Village Hope Technical Report 11b. Education_School Feeding Programs. Barb Briggs April, Standard VHTR disclaimer

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1 Village Hpe Technical Reprt 11b Educatin_Schl Feeding Prgrams Barb Briggs April, 2008 Standard VHTR disclaimer Althugh we have made every effrt t insure the accuracy f infrmatin in Village Hpe Technical Reprts mst were written by students r by the President f Village Hpe as way t learn abut an unfamiliar tpic. Use them t get an intrductin t - r quick verview f - a tpic, fr ideas, and t lcate references. But please d nt treat them as authritative accunts. If yu want t yu use sme f the infrmatin, check the references and reach yur wn cnclusins. We are always happy t hear frm peple with crrectins, updates, r especially with ffers t revise a VHTR r write a new ne. VHTR6: Schl feeding prgrams 1

2 Intrductin... 3 Overview f Schl Feeding Prgrams (SFP)... 3 Increase Enrllment and Attendance and/r Decrease Gender Disparity... 3 Alleviate Shrt-Term Hunger... 4 Imprve Nutritinal Status... 4 Imprve Micrnutrient Status... 4 Designing a Schl Feeding Prgram... 5 Cultural Habits and Beliefs... 5 Available Resurces... 5 Baseline Data fr Mnitring and Evaluatin... 6 Nutritin and Health Knwledge... 7 Educatinal Resurces and Schl Infrastructure... 7 Defining the SFP... 7 Wh is the prgram intended t serve?... 7 Hw will the prgram be financed?... 8 What shuld be prvided in terms f ratins and nutritinal cntent?... 8 When shuld ratins be served and hw many? Hw will the prgram be implemented? What mnitring and evaluatin systems are needed? What ther interventins will be part f the package? Helminth Cntrl Micrnutrient Supplementatin Nutritin, Hygiene and Sanitatin Educatin Best Practices and Guiding Principles fr Schl Feeding Prgrams References VHTR6: Schl feeding prgrams 2

3 Intrductin Schl feeding prgrams have been used in many parts f the wrld fr a number f years, with varying success. Numerus research and literature exists n the theretical underpinnings, methdlgical appraches, impact and effectiveness, gals and bjectives, prject design, management and evaluatin. The purpse f this paper is t prvide a brief verview f the literature n schl feeding prgrams, with a fcus n best practices and implicatins fr Village Hpe Inc. Overview f Schl Feeding Prgrams (SFP) Schl feeding prgrams have been implemented bth in develped and the develping wrld. Thrughut the develping wrld, these prgrams ften ccur thrugh large rganizatins in cllabratin with natinal gvernments and nn-gvernmental rganizatins [1]. The largest prvider is the UN Wrld Fd Prgramme (WFP), which perated in 78 cuntries in 2006 [24]. Numerus ther agencies and NGOs perate schl feeding prgrams at the natinal, reginal and lcal level. The primary assumptin f SFPs is that educatin and learning depend n gd nutritin. Ample evidence exists t supprt this assumptin. Hwever, in designing and implementing a schl feeding prgram, a number f ptins are available, depending n the primary and secndary bjectives f the prgram. SFPs can range frm simple snack prvisin (usually frtified biscuits) t breakfast r lunch prgrams, t take-hme ratins. Often, these prgrams perate in cnjunctin with ther health and nutritin initiatives t increase their success and impact [1, 3]. A number f categries f SFPs exist, linked t the primary bjectives f the prgram [1, 3, 13, 16, 20, 25, 28]: Increase enrllment and attendance and/r decrease gender disparity Alleviate shrt-term hunger, thereby increasing learning capacity Imprve nutritinal status, thereby increasing learning capacity Imprve micrnutrient status Each bjective is discussed belw. Increase Enrllment and Attendance and/r Decrease Gender Disparity There is much evidence t suggest that schl feeding prgrams increase enrllment and attendance in schl, particularly amngst girls [1, 2, 3, 15, 16, 20, 28]. Fd can act as a strng incentive fr children t attend schl n a regular basis. Girls especially benefit VHTR6: Schl feeding prgrams 3

4 frm this, as parents may feel there are sufficient incme-transfer benefits (meaning the meal/fd prvided acts as a frm f incme savings/benefit as they d nt have t spend as much n fd). Often, girls are nt encuraged t attend schl due t cultural practices, beliefs abut educatin and they are needed t prvide valuable labur and cntribute t the husehld. Hwever, in designing a prgram, cautin is needed t ensure that the fd/meal is additive rather than subtractive. If the family subtracts previusly prvided fd frm the child s diet due t the prvisin f fd in schl, many f the benefits f the prvisin are lst [3, 25, 26]. Alleviate Shrt-Term Hunger The evidence that schl feeding prgrams alleviate shrt-term hunger is very strng [3]. Much research has als been cnducted n the effects f shrt-term hunger related t learning capacity. When a child is hungry due t skipped meals r much activity, their ability t learn is dramatically decreased. In many cultures, breakfast is nt prvided. This means the child many nt have eaten since the evening befre. That cmbined with lng travel times, may mean the child begins schl hungry and unable t cncentrate [3, 28]. The prvisin f even a small snack at the start f the day r mid-mrning alleviates the shrt-term hunger and has been linked t increased awareness, activity and learning capacity [3, 8, 10, 16, 20, 22, 28]. Imprve Nutritinal Status The evidence that schl-feeding prgrams can imprve nutritinal status in the lngterm is incnclusive and weak [20]. The physical grwth f children is a result f a number f intercnnected variables, especially in areas where pverty is endemic. Envirnmental factrs, genetics, fd cnsumptin patterns, health and illness, hygiene practices, lack f sanitatin and the nset f puberty are but a few [1, 3, 8]. Data cllectin n these variables has been incnsistent. In additin, it is believed that ptential fr catch-up grwth amng stunted children is limited after 2 years f age, particularly in pr envirnments. Hwever, sme research indicates that undernurished children d benefit frm schl feeding prgrams [3, 20]. Imprve Micrnutrient Status While the evidence related t imprvements in verall nutritinal status is weak, there is gd evidence t suggest that schl feeding prgrams, when designed with micrnutrients in mind, can greatly imprve micrnutrient status [28]. This is ften VHTR6: Schl feeding prgrams 4

5 referred t as hidden hunger as the effects are nt always visible. The three main micrnutrients that SFPs can impact are irn, Vitamin A and idine. All three have been linked t learning capacity. These will be discussed later in this paper. Designing a Schl Feeding Prgram Designing a SFP invlves much planning and careful cnsideratin f a number f factrs. Prir t designing a prgram, it is suggested t gather as much infrmatin as pssible n the lcal cmmunity, as this will greatly impact the success f the prject. In additin, cllabratin with lcal and natinal gvernments, schl fficials, teachers, parents and students is vital thrughut all stages f the prject. Infrmatin n the fllwing shuld be cllected prir t design. Cultural Habits and Beliefs The cultural habits and beliefs f the cmmunity are vital t the success f the prgram. Infrmatin n preferred time f day fr meals, fd preferences, and tabs (fd, serving and preparatin) shuld be cllected and cnsidered. In additin, gathering infrmatin n nutritin and fd beliefs and practices will help determine any ptential barriers and gaps in knwledge [22]. Other cultural habits, practices and beliefs that may need t be examined include beliefs arund the inclusin f females in schl (especially if trying t increase female attendance); use f children as labur during specific times f the year (such as harvest times); health practices (such as feeding a child less when they have wrms); and the value f educatin [22]. If the prgram attempts t incrprate practices that are nt culturally accepted, a great amunt f sensitizatin and awareness raising may be required. Available Resurces The availability f resurces are linked directly t the csts f perating the prgram as well as influencing the design f the prgram. Infrmatin n lcal prduce, meats and ther fd surces shuld be cllected t assist with meal planning and prgram implementatin. In additin, seasnal variatins in fd availability may impact the functining f the prgram. Transprtatin f fd may als need t be cnsidered [22, 25, 26]. Strage and preparatin facilities alng with preparatin equipment and fuel availability will greatly affect the nature f the SFP. Fr example, if firewd is the main surce f fuel fr cking, the amunt f time required t cllect it may impact the time f day VHTR6: Schl feeding prgrams 5

6 fd is prepared and served. The quantity f fuel needed shuld als be examined. As a guide, 1 kilgram f wd is required t bil ne litre f water. Related, is the cking time required t prepare each fd ptin and/r meal [22]. Accessibility f safe water is imprtant in maintaining gd health and prper sanitatin. Where inadequate water is present, schl absenteeism increases, as des viral diseases, bacterial diseases, and wrm infectins. Surces f water fall int three brad categries: 1) grundwater; 2) rainwater cllectin; and 3) surface water. Safe water supply needs t be available n schl premises at all times [25]. Water quality is highly imprtant. Water taken directly frm surface surces such as lakes, rivers and pnds withut treatment is a majr health hazard. Water needs t be disinfected either by biling fr ne minute r thrugh chlrinatin. In additin, if water is stred, care must be taken t ensure that cntainers are clean and biled and/r bleached after each use. The availability f disinfectants shuld be cnsidered [25]. Water quantity is als f cncern. Accrding t the WFP, expected water cnsumptin varies frm litres/day/student in day schls. Each persn requires abut 2 litres f water a day fr basic physilgical needs. As a minimum, 5 litres f water per day per student is needed fr drinking and cking [25]. Related t clean water is sanitatin. Lack f gd sanitatin facilities can lead t cntaminatin f clean water surces and fd [11]. Infrmatin n available human resurces shuld be gathered as well. A number f peple will be required fr fd acquisitin (r grwing/harvesting), meal planning, fd preparatin, and clean up, as well as prject management and peratin. Invlvement f schl staff, parents, students and cmmunity members will be required fr a successful prgram. In many instances, parent vlunteers perate schl feeding prgrams. While keeping csts dwn, it has the added bnus f increasing cmmunity participatin creating a sense f wnership f the prject. Prgrams that invlve parents, staff and students in the peratin and management ften have greater success, hwever care must be taken t ensure that abuses d nt ccur. There have been instances where individuals have taken advantage f students (making them wrk schl gardens and selling the fd fr their wn benefit) and have taken fdstuffs, equipment and materials fr their wn persnal gain [13]. Baseline Data fr Mnitring and Evaluatin Baseline data fr mnitring and evaluatin purpses and t assist in prgram design shuld be gathered as well. This may include varius health indicatrs such as height, weight, age, gender, cmmn illnesses in the cmmunity, micrnutrient deficiencies and the prevalence f wrms. Educatinal indicatrs such as attendance rates, exam scres, VHTR6: Schl feeding prgrams 6

7 activity levels f students, graduatin rates and drput rates shuld be cllected [3, 22, 25]. Nutritin and Health Knwledge Related, is infrmatin n nutritin, health and sanitatin knwledge amngst teachers, parents and students. This is especially imprtant if the SFP will include an educatinal cmpnent. If the teachers and parents d nt have adequate knwledge r have inaccurate knwledge related t nutritin, the impact f the prgram will be greatly decreased [3, 6]. Educatinal Resurces and Schl Infrastructure One final area f infrmatin relates t schl infrastructure and the availability f educatinal resurces. If the main bjective f a SFP is t decrease shrt-term hunger and thereby increase learning capacity, this will mean nthing if the schl des nt have adequate facilities and teaching resurces. Withut textbks and teaching materials, the children will have nthing t learn. If the teachers are inadequately trained, the quality f the educatin received will be limited. If the schl has a leaking rf, weather may impact the peratin f the schl. Therefre, examining pssible mitigating factrs is necessary t implementing a successful SFP [8]. Defining the SFP The first step in designing a schl feeding prgram is t determine the primary bjective (see abve) and develp plicy. Plicy shuld be develped in cllabratin with teachers, parents, students, administratin and any ther stakehlders. This shuld be a written plicy that addresses questins such as [16]: Wh is the prgram intended t serve? Hw will the prgram be financed? What shuld be prvided in terms f ratins and nutritinal cntent? When shuld ratins be served and hw many? Hw will the prgram be implemented? What mnitring and evaluatin systems are needed? What ther interventins will be part f the package? Wh is the prgram intended t serve? While this may seem bvius, there are a few items t cnsider. First, what age grup will the prgram target? Will all the children, regardless f age, gender and ecnmic status participate in the SFP? If the gal is t increase attendance amngst females, than females may receive mre ratins. Ideally, the prgram wuld serve all children in the schl, s t avid any pssible plitical r cntrversial incidences. VHTR6: Schl feeding prgrams 7

8 Regarding the age f target ppulatin, there is sme evidence t suggest that the best windw f pprtunity t address malnutritin and under-nutritin is in the preschl years [2, 8, 9, 18, 20]. By the time children reach schl, much f the damage related t pr nutritin has been dne, therefre impacting their ability t learn and their lng-term prductivity. Secnd, if all children in the schl are t be served, will there be rules relating t enrllment in the schl? In sme instances, parents living utside f the gegraphical area f the schl may wish t send their children t the schl because f the prgram. This can translate int increased enrllment f children utside the gegraphical area f the schl and increased prgram csts [1, 3]. Related t this is whether thse being served by the prgram get fd as a matter f charity r as a matter f entitlement r right [13]. If the fd is prvided as a right then this implies enfrceable claims. A bdy r authrity t which right-hlders culd make a claim wuld need t be established. Duty bearers are bligated t fulfill the right and are held accuntable fr their perfrmance. This culd invlve the frmatin f a Schl Feeding Mnitring Cmmittee, cnsisting f students, parents and teachers (but nt thse invlved in the preparatin and prvisin f fd). Students, teachers and parents culd make claims relating t a number f items such as fd quality that wuld be predetermined in the SFP plicy. Hw will the prgram be financed? The plicy shuld utline the surces f funds r resurces fr the prgram, as well as the duratin f funding. Questins such as hw will csts be divided amngst the schl, parents, lcal surces, gvernment surces, partners and implementing agencies; what ther surces f untapped financing are available; what prprtin f children s needs are already met at hme; and s frth. The plicy shuld clearly utline wh is respnsible fr financing the varius aspects f the prgram and fr hw lng [16]. What shuld be prvided in terms f ratins and nutritinal cntent? The type f ratin is ne f the key cmpnents f the SFP. Will the prgram ffer snacks nly and if s, what type f snacks? Will the prgram prvide full meals? Will the ratin size vary accrding t age f the child? What are the best fd surces? Will meat and dairy be prvided? A number f guidelines exist arund nutritinal requirements and recmmended daily allwances. Table 1 summarized guidelines derived frm WFP, WHO and USAID data [22, 25, 30]. VHTR6: Schl feeding prgrams 8

9 Table 1. Mean Daily Per Capita Energy Requirement and Safe Prtein Intake fr Primary and Pre-Primary Children. Pre Primary Schl Children Primary Schl Children Adlescent years* Adlescent / Teen years** 3-5 years 6-12 years Energy (Kcal) (male) Prtein (grams) * USAID and WHO data nly * * USAID data nly 2200 (female) (male) 44 (female) Wrld Fd Prgramme assumes that at meal distributin, serving prtins will be adapted t the children s ages with yunger children receiving smaller prtins. Calries, prtein and fat cntent are prvided fr children up t age 12 (Table 2). Nutrient requirements fr lder children (particularly adlescent girls) are higher and prtin sizes shuld be adjusted accrdingly [25]. Table 2. Recmmended Nutritive Value f Ratins fr Primary Schls (WFP data) Schl Type Acceptable range f ratins nutritive value (children 6-12 years) Energy (Kcal) Prtein (gram) Fat (gram) Half-Day Schl (30-45%) Day Schl (60-75%) Barding Schl Up t 2000 (up t 100%) (40-60%) (70-90%) At least 40 (up t 100%) The chice f nutritive value shuld be guided by the nutritin situatin in the area (such as magnitude f Prtein Energy Malnutritin) and lcal dietary habits. Fr example, if the area is knwn t be lw in prtein, the ratin shuld meet the upper range f energy and prtein values. Lw prtein diets are cmmn where rts and tubers are the staple diet [25]. In additin t prtein, calric intake and fat, the key micrnutrients identified in the literature are vitamin A, irn and idine. Vitamin A deficiency is the single greatest cause f preventable childhd blindness. Each year half a millin children becme partially r ttally blind. Mderate levels f deficiency can lead t stunted grwth, increased susceptibility t infectin and higher death rates [1]. Supplementatin effectively reverses immediate effects. >23 VHTR6: Schl feeding prgrams 9

10 Irn deficiency anemia is the mst cmmn deficiency in the wrld. Even mild anemia can cause reduced physical and mental capacity [1]. Idine deficiency affects ver 800 millin peple wrldwide. Idine deficiency causes mental retardatin and brain damage, delayed mtr develpment, grwth failure, stunting and hearing and speech defects. Giters are the mst visible sign f idine deficiency. In many cuntries, the use f idized salt has alleviated this prblem [1]. The WFP, WHO and USAID prvide guidelines (Table 3) arund the recmmended daily intakes fr Vitamin A, Irn and Idine [22, 25, 30]. As with nutritive value, micrnutrient intake shuld be guided by the nutritin situatin and lcal diet. It is imprtant t establish cmpsitin f ratins bearing in mind prevailing micrnutrient deficiencies. Sme examples f micrnutrient-rich fds include pulses, vegetables and their leaves, fresh fruits and frtified blended fds [25]. Table 3. Recmmended Mean Daily Intakes fr Vitamin A, Irn and Idine. Age Grup Vitamin A (mg retinl) Irn(mg) Idine (mg) Pre-Primary (3-5 yrs WFP) (1-6 yrs WHO) (4-6 yrs USAID) Primary (6-12 yrs WFP) (7-10 yrs WHO & USAID) (WHO) 500 (WFP) Adlescents (10-15 yrs WHO) (11-14 yrs USAID) 500 (10-12 yrs) 600 (12-15 yrs) * Differences exist between WFP and WHO figures 12 (bys yrs) 15 (girls yrs) 150 Regarding Idine, 3 t 6 grams f idized salt per day shuld be included in the ratin where salt idizatin is nt in place/fully peratinal and the prevalence f giter amngst the children is abve 5% [25]. Table 4 prvides an verview f energy, prtein, fat and mircnutrient cntent fr a number f cmmn fds. Table 4. Nutritive Values f A Few Cmmn Fds [25] VHTR6: Schl feeding prgrams 10

11 Serving SizeFd Energy (Kcal) Prtein (g) Fat (g) Vitamin A (mg) Irn (mg) 100 g Maize Meal g Srghum g Rice g Bulgur Wheat g Beans g Peas g Canned fish in il 20 g Canned meat Other cnsideratins related ratins and nutritinal cntent include the use f meat and/r animal prteins (such as milk). Meats may nt be lcally available and strage and preparatin issues may arise. Fresh milk, while a nutritius and cnvenient ptin, is nt usually recmmended, as it is perishable, subject t cntaminatin and an expensive surce f calries [25]. Fd variety is anther imprtant factr t cnsider. Offering a variety f fds and recipes greatly increases satisfactin amngst the children, as well as imprves nutritin. The WFP suggests having a fd basket that cnsists f a cmbinatin f 4-5 items selected frm the fllwing [25]: Whle grain cereal (e.g. rice) r cereal flur (e.g. maize meal) Pulses Canned fd Vegetable il Sugar Frtified biscuits Frtified blended fds Breads (nly if the supply f fresh bread is feasible) It shuld be nted that WFP and mst SFPs d nt prvide fresh fruit and vegetables and fresh meats [25]. They tend t prvide staple, tried and canned fds. These are easier t cllect and distribute and prvide cnsistent nutrient values. Parents, t imprve palatability and acceptance by the students, ften prvide items such as cndiments and fresh vegetables. Meals can be prepared using a number f lcal recipes. When shuld ratins be served and hw many? VHTR6: Schl feeding prgrams 11

12 The time f day that fd is served has a direct crrelatin t learning capacity as well as implicatins related t prgram peratin. The number and timing f meals shuld take the number and duratin f schl sessins as well as the bjective f the prgram int accunt [25]. A number f studies recmmend breakfast r mid-mrning snacks. Research cnfirms that shrt-term hunger is alleviated and can imprve cgnitin, shrt-term memry and cncentratin. This is mst nticeable amngst malnurished children [3, 8, 20, 22, 25]. Hwever, a few items shuld be taken int accunt when implementing breakfast r early mrning snack prgrams. Practical cnsideratins such as preparatin time may impact the ability t ffer breakfasts. It may nt be feasible t prepare breakfast in time fr students. A mid-mrning snack may ffer a feasible alternative in this instance. Cautin shuld be taken t avid assuming that early schl lunches will serve the same functin as breakfast r a mrning snack [25]. Anther cnsideratin is that ffering breakfast may nt be culturally acceptable and may nt ffer the same attendance incentive as a lunch [25]. Smaller light meals, which are mre effective in relatin t learning, may als nt be as ppular with families. Lunches are cmmnly prvided t schlchildren in many cuntries. Hwever, care shuld be taken in making sure the meal is nt t heavy, as the effects n learning are cunter-prductive. Rather than imprving alertness, cncentratin and shrt-term memry, a heavy lunch can have a temprarily sedative effect [25]. The WFP prvides guidelines (Table 5) fr the number and timing f meals [25]. Table 5. Number and Timing f Meals. Type f Schl Number f Meals Timing f Meals Half-day schl 2 At start f classes and at midmrning Day schl 2 At the start f classes (r mid-mrning meal) & lunch Barding schl 3 Breakfast, lunch and dinner Hw will the prgram be implemented? Plicies arund the implementatin f the prgram shuld be develped. Questins t address include wh will be respnsible fr fd preparatin, serving and clean up? Hw will fd be acquired? What human resurces are available? What training will be prvided? Wh will manage and versee the prgram? Will meals be prepared n r ff site? VHTR6: Schl feeding prgrams 12

13 Varius ptins are available fr acquiring fd fr the prgram. These include the use f dnated fd, purchase f lcal fd, grwing/rearing wn fd, use f lcal fd vendrs r a cmbinatin f these. Each invlves different levels f infrastructure and staffing requirements and faces their wn issues [16]. Dnated fd can cme frm parents, cmmunity members, gvernment, fd agencies r NGOs. The fd can be directly used r sld (mnetizatin) fr the purchase f needed items. Pssible issues include incnsistency in the quantity and type f fd, as well as fd quality. In additin, the pssibility f dnated items being taken and used fr persnal gain by staff, teachers and parents, culd pse a prblem. A high level f infrastructure may be required t take in and mnitr the dnated items [16]. Purchase f lcal fd is anther ptin, but requires cash inputs. This ptin wuld allw greater cntrl f the quality and quantity f items purchased and lcal purchases will cntribute t the lcal ecnmy [16]. Grwing r rearing fd thrugh schl gardens and raising animals is anther ptin. Schl-based gardening can prvide many pprtunities fr learning and skills training, in additin t fd fr the SFP. Hwever, adequate tls and training must be prvided alng with sufficient staffing t maintain the garden [5, 20]. A number f schl-based gardens have been successfully implemented arund the wrld, but much f the literature is critical f them fr a number f reasns including [1, 3, 5, 20]: Schls ften dn t have sufficient land, tls r labr t prduce adequate quantities f fd fr a SFP Gardens are subject t abuse by teachers and fficials Students frced t wrk lng hurs rather than spending time in schl Prduce is stlen r sld fr persnal gain Nutritinal educatin rarely included in daily curriculum Lack f training in agriculture Lack f adequate water supplies t maintain the garden Lack f supprt by parents Parents want their children t learn t read and write and ruralizatin f the curriculum is rejected Time cnstraints and staff changes/turnver Hlidays, schl clsures and sessin breaks can cause difficulties Changes in staff respnsible fr the garden can lead t failure Hwever, a number f steps can be taken t implement a successful schl garden. These include [7]: VHTR6: Schl feeding prgrams 13

14 Invlvement f parents and in planning and implementatin t avid cnflicts and tensins Ensuring gender equity (bys and girls wrking tgether) Prviding adequate teacher training Ensuring that children and adults wrk tgether Tying the garden t the curriculum Develpment f apprpriate teaching materials Linking schl gardens with cmmunity and NGO driven gardens Invlvement f lcal partners Selling a prtin f prduce and save the funds fr future expenses (required fr sustainability) Develping simple irrigatin methds t vercme shrtfalls in rain and water shrtages Chsing simple technlgies fr the gardens Establishment f prcedures fr prject applicatin, review and mnitring T increase prtein availability f SFPs, animal husbandry and fishpnd prgrams may be cnsidered [7]. The use f lcal vendrs fr SFP is anther ptin. This invlves securing a cntract with a lcal business fr the supply and preparatin f snacks and meals. Pssible issues invlve quality cntrl, hygiene and sanitatin and fd variety. Transprtatin f the meals may als be an issue if prepared ff-site [16]. What mnitring and evaluatin systems are needed? Successful SFPs require cnstant mnitring and evaluatin t prvide input n the changing needs f the students as well as data n impacts and effectiveness. As already mentined, baseline data an indicatrs shuld be cllected prir t the start f the prgram. Cnsultatins with parents, staff, teachers and students may als be required at varius stages t address changing needs, cncerns and issues assciated with implementatin [1, 2, 16, 20, 25]. Decisins and plicies n what data shuld be cllected, hw ften data shuld be cllected, methds f cllectin, hw data will be used and the reprting chain, need t be made. These decisins will be directly related t the bjectives f the prject. It is recmmended that a detailed mnitring and evaluatin plan be designed fr the prgram. What ther interventins will be part f the package? VHTR6: Schl feeding prgrams 14

15 While schl feeding prgrams are ntable n their wn, it is recmmended that they be implemented alngside ther interventins t maximize impact. The mst cmmn interventins include [16]: Schl-based helminth cntrl (dewrming) Micrnutrient supplementatin Nutritin Educatin Hygiene and Sanitatin Educatin Helminth Cntrl Helminth cntrl is the prvisin f dewrming drugs t children thrugh the schls. Accrding the Wrld Health Organizatin, wrms infect mre than ne third f the wrld s ppulatin with the mst intense infectins in children and the pr. Children are likely t be infected frm the time they stp breastfeeding and cntinue t be infected fr mst f their lives. The infectin is rarely acute and tends t be chrnic, negatively affecting all aspects f develpment including nutritin, cgnitive develpment and access t educatin [29]. Helminths affect health thrugh abdminal bstructin, muscular pain, diarrhea, vmiting, fatigue, t name a few. Malnutritin is aggravated thrugh diarrhea, which in turn lwers resistance t infectins. The increase malnutritin impairs cgnitive functin and psychmtr develpment, as well as brain develpment. Stunting is a cmmn symptm, which in turn delays children s enrllment in primary schl [3, 25, 29]. Cultural practices ften exasperate the prblem. Many mthers feed their child less during buts based n the belief that the best way t get rid f wrms is t have their children eat less [3]. Hwever, helminth cntrl is simple, safe and inexpensive. All the cmmn wrm infectins can be treated with tw single-dse pills (albendazle (400mg) r mebendazle (500mg) fr intestinal wrms and Praziquantel fr schistsmiasis) typically ffered nce a year. Teachers can deliver the drugs safely with nly a few hurs training t understand the ratinale fr dewrming. In areas where infectin is cmmn all children, regardless f age, shuld be ffered treatment. There is n need fr individual screening. The cst f treatment per child is US $0.22 fr bth tablets [29]. Micrnutrient Supplementatin Micrnutrients play an imprtant rle in the verall nutritin f children. Deficiencies in micrnutrients have been linked t absenteeism, late enrllment in schl and decreased cgnitive functining [3]. The prvisin f regular nutritius meals can alleviate many f the prblems assciated with micrnutrient deficiencies. In sme instances, SFPs may VHTR6: Schl feeding prgrams 15

16 prvide frtified fds such as irn-frtified biscuits. Hwever, ne cncern t cnsider is meal substitutin. If a child served a meal at schl frges an additinal meal at hme, the assciated benefit will be lst [3]. Nutritin, Hygiene and Sanitatin Educatin The mst successful SFPs include varius educatinal cmpnents and sensitizatin in their prgrams, nt nly t students, but als t parents and teachers. Research indicates that children play an imprtant rle in passing educatinal infrmatin n t parents and ther family members. Parents are imprtant t the lng-term adptin f varius health practices. They need t understand the benefits f and reasns fr varius health practices, as well as the reasns fr designing and implementing the SFP in certain ways. As previusly mentined, invlving parents and teachers in prject design can act as a valuable educatin tl and greatly impact the success f the prject [6]. A few key areas t address include the timing f meals, meal substitutin (which shuld be avided), the imprtance f breakfast and early mrning snacks, cgnitive and learning benefits f nutritius fds, prper sanitatin (fr example, sme cultures falsely believe that child feces is safe), the imprtance f hand washing, and safe surces f water (sme children drink frm streams and lakes which are majr health hazards). Withut adequate nutritin, health and hygiene educatin, schl feeding prgrams seem t be less effective [3]. Best Practices and Guiding Principles fr Schl Feeding Prgrams Based n guidelines taken frm a number f surces, the fllwing best practices have been cmpiled. Target all schls in a gegraphical area as ppsed t individual schls It avid ptential plitical issues and inter-schl shifts in enrllment) Determine the age range f the target grup Gather adequate infrmatin prir t prgram implementatin Identify culturally practices and dietary patterns that may effect the prgram Take int accunt the dietary habits f the target ppulatin t cnclude whether students are indeed suffering frm shrt-term hunger and t ascertain when they are mst vulnerable Develp a strng mnitring and evaluatin plan and measure prgram impact in such a way that the multiplicity f factrs which affect the variables can be accunted fr as accurately as pssible Assure that prgram is being implemented as planned Develp sund prcurement, transprtatin, strage and delivery tracking systems t minimize risk VHTR6: Schl feeding prgrams 16

17 Use SFPs t create student fcused incentives fr prmtin and graduatin as ppsed t grade repetitin Identify verall nutritinal needs f the target ppulatin and prvide meals and cmplementary shrt-term interventins which directly crrespnd t lcal need Use frtified ratins r cmplement cmmdities with lcally available vitamin and mineral rich fds Assure that ratin size and quality respnd t the increased needs f the target ppulatin during perids f heightened fd insecurity (fr example during lean seasns) Prvide meals that are f sufficient size and cmpsitin t verride ptential lsses frm meal substitutin effect Deliver fd fr an established minimum number f days Deliver meals early in the day befre lessn begin, r cmplement lunches with early mrning, high-energy snack. It is imprtant hwever that the ratin plan nt encurage the children t leave schl early in the day Determine the perceived nutritinal and incme transfer value f breakfasts and early mrning snacks and cnsider such perceptins in planning the timing and cmpsitin f early feedings Use rapid cking methds where breakfasts r mid-mrning snacks will be served and encurage the use f fds that require little preparatin time Ensure invlvement f PTAs in menu planning and fd preparatin Keep the number f cmmdities t an acceptable minimum Cmpute the cst f the ratin/child per day and per schl year Wrk with schl authrities t devise a lessn schedule that takes advantage f early feeding times by timing the mst demanding subjects half hur t 2 hurs after feeding Develp wrkshps fr teachers and caregivers that fcus n culturally apprpriate active learning techniques that can be used at hme and in the classrm Encurage cmmunity participatin in educatin and the SFP thrugh PTAs, schl infrastructure imprvement prjects, incme generatin prjects, and ther activities Encurage student participatin When using schl gardens, cllabrate with teachers and cmmunities t assure apprpriate use f schl gardens as an educatin tl and a surce f vegetables r incme When encuraging the cnstructin f water and/r sanitatin facilities, supprt a cncmitant initiative t develp a minimum level f water and sanitatin facilities in the cmmunity-at-large, thrugh cllabratin with ther agencies Assure that water/sanitatin facilities are regularly maintained, are sufficient in size, number and lcatin and are cmplemented by hygiene educatin fr students, teachers and cmmunity members Include cllabrative agreements with lcal, reginal and natinal educatin authrities in areas f plicy develpment, prgram design and implementatin and mnitring/evaluatin VHTR6: Schl feeding prgrams 17

18 Rutinely treat schlchildren fr intestinal parasites Incrprate educatin int the prgram References 1. Bennett, Jn. (2003, September). Review f Schl Feeding Prjects. Department fr Internatinal Develpment. 2. Bundy, Dnald. Schl Health and Nutritin: Plicy and Prgrams. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 3. CRS. (2001). CRS Fd-Assisted Educatin Prgramming Manual. Cathlic Relief Services. 4. Cuet, Santiag. Height, Weight, and Educatin Achievement in Rural Peru. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 5. Drescher, Alex. (2002). Imprving Child Nutritin and Agricultural Educatin Thrugh the Prmtin f Schl Garden Prgrams. FAO/TCOS. Retrieved April 8, 2008 frm 6. Galal, Osman M., Ibrahim Ismail, Azza S. Ghar and Zë Fster. Schlteachers Awareness Abut Schlastic Perfrmance and Nutritinal Status f Egyptian Schlchildren. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 7. Gpaldas, Tara. Imprved Effect f Schl Meals with Micrnutrient Supplementatin and Dewrming. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 8. Grantham-McGregr, Sally. Can the Prvisin f Breakfast Benefit Schl Perfrmance? Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 9. Greenhalgh, Trisha, Elizabeth Kristjanssn and Vivian Rbinsn. Realist Review t Understand the Efficacy f Schl Feeding Prgrammes. BMJ 2007: 335: ; riginally published nline 22 Oct Retrieved April 8, 2008 frm VHTR6: Schl feeding prgrams 18

19 10. Hunt, Jseph Michael M., and G. Peralta. (2004). Primer n Health Impacts f Develpment Prgrams. Retrieved April 8, 2008 frm Dcuments/Bks/Primer-Health-Impacts/default.asp 11. INEE Gd Practice Guides Schl Feeding. pid= Jukes, Matthew. The Lng-Term Impact f Preschl Health and Nutritin n Educatin. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 13. Kent, Gerge. (2007, Octber). Designing Rights-Based Schl Feeding Prgrams. Unpublished. Retrieved April 8, 2008, frm www2.hawaii.edu/~kent/ Designing%20Revisin%202.dc 14. Khr, Gek Lin. Micrnutrient Status and Interventin Prgrams in Malaysia. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 15. Levinger, Beryl. Schl Feeding, Schl Refrm, and Fd Security: Cnnecting the Dts. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 16. Miller Del Rss, Jy. (1999, June). Schl Feeding Prgrams: Imprving Effectiveness and Increasing the Benefit t Educatin. A Guide fr Prgram Managers. 17. Mwiria, Kilema. Crucial Rle f Nutritin in Educatin: The Kenya Experience. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 18. Pllitt, Ernest. Intrductin. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 19. Sigman, Marian, Shannn E. Whaley, Charltte G. Neumann, Nimrd Bwib, Dnald Guthrie, Rbert E. Weiss, Li-Jung Liang, and Suzanne P. Murphy. Diet Quality Affects The Playgrund Activities f Kenyan Children. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 20. Tmlinsn, Mark (2007, March). Schl Feeding in East and Suthern Africa: Imprving Fd Svereignty r Pht Opprtunity? Equinet Discussin Paper VHTR6: Schl feeding prgrams 19

20 Number 46. Retrieved April 8, 2008 frm results.php?keywrds=0&wherefrm=pub 21. USDA (2004). Recmmended Daily Intakes. Retrieved April 8, 2008 frm /search?q=cache:5FNYIQqpLLUJ: Master/21/372/0.pdf+usda+rda+2004&hl=en&ct=clnk&cd=1&gl=ca 22. USAID (2006). USAID Cmmdities Reference Guide. Retrieved April 8, 2008 frm van Stuijvenberg, Martha E. Using the Schl Feeding System as a Vehicle fr Micrnutrient Frtificatin: Experience frm Suth Africa. Fd and Nutritin Bulletin, vl. 26, n.2 (supplement 2) 2005, The United Natins University. 24. WFP, sectin=1&sub_sectin=1 Retrieved April 8, WFP, UNESCO and WHO (1999). Schl Feeding Handbk. Retrieved April 8, 2008 frm URL_ID=36315&URL_DO=DO_TOPIC&URL_SECTION=201.html 26. WFP. Schl Feeding in Emergency Situatin. Retrieved April 8, 2008 frm sectin=12&sub_sectin=3 27. WFP (2004). Imprving Fd and Nutritin Security Thrugh Fd fr Educatin Prgrams in Africa Retrieved April 8, 2008 frm fd_aid/schl_feeding/learnmre_publicatins.asp? sectin=12&sub_sectin=3 28. WFP (2004). Schl Feeding Prgrams: Why They Shuld be Scaled Up Nw. 29. WHO (2003, March). Schl Dewrming. At A Glance. Retrieved April 8, 2008, frm pagepk= &pipk= &thesitepk=523679&menupk= &searchmenupk= &thesitepk=523679&entityid= _ &searchMenuPK= &theSitePK= WHO. Energy and Prtein Requirements. Wrld Health Organizatin, Geneva, (WHO Technical Reprt Series N. 724). VHTR6: Schl feeding prgrams 20