan gave a presentation on the “Results of Save
the Children’s School Health and Nutrition / WASH in
Schools Programs over 10 years in Malawi, Mali and
Bangladesh.”
Comparative and International Education Society
(CIES) Conference 2012
Save the Children was represented by 16 staff, including eight
DC-based staff and eight staff from outside the United States,
at the annual conference of the US CIES in San Juan, Puerto
Rico, April 22-27. Save the Children SHN programs were
represented on three panels.
Village of Solutions Highlights Work in Tajikistan
The SHN-PHASE project in Tajikistan was selected as a semifinalist for the Village of Solutions at the World Water Forum
in 2012. The project was selected for its child-centered
behavior change activities that led to key improvements in
health and hygiene. To learn more about the project visit,
http://www.solutionsforwater.org/solutions/a-child-focusedpartnership-for-achieving-wash-behavior-change-in-tajikistan.
Virtual Conference on Menstrual Hygiene
Management (MHM) through WASH in Schools
programs
SCUS participated in the MHM conference hosted jointly by
UNICEF and Columbia University on September 27, 2012.
The event brought together WASH and MHM experts and
provided an opportunity to share experiences in a diversity of
development contexts.
Children at a hand pump built by WASH projects in the Afar region of
Ethiopia. Photo by Lucia Zoro.
Save the Children International, Educational Global
Initiative (EdGI)
In November 2011 in Addis Ababa, the SCI EGI strategy was
presented and discussed with Save the Children education
member representatives from across Africa. One of the main
outcomes of the meeting was the inclusion of SHN in the
EdGI strategy following strong recommendations from a
number of participants. Our representative from Ethiopia said
“Save the Children has been leading the national SHN policy
development in Ethiopia and it would be very confusing for
our government partners if SHN was not included in our
© 2012 Save the Children
Save the Children managers meeting during the Asia SHN Short Course
in Bangkok. Photo by Thailand staff.
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Save the Children’s
School Health and Nutrition Program
Where We Work
Italy
Tajikistan
Armenia
Iraq Afghanistan
United States
(Domestic Programs)
Mexico
Egypt
Haiti
Dominican Republic
Honduras
El Salvador
Guatemala
Nicaragua
Burkina
Faso
Pakistan
Sudan
Mali
China
Yemen
S. Sudan Ethiopia
Nepal
Bangladesh
Philippines
Vietnam
Kenya
Zambia
Bolivia
Zimbabwe
Malawi
Indonesia
Mozambique
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.
For more information about School Health
and Nutrition programming at Save the
Children, please contact:
Seung Lee
Senior Director for SHN
slee@savechildren.org
Natalie Roschnik
SHN Advisor
nroschnik@savechildren.org
Daniel Abbo ,
Senior Specialist, Water, Sanitation and Hygiene
dabbott@savechildren.org
Mohini Venkatesh
SHN Specialist
mvenkatesh@savechildren.org
54 Wilton Road
Westport, Connecticut 06880
www.savethechildren.org
Sarah Bramley SHN Specialist
sbramley@savechildren.org
© 2012 Save the Children
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