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Fit for SchoolBella Monse | CEO Alexander Schratz | Coordinator for M&E Fit for School, Inc., Philippinen

BackgroundThe Fit for School Approach

• Philippine NGO that supports the Philippine government agencies in implementing a school health program

• Focuses on advocacy, capacity development, research and development of tools, templates and guidelines – not on implementation

• Works at the international, national and provincial/divisional level – not on school level

Fit for School, Inc.

Implementing agency of the Essential Health Care Program (EHCP) through school heads, teachers and health personnel

Department of Education (DepED)

National Partners

Provincial and city governments provide funding for hygiene materials and water access

Local Government Units

• Daily handwashing with soap

• Daily toothbrushing with fluoride toothpaste

• Twice yearly mass deworming

• Water access / WASH facilities in schools pre-condition for program support

• (additional modular components)

The Essential Health Care Program

Awarded for Innovation

World Bank, UNDP, WHO/PAHO 2009, Washington DC

Global South-South Development Expo

• Shift tasks

• Don’t just teach, practice

• Create a supportive environment involving the community

• Provide guidance and develop capacities

Key Principles I

• low cost facility at 35$• water consumption is 2 liter for 15 children

Washing facility prototype

• Identify and create incentives

• Local funding

• Promote community ownership

• Inter-sectoral approach

• “Simple, Sustainable, Scalable”

Key Principles II

Packaged program materials

Material and costs per child per year

High quality toothbrush

with cover0.16 US$

60 ml WHO quality tested

fluoride toothpaste 0.22 US$

50 g Soap 0.08 US$

400mg Albendazole tablet

(2x)0.05 US$

Total ~ 0.50 US$

Previous Scale-Up

• Consolidate implementing areas and support DepED/LGU initiatives

• Delegated cooperation between AusAID and GIZ for scale up in the Philippines

• Proposed partnership with UNICEF

−Collaboration to cover additional 10 school divisions (1 million children)

Continuing to Scale Up

• Proposed AusAID / GIZ project integrates sanitation components and targets

− Development, field-testing and implementation of adequate sanitation solutions

− Promotion of school-led total sanitation

• Participation in ‘WASH in Schools’working groups

Expanding Scope

* Top and middle photos courtesy of GIZ Sustainable sanitation - ecosan programme

Impact and ProcessThe two sides of M&E

Measuring health and education indicators through a longitudinal clinical trial in selected intervention schools compared to a control group

Impact M&E

Two Areas of Monitoring and Evaluation

Maintaining and further improving implementation quality in all schools, involving parents and the community

Process M&E

• Follows two cohorts of children in implementing and non-implementing schools for four years

• Measures indicators on nutritional status, worm and oral infections, quality of life, academic performance and absenteeism as well as socio-economic status

Impact M&E

Impact after Year One

Indicators Intervention Control Difference

n = 544 n = 173

Days of absence

SY 2009 3. 2 ± 3.9 4. 4 ± 4.8 27.3 % ***

Prevalence of

children categorized

as underweight28.1% 35.3% 20.4% *

Prevalence of

children with heavy

STH infection10.4% 19.7% 47.2% ***

PUFA Increment 0.08 ± 0.33 0.13 ± 0.40 38.5% *

* 10% significance level, ** 1% significance level

• Stakeholders self assessment of implementationquality at the school level against best practices

− Orientation, availability of program materials, deworming, WASH facilities, group activities

• Random selection of one classroom per school to be monitored

• Results are discussed among stakeholders and communicated to school administration

Process M&E

• Monitoring conducted by a team of school nurse, parent and community representative

• Monitoring form serves as re-orientation about program requirements and implementation guidelines

• Monitoring process provides opportunity for all stakeholders to jointly discuss achievements, challenges and room for improvement

Stakeholder Involvement

Feasibility and reproducibility of M&E tool

• External evaluator reassessed process M&E in 25 schools:

• Findings of monitoring teams were consistent with external evaluator in 80% of cases

• Focus group discussions among parents, community members and school nurses:

• Stakeholder involvement confirmed as a key strength of this self-assessment tool

www.fitforschool.ph

Way Forward

• 2nd-year impact evaluation scheduled for August 2011

• Review of EHCP Process Monitoring together with DepED and nationwide launch in September 2011

• Complementary studies on cost-effectiveness and behavior change