Over recent decades low-income countries have achieved remarkable success in the pursuit of “education for all” and the education Millennium Development Goals (MDGs) through ramping up enrollment and enhancing equitable access. 

These successes have led to greater emphasis on new goals, especially the recognition that more students spending more time in school does not lead to better education outcomes unless there is a concomitant emphasis on learning. 

All of these worthy ideals are now newly minted within the Sustainable Development Goals (SDGs), but the routes to achieving these multiple education goals are characterized as depending upon a few well-worn solutions: more schools, better teachers and better pedagogical materials.

Achieving education for all means going beyond the education sector

A new analysis suggests that there may be value in expanding this vision to include the health and nutrition of the child.

The third edition of Disease Control Priorities (DCP3) is the latest manifestation of a 20-year old analysis of the most cost-effective ways to promote health in low-income countries. 

This latest edition is being published as a series of 9 volumes, the first of which was published in March 2015 and the last being scheduled for December 2016.  For the first time, a full volume of DCP3 specifically addresses child and adolescent development, highlighting education as a key influence on development outcomes.

Children must be healthy to learn

The analysis points out that free, universal access to education for children is one of a very few examples of a public good that has achieved near-universal acceptance, and funding, as a global policy goal. 

The analysis also shows that education outcomes are themselves critically dependent upon the health and nutrition of the individual child: sick and hungry children are less likely to attend school and less likely to learn while there.

Surprisingly, most of the low-income countries that view free education as a good investment do not invest in the health and nutrition for the school children who are supposed to benefit from the education provided.

Yet accumulating evidence shows that for many poor school children further investment in their education should go hand in hand with investing in their health and nutrition to ensure a virtuous cycle.  Investing in the health and nutrition of school children and pre-school children can reinforce the return on the existing investments in education: indeed countries that have already made progress in education often find that it is more cost effective to invest in school children’s health and nutrition than to seek marginal improvements from further education investments.

Investments in health and nutrition programs in schools support education goals

To resolve this paradox, the DCP3 Child and Adolescent Development Volume points out that school health and nutrition programs are near-universal complements to education in high and high-middle income countries.

The volume presents a short list of key investments that constitute an essential package for school-based delivery of health and nutrition interventions in low-income countries, supporting child development and thus education outcomes:

• sound school policies (e.g. on diet and exercise)
• access to potable water and sanitation in schools
• provision of low cost/high return health services (e.g. deworming, oral health education and fluoridation; targeted school meals)
• curriculum-based health and nutrition education.

The beneficial effects of these interventions are strongest in the poorest and sickest children, and in girls; and therefore, target equity goals in education. For example, schools that undergo mass deworming campaigns are likely to see a significant increase in attendance among the subset of children who had the greatest intensity of infection or were stunted.  Similarly, studies have shown that providing malaria prophylaxis to young children can result in higher primary school enrollment rates, especially for girls. This list builds on the FRESH framework (Focusing Resources on Effective School Health), which was launched as part of the World Education Forum in Dakar 2000, and which remains a key guiding principle for school health programming in many low-income countries today.

The Global Partnership for Education’s (GPE) new Strategic Plan 2016-2020 specifically includes health and nutrition as part of the way forward for ensuring universal education of good quality. This is an important development that could result in  enhanced equity and learning and serve to reinforce the returns on global investments in education.  Since many of the Development Partners which support GPE are also major investors in Global Health there is a real opportunity here for synergistically investing in both sectors.

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Donald Bundy is responsible for Neglected Topical Diseases at the Bill and Melinda Gates Foundation, and is the lead editor on Volume 8 “Child and Adolescent Development”, DCP3. Linda Schultz is at the World Bank, and is the coordinator for Volume 8, DCP3. The DCP3 Child and Adolescent Development Volume will be published in December 2016.  All published volumes in the series can be downloaded for free from DCP-3.org.