The expanded commentary on the Dakar Framework for Action reflects the recommendations of this multi-agency partnership and describes three ways in which health relates to Education for All: as an input and condition necessary for learning, as an outcome of effective quality education, and as a sector that must collaborate with education to achieve the goal of Education for All. In the follow up to the Dakar Forum, UNESCO designated FRESH as an "inter-agency flagship program" that will receive international support as a strategy to achieve Education for All.
The FRESH framework. Focusing Resources on Effective School Health is based on good practice recognized by all the partners and provides a consensus approach for the effective implementation of health and nutrition services within school health programs. The framework proposes four core components that should be considered in designing an effective school health and nutrition program and suggests that the program will be most equitable and cost-effective if all of these components are made available, together, in all schools:
Policy: health- and nutrition-related school policies that are non-discriminatory, protective, inclusive, and gender sensitive, and promote the nutrition and physical and psychosocial health of staff, teachers, and children.
School environment: access to safe water and provision of separate sanitation facilities for girls, boys, and teachers.
Education: skills-based education, including life skills that addresses health, nutrition, HIV/AIDS prevention, and hygiene issues, and promotes positive behaviors
Services: simple, safe, and familiar health and nutrition services that can be delivered cost-effectively in schools (such as deworming, micronutrient supplements, and snacks that avoid hunger) and increased access to youth-friendly clinics.
The FRESH framework further proposes that these four core components can be implemented effectively only if supported by strategic partnerships between the following groups:
Health and education sectors, especially teachers and health workers
Schools and the community
Children and others responsible for implementation.
Adoption of the FRESH framework does not imply that these core components and strategies are the only important elements; rather it implies that implementing all of these components in schools would provide a sound initial basis for any pro-poor school health program. This common focus has encouraged concerted action by participating agencies. It has provided a common platform upon which countries, agencies, donors, and civil society can support all programs, including agency-specific programs. Additionally, another important consequence of the FRESH consensus framework has been to offer a common "point of entry" for new efforts to improve health in schools, as illustrated by the following two examples.
The "Global School Feeding Campaign" of the World Food Program (WFP) has gone beyond the provision of food aid to develop a programmatic link between nutrition and education. Working with partners, including national governments, parent-teacher and other community organizations, UNICEF, WHO, the World Bank, UNESCO, and FAO, it promotes the following:
Policies that make food aid conditional upon girls’ participation in education
A minimum package that includes school sanitation, and water and environmental improvement
Nutrition education that improves the quality of students' diets, and HIV prevention education
Nutrition services that include food, deworming, and the alleviation of short-term hunger.
Some 70 countries have begun to implement these principles and activities since 2002.
The Partnership for Parasite Control (PPC) led by the WHO and involving a broad range of development partners, promotes public and private efforts to include deworming in school health services, following a resolution of the 54th World Health Assembly to provide by 2010 regular deworming treatment to 75 percent of school-age children at risk (an estimated target population of 398 million). Since 2001, nineteen of 41 target countries in Africa have begun school-based deworming programs since 2001.
This consensus approach has increased significantly the number of countries implementing school health reforms. The simplicity of the approach, combined with the enhanced resources available from donor coordination, has helped ensure that these programs can go to scale. Annual external support from the World Bank for these actions approaches US$ 90 million, reaching some 100 million school children.
Deworm the World (DtW) is a coalition of partners working to improve access to education through supporting, coordinating, and advocating for school-based deworming programs. In support of the achievement of Education for All, the goal of DtW is to support the WHO resolution to provide regular deworming treatment to 75 percent of school-age children at risk by 2010. Together with partners, DtW will reach up to 28 million children in 2009.
DtW coordinates the provision of technical, financial, political, and in-kind support for the implementation of large scale, sustainable and systematic school-based deworming programs to improve learning outcomes in low income countries. Working closely with Ministries of Education and engaging with local education development partners, DtW also provides operational and technical assistance to support the Ministries’ efforts to scale up deworming activities through their national school health programs.
DtW is currently working with deworming programs in 35 countries, together with partners including national and state governments as well as the Abdul Latif Jameel Poverty Action Lab, American Institutes for Research, Education For All-Fast Track Initiative, Feed the Children, Forum of Young Global Leaders, Global Network for Neglected Tropical Diseases, Innovations for Poverty Action, Partnership for Child Development, Save the Children, World Bank, World Food Program and World Health Organization, among others.