Integrating Education and Health - what can schools do? Elisabetta Aurino

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1 Integrating Education and Health - what can schools do? Elisabetta Aurino Research Fellow Partnership for Child Development 29 January 2016

2 RESEARCH INTO ACTION

3 RESEARCH QUESTIONS UNDERSTANDING CONTEXT / OPPORTUNITIES DATA PROGRAMME RESEARCH EVIDENCE FOR ENHANCED SHN POLICY-MAKING

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5 Healthy Children Learn Better Complementary Strengths of Ministries MoH MoE Learning for health Drug management & procurement Treatment supervision Technical resources Programme monitoring Strong community links Demand for improved health for better learning Large & stable platform Significant human resources Strong community links Financing

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7 3 examples: What schools do? School feeding Vision screening Deworming

8 Every country in the world does it to some extent. 368 million children fed every school day. US$ 75 billion global business

9 Home Grown School Feeding Promoting agricultural development by improving access to the school feeding market A potential win-win for children and communities improving their education, health, and nutrition Smallholder farmers providing regular orders and a reliable income

10 The School Meals Planner Package: A strategic approach to: Cost effective and nutritious menu planning Evidence into Action Behaviour change and nutrition education Improve market access for smallholder farmers

11 Impact evaluation in Ghana RCT to evaluate multiple impacts of HGSF and meals planner package Emerging research questions: Impact of nutrition interventions on adolescent health Changing food systems/environments and children/adolescent nutrition Cost-effectiveness/impact different delivery modalities

12 Refractive Error in Children 13 m SACs affected (Resnikoff et al 2008 WHO Bull) 8% in Malawi 15% China 31% high-poverty districts of the US Refractive error is responsible for 97% of vision problems in SACs Reduced learning Global costs of $200b per year (Fricke et al 2008 WHO Bull)

13 Why schools for vision screening? Source: Centre for Vision in the Developing World 2016

14 Cambodia Vision Screening & Scale-up: School-based screening by trained teachers (n=12,500) -Provision of eye glasses on the same day -6 month follow up -100% agreement between teacher screening and professional screening -Government of Cambodia scaling up nationally in Cost most entails provision of glasses

15 MDA through schools Ascaris lumbricoides (roundworm) Trichuris trichiura (whipworm) Ancylocstoma duodenale Necator americanus (hookworm) Schistosoma haematobium S. Mansoni S. japonicum

16 Evidence shows that simple, school-based health and nutrition interventions can have significant impact on health, nutrition, education and long-term development. In terms of access to education, such interventions have been shown to increase attendance by 25%. In terms of quality such interventions improve the ability of the child to absorb the education on offer.

17 Quality of the Evidence Intervention Enrolment Attendance Educational achievement Cognition School meals +++ ( effect) Take-home rations +++ ( effect) Fortified biscuits Dietary iron Deworming NA Eyeglasses Adapted from D. Bundy, C. Burbano, M. Grosh, A. Gelli, M. Jukes, and L. Drake. Rethinking School Health. World Bank, & Aurino et al 2016 forthcoming + = evidence from quasi-experimental evaluation ++ = evidence from at least one RCT +++ = evidence from more than one RCT NA = not assessed

18 Scaling Up

19 Mainstreaming SHN into ESPs Subject Costs $ Curriculum $ Textbooks $ Teacher Training $ Classrooms $ Examinations $ SHN???

20 ESHI

21 The benefits of Integrating SHN (Deworming, HGSF & WASH in Ethiopia) Overall SF: $28.01/chd/yr Including a $4.16 CC & $0.57 Local Government cost Deworming: $0.40 per child (drugs were donated) Made up of transport and salary costs Overall WASH and deworming: $6.68/chd/yr $1.05 in CC and $0.06 in government contribution Government 2% Depreciation (capital) 6% Indirect 7% Training/Aw areness 7% Community 14% Other Direct 10% Monitoring 3% Transport 8% Food 43% Overall: $35.15 per child per year.

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23 Find out Downloadable Documents & resources News & Events SHN topic information Country specific data Follow:

24 SHN services over time in SSA 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Health screening/services Deworming Drug provision School feeding Earlier period ( ) Later period ( )

25 Cost per school year of intervention Days per school year gained Cost and effectiveness of education interventions $0.00 School feeding Basic school health services CCT (PROGRESA) Extra Textbooks $20.00 $40.00 $60.00 $80.00 $ $8.03/ day gained $0.14/ day gained $7.21/ day gained $0.27/ day gained $ $ $ Bundy et al 2008

26 Attendance Rate Improved school attendance following deworming 0.85 Treatment 1 Treatment Treated Schools Untreated Schools Busia, Kenya Months Since Baseline Source: Miguel and Kremer 2000

27 Impact of deworming and school health on cognitive test scores uninfected treated placebo Source: Nokes et al Source: Grigorenko et al. 2007