The expanded commentary on the Dakar Framework for Action reflects the recommendations of a multi-agency partnership and describes three ways in which health relates to EFA: 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 EFA. 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 EFA.
The FRESH framework. Focusing Resources on Effective School Health (FRESH) 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 this framework does not imply that these core components and strategies are the only important elements; rather, implementing all of these in all schools would provide a sound initial basis for any pro-poor school health program. The common focus has encouraged concerted action by the participating agencies. It has also provided a common platform upon which countries, agencies, donors, and civil society can support all programs, including agency-specific programs. 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 three examples.
The multi-agency effort to Accelerate the Education Sector Response to HIV/AIDS in Africa, coordinated by a Working Group of the UNAIDS Inter-Agency Task Team (IIAT) on HIV/AIDS and Education, promotes the FRESH framework specifically and assists education systems to do the following:
adopt policies that avoid HIV/AIDS discrimination and stigmatization
provide a safe and secure school environment
provide skills-based health education, including life skills, in schools to promote positive behaviors and healthy life styles
improve access to youth-friendly health services.
More than 25 countries, and a similar number of agencies, bilateral donors, and NGOs have collaborated in this effort since November 2002.