Monitoring and Evaluation Guidance for School Health Programs. Eight Core Indicators to Support FRESH (Focusing Resources on Effective School Health)

Transcription

1 Monitoring nd Evlution Guidnce for School Helth Progrms Eight Core Indictors to Support FRESH (Focusing Resources on Effective School Helth) Ferury 2014

2 This work is licensed under the Cretive Commons Attriution-NonCommercil-ShreAlike 4.0 Interntionl License. To view copy of this license, visit MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

3 Contents Arevitions nd Acronyms 4 Acknowledgments 5 Introduction 6 Purpose nd document use 6 The FRESH Frmework 7 Equitle School Helth Policies 7 Sfe Lerning Environment 8 Skills-Bsed Helth Eduction 8 School-Bsed Helth nd Nutrition Services 9 Cross-Cutting Themes 9 FRESH Core Indictors 10 Dt Collection Guidnce 11 Appointing n in-country consultnt 11 Integrtion of existing ssessments 11 Dt hndling 11 Overll step-y-step guidnce 12 Scoring the FRESH Checklists 12 FRESH Core Indictors: Summry 18 FRESH Core Indictors: Checklists 19 Core Indictor 1: 20 Core Indictor 2: 22 Core Indictor 3 26 Core Indictor 4: 29 Core Indictor 5: 33 Core Indictor 6 39 Core Indictor 7: 45 Core Indictor 8 49 APPENDICES: Dt Collection Guidnce on Using the FRESH Core Indictor Checklists 53 Cover Photo courtesy of Frncis Peel, The Prtnership for Child Development. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

4 Arevitions nd Acronyms AIDS EFA EMIS FRESH SHPPS HIV M&E PCD SABER UNESCO UNICEF WASH WFP WHO Acquired immune deficiency syndrome Eduction for All Eduction Mngement Informtion System Focusing Resources on Effective School Helth School Helth Policies nd Prctices Study Humn immunodeficiency virus Monitoring nd evlution The Prtnership for Child Development Systems Approch for Better Eduction Results United Ntions Eductionl, Scientific nd Culturl Orgniztion United Ntions Children s Fund Wter, snittion nd hygiene United Ntions World Food Progrmme World Helth Orgniztion 4 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

5 Acknowledgments This FRESH Monitoring nd Evlution (M&E) Guidnce ws developed with the support, dvice nd insights of numerous individuls nd orgniztions over the yers. The FRESH M&E Coordinting Group ws ppointed to led the development of this M&E Guidnce nd would like to thnk ll those who hve contriuted, directly or indirectly to this effort, in prticulr: The FRESH M&E Coordinting Group memers who over the yers hve remined dedicted to the development of this FRESH M&E Guidnce devoting their time nd expertise dditionl to their full-time work commitments: Michel Besley nd Kristie Wtkins (The Prtnership for Child Development, PCD); Ntlie Roschnik nd Mohini Venktesh (Sve the Children); Ull Klh, Rmy Viveknndn nd Scott Pulizzi (United Ntions Eductionl, Scientific nd Culturl Orgniztion, UNESCO); Ann-Mri Hoffmnn (United Ntions Children s Fund, UNICEF); Giovnn Cmpello, Ktri Tl, Wdih Mlouf, nd Hnn Heikkil (United Ntions Office on Drugs nd Crime); Kwok-Cho Tng nd Timo Sthl (World Helth Orgniztion, WHO); Crmen Aldinger (Eduction Development Center, Inc.); Jefferson Berriel Pessi nd Delphine Sngln (Eduction Interntionl); Trici Young nd Sonl Zveri (Child-to- Child Trust); Roshini Eenezer nd Andy Temon (World Bnk); nd Cheryl Vince Whitmn (Americn Institutes for Reserch). The FRESH M&E Advisory Bord memers nd prticipnts t the 2008 WHO meeting, 2010 UNESCO meeting, nd 2011 PCD meeting who lso imprted vlule insight nd dvice to help move the development of this FRESH M&E Guidnce forwrd: Mru Aregwi (Roll Bck Mlri Prtnership Secretrit); Isolde Birdthistle (London School of Hygiene nd Tropicl Medicine); Christinn Brown (Child-to- Child Trust, Institute of Eduction); Donld Bundy (World Bnk); Vness Cndeis, Lenne Riley, Melnie Cown, Venktrmn Chndr-Mouli, Bruce Dick nd Meen Crl de Mello nd Pmel Sin Mzi (WHO); Lesley Drke, Aulo Gelli nd Jne Lillywhite (PCD); Deorh Hines, Kte Newton nd Nncy Wlters (United Ntions World Food Progrmme, WFP); Yossi Hrel-Fisch (Isrel Anti-Drug nd Alcohol Authority); Seung-Hee Frnces Lee (Sve the Children); Christophe Cornu, Audrey Kettneh, Yongfeng Liu (UNESCO); Kthleen Letsho (UNICEF); nd Adisk Sttm (WHO Thilnd). Independent consultnts helped generte different drfts of this document nd contriuted with their M&E nd school helth expertise: Aigil Kpln Rmge, Orlndo Hernndez, Clre Hnury, nd Crmen Aldinger. Review comments were received from Goof Buijs (Netherlnds Institute for Helth Promotion) nd Srh Brmley (Sve the Children) s well s from prticipnts in weinr orgnized y Dougls McCll (Interntionl School Helth Network) nd prticipnts of workshop t the Comprtive nd Interntionl Eduction Society 2013 Conference. Revisions were mde sed on pilot test results in four countries, conducted under the ledership of the following in-country consultnts: Jorge Lemus (El Slvdor); Seid Mohmmed (Ethiopi); Anjn K.C. (Nepl); nd Tny Mi Hisnn (Philippines), with kind collortion of Sve the Children in-country offices in respective countries. Additionl revisions were mde in lte 2013 following field use of the tools y Sve the Children nd review y WHO. Luren (Lcey) English (Sve the Children) ssisted with proofreding nd ensuring consistency. This FRESH M&E Guidnce ws edited y Anstsi Sid (PCD) nd designed y Helen Wller (PCD). MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 5

6 Introduction Ensuring tht children re helthy so tht they cn lern nd re le to cquire helthy ehviors is essentil for n effective eduction system. At the World Eduction Forum in Dkr in 2000, interntionl gencies greed on common frmework for school helth FRESH (Focusing Resources on Effective School Helth). FRESH supports efficient, relistic nd results-oriented implementtion of school helth progrms to mke schools helthier for children to lern nd where children lern to e helthy. These progrms help ensure tht children enroll nd sty in schools, lern more while in school nd develop skills, knowledge nd helthy ehviors tht protect themselves nd their future children from disese. School helth progrms contriute to the United Ntions Eductionl, Scientific nd Culturl Orgniztion (UNESCO) Eduction for All (EFA) gols to improve the qulity of eduction nd lerning outcomes, while lso indirectly contriuting to the mjor helth nd development gols y promoting helthy ehviors mongst schoolchildren nd the roder community in which they live. Over the yers, growing numer of governments nd interntionl gencies hve egun implementing school helth. A survey of 36 countries in su-shrn Afric conducted in 2000 nd gin in 2007, showed n increse in implementtion of school helth progrmming tht meet the minimum criteri of equity nd effectiveness from 8% to 44%. It lso showed tht school helth progrms re ecoming more comprehensive nd thus, more reflective of the FRESH frmework 1. Despite the huge growth in the implementtion of FRESH t oth ntionl- nd locllevels, no interntionlly greed guidnce on how to monitor nd evlute school helth progrms exist. While mny guidelines focus on prticulr school helth issues, no guideline s yet hs recommended indictors to ssess progress in implementing FRESH or pooled ll school helth-relted indictors into one document for the purposes of comprehensive monitoring nd evlution (M&E) of school helth. This document is sed on the interntionlly greed FRESH frmework nd drws on wide rnge of school helth-relted M&E guidnce from ll helth fields. It ws developed etween 2008 nd 2013 y FRESH prtners (the FRESH M&E Coordinting Group nd themtic experts, overseen y roder FRESH M&E Advisory Bord) representing 12 interntionl gencies. Three meetings of FRESH prtners were held during this period to review progress nd next steps: the first hosted y the World Helth Orgniztion (WHO) in Septemer 2008, the second hosted y UNESCO in Novemer 2010, nd the third hosted y The Prtnership for Child Development (PCD) in Octoer In Mrch nd April 2013, the FRESH M&E Core Indictor Checklists were pilot-tested in four countries (El Slvdor, Ethiopi, Nepl, nd the Philippines), nd the Themtic Indictors were reviewed y experts from relevnt interntionl gencies. In lte 2013, the document (June 2013 version) ws field tested y Sve the Children nd reviewed y WHOnd sed on this, the document ws further revised in Jnury Purpose nd Document Use Trget udience: The FRESH M&E Guidnce is trgeted t governments nd orgniztions in low- nd middleincome countries intending to use this document to develop ntionl self-ssessment tool 2 to monitor nd evlute their school helth progrms. It is lso intended for progrm directors nd mngers to use this rod guidnce to develop specific questionnires for their ssessments. Purpose: With its set of recommended indictors, the FRESH M&E Guidnce intends to help progrms ensure their implementtion is more stndrdized nd evidence-sed nd will llow esier comprtive enchmrking nd monitoring cross countries. Additionlly, it is hoped tht the FRESH M&E Guidnce 1 PCD. (2007). Directory of support to school-sed helth nd nutrition progrms. London, PCD. 2 Schools-for-All. (2012). Monitoring, reporting nd evlution in school helth, sfety, equity, socil nd sustinle development: A glossry of terms. Aville t: 6 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

7 will help led to etter coordintion etween progrms nd the priorities they ddress nd ultimtely contriute to etter helth nd eduction outcomes. Use: The eight Core Indictors presented in this prt of the FRESH M&E Guidnce focus on ntionl-level nd school-level efforts to implement comprehensive school heth progrms s defined in the interntionl FRESH frmework. The mesurement of ech Core Indictor is presented s Checklist which includes Su-Indictors tht re ccompnied y Guiding Questions to nswer the Core Indictor. The Guiding Questions re very rod, sometimes compound, nd ment not for direct use, ut for questionnire development. To mke it userfriendly for orgniztions to develop their questionnires, the Guiding Questions re lso orgnized y their trget tools (ntionl- nd school-level questionnires) (see Appendices B nd C). Collecting the eight Core Indictors will llow countries to identify the strengths nd weknesses of their school helth progrmming. Using this informtion, countries cn strengthen policy nd implementtion nd monitor progress towrds meeting the FRESH frmework stndrds over time. The Themtic Indictors section of the FRESH M&E Guidnce (ville seprtely) is focused on progrmlevel M&E of school helth. It contins menu of round 250 Themtic Indictors, lrgely drwn from existing M&E guidnce or developed y themtic expert groups, covering 15 school helth topics for reserchers nd progrm stff to choose from. As with this section, it is lso intended for progrm directors nd mngers to define the Themtic Indictors to their context nd develop questionnires to mesure their indictors. Existing ssessment tools such s the World Bnk Systems Approch for Better Eduction Results (SABER) or the WHO Glol School Helth Policies nd Prctices Study (SHPPS) my e sustituted for prt of the ssessments in this FRESH M&E Guidnce, s indicted in the FRESH Checklists. This informtion cn e complemented y ehviorl surveys such s the Glol School-Bsed Student Helth Survey (GSHS). The FRESH Frmework The FRESH frmework is n intersectorl prtnership nd ws lunched t the World Eduction Forum in Dkr in It highlights the importnce of school helth for the chievement of the eduction Millennium Development Gols nd provides the context for developing effective school helth progrms. FRESH recommends the four following components (progrm pillrs) to e ddressed in ll schools: 1. Equitle school helth policies Sfe lerning environment Skills-sed helth eduction. 4. School-sed helth nd nutrition services. FRESH is comprehensive, overrching frmework for promoting helth through schools which cn e used in prllel or insted of other well-known school helth frmeworks such s Helth-Promoting Schools, Child-Friendly Schools, or school helth nd nutrition progrms to promote the helth nd well-eing of students, their fmilies, nd school stff. Equitle School Helth Policies Ntionl- nd locl (school)-level school helth policies re necessry to promote effective school helth progrmming: School-level: School helth-relted policies set priorities, ojectives, stndrds nd rules to protect nd promote the helth nd sfety of students nd stff. School helth-relted policies should ddress physicl sfety issues, such s guidelines to ensure the school hs dequte wter nd snittion fcilities. These policies should lso ensure sfe environment to protect students nd stff from use, sexul hrssment, discrimintion, nd ullying nd foster helthy socio-emotionl environment tht uilds resilience nd self-esteem. School helth-relted policies should respond to locl priorities nd the needs of ll students, including mrginlized children. For exmple, where teenge pregnncy is 3 Originlly referred to s helth-relted school policies. The word equitle ws included to ensure tht helth-relted school policies ddress issues of ll children, including disdvntged minorities. 4 Originlly referred to s sfe wter nd snittion. This ws rodened to sfe lerning environment to include socio-emotionl spects of the lerning environment nd other physicl sfety issues esides wter nd snittion. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 7

8 common, school helth-relted policy my focus on the inclusion of pregnnt school girls nd young mothers; nd where rod trffic ccidents re prticulr dnger, school helth-relted policy my prioritize the protection of children from the rod. Policies regrding the helth-relted prctices of techers nd students cn reinforce helth eduction. Techers cn ct s positive role models for their students, for exmple, y not smoking in school. The process of developing nd greeing upon policies drws ttention to these issues. Ntionl-level: School-level helth-relted policies re most effective when supported y ntionllevel policy frmework tht rticultes expecttions for schools cross the country. For exmple, the ntionl school helth policy my recommend tht ll schools hve sfe nd seprte wter nd snittion fcilities for girls nd oys; tht ll children re dewormed t lest once yer; nd tht child helth clus re set up in every school to improve child prticiption in school helth. Both ntionl- nd school-level helth-relted policies re est developed y involving s mny stkeholders s possile, such s techers, students, helth cre providers nd the community. Sfe Lerning Environment The school environment refers to either the physicl nd socio-emotionl environment, or spects of the school or lerning spce tht ffects oth the physicl nd socioemotionl well-eing of students. Physicl environment: The school environment should e plce where students re free from dnger, disese, physicl hrm or injury; where sufficient wter nd snittion fcilities re provided nd where physicl structures (uildings, courtyrds, pths nd ltrines) re sound, welcoming nd secure. The school environment cn potentilly dmge the helth nd development of students, prticulrly if it increses their exposure to hzrds such s infectious diseses due to n unsfe wter supply, lck of hnd wshing fcilities or unsnitry ltrines. Clen wter nd dequte snittion fcilities help reinforce the helth nd hygiene eduction in school llowing students to prctice wht they lern. They lso mke the school more welcoming nd cn increse school ttendnce nd retention, especilly mongst girls who require the privcy of single sex toilets (prticulrly during their menses). Socio-emotionl environment: The school environment should e plce where ll students re free from fer or exploittion, nd where codes ginst misconduct exist nd re enforced. When students do not feel sfe t or on their wy to school ecuse they re sujected to violence, use or neglect, the consequences for children, stff, the school nd the wider community re mny: vndlism ginst the school nd community property increses, usive ehvior towrd school stff escltes, nd conflict mong peer groups heightens. In generl, children re unle to lern, less likely to ttend nd more likely to eventully drop out of school. Preventing nd stopping ll forms of ggression (physicl, sexul nd verl) is first step to mking children feel sfe in school. Hving cler rules nd procedures for responding to ggressive cts nd ensuring tht students, stff nd prents re wre of nd enforce these rules nd procedures, re essentil. Skills-Bsed Helth Eduction Skills-sed helth eduction uses prticiptory exercises to ssist students to cquire knowledge nd develop the ttitudes nd skills required to dopt helthy ehviors. The skills developed cn include cognitive skills such s prolem solving, cretive nd criticl thinking, nd decision-mking; personl skills such s self-wreness, nger mngement nd emotionl coping; nd interpersonl skills such s communiction, coopertion nd negotition skills. For exmple, skills-sed helth eduction cn clrify students perceptions of risk nd vulnerility, which cn help them void situtions of incresed risk of ecoming infected with HIV, mlri or other diseses; increse their understnding of the importnce of wshing hnds fter going to the ltrine or efore eting; or relize their own role in the use of resources nd their impct on the environment. Thus, skills-sed helth eduction hs the potentil to empower individuls to protect nd improve their own nd others helth, sfety nd well-eing, which cn in turn led to etter helth nd eductionl outcomes for children nd their communities now nd in the future. 8 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

9 School-Bsed Helth nd Nutrition Services Mny common helth prolems which students fce in school cn e mnged effectively, simply, nd inexpensively through school-sed helth nd nutrition services. Tretment services, such s deworming nd micronutrient supplementtion re simple, esy, sfe nd chep to dminister y techers. These tretments cn immeditely improve children s helth nd nutritionl sttus nd consequently their ility to concentrte nd lern in school. School-sed counseling services cn help identify nd support children nd young people during difficult times nd prevent school senteeism nd dropout. A strong referrl system with helth service providers, child protection services nd community support groups re lso essentil to ensure tht children with serious helth prolems which cnnot e delt with t school re referred to the pproprite services. While the school system is rrely universl, coverge is often superior to helth systems, with n extensive skilled workforce nd dily contct with children nd the community. The school system is therefore in unique position to ddress common helth prolems which re preventing children from ttending nd prticipting in schools in prompt nd cost-effective mnner. Cross-Cutting Themes Effective prtnership etween helth nd eduction sectors: The helth sector retins the responsiility for the helth of children while the eduction sector retins responsiility for implementing nd often funding school-sed interventions. However, oth of these sectors need to identify their responsiilities nd present coordinted ction to improve the helth nd eduction outcomes of children. The strting point is usully the estlishment of cross-sectorl working groups or steering committees t ntionl-, district- nd locl-level to coordinte ctions nd decision-mking. Community prticiption nd ownership: This is chieved through effective community moiliztion strtegies nd strong prtnerships etween relevnt stkeholders, which engender sense of collortion, commitment nd communl ownership, uild pulic wreness nd strengthen demnd. The community includes the privte sector; women s, men s, nd youth groups; school mngement committees; prent-techer ssocitions; locl helth cre providers; villge nd religious leders; nd ny community group interested in improving the lives nd futures of children in the community. These prtnerships work together to mke schools helthier nd more childfriendly y jointly identifying helth issues in the school nd then designing nd mnging ctivities to ddress them. Effective prtnerships etween the school system nd community hve the power to improve the effectiveness, relevnce nd sustinility of school helth progrm. Child prticiption: The right to prticipte is one of the guiding principles of the Convention of the Rights of the Child. 5 Article 12 of the Convention sttes tht children hve the right to prticipte in decision-mking processes tht my e relevnt in their lives nd to influence decisions tken in their regrd within the fmily, the school or the community. Child prticiption mens tht children hve the opportunity to express view, influence decision-mking nd chieve chnge. It must e integrl to every ctivity, from plnning to implementing to evluting ctivities t locl-, district- nd ntionl-level nd e prcticed y ll stkeholders (techers, helth cre providers, prents nd community memers). Therefore, child prticiption must e ddressed in every trining nd orienttion. When children prticipte in ctivities, they lso cquire the knowledge, nd develop the ttitudes, vlues nd skills needed to dopt helthy lifestyles nd ecome more ctive citizens. Child helth clus nd governments, child suggestion oxes nd ctive teching methods re some wys of ensuring tht children s views nd concerns re considered. 5 United Ntions Office of the High Commissioner for Humn Rights [OHCHR]. (2013). Convention on the rights of the child. Genev, OHCHR. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 9

10 FRESH Core Indictors The min purpose of the eight FRESH Core Indictors is to ssess nd monitor ntionl- nd locl-level progress in implementing comprehensive school helth progrm, specificlly the four FRESH pillrs recommended in the interntionlly greed FRESH frmework. They ttempt to nswer the following question: To wht extent re the four FRESH pillrs of school helth implemented in your country? There re two Core Indictors per FRESH pillr. For ech pillr, there is Ntionl-Level Core Indictor nd School-Level Core Indictor: Ntionl-Level Core Indictors ssess the existence nd qulity of ntionl-level policies, stndrds nd guidnce to support the implementtion of ech FRESH pillr. For exmple, wter nd snittion policies to guide WASH (wter, snittion nd hygiene) improvements or the helth eduction curriculum to support skills-sed helth eduction. This indictor is collected through key informnt interviews nd desk reviews of relevnt documents (ntionl policies, strtegies, stndrds, nd curricul, etc). School-Level Core Indictors ssess the level to which elements of ech FRESH pillr re implemented in school. For exmple, the extents to which schools hve sfe school environment, nd the proportion of schools tht implement regulr skills-sed helth eduction. These indictors re collected through focus groups or key informnt interviews nd oservtions in smple of schools representtive of ll schools in the country (preschool, primry nd secondry; privte nd pulic; different geogrphicl res; nd diverse ethnic groups). There re eight FRESH Checklists one for ech Core Indictor which include Su-Indictors nd their respective Guiding Questions to support dt collection nd nlysis of the FRESH Core Indictors. The Guiding Questions re lso orgnized y their trget tools-the ntionl- nd school-level questionnires (Appendices B nd C). The cross-cutting themes re not ddressed seprtely in the FRESH Checklists, ut re included in some of the Su-Indictors. Countries re encourged to include questions relted to cross-cutting themes if they prefer to mesure them seprtely. The Themtic Indictors section of the FRESH M&E Guidnce focuses on progrm-level M&E. It includes round 250 themtic school helth indictors, drwn lrgely from existing M&E guidnce nd orgnized y helth topic (or themtic re) to support the selection of progrm-specific indictors. Ech Themtic Indictor pge includes short introduction to the helth topic with rtionle for ddressing the prticulr helth issue in schools, recommended strtegies, suggested indictors nd list of references for more informtion. The suggested indictors were drwn from existing vlidted documents or developed y themtic expert groups. The helth themes covered re: WASH Worms Food nd Nutrition Physicl Activity Mlri Orl Helth Eye Helth Er nd Hering Immuniztion Violence in Schools Injury Prevention HIV nd AIDS Sexul nd Reproductive Helth Sustnce Use Disster Risk Reduction 10 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

11 Dt Collection Guidnce This section descries how to prepre for nd implement the dt collection nd nlysis process for the eight FRESH Core Indictors. Appointing n In-Country Consultnt A ntionl or independent consultnt will e ppointed y locl ministry or ntionl or interntionl orgniztion to led n M&E tem nd oversee dt collection. It is importnt tht the in-country consultnt is neutrl nd not prt of the institutions to e ssessed. Responsiilities of the in-country consultnt include: developing specific questionnires for dt collection on Survey tool nd Source SABER school helth enchmrking (World Bnk): Section 1: Helth-Relted School Policies Section 2: Sfe School Environment Section 4: Skills-Bsed Helth Eduction Section 3: School-Bsed Helth nd Nutrition Services the eight FRESH Core Indictors, otining ccess to ntionl dt for ech FRESH pillr; selecting representtive smple of schools; overseeing of nd/or prticipting in collecting dt t ntionl- nd schoollevel (my include ny of the following key informnt interviews, ntionl workshop, focus group discussions nd school oservtions); followed y consolidting, nlyzing, nd shring dt. Integrtion of Existing Assessments If governments or orgniztions hve lredy conducted the following surveys, they my e sustituted for prt of the FRESH Checklists: Sustitute for the following FRESH Checklists Ntionl-Level FRESH Checklists for ll four FRESH pillrs: Checklist 1: (Equitle School Helth Policies) Checklist 3: (Sfe Lerning Environment) Checklist 5: (Skills-Bsed Helth Eduction) Checklist 7: (School-Bsed Helth nd Nutrition Services) Glol SHPPS (WHO): Helthy nd Sfe Schools Environment Survey (Questions 21 to 48) Helthy nd Sfe Schools Environment Survey (Questions 10 to 20, nd 148 to 151) Instruction on Helth-Relted Topics Survey (Questions 111 to 147) Helth Services Survey (Question 49 to 110) School-Level FRESH Checklists for ll four FRESH pillrs: Checklist 2: Question 3 (Equitle School Helth Policies) Checklist 4: Question 3 (Sfe Lerning Environment) Checklist 6: Question 2 (Skills-Bsed Helth Eduction) Checklist 8: Question 1 (School-Bsed Helth nd Nutrition Services) Eduction Mngement Informtion System (EMIS) Other school helth concepts nd pproches from FRESH prtners, such s Child-Friendly Schools (the United Ntions Children s Fund [UNICEF]), Lerning- Friendly-Environment (UNESCO), nd Qulity Lerning Environment (Sve the Children) re complementry to FRESH nd their ssessments mesure specific spects of FRESH. School-level questions from FRESH Checklists 2, 4, 6, nd/or 8 tht mtch with prticulr country s EMIS indictor(s). Dt Hndling All dt need to e treted confidentilly with only ggregted dt shred pulicly. Dt will e shred with decision-mkers in-country nd with interntionl prtners nd gencies. Ultimtely, n interntionl dtse for collecting nd shring dt from vrious countries my e developed. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 11

12 Overll Step-y-Step Guidnce 1. Form n M&E tem fter initil multisectorl consulttion on implementing the dt collection nd nlysis process for the eight FRESH Core Indictors. The sectors to e consulted would include: eduction nd helth; ntionl nd locl governments; nd development prtners, schools nd communities. 2. Estlish the overll ims, ojectives, context, scope, scle nd resources ville to conduct the ssessment. 3. The M&E tem led (i.e. the ntionl or independent consultnt), conferring with key ntionl nd locl stkeholders, is to use the FRESH Checklists nd Appendices B nd C to develop ntionl- nd school-level questionnires. Use the Guiding Questions to develop simple questionnires, trnslte them into the locl lnguge nd field test them prior to country-wide dt collection. As needed, in the simple questionnires, djust the scoring criteri of questions nd include enumertor notes for key concepts tht my e needed to explin to the respondents. 4. The M&E tem enumertors re trined on concepts, questionnires nd methodologies, including dt entry system. This trining would ensure tht ll enumertors hve the sme interprettion of the questions. This is prticulrly relevnt for fcilittors nd documenters gthering school-level dt. 5. Conduct ntionl-level dt collection (see Ntionl- Level FRESH Checklists: Methodology). 6. Consolidte nd nlyze ntionl-level dt to inform school-level dt collection. Encode dt nd informtion on the dt entry system. 7. Bsed on ntionl-level scenrio, determine pproprite smpling of schools for school-level dt collection. 8. Secure necessry permission to visit prticipting schools. 9. Conduct school-level dt collection (see School- Level FRESH Checklists: Methodology). 10. Consolidte nd nlyze school-level dt. Encode dt nd informtion on the dt entry system. 11. Turn dt into useful informtion to support sound progrm decision-mking. Disseminte to vrious stkeholders to gin more support for FRESH nd school helth progrmming. 12. As reserch dissemintion ctivity, orgnize policy forum gthering vrious stkeholders for policy development nd school helth progrm support. Scoring the FRESH Checklists Of the eight FRESH Checklists: four re for the Ntionl- Level Core Indictors (one for ech of the four FRESH pillrs) nd four re for the School-Level Core Indictors (one for ech of the four FRESH pillrs). Under ech Su-Indictor, ech Guiding Question in the FRESH Checklists includes instructions on how to mesure the responses nd score the question. In generl terms, the following words re most commonly used with the ssocited score. 0 = Ltent/Poor/No 1 = Emerging/Beginner/Limited 2 = Estlished/Good/Yes There will e some degree of ssessor sujectivity when judging the firest score to select. Further detils on scoring the Ntionl-Level FRESH Checklists nd the School-Level FRESH Checklists re given on pge MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

13 Ntionl-Level FRESH Checklists FRESH Checklists 1, 3, 5 nd 7 re the four t ntionllevel. They ssess the extent to which comprehensive school helth policy is in plce nd wht systems nd stndrds exist to support the effective implementtion of comprehensive school helth progrm. Enumertors selected to complete the Ntionl-Level FRESH Checklists should hve reserch ckground or experience with undertking key informnt interviews nd desk reviews. There is degree of sujectivity linked to the tsk nd the tsk is est performed y tem of two or more people. Assessment Methodology 1. Red through the four Ntionl-Level FRESH Checklist(s) to select the Su-Indictors nd Guiding Questions. Where relevnt, gther nd list documents relevnt to the purpose of the Ntionl- Level FRESH Checklist, such s ntionl school helth curricul nd ntionlly recommended school helth nd nutrition services. 2. Identify the key informnts for the interviews from rnge of multisectorl stkeholders t different levels (including officers from the Ministries of Eduction nd Helth, s well s relevnt interntionl non-governmentl orgniztions). 3. Develop the questionnires, for ech key informnt or group using the Guiding Questions in the Ntionl-Level FRESH Checklists. As needed, djust the scoring criteri of ech question nd include notes on key concepts. Refer to Appendix B where the questions in the Ntionl-Level FRESH Checklist re orgnized y trget tool. 4. Conduct key informnt interviews. Ensure the questionnire is given eforehnd so tht key informnts hve relevnt informtion nd documents. 5. Alterntive to step 4, conduct multisectorl workshop or series of workshops for ech of the four Ntionl-Level FRESH Checklists with the key informnts identified. Provide questionnires to key informnts eforehnd. 6. Gther nd list documents tht re relevnt to the purpose of the Ntionl-Level FRESH Checklist nd tht hve een recommended y key informnts. 7. Review the documents nd on the sis of informtion gthered, cross-check or nswer the questions set out on ech Ntionl-Level FRESH Checklist noting the specific mesurement guidnce for ech section. 8. Write report on the ssessment of ech Ntionl-Level FRESH Checklist nd explin the scoring for ech Core Indictor ssessed. Scoring nd Anlysis Scoring: Once dt for ech Ntionl-Level FRESH Checklist is collected, clculte the totl in ech Su- Indictor section y dding the scores together (where there is more thn one score) nd clculting the men score for tht Su-Indictor. Note tht ech Su- Indictor is weighted eqully. Thus, the overll totl is clculted y dding together the scores for ech Su- Indictor nd dividing the totl score y the numer of Su-Indictors to otin the men score. (See elow s n exmple of scoring). MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 13

14 Core Indictor I: Existence, qulity nd dissemintion of comprehensive ntionl-level school helth policy Su-Indictor 1 The extent to which ntionl-level school helth policy or strtegy 6 exists nd hs een disseminted. Does school helth-relted strtegy or policy exist, either s prt of roder helth, eduction or poverty reduction policy or strtegy or s stnd-lone document? Hs the school helth policy or strtegy een disseminted ntionlly, to ll schools? c d Totl nd men score for 1.1 (Totl score [4] divided y the numer of questions [2]) The extent to which the school helth policy ddresses the helth needs nd priorities of school-ge children t ntionl-level. Hs there een comprehensive situtionl nlysis of the helth needs nd priorities of school-ge children s whole? Does the policy on school helth reflect the findings nd recommendtions in the situtionl nlysis? Totl nd men score for 1.2 The extent to which the school helth policy ddresses the helth needs nd priorities of school-ge children t ntionl-level. Does the school helth policy or strtegy recommend locl-/school-level dpttion or development of the school helth policy? Does the ntionl school helth policy or strtegy recommend sfe physicl nd socioemotionl lerning environment? Does the school helth policy or strtegy recommend helth lerning nd teching or helth promotion eing skills-sed or out developing skills to? Does the school helth policy or strtegy recommend pckge of school-sed helth nd nutrition services? 4, 2 (4/2) 0 0 0, 0 (0/2) Totl nd men score for 1.3 6, 1.5 (6/4) Overll men score (the 3 Su-Indictors men score totls ( = 3.5) divided y the numer of Su-Indictors[3]) 3.5/3 = 1.17 Score for country X on Core Indictor I: The existence of comprehensive ntionl school helth policy = 1.17 which is etween emerging nd estlished. Anlysis: In the Su-Indictors, score with men of 2 indictes tht the FRESH pillr, which is eing mesured, is well-estlished. A score of 1 mens tht the FRESH pillr is emerging, nd score of 0 mens tht the FRESH pillr is not yet estlished. In the exmple ove, Su-Indictor 1 chieves n idel score of 2 which mens it is well-estlished. Su-Indictor 2 scores zero which mens it is not yet estlished. Su-Indictor 3 chieves score of 1.5 which mens it is etween emerging nd estlished. An overll totl score of 1.5 or higher is desirle. When compring the results with nother set of results, further nlysis cn e performed on ech question within the Ntionl- Level FRESH Checklist. 6 A school helth strtegy sets out how specific set of ctivities is to e implemented within given timefrme. 14 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

15 School-Level FRESH Checklists FRESH Checklists 2, 4, 6 nd 8 re the four t schoollevel nd ssess the extent to which the four pillrs of FRESH re eing implemented t school-level. The M&E tem my focus on one or more of the School- Level FRESH Checklists s determined during their initil consulttions with key stkeholders. Enumertors selected to complete the School-Level FRESH Checklists will need to hve skills to conduct focus group discussions nd e fmilir with the distinctions etween conducting focus groups with children nd dults. It is est if memers of the enumertor tem hve hd experience working with children nd/or hve the skills to develop rpport with children. The School-Level FRESH Checklists cn e dministered y: A locl survey tem such s n independent consultnt hired y the Eduction nd Helth Ministries. An externl survey tem such s reserchers from n cdemic institution or ntionl or interntionl orgniztion. The School-Level FRESH Checklists include questions for techers, students, prents nd community memers, s well s oservtions to ensure tht the dt represents the views of ll stkeholders, prticulrly children, nd wht is oserved in schools. The M&E tem will need to develop questionnires for techers/dministrtors, students, prents/community memers nd school oservtions dpting the relevnt Guiding Questions. Refer to Appendix C for Guiding Questions orgnized y trget tool to develop the questionnires. The survey will need to e dministered to smple of schools. It is importnt to ensure the smpling is closely tied to the im of the survey. For exmple, if the im of the survey is to ssess effective implementtion of school helth t ntionl-level, then the schools smpled should e representtive of the entire popultion, i.e. the smple should include ll geogrphic regions, ethnic groups nd the different types of schools (primry vs. secondry, pulic vs. privte, rurl vs. urn, etc.) present in the country. Assessment Methodology 1. Red through the four School-Level FRESH Checklist(s) to select the Su-Indictors nd Guiding Questions. Where relevnt, gther nd list documents relevnt to the purpose of the School-Level FRESH Checklist, such s the locl school helth curricul nd locl policy for school helth nd nutrition services. Consult with rnge of people involved in school helth t community-level to ensure tht ll relevnt documents hve een ssemled. 2. Develop the questionnires, for ech key informnt or focus group (dministrtors/techers, students, nd prents/community memers) nd school oservtion using the Guiding Questions in the School-Level FRESH Checklists. Refer to Appendix C where the questions in the School-Level FRESH Checklist re orgnized y trget tool. Develop questions tht re phrsed simply in the locl lnguge, nd dpt questions to the countrycontext nd ge-level. As needed, djust the scoring criteri of ech question nd include enumertor notes on key concepts tht informnts my not understnd (such s those included in the Glossry in Appendix A). 3. Select schools ccording to the purpose of the survey nd gin permission to visit the schools (from the Ministry of Eduction nd from the principl). Then gther sic demogrphic informtion on ech selected school. 4. Conduct key informnt interviews nd focus groups. Depending on the numer of people ville to nswer the questions, decide whether key informnt interviews or focus groups re more pproprite. Likely, questions for dministrtors will e ddressed y key informnt interviews. 5. Conduct n oservtion of the school environment. 6. Alterntive to steps 5 nd 6, schools my choose to dminister self-completed surveys. 7. Write report on the ssessment of ech School- Level FRESH Checklist nd explin the scoring for ech Core Indictor ssessed. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 15

16 Orgnizing Focus Group Discussions Key Informnts (School Administrtors nd Techers) When selecting the person to led the discussions, e wre tht the sttus of tht person could ffect the nswers given. Select surveyors who re likely to hve s neutrl effect s possile on the nswers or control for is. Ensure tht ll those selected to e key informnts in the discussions (either s individuls or in group discussion) re le nd willing to provide n unised nd lnced view of the rnge of school helth ctivities nd services in the school nd tht there would e no negtive consequences for them in responding to the questions openly nd ccurtely. Key informnts mong techers should include the helth techer nd others who tech helth topics. Orgnize the questions so tht ll the questions for one group cn e sked t single meeting, for exmple, compile ll the students questions from FRESH Checklists 2, 4, 6 nd 8 into one document (see Appendix C). Administer the survey t reltively quiet time of the yer. Be wre of term dtes, school-sed events, pulic holidys, sesonl effects on school life nd the exmintion period. Utilize trined fcilittor who knows the concepts nd cn explin them clerly nd sks the questions in converstionl style. Recruit trined documenter who records the responses. Students Ensure tht selected students provide informtion in group of no fewer thn five students nd who re from the sme clss/ge grouping. Seprte discussions should e held when more thn one clss is needed to represent the school nd/or if school hs children from two distinct ethnic groups nd/or if the survey tem wishes to include opinions from group of older students s well s from group of younger students in the school. The results would e collected nd then verged. (Note: In generl, older students, prticulrly in primry schools, will more likely e etter le to respond to these questions thn younger students.) Mke note of the verge ge nd numers of students tking prt in ech of the group discussions. Use the following method to guide discussion, sking the specific questions on ech School-Level FRESH Checklist: 1. Strt with n ice reker. 2. As necessry estlish some rules of the discussion, for exmple, not speking for too long; ensuring tht everyone hs chnce to spek; listening to ech other; treting informtion shred confidentilly; nd only dding comments rther thn repeting them. 3. Ask the group prticipnts wht they rememer seeing or hering (for exmple, during their helth lesson). Keep people focused on wht they oserved with their senses. Do not llow opinions t this stge. 4. Ask them wht they liked. 5. Ask them wht they disliked. (Note: Wht will e positive for some my e negtive for others. Tht is fine nd ctully strength of this method.) 6. Ensure ech person in the group hs hd chnce to spek. 7. Ask prticipnts the questions from the checklist nd help them uild towrds group decision. The documenter should record their discussion nd decision. Prents nd Community Leders Some School-Level FRESH Checklists sk for the views of prents nd community leders. The process used in these group discussions is the sme s for the students group discussions, though the group dynmics might e different. For prents to e prt of focus group, they could e sked to rrive it erlier when picking up their children or the focus groups could e crried out efore or fter periodiclly scheduled meetings with prents. Mke note of the numers nd constituency of ll dult groups consulted, for exmple, note if the group contins prents from the school, community leders, youth workers, etc. 16 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

17 Scoring nd Anlysis Scoring: The scoring nd the clcultion of totl nd men scores re the sme for the School-Level FRESH Checklists s they re for the Ntionl-Level FRESH Checklists. However, there will e numerous schools selected for the survey nd in this cse it will not e one score, ut mny scores (possily hundreds). The enumertor tem will need to decide how to smple nd cluster schools. Once the dt re collected from ech school the scores cn e determined s follows. Note tht ech question, Su-Indictor nd Core Indictor s well s schools re weighted eqully in determining men scores. In the dpttion of the FRESH M&E Guidnce, countries my choose to use other weights for their scoring. 1. The surveyors would need to finlize the scores for questions under ech Su-Indictor. This is to e crried out in consulttive nd consensus-sed mnner. Where question is sked in more thn one tool, the finl score for the question should e ssigned y tringulting the dt from the different tools. To compre the scores of ech question sked under ech Su-Indictor cross cluster of schools, summry tle s elow my e used. Anlysis: 2. Once the score for ech question is determined, the totl nd men score for ech Su-Indictor (similr to the Ntionl-Level FRESH Checklist) is determined. To compre the Su-Indictor totl scores cross cluster of schools, summry tle s elow my e used. FRESH Checklist 2 Su-Indictor 1 The extent to which helth-relted policies exist in schools, long with procedures to monitor nd enforce the policies. Su-Indictor 2 The extent to which schools ddress ntionl nd locl helth priorities. Su-Indictor 3 The existence of school helth policies tht ddress the remining three FRESH pillrs. Su-Indictor 4 The extent to which students know, understnd nd cn contriute to the school helth policy. Su-Indictor 5 The extent to which school helth policies re known to nd understood y prents nd community leders. Schools / Questions c 4 4 4c 5 5 5c School School School c School d School e Totl for the cluster Men score for the cluster Totl Score for ech school Men Score for the school FRESH Checklist 2 EQUITABLE SCHOOL HEALTH POLICIES FRESH Checklist 4 SAFE LEARNING ENVIRONMENT FRESH Checklist 6 SKILLS -BASED HEALTH EDUCATION FRESH Checklist 8 SCHOOL HEALTH AND NUTRITION SERVICES Schools / Su-Indictors School School School c School d School e Totls for the cluster Men score for the cluster Totl Score for ech school Men Score for the school 3. The Totl nd men score for ech school is determined next. For cluster of schools, the totl or men scores of the schools re to e dded up nd divided y the numer of schools in the cluster. 4. Determine the % of schools tht meet the School-Level Core Indictor, y using cut off point in the men score. For exmple, quote the % of schools tht got 1.5 or more on the men score s the % of schools tht meet their School-Level Core Indictor. Note: men score of 2 indictes tht the FRESH pillr eing mesured is well-estlished. A score of 1 mens tht the FRESH pillr is emerging, nd score of 0 mens tht the FRESH pillr is not yet estlished. An overll score of 1.5 or higher is desirle. NOTE: It is recommended to estlish dt entry nd nlysis system for dt mngement to determine the scores. Also to store dt over multiple yers, dtse my e developed.

18 FRESH Core Indictors: Summry Su-Indictors in red re suggested priorities. FRESH Pillrs Level CORE INDICATORS Definition A. EQUITABLE SCHOOL HEALTH POLICIES NATIONAL 1. Existence, qulity nd dissemintion of comprehensive ntionl-level school helth policy. Using FRESH checklist 1, this indictor is mesured y reviewing ntionl policies nd strtegies, sitution nlyses nd other relevnt documents to determine: The extent to which ntionl-level school helth policy or strtegy exists nd hs een disseminted. The extent to which the school helth policy ddresses the helth needs nd priorities of school-ge children t ntionl-level. The extent to which the school helth policy ddresses ll four pillrs of FRESH. SCHOOL 2. Percentge of schools tht hve comprehensive helth-relted school policies. Using FRESH Checklist 2, this indictor is ssessed through focus group survey in representtive smple of schools to determine: The extent to which helth-relted policies exist in schools, long with procedures to monitor nd enforce the policies. The extent to which schools ddress ntionl nd locl helth priorities. The existence of school helth policies tht ddress the remining three FRESH pillrs. The extent to which students know, understnd nd cn contriute to the school helth policy. The extent to which school helth policies re known nd understood y prents nd community leders. B. SAFE LEARNING ENVIRONMENT NATIONAL 3. Existence of ntionl school sfety stndrds ddressing oth the physicl nd socioemotionl school environment. Using FRESH Checklist 3, this indictor is mesured y conducting key informnt interviews nd reviewing ntionl policies, strtegies nd stndrds for schools to determine: The existence of ntionl stndrds to guide nd ssess the physicl school environment. The existence of ntionl stndrds to guide nd ssess the socio-emotionl school environment. SCHOOL 4. Percentge of schools tht meet the ntionl school sfety stndrds (physicl nd socio-emotionl). Using FRESH Checklist 4, this indictor is ssessed through focus group survey in representtive smple of schools to determine: The extent to which schools hve cpcity to meet the stndrds for helthy nd sfe physicl lerning environment. The extent to which schools hve cpcity to meet the stndrds for sfe socio-emotionl lerning environment. The extent to which schools meet specific spects of the school environment stndrds. Student perceptions of the school providing sfe lerning environment. Prent nd community perceptions of the school providing sfe lerning environment. C. SKILLS-BASED HEALTH EDUCATION NATIONAL 5. Priority helth content nd skills-sed pedgogy re present in ntionl guidnce for school curricul, techer trining nd lerning ssessments. Using FRESH Checklist 5, this indictor is mesured y conducting key informnt interviews nd nlyzing the content of school curricul, techer trining mnuls, student mterils, nd school leving exmintion guidelines to determine: The extent to which helth topics (sed on ntionl helth priorities) re included nd re ccurtely nd geppropritely expressed in the school curricul. The extent to which curricul for school helth include specific skills-sed pedgogicl components. The existence nd qulity of techer trining curricul to support prticiptive, skills-sed helth eduction in schools. The existence nd qulity of techer guidnce nd student mterils for schools on helth topics. The existence nd qulity of priority helth informtion questions in ntionl school leving exmintions. SCHOOL 6. Percentge of schools tht provide regulr skills-sed helth eduction sessions, s recommended in the ntionl guidnce. Using FRESH Checklist 6, this indictor is ssessed through focus group survey in representtive smple of schools to determine: The extent (frequency) helth is eing tught in school. The extent to which ech recommended helth topic is tught cross ll grdes in the school in ccordnce with ntionl guidnce nd dpted to locl context. The extent to which techers hve received the pproprite trining in skills-sed helth eduction. The extent to which techers hve ccess to necessry tools to help them tech the helth topics using pproprite teching pproches. Techers perceptions of the extent to which they re using prticiptive, skills-sed teching pproches to tech helth topics. Students perceptions of the extent to which techers re using prticiptive, skills-sed teching pproches to tech helth topics. D. SCHOOL-BASED HEALTH AND NUTRITION SERVICES NATIONAL 7. A minimum pckge of school-sed helth nd nutrition services hs een defined t ntionl-level sed on locl helth priorities. Using FRESH Checklist 7, this indictor is mesured y conducting key informnt interviews nd reviewing ntionl policies nd strtegies to determine: The extent to which pckge of school-sed helth nd nutrition services hs een defined nd recommended t ntionl-level. The extent to which the recommended pckge of school-sed helth nd nutrition services is sed on rigorous ssessment of the helth nd nutrition needs of school-ge children cross the country. The extent to which school-sed helth nd nutrition services re relevnt to locl-level. SCHOOL 8. Percentge of schools where the minimum pckge of school-sed helth nd nutrition services (s defined t locl- nd ntionl-level) is provided. Using FRESH Checklist 8, this indictor is ssessed through focus group survey in representtive smple of schools to determine: The extent to which the minimum recommended pckge of school-sed helth nd nutrition services is provided in schools. The extent of links etween locl helth nd nutrition services nd schools. The cpcity within schools to deliver minimum pckge of school-sed helth nd nutrition services. Students perceptions of the provision of school-sed helth nd nutrition services. Prents nd other community memers perceptions of the provision of school-sed helth nd nutrition services. 18

19 FRESH Core Indictors: Checklists A. EQUITABLE SCHOOL HEALTH POLICIES Ntionl-Level Core Indictor 1: Existence, qulity nd dissemintion of comprehensive ntionl-level school helth policy. 7 PURPOSE To determine: 1) The extent to which ntionl-level school helth policy or strtegy 8 exists nd hs een disseminted. 2) The extent to which the school helth policy ddresses the helth needs nd priorities of school-ge children t ntionl-level. 3) The extent to which the school helth policy ddresses ll four FRESH pillrs. RATIONALE In the rodest sense, school helth policy is defined s ny ntionl government-endorsed document which outlines the rules nd principles for school helth progrmming ntionwide. It my e stnd-lone or included within wider eduction or helth policy or strtegy. The purpose of school helth policy is to provide common gol, strtegy nd set of recommended interventions for ll schools nd implementing prtners cross the country. Without guiding policy, school helth is less likely to e prioritized y the government, schools, helth system nd development prtners. School helth progrmming my e ptchy, driven y confounding priorities, not evidencesed nd uncoordinted. A wek policy my e even more hrmful. It is essentil tht the policy is sed on rigorous situtionl nlysis nd multi-stkeholder consulttions to ensure tht it ddresses the helth priorities of ll school-ge children (girls nd oys, minority groups, urn nd rurl, from preschool to secondry schools). The policy must lso ddress ll spects of the four FRESH pillrs (equitle school helth policies, sfe lerning environment, skills-sed helth eduction, nd school-sed helth nd nutrition services). Core Indictor 1 ssesses whether school helth policy exists nd hs een disseminted. DATA COLLECTION METHOD Core Indictor 1 is ssessed y conducting key informnt interviews with key stkeholders from the Ministries of Helth nd Eduction nd others, s well s review of ntionl policies nd strtegies, situtionl nlyses nd relevnt meeting reports to ssess the three Su-Indictors descried in the Purpose ove (see dt collection guidnce for more detils). MEASUREMENT TOOLS FRESH Checklist 1 cn e used to review the ove documents. The checklist is orgnized into three sections, with ech section corresponding to one of the three Su-Indictors listed in the Purpose ove nd the overll Core Indictor 1. A score for ech section nd totl is clculted y dding up the responses to the list of questions to show the level to which Core Indictor 1 is ddressed. 7 A school helth policy is defined here s set of principles nd rules governing school ctivities nd opertions for the protection nd promotion of children s helth nd well-eing t school. 8 A school helth strtegy sets out how specific set of ctivities is to e implemented within given timefrme. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 19

20 FRESH CHECKLIST 1 EQUITABLE SCHOOL HEALTH POLICIES (NATIONAL-LEVEL) Core Indictor I: Existence, qulity nd dissemintion of comprehensive ntionl-level school helth policy. 9 Tsk: 1. Red through FRESH Checklist 1 to select the Su-Indictors nd Guiding Questions. 2. Review ll relevnt documents on ntionl school helth nd eduction policies nd strtegies (eduction, helth nd other relevnt documents), situtionl nlyses nd relevnt meeting reports. 3. Identify key informnts for interviews or focus group discussions/ ntionl workshop. 4. Develop the questionnires for the key informnts. Su-Indictor 1 The extent to which ntionl-level school helth policy or strtegy 10 exists nd hs een disseminted. Does school helth-relted strtegy or policy exist, either s prt of roder helth, eduction or poverty reduction policy or strtegy or s stnd-lone document? = No reference to school helth in ny ntionl policy or strtegy; 1 = School helth is fetured to limited extent (e.g. reference to one or two spects of school helth within roder strtegy or policy); 2 = School helth hs dedicted section in roder ntionl-level policy or strtegy or ntionl-level school helth policy nd strtegy exists with detiled reference to trgets nd/or milestones. If the score is 0 here, then go to 2) nd score 0 for ll remining questions on this checklist. Hs the school helth policy or strtegy een disseminted ntionlly, to ll schools? 0 = An existing policy or strtegy hs not een disseminted; 1 = There is concrete pln to disseminte the school helth policy or strtegy nd/or the policy or strtegy hs een prtilly disseminted; 2 = The school helth policy or strtegy (or oth) hs een disseminted to ll schools. Totl nd men score for The extent to which the school helth policy ddresses the helth needs nd priorities of school-ge children t ntionl-level. Hs there een comprehensive situtionl nlysis 11 of the helth needs nd priorities of school-ge children s whole? 0 = No; 1 = Incomplete; 2 = A situtionl nlysis hs een conducted tht ssesses the need for vriety of wys in which schools cn ensure tht children live helthy nd hppy lives nd tht they cn tke n ctive prt in the process. Does the policy on school helth reflect the findings nd recommendtions in the situtionl nlysis? 0 = No situtionl nlysis exists s per nswer to 2., or there is no reference to it; 1 = Less thn hlf of the helth needs identified in the situtionl nlysis re ddressed in the policy or strtegy; 2 = Hlf or more of the helth needs nd recommendtions mde in the sitution nlysis re ddressed in the policy or strtegy. Totl nd men score for A school helth policy is set of ctionle rules nd principles tht guide school-relted ctivities nd opertions tht the school ledership, mngement committees, stff, prents nd students gree to, ide y nd ct upon to ensure tht children led hppy nd helthy lives. 10 A school helth strtegy sets out how specific set of ctivities is to e implemented within given timefrme. 11 For conducting school helth situtionl nlysis nd/or wht such n nlysis would look like see the guidnce provided y PCD ( or 20 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

21 3 The extent to which the school helth policy ddresses ll four pillrs of FRESH 12 Does the school helth policy or strtegy recommend locl-/school-level dpttion or development of the school helth policy? 0 = No reference to the need for school-level policies or strtegies (or the need to dpt ntionl policy or strtegy t locl-level); 1 = A generl recommendtion is mde on the need to dpt the policy t locl-/school-level or develop school-level policies; 2 = Guidnce is provided on how to dpt ntionl school helth policy to locl context or develop school-level policies. Does the ntionl school helth policy or strtegy recommend sfe physicl nd socio-emotionl lerning environment? 0 = No; 1 = Recommendtions re mde for sfe physicl environment only, specificlly wter nd snittion, or socio-emotionl lerning environment; 2 = Recommendtions re mde for children to hve sfe physicl environment nd sfe socio-emotionl environment. 13 c Does the school helth policy or strtegy recommend helth lerning nd teching or helth promotion eing skills-sed or out developing skills to? 0 = No reference to ny form of skills-sed helth lerning nd teching; 1 = Skills-sed helth lerning nd teching is recommended, ut with no specific guidnce on the teching nd lerning methodology; 2 = Guidnce is given on skillssed prticiptive teching methodology to tech helth in schools. d Does the school helth policy or strtegy recommend pckge of school-sed helth nd nutrition services? 0 = No reference to school helth nd nutrition services nor to links etween schools nd existing helth nd nutrition services (provided y the helth sector); 1 = The policy or strtegy includes links etween schools nd existing helth nd nutrition services re mentioned; 2 = The policy or strtegy sets out school-sed helth nd nutrition services (helth nd nutrition services provided t the school nd/or linkges to existing helth nd nutrition services in the community). Totl nd men score for 1.3 Overll men score for Core Indictor 1 List of documents to e reviewed This list should include ny ntionl government endorsed document, which outlines the rules, principles nd content for school helth nd school helth eduction progrmming ntionwide. Exmples of documents to review re listed elow. Plese dd others tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 1 to help explin the scores given. 1. School helth situtionl nlysis (or similr document summrizing helth nd nutrition sitution in schools nd school-ge children). 2. School helth policy, strtegies nd plns (including relted strtegies nd plns for school feeding, WASH, etc.) 3. Eduction policy, strtegies nd plns. 4. Helth policies, strtegies nd plns on HIV nd AIDS, nutrition, mlri, etc. 5. Other relevnt ntionl-level policies, strtegies nd plns (WASH, poverty reduction, etc.) Add others s needed. 12 School helth policy is the first pillr nd is ddressed in FRESH Checklists 1 nd 2; refer to FRESH Checklists 3 to 6 which focus on the three other pillrs. It my e useful to complete FRESH Checklists 1 nd 2 lst when informtion hs een gthered on ech of the three other FRESH pillrs. 13 The detils nd definitions of sfe physicl nd sfe socio-emotionl environment re found in FRESH Checklists 3 nd 4. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 21

22 A. EQUITABLE SCHOOL HEALTH POLICIES School-Level Core Indictor 2: Percentge of schools tht hve comprehensive helth-relted school policies. 14 PURPOSE To determine: 1) The extent to which helth-relted policies exist in schools, long with procedures to monitor nd enforce the policies. 2) The extent to which schools ddress ntionl nd locl helth priorities, s ssessed under Core Indictors 1 nd 2. 3) The existence of school helth policies tht ddress the remining three FRESH pillrs. 4) The extent to which students know, understnd nd cn contriute to the school helth policy. 5) The extent to which school helth policies re known nd understood y prents nd community leders. RATIONALE Most schools round the world hve school policies, defined s set of rules nd principles tht guide schoolrelted ctivities nd opertions. School ledership, mngement committees, stff, prents nd students re ll expected to gree, ide y nd ct upon these policies to ensure the school opertes effectively nd chieves its gol(s). Since children s helth nd well-eing (physicl nd socio-emotionl) re n integrl prt of qulity eduction, helth-relted policies re necessry to protect nd promote children s helth nd well-eing t school. School helth-relted policies should reflect oth the ntionl school helth policy (if present) nd priorities, nd the locl helth priorities which my differ etween schools. For exmple, school locted ner usy rod my include policy which focuses on protecting schoolchildren from trffic ccidents, wheres remote rurl school my focus on ddressing short-term hunger s children wlk long distnces to school. Core Indictor 2 ssesses the extent to which schools hve helth-relted policies, whether these policies ddress oth ntionl nd locl helth priorities nd whether they ddress ll spects of the three other FRESH pillrs. The extent to which school helth-relted policies ddress locl helth priorities will depend in prt on the level of prticiption from different stkeholders, prticulrly children (girls, oys nd minority groups), ut lso prents nd community leders when developing the policy. DATA COLLECTION METHOD Core Indictor 2 is ssessed through review of school-level policies, focus groups nd key informnt interviews in smple of schools representtive of ll schools in the country (see dt collection guidnce for more detils). MEASUREMENT TOOLS FRESH Checklist 2 cn e used to collect informtion on school-level helth-relted policies. It must e dpted to ech context to reflect the ntionl school helth policy (if present) nd priorities. The checklist is orgnized into five sections, with ech section corresponding to one of the five Su-Indictors listed in the Purpose ove. Checklists for schools will need to e ggregted to generte the overll Core Indictor 2 nd Su-Indictors. These cn then e disggregted y district, eduction-level (primry nd secondry) nd type of school (privte nd pulic), nd used to identify higher nd lower performing schools. 14 A school helth-relted policy is defined here s set of principles nd rules governing school ctivities nd opertions for the protection nd promotion of children s helth nd well-eing t school 22 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

23 FRESH CHECKLIST 2 EQUITABLE SCHOOL HEALTH POLICIES (SCHOOL-LEVEL) Core Indictor 2: Percentge of schools tht hve comprehensive helth-relted school policies. Tsk: 1. Red through FRESH Checklist 2 to select the Su-Indictors nd Guiding Questions. 2. Gther ll relevnt documents for review, such s school-level policies, school rules nd regultions, school improvement plns, nd other documents relevnt to ssessing the existence of school-level helth policies in its roder sense. 3. Identify key informnts for interviews or focus group discussions. 4. Develop the questionnires for the key informnts nd school oservtions. Su-Indictor 1 The extent to which helth-relted policies exist in schools, long with procedures to monitor nd enforce the policies. Does the school hve written school helth-relted policy? This my include school helth-relted policies within roder school policy or schools following written ntionl-level school policy (if it is not mndted for schools to hve their own policy). 0 = No reference to helth in ny school policy document; 1 = The gol of improving children s helth is mentioned in policy document, ut with no specific guidnce; 2 = Cler school rules re listed outlining how the school will improve the helth nd well-eing of children nd/or there is seprte nd comprehensive school helth policy document t the school nd/or concrete ction pln with trgets outlining how helth in school will e done with roles nd responsiilities. If the nswer is No, then score 0 here nd on ll susequent questions nd go to FRESH Checklist 3. Are there procedures in plce to monitor nd enforce the school helth policy t school level? 0 = There is no school helth policy document or no procedures in plce to monitor nd enforce it; 1 = There re plns to estlish school-level procedures to ensure the school helth policy is followed; 2 = There re cler procedures estlished to ensure tht the school helth policy is followed nd monitored. Totl nd men score The extent to which schools ddress ntionl nd locl helth priorities. Assuming ntionl helth priorities exist, to wht extent does the school helth policy ddress ntionl school helth priorities? 0 = There is no school helth policy; 1 = There is school helth policy, ut it does not ddress the ntionl school helth priorities; 2 = There re cler linkges etween documented ntionl school helth priorities nd/or the school helth policy is sed on the ntionl school helth policy nd reflects most of the ntionl school helth priorities. Assuming there re locl helth priorities, to wht extent re the locl helth priorities known nd reflected in the school helth policy? 0 = There is no school helth policy; 1 = A school helth policy exists, ut there re no locl helth priorities reflected in the school helth policy; 2 = Locl helth priorities hve een identified nd re reflected in the school helth policy. Totl nd men score 2.2 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 23

24 3 The existence of school helth policies tht ddress the remining three FRESH pillrs. Does the school helth policy include section on providing sfe physicl nd socioemotionl lerning environment for students nd stff? 0 = No reference to the sfety of the lerning environment (physicl or socio-emotionl) in ny school policy; 1 = Either sfe physicl environment (e.g. sfe wter nd snittion fcilities) is mentioned in the school policy, ut no reference to sfe physicl environment or sfe socio-emotionl environment (e.g. positive discipline methods) is mentioned in the school policy, ut no reference to sfe physicl environment; 2 = Both sfe physicl nd socio-emotionl environment re mentioned in the school policy. Does the school helth policy include guidnce on teching skills-sed helth eduction? 0 = No reference to helth eduction or helth promotion of ny form in schools; 1 = The school helth policy refers to helth eduction or helth promotion generlly, ut not to the need for skills-sed, prticiptive teching methodologies; 2 = The school helth policy includes guidnce on teching skills-sed helth eduction nd how to encourge student prticiption, nd my set out requirements for involving students nd responding to students own chllenges nd needs. c Does the school helth policy include the provision of school-relted helth nd nutrition services? 0 = No reference to school-relted helth nd nutrition services; 1 = The school helth policy refers to linkges with existing helth nd nutrition services, ut no school-sed helth nd nutrition services re provided; 2 = The school helth policy refers to oth linkges to existing helth nd nutrition services nd guidnce for loclly relevnt schoolsed helth nd nutrition services. Totl nd men score The extent to which students know, understnd nd cn contriute to the school helth policy. Focus Group Guidnce: Only conduct this discussion if school helth policy exists t school-level. If school helth policy does not exist, score 0 for ech question. If school helth policy does exist, inform the group wht school helth policy is, using concrete exmples, 17 nd sk students which school helth policies they re wre of. Ensure ech person in the group hs hd chnce to spek. Ask the group to discuss the questions elow. Do the older students (>10 yers old) know tht there is school helth policy or written ntionl policy tht the school follows? If so, how mny? 0 = No; 1 = Less thn hlf; 2 = Hlf or more. If children know tht there is school helth policy, cn students descrie wht the school helth policy is out? 0 = No; 1 = Less thn hlf of the students could understnd the policy nd/or could descrie it; 2 = Hlf or more of the students could understnd the policy nd/or could descrie it. 15 Plese see FRESH Checklists 3 to 8 (1 to 6) for detils on the content of the helth eduction curriculum, school helth services nd the physicl nd socio-emotionl environment. 16 This question my e sustituted with Glol SHPPS Helthy nd Sfe Schools Environment Survey (Questions 21 to 48). 17 As school helth policy might e document contining strct ides, the surveyor must tke cre to explin to the pupils in concrete terms wht school helth policy looks like nd wht it includes. 24 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

25 c Is there mechnism for students to contriute to the design or development of school helth policy? 0 = No; 1 = The school hs wys of consulting students tht could e used, ut hve not een used for school helth; 2 = There is n estlished mechnism for consulting students nd there is evidence they hve een consulted out school helth to ensure students helth needs nd priorities re tken into ccount when designing or developing school helth policy or strtegy. Totl nd men score c The extent to which school helth policies re known nd understood y prents nd community leders. Use the sme Focus Group Guidnce s in Su-Indictor 4 ove nd hve the group discuss the questions elow. Do you know if there is school helth policy or written ntionl policy tht the school follows? 0 = No; 1 = Less thn hlf; 2 = Hlf or more. Is there version of the school helth policy tht is esy for prents nd community leders to understnd? 0 = No; 1 = Less thn hlf of the people could understnd the policy nd/or could descrie it; 2 = Hlf or more of the people could understnd the policy nd/or could descrie it. Is there mechnism for prents or community leders to contriute to the design or development of school helth policy? 0 = No; 1 = The school hs wys of consulting prents nd community leders tht could e used, ut hve not een used for school helth; 2 = There is n estlished mechnism for consulting prents nd community leders nd there is evidence they hve een consulted out school helth, to ensure the helth needs nd priorities of fmilies in the community re tken into ccount when designing or developing school helth policy. Totl nd men score for 2.5 Overll men score for Core Indictor 2 List of documents to e reviewed This list should include ny school endorsed document, which outlines the rules, principles nd content for school helth nd school helth eduction progrmming. Exmples of documents to review re listed elow. Plese dd others tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 2, to help explin the scores given. 1. All school policies (list ech policy reviewed). 2. School rules nd regultions. 3. School improvement plns Add others s needed. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 25

26 B. SAFE LEARNING ENVIRONMENT Ntionl-Level Core Indictor 3: Existence of ntionl school sfety stndrds 18 ddressing oth the physicl nd socio-emotionl school environment. PURPOSE To determine: 1) The existence of ntionl stndrds to guide nd ssess the physicl school environment. 2) The existence of ntionl stndrds to guide nd ssess the socio-emotionl school environment. RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS A sfe school environment should protect nd promote oth physicl nd socio-emotionl well-eing. While schools hve huge cpcity to improve the helth of schoolchildren, they cn lso e hrmful if the school environment is not sfe nd supportive. Sfe physicl environments should e free of dngerous ojects, hve sfe structure nd e secure from neighoring hzrds (rods nd rs, etc.) nd provide potle drinking wter, sfe snittion fcilities for girls nd oys, with hnd wshing fcilities to prevent the spred of diseses. Sfe socio-emotionl environments should e free from violence, use, drugs, lcohol, ullying nd discrimintion nd provide friendly, rewrding, cring nd supportive environment for students. School sfety stndrds provide: common understnding of wht sfe nd cring school environment mens; enchmrks for ssessing school environment sfety; nd guidnce on how to improve the school environment. Exmples include how to ddress issues of violence, discrimintion nd ensure children re protected; how to construct/improve the wter nd snittion fcilities. Core Indictor 3 ssesses whether ntionl stndrds (or guidelines) exist on the sfety of the school environment (physicl nd socio-emotionl) nd the qulity of these stndrds. Core Indictor 3 is ssessed y conducting key informnt interviews nd review of ntionl (or progrm) policies, strtegies nd stndrds (eduction, helth, wter nd snittion, nd child protection, etc.) for schools to ssess the two Su-Indictors descried in the Purpose ove (see dt collection guidnce for more detils). FRESH Checklist 3 cn e used to conduct the key informnt interviews nd review the ove documents. The checklist is orgnized into two sections, with ech section corresponding to one of the two Su-Indictors listed in the Purpose ove nd the overll Core Indictor School sfety stndrds re defined here s the norms for ensuring sfe school environment. 26 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

27 FRESH CHECKLIST 3 A SAFE LEARNING ENVIRONMENT (NATIONAL LEVEL) Core Indictor 3: Existence of ntionl school sfety stndrds ddressing oth the physicl nd socio-emotionl school environment. Tsk: 1. Red through FRESH Checklist 3 to select the Su-Indictors nd Guiding Questions. 2. Gther ll relevnt documents for review. 3. Identify key informnts for interviews or focus group discussions. 4. Develop the questionnires for the key informnts. 5. Adpt the List of Stndrds For A Sfe Lerning Environment (elow) to the ntionlly or loclly recommended list of criteri. Where these do not exist use interntionl stndrds (see links to interntionl resources under the heding Supplementry Guidnce, elow). Su-Indictor 1 c The existence of ntionl stndrds to guide nd ssess the physicl school environment. Are there ntionl stndrds to guide nd ssess the physicl school environment 19? 0 = No; 1 = Miniml/includes less thn hlf of the criteri in the List of Stndrds For A Sfe Lerning Environment elow; 2 = Includes hlf or more of the criteri in the List of Stndrds For A Sfe Lerning Environment elow, nd more where relevnt. Do the stndrds for the physicl environment reflect the distinct needs of different groups of children (e.g. seprte snitry fcilities for girls nd oys, for younger nd older children, for children with disilities)? 0 = No; 1 = Some (reference to t lest one distinct need); 2 = Well-estlished (reference to more thn one distinct need). Are the stndrds sed on evidence of priority helth needs nd issues in schools? 20 0 = No; 1 = The stndrds re sed on some evidence; 2 = Yes, the stndrds re sed on comprehensive situtionl nlysis nd re regulrly reviewed d Are the stndrds user-friendly nd ccessile? 0 = No; 1 = To limited extent; 2 = Yes, the stndrds re regulrly distriuted to ll schools nd re orgnized in cler nd usele wy. Totl nd men score for The existence of ntionl stndrds to guide nd ssess the socio-emotionl school environment. 21 Are there ntionl stndrds to guide nd ssess the socio-emotionl spects of the school environment? 0 = No; 1 = Less thn hlf of the criteri elow; 2 = Hlf or more thn hlf of the criteri elow nd more where relevnt. Do the stndrds for the socio-emotionl environment reflect the distinct needs of different groups of children (for exmple HIV positive students nd/or pregnnt students re not discriminted ginst)? 22 0= No; 1 = Some (reference to t lest one distinct need); 2 = Well-estlished (reference to more thn one distinct need). 19 This my include stndrds to guide nd ssess wter nd snittion in schools, the sfety of school uildings nd structures, nd child protection from externl hzrds. 20 Idelly this evidence should e tied to the situtionl nlysis t ntionl-, locl- nd school-level. 21 See the list elow nd supporting documents for exmples of the types of issues (such s stigm nd discrimintion) tht might e included in such ntionl stndrds. 22 To score 1 or more there needs to e some references to the distinct needs of different groups in the school. If these do not exist, score 0. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 27

28 c Are the stndrds sed on evidence of priority helth needs nd issues in schools? 23 0 = No; 1 = The stndrds re sed on some evidence; 2 = Yes, the stndrds re sed on comprehensive situtionl nlysis nd re regulrly reviewed. d Are the stndrds user-friendly nd ccessile? 0 = No; 1 = To limited extent; 2 = Yes, the stndrds re regulrly distriuted to ll schools nd orgnized in cler nd usele wy. Totl nd men score for 3.2 Overll men score for Core Indictor 3 List of documents to e reviewed Plese dd relevnt documents tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 3, to help explin the scores given Add others s needed. List of Stndrds For A Sfe Lerning Environment Adpt this list to the ntionlly or loclly recommended list of criteri. If these do not exist, use interntionl stndrds (see links to interntionl resources under the heding Supplementry Guidnce elow). Physicl School Environment 1. Access nd qulity of potle drinking wter. 2. Access nd qulity of hnd wshing fcilities, including sop. 3. Access nd qulity snittion. 4. Qulity of construction. 5. Protecting children from dngers. Supplementry Guidnce (links from FRESH) 1.Guidelines for the Provision of Sfe Wter nd Snittion Fcilities in Schools This tool sets out some guidelines nd cceptle stndrds for the provision of sfe wter nd snittion fcilities in schools. 2.Wter nd Snittion: A Checklist for the Environment nd Supplies in Schools This tool sets out numer of strtegies tht will help ensure tht schools nd eductionl fcilities hve dequte wter, snittion nd hygiene fcilities to gurntee the helth of their students nd stff. Socio-Emotionl School Environment 6. How to del with ullying (y stff nd students). 7. How to del with incidents of violence in the plyground nd the clssroom. 8. The use of positive discipline. 9. How to del with drugs nd lcohol. 10. How to del with stigm nd discrimintion. 3. Evluting the Psycho-Socil Environment of Your School This tool contins questionnire, the Psycho-Socil Environment Profile (referring to the socio-emotionl lerning environment) developed y WHO to evlute the extent to which school s environment contriutes to the socil nd emotionl well-eing of its students nd stff. It includes instructions for scoring the questionnire, nd for using the findings to pln nd undertke corrective ctions. This tool is primrily intended for school dministrtors, techers, community leders nd memers of school helth tems, ut my e useful to district- nd ntionl-level stff who mke decisions on ehlf of locl schools s well. 23 Idelly this evidence should e tied to the situtionl nlysis t ntionl-, locl- nd school-level. 28 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

29 B. SAFE LEARNING ENVIRONMENT School-Level Core Indictor 4: Percentge of schools tht meet the ntionl school sfety stndrds (physicl nd socio-emotionl). PURPOSE To determine: 1) The extent to which schools hve cpcity to meet the stndrds for helthy nd sfe physicl lerning environment. 2) The extent to which schools hve cpcity to meet the stndrds for sfe socio-emotionl lerning environment. 3) The extent to which schools meet specific spects of the school environment stndrds. 4) Student perceptions of the school providing sfe lerning environment. 5) Prent nd community perceptions of the school providing sfe lerning environment RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS While ntionl stndrds my exist to guide the eduction system nd schools on how to ensure children re sfe nd protected t school, this does not men tht these stndrds will e reflected in schools cross the country. In mny cses, some spects will e ddressed nd others not. A school s ility to meet ntionl stndrds depends on numer of fctors, including stff nd school ledership wreness of the stndrds nd their commitment nd cpcity to implement the stndrds. In turn, their implementtion depends on the eduction system, community or other prtner s support (finncil nd technicl) to help schools meet those stndrds. If ntionl stndrds do not exist, interntionl stndrds cn e used to ssess the sfety of the school environment nd guide improvement of sfety t school. Core Indictor 4 ssesses the extent to which schools hve sfe lerning environment, from oth physicl nd socio-emotionl perspective. Core Indictor 4 is ssessed through focus groups nd key informnt interviews in smple of schools representtive of ll schools in the country (see dt collection guidnce for more detils). It covers oth the physicl nd socio-emotionl spects of the school environment nd should e dpted to ech context to reflect the ntionl stndrds nd progrm gols. FRESH Checklist 4 cn e used to collect informtion on the sfety of the school environment nd inform the five Su-Indictors in the Purpose ove nd the overll Core Indictor 4. Checklists collected in ech surveyed school will need to e ggregted to generte the overll Core Indictor 4 nd Su-Indictors. These cn then e disggregted y district, eduction-level (primry nd secondry) nd type of school (privte nd pulic), nd used to identify higher nd lower performing schools. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 29

30 FRESH CHECKLIST 4 SAFE LEARNING ENVIRONMENT (SCHOOL-LEVEL) Core Indictor 4: Percentge of schools tht meet the ntionl school sfety stndrds (physicl nd socio-emotionl). Tsk: 1. Red through FRESH Checklist 4 to select the Su-Indictors nd Guiding Questions. 2. Gther ll relevnt documents for review. 3. Identify key informnts for interviews or focus group discussions. 4. Develop the questionnires for the key informnts nd school oservtions. 5. Adpt the List of Stndrds For A Sfe Lerning Environment to the ntionlly or loclly recommended list (see FRESH Checklist 3). Where these do not exist use interntionl stndrds (see links to interntionl resources under the heding Supplementry Guidnce ). Su-Indictor 1 c d The extent to which the schools hve cpcity to meet the stndrds for helthy nd sfe physicl lerning environment. (Oservtion) Is drinking wter ville on the dy of the survey? 0 = No; 1 = Drinking wter is provided, ut there is not enough to meet the needs of girls, oys nd school stff; 2 = Yes, there is sufficient drinking wter nd it meets the needs of girls, oys nd school stff. (Oservtion) Are wter nd sop ville for hnd wshing on the dy of the survey? 0 = No; 1 = Wter nd/or sop is provided for hnd wshing, ut there is not enough to meet the needs of girls, oys nd school stff; 2 = There is sufficient wter nd sop for hnd wshing which meets the needs of girls, oys nd school stff. Did stff receive trining during the pst two yers to develop their wreness of the stndrds for helthy nd sfe physicl lerning environment nd where relevnt, how to implement nd/or develop the stndrds? 0 = No; 1 = To limited extent; 2 = Yes, stff received trining in the stndrds nd cn descrie how they hve implemented the stndrds. Wht level of commitment nd support do stff nd/or other prtners show towrds providing, mintining nd developing sfe physicl lerning environment? 0 = None nd/or no externl prtners showing commitment to improve the school s physicl environment; 1 = Stff show interest in the stndrds nd in implementing them, ut the ctul physicl environment of the school is poor nd/or they re wre of prtners who could help, ut no ction hs een tken; 2 = Stff nd others re wre of the stndrds nd cn descrie wht most of them re nd/or there re prtners who re supporting the improvements nd mintennce of the physicl environment of the school. Totl nd men score for The extent to which schools hve cpcity to meet the stndrds for sfe socio-emotionl lerning environment. (Oservtion) Are there indictions tht the school provides wrm, friendly, supportive tmosphere (e.g. signs with encourging words or imges, interctions etween techers nd students, rooms for counseling, etc.)? 0 = No; 1 = There re some indictions of wrm, friendly, supportive school environment; 2 = Yes, there re mny indictions of wrm, friendly, supportive school environment tht meets the needs of girls, oys nd school stff. Did stff receive trining during the pst two yers to develop their wreness of stndrds for socio-emotionl lerning environment nd where relevnt, how to implement nd/or develop the stndrds? 0 = No; 1 = To limited extent; 2 = Yes stff received trining nd cn descrie the stndrds nd re le to implement them were relevnt. 30 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

31 c Wht level of commitment nd support do stff nd externl prtners of the school show towrds providing, mintining nd developing sfe socio-emotionl lerning environment? 0 = None nd there re no externl prtners showing commitment to improve the school s socio-emotionl environment; 1 = Stff show interest in the stndrds nd in implementing them, ut the ctul socio-emotionl environment of the school is poor nd/or they re wre of prtners who could help, ut no ction hs een tken; 2 = Stff nd others re wre of the stndrds nd cn descrie wht most of them re nd/or there re prtners who re supporting the improvements nd mintennce of the socio-emotionl environment stndrds in the school.. Totl nd men score The extent to which schools meet specific spects of the school environment stndrds. 24 Looking t the list of minimum stndrds (physicl nd socio-emotionl, from the Minimum Elements of the Sfe Lerning Environment Stndrds list elow), how mny criteri does the school comply with? 0 = None; 1 = A few (less thn 50%); 2 = Most or ll (more thn 50%). (Oservtion) Are sufficient 25 numers of ltrines provided nd mintined nd re they used y/do they meet the needs of girls nd oys? 0 = No; 1 = Ltrines re provided, ut there re not enough nd/or they re not used y or do not meet the needs of girls nd oys nd/or they re poorly mintined; 2 = There re sufficient numers of ltrines, they re used, mintined nd meet the needs of girls nd oys. c Are there protocols to del with ullying (y stff nd students) nd re they implemented? 0 = No; 1 = There is limited protocol nd it is not well implemented; 2 = Yes, there re protocols nd there is evidence tht the protocols hve een followed. Totl nd men score for Student perceptions of the school providing sfe lerning environment. Focus Group Guidnce: Use the Minimum Elements of the Sfe Lerning Environment Stndrds list to fcilitte discussion mong the group. For Question 4, red out the list of the physicl sfe environment lerning stndrds nd encourge the group to discuss these in more detil. For Question 4, red out the list of the socio-emotionl sfe environment lerning stndrds nd encourge the group to discuss these in more detil. Ensure ech person in the group hs hd chnce to spek. When they re redy, sk them to formulte group nswer. (Using the physicl sfe environment lerning stndrds elow): Do you feel tht this school offers its students physicl environment tht feels helthy nd sfe? (For exmple, the provision nd use of wter, ltrines, clssrooms, nd proximity to dngers like rods etc.) 0 = No; 1 = Less thn hlf of the minimum stndrds seem to e ddressed; 2 = Hlf or more of the minimum stndrds seem to e ddressed. 24 This question my e sustituted with Glol SHPPS Helthy nd Sfe Schools Environment Survey (Questions 10 to 20 nd 148 to 151). 25 WHO stndrd is 25 girls per ltrine, 30 oys per ltrine. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 31

32 B (Using the socio-emotionl sfe environment lerning stndrds elow): Do you feel tht this school offers its students socio-emotionl environment tht feels helthy nd sfe? (For exmple, protection from ullying, violence, drugs nd lcohol, etc.) 0 = No; 1 = Less thn hlf of the minimum stndrds seem to e ddressed; 2 = Hlf or more of the minimum stndrds seem to e ddressed. Totl nd men score for Prent nd community perceptions of the school providing sfe lerning environment Use the sme methodology nd question s in Su-Indictor 4. ove. Use the sme methodology nd question s in Su-Indictor 4. ove. Totl nd men score for 4.5 Overll men score for Core Indictor 4 Minimum Elements of the Sfe Lerning Environment Stndrds Adpt this list to the ntionlly or loclly recommended list of criteri. If these do not exist, use interntionl stndrds (see links to interntionl resources under the heding Supplementry Guidnce elow). Physicl School Environment 1. The provision, use nd mintennce of ltrines of sufficient numer, meeting the needs of girls nd oys. 2. The provision, use nd mintennce of supply of potle drinking wter for children nd stff. 3. The provision, use nd mintennce of hnd wshing fcilities, including wter nd sop. 4. Well-constructed nd mintined lerning res such s clssrooms nd other spces (e.g. plyground nd thletic fcilities). 5. The provision nd mintennce of dily grge removl from school grounds. 6. Protecting children from dngers such s rod trffic, nimls, insects, fire, etc. Socio-Emotionl School Environment 7. Protocols to use Positive Discipline methods vs. Punishment. 8. Protocols to del with incidents of violence in the plyground nd the clssroom. 9. Protocols to del with stff on stff ullying. 10. Protocols to del with children on child ullying. 11. Protocols to del with drugs nd lcohol. 12. Protocols to del with stigm nd discrimintion. 13. Protocols to del with negtive disciplinry prctices. Supplementry Guidnce (links from FRESH) 1.Guidelines for the Provision of Sfe Wter nd Snittion Fcilities in Schools This tool sets out some guidelines nd optiml nd miniml cceptle stndrds for the provision of sfe wter nd snittion fcilities in schools. 2.Wter nd Snittion: A Checklist for the Environment nd Supplies in Schools This tool sets out numer of strtegies tht will help ensure tht schools nd eductionl fcilities hve dequte wter, snittion nd hygiene fcilities to gurntee the helth of their students nd stff. 3.Evluting the Psycho-Socil Environment of Your School This tool contins questionnire, the Psycho-Socil Environment Profile, (referring to the socio-emotionl lerning environment) developed y WHO to evlute the extent to which school s environment contriutes to the socil nd emotionl well-eing of its students nd stff. It includes instructions for scoring the questionnire, nd for using the findings to pln nd undertke corrective ctions. This tool is primrily intended for school dministrtors, techers, community leders nd memers of school helth tems, ut my e useful to district- nd ntionl-level stff who mke decisions on ehlf of locl schools s well. 32 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

33 C. SKILLS-BASED HEALTH EDUCATION Ntionl-Level Core Indictor 5: Priority helth content nd skills-sed pedgogy 25 trining nd lerning ssessments. re present in ntionl guidnce for school curricul, techer PURPOSE To determine: 1) The extent to which helth topics (sed on ntionl helth priorities) re included nd re ccurtely nd ge-ppropritely expressed in the school curricul. 2) The extent to which curricul for school helth include specific skills-sed pedgogicl components. 3) The existence nd qulity of techer trining curricul to support prticiptive, skills-sed helth eduction in schools. 4) The existence nd qulity of techer guidnce nd student mterils for schools on helth topics. 5) The existence nd qulity of priority helth informtion questions in ntionl school leving exmintions. RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS Skills-sed helth eduction refers to developing knowledge, ttitudes, nd especilly skills, using vriety of lerning experiences, with n emphsis on prticiptory methods, to crete or mintin helthy lifestyle. The eduction system is one of the most cost-effective systems through which to ring long-term ehvior chnge in popultion. However, its ility to ring out these chnges depends on the wy helth eduction is delivered in schools. This includes the frequency, relevncy nd ccurcy of the helth informtion provided; the extent to which prticiptive, skills-sed teching pproches re used to tech these topics; nd the scope nd sequence in which they re delivered (progressively uilding on previous helth lessons). In turn, these fctors depend on techers cpcity nd motivtion to tech helth topics using these methodologies, which requires tht: 1. Relevnt helth topics re prioritized in the ntionl school curricul nd exmintions, which motivtes techers to tech these helth topics. 2. Prticiptive, skills-sed teching pproches focused on helth re dequtely covered in pre- nd inservice techer trinings. 3. Techers hve the necessry tools (techer guidnce nd student mterils) to help them tech the recommended helth topics using pproprite teching pproches nd ssess student chievement in helth promotion in the school nd community. Core Indictor 5 is ssessed y conducting key informnt interviews nd desk review (see dt collection guidnce for more detils). Content nlysis of the following documents is recommended: Primry nd secondry school curricul, where sujects nd lerning ojectives re defined y grde. Pre- nd in-service techer trining mnuls nd mterils. Techer guidnce nd student mterils for suject res where helth topics re included. The ntionl school exmintion guidelines nd pst school exmintion ppers. (See dt collection guidnce for more detils.) FRESH Checklist 5 cn e used to conduct key informnt interviews, desk reviews nd content nlysis of the ove documents. The checklist is orgnized into five sections, with ech section corresponding to one of the five Su-Indictors listed in the Purpose ove nd the overll Core Indictor 5. The checklist includes suggested list of helth topics which must e dpted to ech country context. 25 For the pedgogy to e skills-sed, this mens tht y the end of specific component of lerning (such s lesson or lesson series) students should e le to perform certin ctions s result of this lerning tht they were not le to do prior to their lerning. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 33

34 FRESH CHECKLIST 5 SKILLS-BASED HEALTH EDUCATION (NATIONAL-LEVEL) Core Indictor 5: Priority helth content nd skills-sed pedgogy 27 re present in ntionl guidnce for school curricul, techer trining nd lerning ssessments. Tsk: 1. Red through FRESH Checklist 5 to select the Su-Indictors nd Guiding Questions. 2. Assemle, list nd review ll relevnt documents including: The primry nd secondry school curricul, where sujects nd lerning ojectives re defined y grde. In- nd pre-service techer trining mnuls nd mterils. Guidnce for the professionl development of techer eductors in school helth. Techer guidnce nd student mterils for suject res where helth topics re included. The ntionl school exmintion guidelines nd pst school exmintion ppers. 3. Identify key informnts for interviews or focus group discussions/ ntionl workshop. 4. Develop the questionnires for the key informnts Su-Indictor 1 The extent to which helth topics (sed on ntionl helth priorities) re included nd re ccurtely nd ge-ppropritely expressed in the school curricul. Are the helth topics included in the curriculum for primry nd secondry schools selected on the sis of ntionl helth priorities 28? 0 = No; 1 = To limited extent; 2 = Yes, the helth topics included hve direct reltionship with roder ntionl plnning nd include regulr review to ensure the topics selected re responsive to chnging needs Are the helth topics in the ntionl primry school curricul orgnized in logicl sequence so tht s students develop, the topics re repeted in more depth? 0 = No; 1 = Helth topics re tught only once or more thn once, ut not in logicl sequence; 2 = Helth topics re tught more thn once nd uild on ech other, getting grdully more complex. c Are the helth topics in the ntionl secondry school curricul orgnized in logicl sequence so tht s students develop, the topics re repeted in more depth? 0 = No; 1 = Helth topics re tught only once or more thn once, ut not in logicl sequence; 2 = Helth topics re tught more thn once nd uild on ech other, getting grdully more complex. 29 Totl nd men score for The extent to which curricul for school helth include specific skills-sed pedgogicl components. Does the ntionl curricul guidnce on school helth t primry school-level feture specific skills-sed development nd/or the use of child-centered prticiptory pproches? 0 = No; 1 = To limited extent; 2 = The curriculum fetures ims nd ojectives tht set out specific skills students will develop. Does the ntionl curricul guidnce on school helth t secondry school-level feture specific skills-sed development nd/or the use of child-centered prticiptory pproches? 0 = No; 1 = To limited extent; 2 = The curriculum fetures ims nd ojectives tht set out specific skills students will develop. Totl nd men score for For the pedgogy to e skills-sed, this mens tht y the end of specific component of lerning (such s lesson or lesson series) students should e le to perform certin ctions s result of this lerning tht they were not le to do prior to their lerning. 28 As per the situtionl nlysis or other documents referred to in FRESH Checklist It is importnt tht the surveyor does not solely focus on the quntity, ut lso the depth of coverge. 34 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

35 3 c The existence nd qulity of techer trining curricul to support prticiptive, skills-sed helth eduction in schools. Do the pre-service techer eduction curricul include the pedgogy of teching skillssed helth eduction? 0 = No; 1 = To limited extent; 2 = Yes, the pre-service trining curricul include explicit references to skills-sed helth eduction needed to develop skills nd to promote the prticiption of students. Do the in-service techer eduction curricul/modules include stff development linked to teching skills-sed helth eduction or improving the qulity of skills-sed helth eduction in specific topic res (such s sexul nd reproductive helth)? 0 = No; 1 = To limited extent; 2 = Yes, the in-service trining curricul include explicit sessions on the teching pproches to develop skills nd to promote the prticiption of students. Are there curricul or guidnce documents for the professionl development of techer eductors to uild the cpcity nd motivtion of techers to deliver skills-sed helth eduction in schools? 0 = No; 1 = To limited extent; 2 = Yes, the trining of techer eductors includes explicit sessions on the teching pproches to develop skills nd to promote the prticiption of students. Totl nd men score for The existence nd qulity of techer guidnce nd student mterils for schools on helth topics. Are there textooks for techers tht offer guidnce on wht nd how to tech helth in the clssroom nd re these mde ville to techers? 0 = No; 1 = To limited extent; 2 = An dequte numer of useful teching guides nd other resources re mde ville to techers. Are there textooks (or work ooks) on helth topics nd re these mde ville 30 to students nd distriuted to schools in the country? 0 = No; 1 = To limited extent; 2 = Yes, there re dequte numers of textooks for students to e le to shre nd mke good use of the informtion. Totl nd men score for c The existence nd qulity of priority helth informtion questions in ntionl school leving exmintions. Do the primry school leving exmintions include the key helth topics in the curriculum? 0 = No; 1 = To limited extent; 2 = Yes, there is significnt section in the primry school leving exmintions on school helth. Do the specific questions sked of students in the ntionl school leving exmintions t primry nd secondry school-levels include questions on helth promoting skills nd ehviors they might use in their dily lives rther thn knowledge lone? 0 = No; 1 = To limited extent; 2 = Yes, ntionl school leving exmintions include wys to test relevnt skills (such s how they might respond to specific scenrio). Is there dditionl guidnce on how to recognize nd ssess students chievement nd ctivity in helth promotion within the school, home or community? 0 = No; 1 = To limited extent; 2 = Yes, there is sufficient guidnce to ssess students chievements nd ctivity in helth promotion in the school, home nd community. Totl nd men score for 5.5 Overll men score for Core Indictor 5 30 Textooks or work ooks re provided to students for free or re loclly ffordle so tht ech student hs ccess to textook or work ook to do required redings nd homework. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 35

36 Primry School Helth Eduction Curricul List of Helth Topics* Primry-Level Mlri Hygiene (Generl) Nutrition nd Blnced Diet Dirrhe, Choler nd Rehydrtion Worms Clen, Sfer Wter Looking fter our Eyes Looking fter our Teeth Immuniztion Infectious Disese Prevention Injury Prevention/Accidents Tocco Use Alcohol nd Other Drugs First Aid Sexul nd Reproductive Helth HIV nd AIDS nd Sexully Trnsmitted Diseses Disility Addressing Stigm (HIV, Orphns, Disility) Accessing Helth Informtion Life Skills (Interpersonl Communiction, Decision-Mking, Gol-Setting, Advoccy) Physicl Activity nd Fitness Emotionl nd Mentl Helth Suicide Prevention Violence Prevention (Bullying, Fighting, Dting Violence) Non-Communicle Disese Prevention Other *Revise to reflect ACTUAL ntionl curriculum Tick the topics ACTUALLY covered in the curriculum per grdelevel. If more thn one lesson is included on this topic then put the numer of ticks tht mtch the numer of lessons. For exmple, if hygiene hs three lessons (generl, personl nd school community hygiene), then it receives three tick mrks. Grde/Clss/Stndrd/Primry-Level (8) 36 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

37 Secondry School Helth Eduction Curricul List of Helth Topics* Primry-Level Mlri Hygiene (Generl) Nutrition nd Blnced Diet Dirrhe, Choler nd Rehydrtion Worms Clen, Sfer Wter Looking fter our Eyes Looking fter our Teeth Immuniztion Infectious Disese Prevention Injury Prevention/Accidents Tocco Use Alcohol nd Other Drugs First Aid Sexul nd Reproductive Helth HIV nd AIDS nd Sexully Trnsmitted Diseses Disility Addressing Stigm (HIV, Orphns, Disility) Accessing Helth Informtion Life Skills (Interpersonl Communiction, Decision-Mking, Gol-Setting, Advoccy) Physicl Activity nd Fitness Emotionl nd Mentl Helth Suicide Prevention Violence Prevention (Bullying, Fighting, Dting Violence) Non-Communicle Disese Prevention Other *Revise to reflect ACTUAL ntionl curriculum Tick the topics ACTUALLY covered in the curriculum per grdelevel. If more thn one lesson is included on this topic then put the numer of ticks tht mtch the numer of lessons. For exmple, if hygiene hs three lessons (generl, personl nd school community hygiene), then it receives three tick mrks. Clss/Stndrd/Secondry-Level MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 37

38 List of documents to e reviewed This list should include ny ntionl government-endorsed document relted to helth eduction in schools. Exmples of documents to review re listed elow. Plese dd others tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 5, to help explin the scores given. 1. Primry school curricul (list nme). 2. Secondry school curricul (list nme). 3. Pre-service techer trining curricul (list nme). 4. In-service techer trining curricul (list nme). 5. Professionl development guidnce/workshop for techers (list nme). 6. Ntionl school exmintion guidelines nd pst school exmintion ppers. Add others s needed. 38 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

39 C. SKILLS-BASED HEALTH EDUCATION School-Level Core Indictor 6: Percentge of schools tht provide regulr skills-sed helth eduction sessions, s recommended in the ntionl guidnce. PURPOSE RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS To determine: 1) The extent (frequency) helth is eing tught in school. 2) The extent to which ech recommended helth topic is tught cross ll grdes in the school in ccordnce with ntionl guidnce nd dpted to locl context. 3) The extent to which techers hve received the pproprite trining in skills-sed helth eduction. 4) The extent to which techers hve ccess to necessry tools to help them tech the helth topics using pproprite teching pproches (such s recommended techer guidnce nd student mterils). 5) Techers perceptions of the extent to which they re using prticiptive, skills-sed teching pproches to tech helth topics. 6) Students perceptions of the extent to which techers re using prticiptive, skills-sed teching pproches to tech helth topics. Skills-sed helth eduction cn influence helth ehvior y equipping students with the knowledge, ttitudes nd skills they need to sty sfe nd helthy. Skills-sed helth eduction cn clrify students perceptions of risk nd vulnerility to help them void situtions of incresed risk nd empower individuls to protect nd improve their own nd others helth, sfety nd well-eing, which cn in turn led to etter eductionl outcomes. Core Indictor 6 ssesses the extent to which skills-sed helth eduction is eing provided in schools. Core Indictor 6 is ssessed through focus groups nd key informnt interviews in smple of schools representtive of ll schools in the country (see dt collection guidnce for more detils). FRESH Checklist 6 cn e used to conduct the focus groups nd key informnt interviews mentioned ove. The checklist is orgnized into six sections, with ech section corresponding to one of the six Su-Indictors listed in the Purpose ove nd the overll Core Indictor 6. These will e ssessed through discussion with techers nd students in ech surveyed school. Checklists from ech school will need to e ggregted to generte the overll Core Indictor 6 nd Su- Indictors. These cn then e disggregted y district- nd eduction-levels (primry nd secondry) nd type of school (privte nd pulic), nd used to identify higher nd lower performing schools. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 39

40 FRESH CHECKLIST 6 SKILLS-BASED HEALTH EDUCATION (SCHOOL-LEVEL) Core Indictor 6: Percentge of schools tht provide regulr skills-sed helth eduction sessions, s recommended in the ntionl guidnce. Tsk: 1. Red through FRESH Checklist 6 to select the Su-Indictors nd Guiding Questions. 2. Gther ll relevnt documents for review. 3. Identify key informnts for interviews or focus group discussions. 4. Develop the questionnires for the key informnts nd ny school oservtions. 5. Adpt the list of helth topics (for Question 2) to the ntionlly recommended list of topics for schools in Supporting Documents Checklist Fill in the nmes of the ntionlly recommended nd supplied textooks nd curriculum guidelines (for Question 4) on helth in Supporting Documents Checklist 6.. Su-Indictor 1 c The extent (frequency) helth is eing tught in school. 31 How mny distinct helth lessons 32 hve een tught per grde-level during the lst school month 33? Plese nme the topics. 0= None; 1 = One lesson; 2 = Two or more lessons. How mny helth topics tht re infused into other lessons (such s mth, lnguge, rt) hve you tught during the lst school month? 0 = None; 1 = One helth topic; 2 = Two or more helth topics. How mny helth topics hve een ddressed in non-clssroom school time during the lst six school months? (For exmple: ssemlies, clus, nd informl ctivities in the plyground.) 0 = None; 1 = One helth topic; 2 = Two or more helth topics Totl nd men score for The extent to which ech recommended helth topic is tught cross ll grdes in the school in ccordnce with ntionl guidnce nd dpted to locl context. 34 (Showing techers the list of helth topics from FRESH Checklist 6. elow): Which of these helth topics re eing tught this school yer in your prticulr grde-level? Specify grde(s):.. 0 = None of the helth topics for your prticulr grde; 1 = Less thn hlf of the helth topics for your prticulr grde; 2 = Hlf or more of the helth topics for your prticulr grde. To wht extent re you le to select nd dpt helth topics to fit the locl conditions nd chllenges? 0 = No dpttion to the locl conditions; 1 = Less thn hlf of the helth topics dpted); 2 = Hlf or more of the helth topics dpted). c To wht extent re you le to select nd dpt helth topics to fit students ides out the common prolems nd chllenges they fce? 0 = No dpttion to students ides; 1 = Less thn third of the helth topics dpted); 2 = A third or more of the helth topics dpted). Totl nd men score for This question is ddressing frequency. Only score lessons where there is evidence tht sufficient time hs een spent on the lesson nd tht the lesson hs een tught t n pproprite level for the ge of the pupils. 32 Plese note the distinction etween lessons nd topics. Severl lessons cn e used to tech topic. A lesson is t lest 30 minutes of instruction, which my include interctive ctivities. 33 Countries my djust the timefrme so tht it is relevnt to their teching schedule. 34 This question my e sustituted with Glol SHPPS Instruction on Helth-Relted Topics Survey (Questions 111 to 147). 40 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

41 3 The extent to which techers hve received the pproprite trining in skills-sed helth eduction. How mny techers hve received pre-service trining 35 in skills-sed helth eduction, including prticiptive teching pproches? 0 = None; 1 = Less thn hlf of the recommended pre-service trining; 2 = Hlf or more of ll techers hve received the recommended pre-service trining in skills-sed helth eduction. How mny techers hve received in-service trining 36 in skills-sed helth eduction, including prticiptive teching pproches? 0 = None; 1 = Less thn hlf of the recommended in-service trining; 2 = Hlf or more of ll techers hve received the recommended in-service trining in skills-sed helth eduction. Totl nd men score for The extent to which techers hve ccess to necessry tools to help them tech the helth topics using pproprite teching pproches. (Show prticipnts FRESH Checklist 6. elow) How mny of the following textooks or curriculum guidelines tht re sed on skills-uilding pproch or other evidence-sed pproches does the school hve? 0 = None; 1 = Less thn hlf; 2 = Hlf or more. Are other mterils (other ooks, posters, nd resources) thn those listed, re used to support the teching of helth lessons? 0 = None; 1 = Less thn five items; 2 = Five items or more. NOTE: Descrie or mke list of the items on FRESH Checklist 6 elow. Totl nd men score for Techers perceptions of the extent to which they re using prticiptive, skills-sed teching pproches to tech helth topics. 37 In your helth lessons, how often re you le to develop students skills in order for them to prctice ehviors for good helth? 38 0 = Not t ll; 1 = Less thn hlf of the time; 2 = Hlf the time or more. In your helth lesson plns, how often do you trget skills s competency which you wish to develop mong your students? 0 = Not t ll; 1 = Less thn hlf of the time; 2 = Hlf of the time or more. c During your helth lessons, do you sk the students open questions (i.e. questions tht hve more thn one possile nswer) nd/or give them n ctivity to do to prctice skill? 0 = No; 1 = Less thn hlf of the time; 2 = Hlf of the time or more. 35 Define relistic locl stndrd, for exmple, t lest one yer or one semester of trining. 36 Define relistic locl stndrd, for exmple, t lest hlf dy of trining within the lst 2 yers. 37 A prticiptive pproch should include process where techers fcilitte their pupils to nlyze the helth prolem; find out more out it in their communities nd schools; pln wht they cn do out it individully nd with other children; nd ctully tke ction nd then review wht they did. 38 Students skills is the ility of pupils to do something new or do something etter tht cn e used eyond the clssroom nd tht will protect their own or others helth. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 41

42 6 Students perceptions of the extent to which techers re using prticiptive, skills-sed teching pproches to tech helth topics. Focus Group Guidnce: Hve the group discuss the questions elow nd mke sure tht everyody gets chnce to spek. To fcilitte discussion for Question 6, show students the list of helth topics from FRESH Checklist 6 in Supporting Documents elow. Averge the responses given y ech prticipnt to record the scores. (Show students the list of helth topics on FRESH Checklist 6. elow.) Which of these helth topics hve you een tught in the lst three months? 0 = None. 1 = One helth topic; 2 = two or more helth topics. Think out the lst lesson you were tught either in clss or during n extrcurriculr ctivity tht focused on helth. Nme the lesson/session nd wht you lerned. 0 = Cnnot recll lst lesson; 1 = Vguely recll the lesson/session nd wht ws tught; 2 = Recll the lesson/session nd wht ws tught. c Which of the following sttements is most like the lesson you were tught? 0 = We st quietly s the techer spoke to us for the lesson nd we wrote notes from the ord nd/or from wht the techer sid; 1 = The techer spoke most of the time nd sked us questions from time to time to test our knowledge; 2 = The techer spoke for out hlf the lesson. In the other hlf we were sked to hve discussions with other students to shre our ides, or we did n ctivity 39 nd the techer sked questions linking our ides on helth to our own lives. We discussed these ides with ech other. The techer sked us to think out helth in the context of our rel life. d After this lesson, did you feel tht you could do something new or different tht would improve your own or nother s helth? 0 = No; 1 = A little; 2 = A lot. Totl nd men score for 6.5 Overll men score for Core Indictor 6 39 An ctivity could e role ply, simultion exercise, group work, gme, cse study, etc. 42 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

43 Supporting Documents FRESH Checklist 6: Helth Eduction Content List of Helth Topics* Primry School Secondry School Tick the topics ACTUALLY covered in prctice. If more thn one lesson is tught on this topic then put the numer tht mtches the numer of lessons. For exmple, if hygiene hs three lessons (generl, personl nd school community hygiene), then it receives three tick mrks. Techers Students Techers Students Mlri Hygiene (Generl) Nutrition nd Blnced Diet Dirrhe, Choler nd Rehydrtion Worms Clen, Sfer Wter Looking fter our Eyes Looking fter our Teeth Immuniztion Infectious Disese Prevention Injury Prevention/Accidents Tocco Use Alcohol nd Other Drugs First Aid Sexul nd Reproductive Helth HIV nd AIDS nd Sexully Trnsmitted Diseses Disility Addressing Stigm (HIV, Orphns, Disility) Accessing Helth Informtion Life Skills (Interpersonl Communiction, Decision-Mking, Gol-Setting, Advoccy) Physicl Activity nd Fitness Emotionl nd Mentl Helth Suicide Prevention Violence Prevention (Bullying, Fighting, Dting Violence) Non-Communicle Disese Prevention Other *Revise to reflect ACTUAL ntionl curriculum MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 43

44 Supporting Documents FRESH Checklist 6: Helth Eduction Content List of textooks nd other mterils to support helth teching Primry School Secondry School * * *Insert the nmes of the recommended textooks nd/or curriculum guidelines supplied to schools to help them pln nd tech helth topics. (Recommended textooks should e sed on skills-uilding pproch or other evidence-sed pproches.) 44 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

45 D. SCHOOL-BASED HEALTH AND NUTRITION SERVICES Ntionl-Level Core Indictor 7: A minimum pckge of school-sed helth nd nutrition services hs een defined t ntionl-level sed on locl helth priorities. PURPOSE RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS To determine: 1) The extent to which pckge of school-sed helth nd nutrition services hs een defined nd recommended t ntionl-level. 2) The extent to which the recommended pckge of school-sed helth nd nutrition services is sed on rigorous ssessment of the helth nd nutrition needs of school-ge children cross the country. 3) The extent to which school-sed helth nd nutrition services re relevnt to locl-level. The eduction system provides highly orgnized system through which to provide key helth nd nutrition services to school-ge children nd ddress helth nd nutrition prolems which ffect their prticiption nd lerning in school. Selection of specific services to e provided in ech school depends on the ntionl nd locl helth nd nutrition priorities in this ge group nd the reltive cost nd ese of dministrtion of the services through the eduction system. There is lrge evidence se for numer of school-sed helth nd nutrition services including deworming, iron supplementtion nd school feeding, which highlights their reltive costeffectiveness in different contexts. However, less evidence exists for other eqully populr services like school phrmcies or first id kits, physicl screening or school counseling. A rigorous situtionl nlysis (with review of survey reports nd studies) should help identify the helth nd nutrition priorities, informtion gps nd existing experience nd evidence in the country. An dditionl survey my e required however, to confirm the prevlence of specific helth nd nutrition prolems in different prts of the country nd confirm the service provision protocol. Core Indictor 7 is ssessed y conducting key informnt interviews nd review of ntionl (or progrm) policies, strtegies nd reports (see dt collection guidnce for more detils). Suggested documents to review include ny ntionl guidnce on the rnge of helth nd nutrition services tht should e mde ville in nd from schools. FRESH Checklist 7 cn e used to conduct key informnt interviews nd review the ove documents. The checklist is orgnized into three sections, with ech section corresponding to one of the three Su-Indictors listed in the Purpose ove nd the overll Core Indictor 7. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 45

46 FRESH CHECKLIST 7 SCHOOL-BASED HEALTH AND NUTRITION SERVICES (NATIONAL-LEVEL) Core Indictor 7: A minimum pckge of school-sed helth nd nutrition services hs een defined t ntionl-level sed on locl helth priorities. Tsk: 1. Red through FRESH Checklist 7 to select the Su-Indictors nd Guiding Questions. 2. Gther nd list the document(s) tht set(s) out ntionl or locl guidnce on the rnge of helth nd nutrition services tht should e mde ville in nd from the schools. For guidnce on recommended school-sed helth nd nutrition services, see FRESH Checklist Identify key informnts for interviews or focus group discussions/ ntionl workshop. 4. Develop the questionnires for the key informnts. Su-Indictor The extent to which pckge of school-sed helth nd nutrition services hs een defined nd recommended t ntionl-level. Is pckge of school-sed helth nd nutrition services recommended within ntionl strtegy or policy? 0 = No; 1 = One or two school-sed helth nd nutrition services re recommended in ntionl strtegy or policy, e.g. school feeding in the school feeding strtegy; 2 = Yes, pckge of three or more school-sed helth nd nutrition services is recommended in ntionl strtegy or policy. Totl nd men score for 7.1 The extent to which the recommended pckge of school-sed helth nd nutrition services is sed on rigorous ssessment of the helth nd nutrition needs of school-ge children cross the country. Hve the school-sed helth nd nutrition services een recommended on the sis of documented needs, e.g. situtionl nlysis? 0 = No situtionl nlysis; 1 = One or two recommended school-sed helth nd nutrition services re sed on needs ssessment, e.g. deworming sed on findings of ntionl survey; 2 = Yes, three or more of the recommended school-sed helth nd nutrition services re sed on documented evidence of locl need. The extent to which school-sed helth nd nutrition services re relevnt to locl-level 40 Totl nd men score for 7.2 Is the recommended pckge of school-sed helth nd nutrition services djusted to regionl helth priorities nd needs? 0 = No recommended school-sed helth nd nutrition services t ntionl-level, or no locl djustment mde; 1 = Locl djustment mde for one or two of the recommended schoolsed helth nd nutrition services; 2 = Guidnce provided for contextul djustment for three or more of the recommended school-sed helth nd nutrition services Totl nd men score for 7.3 Overll men score for Core Indictor 7 40 It is essentil tht school-sed helth nd nutrition services re tilored to locl needs, for exmple, deworming only where there is prevlence of worms. 46 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

47 School-Bsed Helth nd Nutrition Services FRESH Checklist 7 41 A Minimum Recommended Pckge Intervention Deworming Micronutrient supplementtion, e.g. iron School feeding (mels or sncks to ddress short-term hunger nd improve ttendnce) School nurses for first id (cuts nd sores, hedches, etc.) Vccintions Counseling or referrl of stff or students needing socio-emotionl support Screening services: Eye tests; hering tests; nd dentl checks Notes/Links WHO. (2011). Helminth control in school-ge children: A guide for mngers of control progrmmes 2nd ed. Genev, WHO. WHO. (2011). Guideline: Intermittent iron supplementtion in preschool nd school-ge children. Genev, WHO. WFP. (no dte). Home-grown school feeding: A frmework to link school feeding with locl griculturl production. Bundy, D.A.P., Burno, C., Grosh, M., Gelli, A., Jukes, M.C.H. nd Drke, L.J. (2009). Rethinking school feeding: Socil sfety nets, child development, nd the eduction sector. Wshington D.C., The World Bnk. SchoolNurse.com WHO. (2013). WHO recommendtions for routine immuniztion summry tles. Genev, WHO. WHO. (2001). Through children s eyes: A collection of drwings nd stories from the WHO Glol School Contest on Mentl Helth. Genev, WHO. Gilert, C. (n.d.). Comprehensive school eye helth progrmmes. (Powerpoint presenttion.) London, IAPB. Sve the Children. (2008). Vision nd hering screening in schools: Successes nd lessons lerned from Mngochi District, Mlwi. Wshington D.C., Sve the Children. WHO. (2003). WHO Informtion Series on School Helth Document 11. Orl Helth Promotion: An Essentil Element of Helth-Promoting School. Genev, WHO. Mlri control (intermittent preventtive tretment) Clrke, S.E., Jukes, M.C.H, Njgi, J.K., Khskhl, L., Cundill, B., Otido, J., Crudder, C., Estmle, B.B.A. nd Brooker, S. (2008). Effect of intermittent preventive tretment of mlri on helth nd eduction in schoolchildren: A cluster-rndomized, doule-lind, plceo-controlled tril. The Lncet, 372(9633): 127_ Others 41 The recommended pckge of school-sed helth nd nutrition services my e determined t ntionl-level (within the ntionl school helth policy) or t progrm-level. The pckge of schoolsed helth nd nutrition services should ddress ntionl (nd or locl) helth nd nutrition priorities nd e cost-effective. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 47

48 List of documents to e reviewed This list should include ny ntionl government endorsed documents, which outline the rules, principles nd content for school helth progrmming ntionwide. These might lso include ny ntionl (or progrm) policies, strtegies nd reports tht ssess school-sed helth nd nutrition services either within or seprte from the roder school helth policy. In ddition, ny cdemic puliction or field reports tht look t the links etween the provision nd delivery of school-sed helth nd nutrition services nd the helth of school-ge children could e included s well. Plese dd others tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 7, to help explin the scores given. Nme of document (e.g. ntionl-level poverty reduction strtegy, ntionl-level school helth nd nutrition policy) Source of document (e.g. wesite, lirry, ministry office) Add others s needed. 48 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

49 D. SCHOOL-BASED HEALTH AND NUTRITION SERVICES School-Level Core Indictor 8: Percentge of schools where the minimum pckge of school-sed helth nd nutrition services (s defined t locl- nd ntionl-level) is provided. PURPOSE RATIONALE DATA COLLECTION METHOD MEASUREMENT TOOLS To determine: 1) The extent to which the minimum recommended pckge of school-sed helth nd nutrition services is provided in schools. 2) The extent of links etween locl helth nd nutrition services nd schools. 3) The cpcity within schools to deliver minimum pckge of school-sed helth nd nutrition services. 4) Students perceptions of the provision of school-sed helth nd nutrition services. 5) Prents nd other community memers perceptions of the provision of school-sed helth nd nutrition services. Core Indictor 8 ssesses the extent to which the minimum pckge of school-sed helth nd nutrition services (defined either t ntionl- or locl-level) is eing provided in schools. The recommended pckge of school-sed helth nd nutrition services my e determined t ntionl-level (within the ntionl school helth policy) or t school-level. In either cse, the pckge of school-sed helth nd nutrition services should ddress ntionl (nd or locl) helth nd nutrition priorities tht re sed on glolly recommended services tht hve een proven to e cost-effective. The pckge my include rnge of services ddressing oth physicl nd socioemotionl helth prolems ffecting schoolchildren nd their prticiption nd lerning in school. Exmples of school-sed helth nd nutrition services include mss deworming nd micronutrient supplementtion s recommended y WHO in res where prevlence of worms or nemi re high; school mels or sncks to ddress short-term hunger nd improve ttendnce; school nurses or first id kits; vccintions (usully oosters); counseling of children nd n effective referrl system for more serious helth prolems. The services my e dministered y techers nd/or helth professionls, ut re school-sed, rther thn helth center- or community-sed. Core Indictor 8 is ssessed through focus groups nd key informnt interviews in smple of schools representtive of ll schools in the country, s well s desk review of school documents, strtegies, or policies relted to school-sed helth nd nutrition services (see dt collection guidnce for more detils). FRESH Checklist 8 cn e used to collect informtion on school-sed helth nd nutrition service provision. The checklist is orgnized into five sections, with ech section corresponding to one of the five Su-Indictors listed in the Purpose ove nd the overll Core Indictor 8. It must e dpted to ech context to reflect the recommended minimum pckge of school-sed helth nd nutrition services. Minimum stndrds for ech school-sed helth nd nutrition service should e provided longside the checklist to clrify wht school should consider provision of helth nd nutrition service. Checklists from ech school will need to e ggregted to generte the overll Core Indictor 8 nd Su-Indictors. These cn then e disggregted y district- nd eduction-levels (primry nd secondry) nd type of school (privte nd pulic), nd used to identify higher nd lower performing schools. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 49

50 FRESH CHECKLIST 8 SCHOOL-BASED HEALTH AND NUTRITION SERVICES (SCHOOL-LEVEL) Core Indictor 8: Percentge of schools where the minimum pckge of school-sed helth nd nutrition services (s defined t locl- nd ntionl-level) is provided. Tsk: 1. Red through FRESH Checklist 8 to select the Su-Indictors nd Guiding Questions. 2. Identify key informnts for interviews or focus group discussions. 3. Develop the questionnires for the key informnts nd school oservtions 4. Gther nd list the document(s) tht set(s) out guidnce on the rnge of locl helth nd nutrition services tht should e mde ville in nd from the school. If guidnce does not exist, recommended pckge should e defined see FRESH Checklist Using this list dpt Questions 1, 4, nd 5. Su-Indictor 1 The extent to which the minimum recommended pckge of school-sed helth nd nutrition services is provided in schools Is the recommended pckge of school-sed helth nd nutrition services provided in the school (during this or the previous school yer)? = No; 1 = Less thn hlf of the recommended school-sed helth nd nutrition services re provided; 2 Hlf or more thn hlf of the recommended school-sed helth nd nutrition services re provided. 2 Totl nd men score for 8.1 The extent of links 44 etween locl helth nd nutrition services nd schools. To wht extent re there links etween locl helth nd nutrition services nd the schools? 0 = There re no links; 1 = There re links, ut they re limited to very occsionl visits; 2 = There re good links nd the school stff work closely with community-sed helth nd nutrition professionls to provide services (e.g. identify nd refer children to ccess helth or socil services, nd design nd deliver services tht meet the needs of the children nd their fmilies). Totl nd men score for The cpcity within schools to deliver minimum pckge of school-sed helth nd nutrition services. Hve stff een trined during the lst two yers to deliver school-sed helth nd nutrition services (delivery includes referrls)? 0 = No trined stff in school; 1 = Less thn hlf of stff trined; 2 = Hlf or more thn hlf of relevnt stff hve een trined to deliver the required school-sed helth nd nutrition services. Is there support system for stff who re involved in the delivery of school-sed helth nd nutrition services? 0 = No; 1 = To limited extent; 2 = Stff re well supported from within the school nd through the links the school hs with helth nd nutrition professionls to ensure ongoing support to deliver high qulity school-sed helth nd nutrition services. Totl nd men score for As the pckge of school-sed helth nd nutrition services should e djusted to meet locl needs, the list of services will vry. Adjust the scoring so tht score 0 refers to no services, score 1 refers to up to 50% of the recommended services nd score 2 refers to 50% nd more of the recommended services. 43 This question my e sustituted with Glol SHPPS Helth Services Survey (Questions 49 to 110). 44 Links refer to estlished reltions etween locl helth nd nutrition services nd the school. For exmple, the school regulrly refers students to prticulr helth clinic, nd certin optometrist provides school-sed eye exms every yer. 50 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

51 4 Students perceptions of the provision of school-sed helth nd nutrition services. Focus Group Guidnce: Use loclly dpted version of FRESH Checklist 8 School-Bsed Helth nd Nutrition Services elow to fcilitte discussion mong the group. For Question 4, show the group of students the full list of school-sed helth nd nutrition services, ddressing oth physicl helth needs nd socio-emotionl helth needs. Encourge the group to discuss these more in detil. Ensure ech person in the group hs hd chnce to spek. When they re redy, sk them to formulte group nswer. How mny of these school-sed helth nd nutrition services re you wre of in this school? (Awrd score nd mke note of unmet needs in the ox elow). 0 = None; 1 = One to two school-sed helth nd nutrition services; 2 = Three or more school-sed helth nd nutrition services. Do the school-sed helth nd nutrition services meet the physicl (odily) helth needs of students? 0 = The school-sed helth nd nutrition services do NOT meet students physicl helth needs; 1 = The school-sed helth nd nutrition services re meeting few of the students physicl helth needs; 2 = The school-sed helth nd nutrition services re doing well in meeting most of the students physicl helth needs. c Do the school-sed helth nd nutrition services meet the socio-emotionl helth needs of students? 5 0 = The school-sed helth nd nutrition services do NOT meet students socio-emotionl helth needs; 1 = The school-sed helth nd nutrition services re meeting few of the students socio-emotionl helth needs; 2 = The school-sed helth nd nutrition services re doing well in meeting most of the students socio-emotionl helth needs. Totl nd men score for 8.4 Prents nd other community memers perceptions of the provision of school-sed helth nd nutrition services. Use the sme Focus Group Guidnce s in Su-Indictor 4 ove nd hve the group discuss the questions elow. c How mny of these school-sed helth nd nutrition services re eing delivered y the school? (Mke note of unmet needs in the ox elow.) 0 = None; 1 = One to two school-sed helth nd nutrition services; 2 = Three or more school-sed helth nd nutrition services. Do you think tht the school-sed helth nd nutrition services re meeting the physicl helth needs of students or do you think there is more tht the school could e doing? 0 = The school-sed helth nd nutrition services do NOT meet our children s physicl helth needs; 1 = The school-sed helth nd nutrition services re meeting few of our children s physicl helth needs nd could e doing more; 2 = The school-sed helth nd nutrition services re doing well in meeting most of our children s physicl helth needs. Do you think tht the school-sed helth nd nutrition services re meeting the socio-emotionl helth needs of students or do you think there is more tht the school could e doing? 0 = The school-sed helth nd nutrition services do NOT meet the socio-emotionl helth needs of our children; 1 = The school-sed helth nd nutrition services re meeting few of the socio-emotionl helth needs of our children; 2 = The school-sed helth nd nutrition services re doing well in meeting most of the socio-emotionl helth needs of our children. Totl nd men score for 8.5 Overll men score for Core Indictor 8 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 51

52 School-Bsed Helth nd Nutrition Services FRESH Checklist 8 45 A Minimum Recommended Pckge Intervention Deworming Micronutrient supplementtion, e.g. iron School feeding (mels or sncks to ddress short-term hunger nd improve ttendnce) School nurses for first id (cuts nd sores, hedches, etc.) Vccintions Counseling or referrl of stff or students needing socio-emotionl support Screening services: Eye tests; hering tests; nd dentl checks Notes/Links WHO. (2011). Helminth control in school-ge children: A guide for mngers of control progrmmes 2nd ed. Genev, WHO. WHO. (2011). Guideline: Intermittent iron supplementtion in preschool nd school-ge children. Genev, WHO. WFP. (no dte). Home-grown school feeding: A frmework to link school feeding with locl griculturl production. Bundy, D.A.P., Burno, C., Grosh, M., Gelli, A., Jukes, M.C.H. nd Drke, L.J. (2009). Rethinking school feeding: Socil sfety nets, child development, nd the eduction sector. Wshington D.C., The World Bnk. SchoolNurse.com WHO. (2013). WHO recommendtions for routine immuniztion summry tles. Genev, WHO. WHO. (2001). Through children s eyes: A collection of drwings nd stories from the WHO Glol School Contest on Mentl Helth. Genev, WHO. Gilert, C. (n.d.). Comprehensive school eye helth progrmmes. (Powerpoint presenttion.) London, IAPB. Sve the Children. (2008). Vision nd hering screening in schools: Successes nd lessons lerned from Mngochi District, Mlwi. Wshington D.C., Sve the Children. WHO. (2003). WHO Informtion Series on School Helth Document 11. Orl Helth Promotion: An Essentil Element of Helth-Promoting School. Genev, WHO. Mlri control (intermittent preventtive tretment) Clrke, S.E., Jukes, M.C.H, Njgi, J.K., Khskhl, L., Cundill, B., Otido, J., Crudder, C., Estmle, B.B.A. nd Brooker, S. (2008). Effect of intermittent preventive tretment of mlri on helth nd eduction in schoolchildren: A cluster-rndomized, doule-lind, plceo-controlled tril. The Lncet, 372(9633): 127_ The recommended pckge of school-sed helth nd nutrition services my e determined t ntionl-level (within the ntionl school helth policy) or t progrm-level. The pckge of schoolsed helth nd nutrition services should ddress ntionl (nd or locl) helth nd nutrition priorities nd e cost-effective. 52 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

53 Notes Plese mke note of ny physicl helth or socio-emotionl helth needs tht re not met y the school-sed helth nd nutrition services where relevnt List of documents to e reviewed This list should include ny guidnce on the rnge of locl helth nd nutrition services tht should e mde ville in nd from the school. Plese dd others tht you feel should e reviewed. A short report of the findings of this review should e included s n ppendix to FRESH Checklist 8, to help explin the scores given Add others s needed. APPENDICES: Dt Collection Guidnce on Using the FRESH Core Indictor Checklists Appendix A: Glossry of Terms An overview of terminology nd concepts tht my need to e explined y the fcilittor during focus groups nd key informnt interviews. Appendix B: Tool for Ntionl-Level Questionnires Guiding Questions for key informnt interviews nd desk reviews with the Ministry of Helth nd/or Eduction derived from FRESH Checklists 1, 3, 5, nd 7. Appendix C: Tool for School-Level Questionnires Guiding Questions for focus groups nd key informnt interviews with school dministrtors, techers, students, nd prents, s well s short oservtion tool, derived from FRESH Checklists 2, 4, 6, nd 8. The tools in Appendices B nd C serve to ssess to wht extent countries re implementing the four pillrs of the FRESH frmework-t ntionl- nd school-level. They include the Guiding Questions which re rrnged in userfriendly formt, per trget group, so tht it is esy to develop ntionl- nd school-level questionnires. In using the Guiding Questions, plese follow the instructions under Dt Collection Guidnce in the front section of this document. The numers in the rckets in Appendices B nd C refer to the numer of the Su-Indictor in FRESH Checklists 1 through 8 tht these questions re relted to. Responses eventully need to e recorded in the FRESH Checklists so tht they cn e scored nd nlyzed. MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 53

54 For further informtion, plese contct the FRESH prtner orgniztions through