The FRESH framework, an intersectoral partnership to Focus Resources on Effective School Health, provides the context for effective health related school policies. School policies, promoting good health and a non-discriminatory, safe and secure physical and psychosocial environment, are most effective when supported by other reinforcing strategies such as provision of safe water and sanitation, skills based health education, provision of health and other services, effective referral to external health service providers and links with the community. The FRESH framework provides this context by positioning health related school policies among its four core components, that should be made available together for all schools:
Health related school policies
Ensuring that children are healthy and able to learn is an essential component of an effective education system. This is especially relevant to efforts to achieve education for all in the most deprived areas. Good health increases enrolment, reduces absenteeism and brings more of the poorest and most disadvantaged children, many of whom are girls, to school. It is these children who are often the least healthy and most malnourished, who have the most to gain from improved health, and who need health related school policies that, when effectively endorsed, can lead to better educational outcomes.
1. Why health related school policies?
Health policies in schools, including skills-based health education and the provision of some health services, can help promote the overall health, hygiene and nutrition of children. But good school health policies should go beyond this to ensure a safe and secure physical environment and a positive psychosocial environment. Such policies, should address issues of abuse of students, sexual harassment, health-related practices of teachers and students, school violence, bullying, and guaranteeing the further education of pregnant schoolgirls and young mothers, to help promote inclusion and equity in the school environment.
Policies that help to prevent and reduce harassment by other students and even by teachers, also help to fight against reasons that girls withdraw or are withdrawn from schools. Policies regarding the health-related practices of teachers and students can reinforce health education: teachers can act as positive role models for their students, for example, by not smoking in school. The process of developing and agreeing upon policies draws attention to these issues. The policies are best developed by involving many levels, including the national level, regional and district level, and the school level – including the teachers, children, parents and the wider community.
2. Why School health policies are necessary for effective school health and nutrition programmes.
- School health policies can provide highly visible opportunities to demonstrate commitment to equity, non-discrimination, gender issues and human rights and be a positive model for the whole society.
- Policies are necessary for and can give a clear structure to a safe, protective and inclusive school environment.
- Policies, when clearly communicated to the school population and the whole society, can give rules on how to behave and what is accepted or not in the school setting.
- Policies that are actively accepted and endorsed by the PTA and the community can be followed more effectively. In cases when policies are not followed there will be a demand for change and stricter monitoring will be possible.
School health and nutrition policies must be developed and supported by key stakeholders at all levels. At the national level, for example, this involves an agreed framework of responsibility, policies and action between the key government ministries (such as Health and Education ministries) and other institutions and organizations with an input and responsibility for school health programming. At district and school levels, policies should be clearly understood, implemented and supported by all those responsible for the education, health and well being of the children. Policies should cover a broad spectrum of areas critical for the health and development of school age children. Examples given here include policies relating to: early pregnancy and exclusion from school; tobacco and tobacco free schools; sanitation in the school environment; HIV and reproductive health education; sexual harassment and abuse of students; the role that teachers can play in delivering simple health services through schools; and the public-private partnerships for delivery of school food services.
To be effective, school policies need resources for their implementation. This means that adequate resources must be made available at the national, regional, district and local levels. Such resources include government financing, but may also include contributions from other donors such as NGOs, and ultimately, to ensure long term sustainability of effective implementation of school health and nutrition policies, support from parents and the local community.
3. Content of school health policies
Strong intersectoral cooperation is required to plan, implement and monitor a sustainable school health program. It should be clearly defined and inscribed in a common statement, describing who is responsible for the interventions planned and who will be implementing those interventions. This cooperation and communication strategy should be written down in a ‘protocol d’accord’ or ‘memorandum of understanding’ between the education and health sectors.
The Ministry of Health (MoH) is responsible for the health of school age children, but this age group is rarely a priority for the health sector. Delivery of health services to children under 5 and pregnant women – the typical priority groups for the MoH – frequently leaves few resources left for the school children. The education of school children is the priority of the Ministry of Education and if “improved learning and education achievement by improving health and nutrition” is adopted, then it also becomes their priority to assure the health of the school-aged child. Thus the protocol d’accord needs to make transparent the tasks to be shared between the two ministries. This is the first step towards a successful school health programme.
4. Examples of policies
4. The way forward
The Convention of the Rights of the Child, now ratified by most countries of the world give Governments the political responsibility to endorse and monitor clear health related policies. School health policies can provide highly visible opportunities for the Governments and the whole society to demonstrate commitment to equity, non-discrimination, gender issues and human rights in all the schools in their countries. School policies should be clearly communicated to the school population and actively monitored by the PTA and the community. In the new FRESH framework school policies providing a safe, inclusive and non-discriminatory environment is one of the four core interventions. These policies are most effective when supported by other reinforcing strategies such as provision of safe water and sanitation, skills based health education and provision of basic health and other services. Implemented together those four interventions will lead to better learning outcomes and health of school children in the 21 century.
