Integrated delivery of school health interventions through the school platform: Investing for the future

Abstract

School health and nutrition (SHN) programmes are recognized as a significant contributor to both health and education sector goals. The school system offers an ideal platform from which to deliver basic health interventions that target the most common health conditions affecting school-age children (SAC) in low-income countries, leading to improved participation and learning outcomes. However, governments require evidence to cost, design, and implement these programmes. In Ethiopia, prevalent health conditions affecting SAC's education participation and learning outcomes include infection with soil-transmitted helminths (STHs), hunger, and malnutrition. In recognition of the multiple issues affecting the health and education of SAC, the government has taken a proactive approach, coordinating an integrated SHN programme designed to be implemented in partnership and monitored and financed through a single, integrated mechanism. The programme, known as the Enhanced School Health Initiative (ESHI), integrates three complimentary health interventions: deworming; school feeding; and provision of a water, sanitation, and hygiene (WASH) package in schools, which in delivery aim to maximize the benefits of each of the individual components. Operational research surrounding the ESHI programme includes both qualitative and quantitative analyses. Here, we present an overview of the ESHI programme and its genesis. We also introduce three additional supporting papers that provide in-depth analyses of key findings, including the baseline situational analysis, the costs, and community perceptions of the programme. The findings from ESHI provide initial evidence to develop an understanding of the related costs and synergies of integrating multiple health interventions onto a single platform. The work has translated into strengthened institutional capacity and improved cross-sectoral coordination. The government is now committed to supporting 25 million school children in Ethiopia through SHN. The ESHI model serves as a reference point for other countries looking to scale up targeted SHN interventions.

High burden of undernutrition among primary school-aged children and its determinant factors in Ethiopia; a systematic review and meta-analysis

“…Globally, more than 200 million school-aged children are stunted and underweight which contributes to 2.2 million deaths annually [ 4 ]. If an interventional action is not taken, the cognitive and physical impairment will increase to one billion by 2020 [ 6 – 8 ]. Like under-five children, school-aged children are among the most vulnerable segments of the population to undernutrition in Sub-Saharan Africa [ 6 , 9 ].…”

“…If an interventional action is not taken, the cognitive and physical impairment will increase to one billion by 2020 [ 6 – 8 ]. Like under-five children, school-aged children are among the most vulnerable segments of the population to undernutrition in Sub-Saharan Africa [ 6 , 9 ]. Undernutrition among school-aged children results in poor cognitive development, lower school performance, reduced body size, reduced muscular strength, and depleted work capacity [ 8 , 10 – 13 ].…”

Secular Trends of Ascariasis Infestation and Nutritional Status in Chinese Children From 2000 to 2014: Evidence From 4 Successive National Surveys

“…However, they also followed the developed provinces with a relatively large decrease in ascariasis infestation rates and rapid nutritional transition from malnutrition to overnutrition over time. Thus, more increased efforts and multiple investments on health to improve nutrition, water, sanitation, and hygiene were needed in developing countries [32, 33], which can offset the ascariasis infestation’s impact on nutrition in children.…”

Local Perceptions of an Integrated School Health and Nutrition Programme involving WASH, school feeding and deworming in Southwest Ethiopia

“…Full detail of the baseline sanitation and hygiene is described elsewhere, as well as a map for location of each school [ 12 ]. In short, at baseline all schools had poor levels of WASH, with evidence of open defecation in 43% of schools and no access to safe water sources in over 66% of schools [ 13 ].…”

“…The programme was designed to address some of the burden of under-nutrition and infection in the area, and implemented by multiple coordinating partners with monitoring and evaluation conducted by the Partnership for Child Development (PCD) Imperial College London in collaboration with the Ethiopian Public Health Institute (EPHI). The full umbrella report is available elsewhere [ 13 ].…”