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EDUCATION FRESH
 
Stories for Health Education and Skills Development
 
 
 
 
 
 


Why FRESH

The FRESH initiative is based on research and experience that show that school-based health programmes can significantly improve both health and learning outcomes, and that successful efforts typically include a combination of activities in four core areas:

  • school health policies
  • water, sanitation and the environment
  • skills-based health education
  • school-based health and nutrition services

    FRESH is both a call to action and a recipe for success. It provides a framework for identifying needs and undertaking an effective combination of programme “ingredients”. It recommends activities across a core group of cost-effective programme components as a basic starting point for all schools.

    The key to the effectiveness of the FRESH approach lies in the reinforcing effect of activities across each of the core components. De-worming services are supported by hygiene education that helps children prevent re-infection, and by water and sanitation facilities that prevent re-exposure. Anti-tobacco education is reinforced by a policy prohibiting smoking on school grounds. Policies guaranteeing gender equity become more than paper promises when girls have access to appropriate water and toilet facilities at school, and when they are supported by education that addresses the way boys and girls define themselves and each other. In a nutshell, programmes that include activities in all four components of the FRESH initiative are simply more effective than piecemeal, single-strategy approaches.

  •   Using the FRESH framework

    A variety of factors are correlated with the prevalence and severity of health problems affecting children and youth. They include aspects of the physical environment, the availability and quality of basic health services (both public and private), the level of educational attainment, social and cultural norms, economic conditions and individual behaviour. Where a specific health problem reaches epidemic proportions, a combination of these factors is usually at work. It is for this reason that the FRESH framework proposes a combination of basic actions to achieve the most effective reduction in the incidence of particular health problems. It can be used in two ways; first, to identify factors that contribute to health problems among school age youth; and second, to build an effective response.

    Identifying factors

    What schools can and should do to improve the health of school-age children varies from country to country and even within countries. To identify the priority health problems in a specific school catchment area and design an appropriate and effective school health programme in response, it is imperative to conduct a local situation analysis to learn not only who is sick, and with what, but also why. Much can be learned about the “why” by looking into the four core areas of the FRESH framework, i.e. school health policies, the physical and psychosocial school environment, the content and quality of health education and the availability of necessary health services.

    Building an effective response

    When programmes are designed to include activities across the four components of the FRESH model, there is a reinforcing, or synergistic effect, that ensures that efforts in one area of need are not undermined by lack of attention in other areas.

    For example:

    Micronutrient deficiencies (iron deficiency anaemia, protein energy malnutrition, vitamin A deficiency, and iodine deficiency) impair children’s physical and mental health and thus impact school enrolment, attendance and learning. By providing supplements and/or a healthy snack to children in schools, governments can cure children of such deficiencies.

    BUT… Micronutrient deficiencies result not only from poor or insufficient diet, but also from infection with parasites commonly found in contaminated water and faeces.

    AND… Children are a significant vector for the spread of such parasites, primarily because of their underdeveloped understanding and practice of effective hygiene behaviours.

    How effective will micronutrient supplementation be if, because of a contaminated water supply or the lack of hand-washing and toilet facilities, children are routinely infected or re-infected by parasites that deplete the body of the very nutrients provided?

    Using the FRESH framework, micronutrient supplementation (a health service - FRESH component #4) would have been reinforced and supported by activities across the other three components of the framework. For example:
    • by policies related to waste management and infection control (FRESH component #1),
    • by efforts to ensure clean water and appropriate sanitation facilities (FRESH component #2), and
    • by health and hygiene education to teach young people how to reduce the spread of infections (FRESH component #3).

    Because FRESH is a model - not another "new" programme - it is flexible and adaptable. The FRESH framework respects the realities “on the ground”, i.e. local issues and needs and the fact that resources are often limited. Thanks to the "multiplier effect" of efforts across the four core components, significant results are possible at every level of investment. Thus FRESH can be used even in the most resource-poor schools, and in hard-to-reach rural areas, as well as in more accessible urban areas. And governments can start small, and build on their investment as necessary and possible to reap additional benefit.


    What does it cost?

    Because FRESH programs are individually designed to meet the specific needs of the children served by a particular school, they are also tailored to the available resources. Whether the amount of money that can be devoted to solving the health problems that interfere with learning is large or small, effective programs can be developed. The key is in the synergy of activity across the four components of the framework, and in the FRESH supporting strategies, which call for effective partnerships between teachers and health workers, the involvement and support of parents and the community-at-large, and the active participation of young people in the design and implementation of health-promoting activities.

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