• Introduction and Overview of Possible Interventions
  • Fee Waivers and Exemptions
  • Conditional Transfers
  • FRESH – Focusing Resources on Effective School Health
  • Home Visitors Program
  • Psychosocial supports
  • Addressing OVC Nutrition

FRESH – Focusing Resources on Effective School Health

Healthy young people are likely to complete more years of education, and be healthier and more productive as adults. One of the strengths of the FRESH approach is that it can be adapted to address the needs of children in different contexts, including communities with large number of AIDS Orphans, former child soldiers, and other children who have been disabled or traumatized by war. The FRESH program is a way of preventing children from becoming OVC and providing health education and health services to existing OVC. The main limitation of the program is that it does not reach out-of-school children. However, the availability of health services at school has proven to be an incentive to households to enroll children.

The FRESH approach was developed in light of the finding of a number of evaluations that confirmed the effectiveness of school health interventions for improving learning outcomes. These evaluations found that single strategy or “piecemeal” interventions that ignore the specific characteristics and needs of the target group are less effective than more comprehensive, coordinated and customized strategies. Evidence supports approaches in which policy development, health-promoting environmental change, skills-based health education and school-based health services are strategically combined to address priority health problems that interfere with learning for the targeted group. Such approaches extend the vision of health to include emotional and psychosocial well-being as well as physical health.

UNESCO, UNICEF, WHO, the World Bank and Education International, collaborated to develop a joint set of recommendations for the implementation of effective school-based health and nutrition program. These are summarized in the FRESH approach.

The FRESH approach has four basic components:

Component #1: Health-related school policies: Health policies in schools, mandating a healthy, safe and secure school environment, guaranteeing equal rights and opportunities and regulating the provision of health education and health services are necessary to harness the potential of health to improve education outcomes. It is best if these policies are developed by a representative cross-section of stakeholders, including education and health officials, teachers, students, parents and civil society. This builds awareness, while strengthening partnership. FRESH recommends that responsibility and authority for school health programs be designated at every level of education planning and administration. School administrators and teachers should be trained to implement the policies.

Component #2: Provision of safe water and sanitation: The provision of safe water and appropriate sanitation facilities are basic first steps to creating a healthy physical learning environment. School construction policies need to ensure that clean water and toilets are available at school. Separate toilets for girls are necessary to prevent them from dropping out or being withdrawn particularly around the onset of menses. Maintenance policies must ensure that these facilities are cared for and used properly over time. Healthy and hygienic schools may serve as an example to both students and the wider community.

Component #3: Skills-based health education: Quality skills-based health education helps young people to acquire communication, negotiation and refusal skills, and to think critically, solve problems and make independent decisions. Skills based health education contributes to the development of attitudes and values that promote respect for one-self and for others, tolerance of individual differences and peaceful co-existence. It results in the adoption of health-promoting habits and reduces risk-taking behavior associated with HIV/STD infection, unplanned pregnancy, drug and alcohol abuse, violence, injury, etc. Young people who receive quality skills-based health education are more likely to adopt and sustain a healthy lifestyle not only during their school years, but throughout their lives. Thus, FRESH interventions serve to prevent more OVC and protect those OVC who are enrolled in school.

Component #4: School-based health and nutrition services: It is well documented that school-based health services are very well received by the community as a whole. In particular, malaria treatments, micronutrient supplementation, de-worming and school feeding programs have been perceived as a substantial added benefit of schooling and have thus improved enrollment and attendance. As students become healthier, they participate more fully in education opportunities.

The success of school health programs requires an effective partnership between the Ministries of Education and Health, and between teachers and health workers. The health sector retains the responsibility for the health of children, but the education sector is responsible for implementing, and often funding, school-based programs. These sectors need to identify responsibilities and develop a coordinated plan of action to improve the health and learning outcomes of children. This program also requires teachers and other school personnel to be trained and supported in their new roles.

Effective community partnerships ensure broad-based agreement about the health issues that schools should address. Parent input and support increases the likelihood that health –promoting education will reach the entire family and be reinforced at home.

The FRESH approach argues that school-age children’s health is one of the basic investments that governments must make to accomplish their education goals. The approach can be adapted to address the specific health psychosocial needs in an environment. For example, in areas with high rates of HIV/AIDS infection, the program uses participatory learning techniques to help children learn how to protect themselves and others from HIV. Research has confirmed that this approach is effective for producing behavior change that reduces the spread of HIV and the discrimination that complicates prevention, detection and treatment of this disease. FRESH initiatives can also provide support and counseling for students affected by HIV/AIDS.