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) June 2013

2 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 8 Cross-Cutting Themes 9 FRESH Core Indictors 9 Dt Collection Guidnce 10 Appointing n in-country consultnt 10 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 27 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 54 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. Finl 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. 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. Purpose nd document use This document is prt of the roder FRESH M&E guidnce. It is ntionl self-ssessment tool 2 to support governments nd orgniztions in monitoring nd evluting school helth progrms. With its set of recommended indictors, this FRESH M&E Guidnce intends to help progrms in low- nd middleincome countries 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 will help led to etter coordintion etween progrms nd the priorities they ddress nd ultimtely contriute to etter helth nd eduction outcomes. The eight Core Indictors presented in this 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. Dt collection tools re ville seprtely to support the 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 collection nd compiltion of these eight Core Indictors (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. Another prt of the FRESH M&E Guidnce (ville seprtely) is focused on progrm-level 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. 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 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 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 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. 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 8 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

9 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. FRESH Core Indictors The min purpose of the 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 eight Core Indictors, two 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 documenttion 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.). 5 United Ntions Office of the High Commissioner for Humn Rights [OHCHR]. (2013). Convention on the rights of the child. Genev, OHCHR. 8 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS 9

10 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 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). Questionnires per trget group hve een developed s well s eight FRESH Checklists to support dt collection nd nlysis of the eight FRESH Core Indictors. 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. A seprte prt 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: Dt Collection Guidnce This section descries how to prepre for nd implement the dt collection process nd nlysis 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 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 incountry consultnt include: 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 school-level (this my include fcilitting key informnt interviews nd performing desk review t ntionl-level, nd conducting focus groups nd fcilitting key informnt interviews t school-level); followed y consolidting, nlyzing, nd shring dt. 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 Integrtion of existing ssessments If governments or orgniztions hve lredy conducted the following surveys, they my e sustituted for prt of the FRESH Checklists: Survey tool nd Source Sustitute for the following FRESH Checklists 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 Ntionl-level 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 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) School-level questions from FRESH Checklists 2, 4, 6, nd/or 8 tht mtch with prticulr country s EMIS indictor(s). 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. 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. Aligned with FRESH cross-cutting themes, conduct multisectorl consulttion nd form n M&E Tem. Estlish the overll ims, ojectives, context, scope, scle nd resources ville to conduct the ssessment. 2. Through consulttive process, dpt dt collection tools nd reporting forms with instruction sheets (trnslte into locl lnguge nd, if possile, field test tools prior to country-wide dt collection). 3. Trin dt collection tem on concepts, tools nd methodologies, including dt entry on to the dtse. This trining would ensure tht ll dt collectors hve the sme interprettion of the questions. This is prticulrly relevnt for fcilittors nd documenters gthering school-level dt. 4. Conduct ntionl-level dt collection (see Ntionl- Level Checklists: Methodology). 5. Consolidte nd nlyze ntionl-level dt to inform school-level dt collection. Encode dt nd informtion on the dtse. 6. Bsed on ntionl-level scenrio, determine pproprite smpling of schools for school-level dt collection. 7. Secure necessry permission to visit prticipting schools. 8. Conduct school-level dt collection (see School- Level Checklists: Methodology). 9. Consolidte nd nlyze school-level dt. Encode dt nd informtion on the dtse. 10. 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. 11. As reserch dissemintion ctivity, orgnize policy forum gthering vrious stkeholders for policy development nd school helth progrm support. Scoring the FRESH Checklists There re eight FRESH Checklists: four focus on ntionl-level (one for ech of the four FRESH pillrs) nd four focus on school-level (one for ech of the four FRESH pillrs). Ech question gives detiled guidnce on how to mesure the responses. In generl terms the following words re most commonly used with the ssocited score. The FRESH Checklists re set out using simple scoring system where: 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. 12 MONITORING AND EVALUATION GUIDANCE FOR SCHOOL HEALTH PROGRAMS

13 Further detils on scoring the ntionl-level checklists nd the school-level checklists re given elow. Ntionl-Level 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. Personnel selected to complete the ntionl-level 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. Methodology Most of the ssessment ctivity is on undertking key informnt interviews nd desk reviews where n ssessor or tem of ssessors will: 1. Conduct key informnt interviews with rnge of multisectorl stkeholders t different levels (including officers from the Ministries of Helth nd Eduction, s well s relevnt interntionl nongovernmentl orgniztions) who cn initilly respond to the questions t ntionl-level nd identify source documents for review. (Ensure the questionnire is given eforehnd so tht key informnts hve relevnt informtion nd documents.) Alterntively, the four ntionl-level checklists could e completed through multisectorl workshop or group of four workshops in which ech workshop focuses on one of the four checklists. 2. Gther nd list documents tht re relevnt to the purpose of the checklist nd tht hve een recommended y key stkeholders. 3. Review the documents nd on the sis of informtion gthered, cross-check or nswer the questions set out on ech ntionl-level checklist noting the specific mesurement guidnce for ech section. 4. Write rief report of the review of ech checklist to provide context nd to explin the scoring. Scoring nd Anlysis Scoring: Once ech checklist is complete, 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 questions[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 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 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. Surveyors my focus on one or more of the checklists. If ll the checklists re eing dministered, dt collectors will need to orgnize the questions for techers/ dministrtors, students nd prents/community memers from ech of the checklists into one document so tht the relevnt questions for ech group cn e ddressed in single meeting (see Appendix C). 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. The school-level checklists include questions for techers, students nd, in some cses, their prents nd community memers to ensure tht the views of ll stkeholders, prticulrly children, who re the min eneficiries of the progrm, re considered. Personnel selected to complete the school-level checklists will need to hve skills to conduct focus group discussions nd e fmilir with the distinctions etween conducting focus groups with children nd with dults. It is est if memers of the dt collection tem hve hd experience working with children nd/or hve the skills to develop rpport with children. The school-level 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. Methodology 1. Red through the four school-level checklist(s) to identify the questions requiring dpttion through review of documents t school-level nd those tht require nswers generted y individul or group discussions. 2. Where relevnt, gther nd list documents relevnt to the purpose of the checklist, such s ntionl school helth curricul nd ntionlly recommended school helth nd nutrition services. 3. Consult with rnge of people involved in school helth t community-level to ensure tht ll relevnt documents hve een ssemled nd locl dpttions to the checklists hve een mde. 4. 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. 5. Conduct key informnt interviews nd focus groups (with dministrtors/techers, students, nd prents/community memers) relevnt to the checklists to nswer the questions set up in ech school-level checklist. (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.). Ask questions in the locl lnguge, dpted to country-context nd ge-level, nd e redy to explin concepts tht respondents my not understnd (such s those included in the Glossry in Appendix A). When pproprite, sk respondents to give exmples to mke sure they hve understood the concept. 6. Conduct n oservtion of the school environment. 7. Alterntively, schools my choose to dminister selfcompleted surveys insted of focus groups for which the survey questions hve to e simplified nd nswer sheets hve to e provided (with nswer choices,, c rther thn 1, 2, 3). 8. Write rief report of the review of ech checklist to provide context nd explin the scoring. 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 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 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 totls nd men scores re the sme for school-level s they re for ntionl-level. 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 dt collection tem will need to decide how to smple nd cluster schools. Once the dt re collected from ech school, the dt will need to e entered onto second tle to give su-indictor scores for clusters of schools. It is recommended to estlish dtse for this dt nlysis. Here is n exmple of the elements for scoring tle to orgnize the scores of five schools. 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 / Indictors School School School c School d School e Totls for the cluster Men score for the cluster Totls for ech school Men scores To compre the scores of ech question sked under ech su-indictor, there would need to e ox for ech question. To orgnize this informtion, the tle for ech checklist might look similr to the one elow. 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. FRESH Checklist 2 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 / Indictors c 4 4 4c 5 5 5c School School School c School d School e Totl for the cluster Men score for the cluster Totls for ech school Men scores for the school Anlysis: As efore, 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.

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. 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. SCHOOL 2. Percentge of schools tht hve comprehensive helth-relted school policies. 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 Preprtion: 1. Assemle, list elow nd 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. 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 (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