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Social Media and Teen Anxiety
Layout options: Carousel Grid List Card. Include data citation:. Copy to clipboard Close. Cite Data - Experimental. Structured data from the Bibframe namespace is licensed under the Creative Commons Attribution 4. Additional terms may apply to data associated with third party namespaces. Link Analysis Experimental. Schools are one of the few institutions in poor communities that provide access to trained human resources. In contrast, the health systems in many LMICs experience multiple barriers, especially in costs and human resources, that limit their ability to reach beyond health facilities.
Schools cannot replace health systems, which remain the formal avenue for health delivery, but education systems can complement health delivery mechanisms by providing outreach opportunities through schools. Even in LMICs, school-based interventions can be widely implemented by the education sector, with the health sector ensuring proper oversight and training of school staff Bundy School-based health programs have the potential to reach an estimated million school-age children in low-income countries UNESCO This opportunity is particularly relevant to Sub-Saharan Africa.
Young people constitute the greatest proportion of the population, and this is the only region in which the number of young people continues to grow substantially UNFPA It is also important that this is now a region in which most children attend school. As shown in figure Despite the increasing number of children in school, Sub-Saharan Africa has low enrollment rates compared with the rest of the world.
Looking ahead, an unprecedented number of children are anticipated to be in school in this region as enrollment rates improve.
Education Programs for Teens
Because most countries have SHN programs, opportunities exist to scale up the scope of services and tailor specific types of programs to local contexts. It is important to note that the high pupil-to-teacher ratio in many schools may discourage educators and the education sector from adding extra responsibilities that accompany SHN programming. Preservice sensitization and training can help educators recognize that healthy children learn better. SHN systems build on existing infrastructure, curriculum opportunities, and teacher networks to accelerate implementation and reduce costs.
There are more teachers than nurses and more schools than clinics, often by an order of magnitude. Including teachers—as the largest segment of the workforce and often community leaders—in public health activities can also broaden awareness of, and community commitment to, public health interventions. SHN programs can help level the playing field for the most vulnerable students: the poor, the sick, and the malnourished. These are the children who require the greatest support throughout their schooling to minimize the risk of absenteeism and dropping out, but who generally have the least access to care and support World Bank SHN and nutrition programs are pro-poor because the greatest benefits accrue to those children who are most affected at the outset Bundy Poverty is a key consideration in the design of SHN and school feeding programs.
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The negative correlations between ill health, malnutrition, and income level are clearly demonstrated in both cross-country comparisons and individual country analyses de Silva and others , partly because low income and poverty promote disease and inadequate diets. Paradoxically, SHN programs are often most equitable when they are universal; mass delivery can help ensure that the interventions reach those poorest children who are more often systematically overlooked, especially by intervention programs that operate through diagnoses at health facilities.
However, the equity value of universal access within schools does not imply that there is no value in targeting poor communities. With few exceptions, the diseases that affect children and their education are most prevalent in poor countries, particularly in the poorest communities within those countries. As a result, targeting interventions to those communities most likely to benefit is cost-effective and a common characteristic of strong SHN programs.
The benefits of targeting school feeding interventions is discussed in depth in chapter 12 in this volume Drake, Fernandes, and others Lessons gleaned from country case studies can illustrate the strengths of different school feeding approaches in both program design and service delivery Drake, Woolnough, and others Girls and young women benefit particularly from SHN and school feeding programs because some of the most common health conditions affecting education are more prevalent in girls, and because gender-based vulnerability and exclusion can place girls at greater risk of ill health, neglect, and hunger Bundy Deworming and iron supplementation offer particular benefits to girls because women and girls are, for physiological reasons, more likely to experience high rates of anemia.
SHN programs draw children—especially girls—into schools and encourage them to stay Gelli, Meir, and Espejo This dynamic is particularly relevant to achieving EFA; marginalized children, among whom girls are overrepresented, account for the majority of out-of-school children UNESCO Moreover, improved health and increased educational attainment for young women can help delay age at first birth, which is associated with improved financial risk protection and enhanced intergenerational health outcomes; see chapter 28 in this volume Verguet and others Girls can benefit greatly from health promotion and life-skills lessons offered in schools.
Health responses are more sustainable and have a greater reach when integrated into an existing framework, such as through a wider curriculum of health promotion Jukes, Simmons, and Bundy A wide range of life skills and health promotion curriculum design, content, and implementation is available Hargreaves and Boler Relatively simple lessons on skills-based health education can usefully address stigma and discrimination, and an integrated curriculum at a higher level of complexity can usefully influence protective health behaviors.
The years of school attended may not equate to greater attainment of skills-based health education because curriculum quality and extent of integration into the larger school framework vary widely Hargreaves and others ; Jukes, Simmons, and Bundy SHN programs may also work synergistically with conditional and unconditional social transfer programs; see chapter 7 in this volume Alderman and others and chapter 12 in this volume Drake, Fernandes, and others Take-home rations and conditional cash transfers can encourage girls to go to school; bursaries, which give rations directly to girl students, can encourage girls to stay in school Chapman The broader value of these programs is discussed in chapter 23 in this volume de Walque and others Schools are an increasingly attractive and effective platform for reaching girls given that the gender gap in enrollment is closing in most countries.
The trend for girls is especially clear: between and the significant gap in enrollment of boys and girls was dramatically reduced, although a substantial number of children—more or less equally boys and girls—never enroll in school. Figures Significant cross-country differences exist in gender disparities in enrollment rates based on historical experience and government policies. Data from five Sub-Saharan African countries are presented in figure In Mozambique, the number of out-of-school children decreased significantly from to , while gender gaps remained substantial.
In contrast, the gender gap remained small in Ghana, while the trend was downward; in Niger, the number of out-of-school children remained relatively constant over the period, while the gender gap widened. In some Sub-Saharan African countries, the numbers of out-of-school children have proved difficult to reduce; as a result, the observation that SHN programs can benefit out-of-school children becomes increasingly important.
As documented in Guinea and Madagascar, many out-of-school children will take advantage of simple health services provided in schools, for example, deworming and micronutrient supplements; school feeding programs, especially take-home rations, have been shown to benefit siblings at home Adelman and others ; Bundy and others ; Del Rosso and Marek Deworming programs in schools have been found to reach out-of-school children at scale Drake and others and reduce disease transmission in the community as a whole Bundy and others ; Miguel and Kremer Although the benefits of SHN programs can extend beyond those who attend school, SHN programs are best considered in conjunction with other approaches to encouraging enrollment and attendance.
The implementation, funding, and oversight of SHN programs do not fall squarely within either the education or the health sector. Rather, many approaches, stakeholders, and collaborations are involved in the delivery of health and nutrition services in schools.
Diverse experiences suggest that existing programs highlight certain consistent roles played by government and nongovernmental agencies and other partners and stakeholders. It is clear that program success depends on the effective participation and support of strategic partnerships, especially with the beneficiaries and their parents or guardians table In nearly every national SHN program, the Ministry of Education is the lead implementing agency, reflecting both the goal of SHN programs to improve educational achievement and the fact that the education system often provides the most complete existing infrastructure to reach school-age children.
In successful programs this responsibility has been shared between the Ministry of Education and the Ministry of Health, particularly since the latter has the ultimate responsibility for the health of all children. However, collaboration across sectors is not easy, particularly given different institutional structures, operational mechanisms, and working cultures between different line ministries. Each sector needs to identify its respective role and responsibilities and present a coordinated plan of action to improve the health and education outcomes of children.
Beyond the education and health ministries and nonstate actors, intersectoral collaboration is more complex. The starting point is usually the establishment of cross-sectoral working groups or steering committees at national, district, and local levels to coordinate actions and decision making FRESH Successful multisector school-based health service delivery includes referral and treatment opportunities that extend beyond the school platform.
School-based responses to the various diseases affecting school-age children vary depending on the nature of the treatment required. For example, there is a clear policy context for integrating the identification and referral of refractive error into wider SHN programs. It is essential that school-based vision screening programs include screening and referral at the primary level; refraction and optical dispensing at the district level; and supported advanced care, including pediatric and contact lens services, at the tertiary health care level, although the costs increase and feasibility decreases with each step away from the primary level World Bank See chapter 17 in this volume Graham and others for a more detailed look at school-based vision programming.
SHN programs offer a compelling case for public sector investment and interventions. First, these interventions may create externalities whereby external benefits accrue to people other than treated individuals. For example, deworming programs reduce the intensity of infection in untreated children in schools, in neighboring schools, and in siblings of those treated at schools Miguel and Kremer Second, some health interventions are pure public goods—all school-age children are eligible to access these services and there is typically little private demand for general preventive measures.
Accordingly, the private sector is unlikely to compete to deliver these goods and services. SHN programs are most likely to achieve universal coverage and be sustainable when they are under the jurisdiction of the public sector and integrated into national education sector plans ESPs. In the complex set of conditions required for children to learn well, improved health can be one of the simplest and cheapest conditions to achieve World Bank The focus of this economic rationale is on conditions for which there are existing interventions that are sufficiently safe, simple, and well evaluated to be appropriate for education sector implementation through schools, typically with health sector supervision.
Several factors support the economic rationale for schools as a platform for the delivery of health interventions. One of the main factors is the potential savings offered by school systems, rather than health systems, as the delivery mechanism. From this perspective, schools provide a preexisting mechanism, so costs are marginal; they also provide a system that as part of its primary educational purpose aims to be sustainable and pervasive, reach disadvantaged children, and promote social equity. Tailoring and targeting the types of interventions to local contexts lies at the heart of practical success.
Targeting reduces costs and facilitates management; it may optimize outcomes. Education sector spending exceeds public health spending in most LMICs. In Ghana, Mozambique, and Niger, for example, public expenditures for education are more than double those for public health figure The higher investment in the education sector relative to the health sector is reflected in the greater number of schools and teachers versus health centers and health workers in communities see figure The large share of the population that school-age children represent and the high percentage of children that attend school imply significant economies of scale in the cost of delivering school-based health interventions.
The economies of scale can be expected to be larger for interventions with small variable or marginal costs, that is, the cost of treating an additional child. School-based health interventions may also have fixed costs for establishing infrastructure, staffing, government capacity, intersectoral policies, and monitoring systems. The rationale for school-based health interventions is also stronger for interventions that address prevalent conditions in populations see table In this case, the expected benefits are higher per dollar invested. Targeting school-based health interventions to children at greater risk may lead to greater benefits, but it may also lead to higher costs, depending on how the targeting is achieved.
Schools offer advantages over community and primary health center platforms. Chapter 25 in this volume presents an essential package of low-cost health interventions that can be delivered effectively in LMICs through schools Fernandes and Aurino