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EDUCATION AND HEALTH FOR GIRLS

PHFO - Pan American Health Organization

http://www.paho.org/English/DD/PIN/Number23_article5.htm

In Colombia and throughout
the Americas, health-promoting schools are
launching children on a lifelong quest for
better health and quality of life.

At La Esperanza, a small rural school in the community of La Mesa, in central Colombia, a clutch of baby chicks recently served as the raw material for an unlikely educational exercise. At the beginning of the school year, teachers asked students to team up in couples and assume the responsibility of raising and caring for the little birds.

The results were mixed. Some of the more unruly chicks ran away, some fell ill, and others, sadly, were abandoned by their adoptive parents. It wasn’t easy for the students either. Many of the couples broke up, others went “bankrupt,” and many of the girls ended up as “single mothers.” Indeed, the experiences ran the gamut of true-life parental vicissitudes.

A girl checks her weight as part of her school’s efforts to promote healthy lifestyles. (Photos by Marcelo Riccardi Doria)

If the purpose of the hands-on project was to teach lessons about subjects such as marital relations, family finances, and interpersonal relationships, it certainly seemed to have an impact. According to Johana Cortés, one of the girls involved in the project, “The teachers were affected, the students were affected, and the chicks were affected, too!”

Similar educational experiments have been popping up in public schools in Colombia and throughout Latin America and the Caribbean. Children are learning healthy habits in interesting and original ways, improving their diets and increasing their physical activity, building self-esteem and avoiding risky behaviors, and helping to improve living conditions in their communities by participating in “ecology days” and recycling programs. It’s all part of an approach known popularly as “healthy schools,” which has spread to a growing number of countries over the past decade.

“The idea is to promote health and development in the context of children’s daily lives. And, of course, for children that means at school,” says Josefa Ippolito-Shepherd, regional advisor on health promotion and health education at the Pan American Health Organization (PAHO). “The goal is for children themselves to become central actors in their own lifelong pursuit of good health and a better life, not just for themselves but for their families and communities.”

Health-promoting schools strive to provide healthy environments where children can grow and develop physically, emotionally, and intellectually.

Flexible strategy

The Regional Health-Promoting Schools Initiative was officially launched by PAHO in 1995 as an effort to make health—in the broadest sense of the term—an integral part of education. The initiative promotes conditions conducive to learning healthy habits and better quality of life for children, teachers, administrators, and parents, with spillover effects that benefit the entire community.

Two years after the official launch, Colombia’s Ministry of Health signed on to the PAHO initiative, committing itself to nationwide implementation. But this would require the involvement of more than just the health sector, and thus began a long process of consultations among the ministries of health and education, the Colombian Institute of Family Welfare, and PAHO. Two years later, the result was a national strategy titled “Healthy Schools: The Joy of Living in Peace.” It outlined a standard set of concepts, an operational plan with responsibilities for each sector, and a set of indicators for measuring progress in implementation. The strategy set a goal of getting 80 percent of local school districts on board within six or seven years. (continues below...)

Building blocks for a healthy school

There is no set formula for creating a health-promoting school, but there are a number of key principles that should guide the process. According to the Pan American Health Organization’s Regional Health-Promoting Schools Initiative, every healthy school should:

• Involve everyone—from teachers, students, and parents to community leaders and health workers—in decision-making and activities.
• Offer integrated health education, including life skills training to reinforce healthy behaviors and reduce risk factors.
• Provide a safe, caring, and healthy environment, with clean water and sanitation, smoke-free air, and freedom from drugs, violence, and physical or emotional abuse.
• Provide teachers with relevant training and materials.
• Facilitate access to health services, counseling, good nutrition, and physical activity.
• Promote values of mutual respect, gender equality, and individual and collective well-being.
• Work to improve the health of the entire community.

In practice, the healthy schools strategy means different things in different settings. In general it promotes activities in three main areas: life skills education; healthy and supportive environments; and nutrition, physical activity, and essential health services.

How these areas are addressed varies from school to school. The chickens at La Esperanza, for example, were a hands-on experiment aimed at teaching practical lessons about family life and sexual and reproductive health. Luz Marina Caicedo, the school’s academic coordinator, notes that it was just one of many healthy schools activities carried out throughout the year. “At our school we celebrate World Health Day, hold clean-up days, do eco-walks and time management projects, and play school sports,” she says.

Activities like these complement longer-term efforts such as incorporating health themes into school curricula and making improvements in school facilities, which can range from installing running water or building a simple latrine to planting trees and shrubs or even vegetable gardens.

One of the strengths of the healthy schools strategy is its flexibility. It offers general lines of action, technical guidance, and suggestions on how to spend resources. But it doesn’t tell anyone exactly what to do. Instead, the strategy leaves space for participation, creativity, and local initiatives to address the particular problems of each community.

This has led to widely varied initiatives. In Ubaté, a town 100 kilometers northeast of Bogotá, one of the first things school officials did was to hang mirrors on the school walls. They found that when the children—mostly from remote rural villages—saw themselves in the mirrors, they began to take more interest in their personal hygiene and appearance. The school also decided to offer classes for parents and caregivers to make sure that the healthy habits they were promoting among children would be reinforced, not undermined, at home.

Resources

Activities like these, of course, require money. Colombia’s Ministry of Health directly funded the early development of the health-promoting schools initiative and continues to provide support through annual budget allocations to various regions. However, no region is obligated to spend its budgetary resources on healthy schools.

This could leave the initiative in a weak position. But some promoters say the opposite is true. According to Mayden Cardona, national coordinator for Colombia’s health-promoting schools, regional and local officials fully recognize the program’s value.

“Healthy schools has been well received because it has truly helped promote health and disease prevention in the school community—among kids, teachers and parents,” she says.

In cases where local authorities have not assigned funds for the strategy, schools have managed to find their own resources. At La Esperanza, supporters have organized collection drives to purchase trash bins, raffles to buy tape recorders, and movie presentations to finance teaching materials. Sometimes teachers use their own money to buy what they need, as was the case in the baby chick experiment.

In Ubaté, healthy schools advocates expect to receive funding to support their efforts starting in early 2007. In the meantime, they have been actively implementing the strategy in eight local schools over the past year. Cooperation from members of the community has helped make up for the delay in getting resources. The local Municipal Agency for Agrarian Technical Assistance has donated trees for school ecology projects, the city dump has hosted student visits to teach about recycling, and a local doctor has volunteered to provide medical checkups for students, to name just three examples. (continues below...)

From checkups to life skills

Before the mid-1990s, school health programs in Latin America and the Caribbean were focused on improving hygiene and sanitary conditions, preventing communicable diseases, treating illnesses, and providing periodic medical checkups and screening.

“The early programs were important for child and community health, but they didn’t go far enough,” says Josefa Ippolito-Shepherd, regional advisor on health education and health promotion for the Pan American Health Organization (PAHO). The Regional Health-Promoting Schools Initiative, launched by PAHO in 1995, significantly broadens the concept of health promotion in schools.

“It takes a comprehensive, multidisciplinary approach to promoting health and development in children and adolescents, and health in the community at large,” says Ippolito-Shepherd.

A year after the initiative’s launch, at a meeting organized by PAHO in San José, Costa Rica, 11 countries got together and formed the Latin American Network of Health-Promoting Schools. In 2001, the countries of the Caribbean launched their own network with 14 member countries. Today all the region’s countries have signed on to the health-promoting schools initiative, with tens of thousands of participating schools.

PAHO has continued to provide support for their efforts through technical cooperation focused on raising awareness among policymakers, forging partnerships across different sectors, analyzing and updating policies and legislation, sponsoring regional meetings and training activities, and assisting with program development, implementation, and evaluation.

The challenge ahead, says Ippolito-Shepherd, is to get society as a whole on board: “Our success and sustainability will depend in large part on the level of commitment in the countries and how well the different sectors can play a leadership role. We need to encourage community leaders, decision-makers, and other influential people to become advocates for the initiative, so we can increase our visibility and mobilize public support and resources.”

Patricia Segurado, environmental health advisor in PAHO’s country office in Bogotá, notes that the healthy schools strategy sees children themselves as important actors in making things happen.

“Children can become agents of change,” she says. “They can bring members of the community together to work for the common good. And joint action by communities and institutions leads to a better society.”

PAHO’s Ippolito-Shepherd adds: “Clearly, the driving force at the local level is the people who are committed to the idea of building healthy schools. But there also needs to be leadership at the national level and resources to support technical cooperation and to expand the strategy’s scope.”

Colombia’s experience has born out both these ideas. In 2002, the Ministry of Health counted 1,248 schools that were implementing the strategy. Then came a major restructuring of the public sector, which meant the elimination of some ministries, major changes in others, and a redistribution of functions across the board. That process took about a year.

For health-promoting schools, “it was a quiet year,” recalls Cardona, “mainly because it wasn’t clear who would take over the program.” Coordination and follow-up at the national level virtually disappeared, she says.

Then in 2003, Cardona was named national coordinator of the strategy and began to renew her regional contacts and evaluate the status of the program. She says she was surprised to find that the number of healthy schools had not declined; municipalities had continued to assign resources to the program, and in general the strategy had kept going on its own.

From her office at the new Ministry of Social Protection, Cardona began to reach out to both old and new partners at the national level. The result was the reactivation of a National Technical Committee with members from Cardona’s ministry; the Ministry of Education; the Ministry of Environment, Housing and Development; the Colombian Institute of Family Welfare; and the National Teaching Service, among others.

With this new momentum, the strategy began to take a new path. At the time, PAHO was actively promoting a regional initiative on healthy housing. It seemed a good idea to combine efforts in the larger framework of healthy environments. A document outlining this new approach is expected to be signed soon by the participating ministries and other partners.

Positive experiences

About the time these new lines of action make their way to regional and local coordinators (probably in the first half of 2007), the results of an official evaluation of the healthy schools strategy should also be available. Early numbers suggest the results will be mostly positive. By now the strategy is being implemented to one degree or another in all of Colombia’s 32 departments. In the nine departments already evaluated, there are some 2,000 schools with an estimated 200,000 students benefiting from the program.

Pending the results of the evaluation, the feedback to date is mostly anecdotal. Caicedo, of La Esperanza school, says: “We’ve seen parents’ participation grow, and we’ve seen the kids begin to appreciate their environment and get more involved in projects. In fact, sometimes it’s hard to get them to leave school. We have to say, ‘Okay, it’s time to go home now!’ because they don’t want to leave.”

Similar stories can be heard in other schools where the strategy has shown clear results. Nubia Carrasco, a supporter of Ubaté’s healthy schools, says that thanks to the regular medical checkups, a number of children have been referred to specialists for serious conditions that were previously undetected. Others have been found to be victims of child abuse. School officials have also seen less dramatic outcomes, such as improvements in appearance and personal hygiene.

As for the chickens at La Esperanza, their outcomes varied. After serving as object lessons in reproductive health, a few ended up as school lunch. Alejandro Ortega, one of the students involved in the project, sold his grown chicken and used the proceeds to buy more baby chicks. The fate of Johana Cortés’s bird is a bit more uncertain: “My dad has my chicken. He wants to eat it, but I think it’s still alive.”

Marcelo Riccardi Doria is a Colombian journalist living in Bogotá.

Healthy initiatives

Every country in Latin America and the Caribbean has signed on to the Pan American Health Organization’s (PAHO) Regional Health-Promoting Schools Initiative. Different countries—and different regions within the same country—have taken different approaches to implementing the initiative. Below are a few examples.

• Argentina’s Salta province has been promoting healthy schools since 1998 through training of multidisciplinary teams and through networks linking various government ministries.
• Bolivia has focused efforts on sexual and reproductive education, using a gender perspective. Some 177 schools have joined the program, representing 1,400 teachers and 60,000 students.
• Chile’s healthy schools efforts have included training programs for educators in nutrition, oral health, reduction of tobacco use, and increased physical activity.
• Cuba was one of the first countries in the region to adopt the healthy schools approach. As of 2005, 2,000 Cuban schools and 22 universities were implementing the strategy.
• El Salvador has focused much of its healthy schools efforts on nutrition. In 2005, 750,000 students benefited from the strategy; more than 360,000 received free nutritional snacks.
• In Mexico, health-promoting schools have developed alongside training programs and awareness-raising on environmental conservation.
• In Peru, a “Healthy Playgrounds” initiative has combined health promotion with recreation in the departments of Lima, Ayacucho, and Cusco. Schools throughout the country are incorporating health themes into their curricula, promoting personal hygiene, improving school environments, and training teachers.
• The Venezuelan state of Aragua has established minimum standards for certification of health-promoting schools, with emphasis on nutrition, oral health, and teacher training.

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