Few development interventions pass the synergy test better than school-based health programs. Schools are the perfect setting for tackling the health needs of children across all grades, and an abundance of evidence shows this can deliver impressive gains in education.
However, the dynamic relationship between health and education, though increasingly recognized, is too often neglected in national education plans. Low-income countries in particular have the most to gain from tapping into this synergy.
New report shows evidence that school-based health works
A new publication by the Disease Control Priorities, the World Bank and GPE aims to convince policymakers and their development partners that school-based health programs can deliver big development gains.
Optimizing Education Outcomes: High-Return Investments in School Health for Increased Participation and Learning presents the latest evidence on how health affects education outcomes, and offers practical and affordable health interventions that can be used in schools.
We at GPE hope it will resonate in partner developing countries. GPE understands well that decision-makers in these countries, faced with spending constraints and an array of persistent development challenges, have difficult choices to make on where to direct precious resources. The report makes a compelling case for investing in school-based health programs.
For example, we know that school-based health interventions for poor girls and boys where worms and anemia are prevalent could lead to 2.5 years of additional schooling. Evidence also shows that malaria prevention activities can lead to a 62% reduction in absenteeism from school.
Fast uptake of school health programs but too little funding
It was only in 2000, at the World Education Forum in Senegal, that a formal commitment was made by countries to improve school health programs for better education results. At that time, awareness of this was low, with education ministries of only 10% of sub-Saharan Africa's countries having policies and programs that reflected the importance of health and nutrition for education outcomes.
By 2010 school health programs were nearly universal, though quality and coverage varied widely. Forward to 2015 and the World Education Forum in Incheon, where important progress was made on advancing our understanding of the interactions between education and health.
The big disappointment is that this growing recognition of the benefits isn't yet reflected in education spending. Of the US$210 billion a year spent on education in low- and lower-middle income countries, only US$2 billion funds the health needs of school-age children and adolescents (ages 5–19). By contrast, US$29 billion is spent on the health needs of children aged under 5.
Similarly, in research on the health of children, it is estimated that school-age children are the focus of less than 10% this effort.
Increasing health spending on these children could—if the resources are there—play a significant role in helping overcome the learning crisis blighting low-income countries, which have a high proportion of young people in their populations.
Of the 240 million students in school in lower-income countries, only 23% will likely learn basic secondary level skills. Illness, often from preventable conditions, and malnutrition prevents large numbers of children from going to school or attending school regularly. This makes a strong case for school-based health programs being in the toolkit of fixes to improve education outcomes.
Girls can benefit the most from school health programs
The report contains a comprehensive package of interventions for these programs, designed for ages 5- to 19-year-olds, that are both cost-effective and have high cost–benefit ratios. The “essential package” includes tetanus and HPV vaccination, oral health promotion, vision screening and treatment, promoting insecticide-treated mosquito net, deworming, and school meals fortified with micronutrients.
The package's development gains are particularly promising for girls, given the multiplier effects not only on their own health and economic prospects, but, later, on their children as well.
The publication breaks down the cost of the package's components, with the total package having an annual cost of about US$10 for children aged 5 to 14 and US$9 for adolescents between 10 and 19 in low income countries.
As of February, GPE is supporting 52 partner countries with designing school health interventions and integrating them into their education sector plans to target the poorest and most marginalized children. We are also already providing grant funding to 22 countries to implement these programs.
As part of our technical and financial support to partner countries, with the added evidence presented in the report, we will continue to promote school-health programs as some of the key interventions countries can make to improve both health and learning for their children.