United Nations System
Standing Committee on Nutrition

Working Group on Nutrition of School-Age Children

held during the ACC/SCN's 30th Session in Chennai, India, March 2003

Chaired by Arlene Mitchell (WFP)
Rapporteurs: Helen Moestue (Partnership for Child Development, UK) and Lisa Studdert (Asian Development Bank)
Apologies: Joy del Rosso (Save the Children/USA and Co-Chair of the Working Group)

Approximately 26 people attended the session which included several presentations and extensive discussion.

Overview of the Working Group accomplishments - Arlene Mitchell (WFP)

Celia Maier (Partnership for Child Development, PCD) presented an update on the nutrition of school-age children based on the review "School-Age Children: Their Nutrition and Health" which was initiated and completed in the previous chairmanship of the working group, under Don Bundy, the work was funded and supported by the World Bank. The review is published in the December 2002 issue of SCN News, and is downloadable from the SCN website. The work is based on a literature review covering the last four years.

The review identifies the main health and nutrition issues for school aged children to be: the persistent stunting and underweight, micronutrient deficiencies, overweight and obesity in countries undergoing the nutrition transition, malaria, water and sanitation related diseases, helminth infections, anaemia and HIV/AIDS. In particular,

• HIV/AIDS and overweight and obesity were identified as major, newly emerging health issues for school-age children.
• Data on stunting shows that the process continues into school years and adolescence. Moreover, several studies show that boys are more stunted than girls and that this divergence increases through the school years. There appears to be a relationship between the severity of stunting and the lack of progress in educational attainment.
• Multiple micronutrient deficiencies are common in school-age children.
• Helminth infections are a large contributor to infection and disease for this age group. The prevalence and intensity of infection increases through childhood and peaks during school-aged years. De-worming can improve haemoglobin status and treating children alone can reduce the intensity of infection throughout the community.
• There is evidence that helminth infection can increase susceptibility to HIV infection and shorten the time of progression to HIV-related disease.
• While HIV infection rates amongst school-aged children remain relatively low, high rates of HIV infection amongst their parents mean that school age children drop out of school to care for sick parents or support families and care for young children where the parents can no longer do so.

Dr Maier noted that there is increasing commitment to tackle these problems through Food for Education (FFE) programmes (FFE is a comprehensive approach, combining food with other education and health measures at the school level), the Partnership for Parasite Control, the Roll Back Malaria initiative, the Interagency Task Team Initiative for HIV/AIDS and the sourcebook of HIV/AIDS prevention programmes being developed by PCD, and the FRESH framework for school-based health interventions.

Discussion

There were requests for further information on particular issues which Dr Maier explained were available in the full report, such as the problem of acute respiratory tract infections and why the prevalence of stunting tended to increase with age more for boys than girls. A question was raised about the sex differences in stunting and whether these may be explained by differences in drop-out rates or maturation. The issue of reaching children out of school was discussed. Children in school can extend school-based services to non-enrolled children who also tend to be poorer and more malnourished than children enrolled in school. The issue of sustaining programmes was briefly discussed and Dr Maier mentioned examples from Ghana and Tanzania where programmes have continued after funding has been withdrawn but concluded that more work was needed to explore this important issue.

Alliances for Action in School Health and Nutrition

1. WFP perspective - Arlene Mitchell
WFP has provided school feeding for the last 40 years, and a renewed campaign began in 2000. In 2001, 15m children were included in WFP's school feeding programmes in 57 countries. The number of countries included increased to 64 in 2002 (Note: AM reported 67 in the meeting; the correct figure is 64, with 15.6 million children being fed). In 2001 WFP undertook a global survey of national school feeding programmes. The survey included some school health and educational data, and fed into a new database that covers 153 countries and is available on the WFP website. WFP also undertook several special studies, developed a research agenda, a deworming campaign, expanded partnerships, released new publications and increased the number of donors supporting school feeding programmes. The emphasis now is on the expansion of alliances foschool feeding in the Sahel and elsewhere.

2. Sahel example: National Government/The Gambia - Mrs Isatou Mamadi Nyang, Principal Education Officer/Project Manager for the National School Feeding Programme
An overview of the school feeding programme operating in the Gambia through the Department of State for Education in collaboration with WFP was presented. School feeding is seen as an important component. New alliances are being created in the Gambia and the region as a whole. The success of the school feeding programme in the Gambia could be used as an example for other countries. School feeding in the Gambia has brought stability, peace and a more sustainable environment for children attending school.

3. UNICEF perspective - Flora Sibanda-Mulder
The main priorities and strategies that came out of UNICEF's Medium-Term Strategic Plan (2002-2005), which included girls' education as an opportunity and "partnerships for shared success" as a strategy, were outlined. Close collaboration between UNICEF and WFP is an example of such a partnership and a minimum package of health and nutrition interventions for schools has been developed with the goals of 'Education for All' in mind. In Mauritania there is a high enrolment rate but drop-out rates are high due to early marriages; Government policies combined with a school programme has increased retention of children in schools. The UNICEF-WFP alliance allowed the agencies' comparative advantages to be exercised while maximising impact. WFP has focused on providing school feeding, deworming and transport logistics for food and school supplies; UNICEF has focused on promoting girl's education and child-friendly/girl-friendly school environments.

4. NGO perspective - Arlene Mitchell (presented on behalf of Joy del Rosso)
The advantages that NGOs have and the benefit they bring in expanding school health programmes were described. These include an on-the-ground long-term presence. NGOs have been involved in developing and testing models in line with FRESH, they often provide the link between governments, donors and communities. The activities of Save the Children/US in Africa were also covered.

Discussion

Long-term sustainability of programmes was discussed at length. Arlene Mitchell presented an overview of the studies WFP has undertaken recently with regard to the sustainability of WFP-supported school feeding programmes. The studies were conducted in countries where WFP previously supported school feeding to see whether the programmes were sustained after WFP support ended and what factors had helped or hurt programme sustainability. Key factors that contributed to successful ongoing programmes were identified and are spelled out in a paper presented to WFP's Executive Board. The paper is available on the WFP website.

Discussants mentioned the need for a long-term vision as to what role school feeding will play in national development. Many developed countries continue support for school-based feeding in some form, with differing private and public funding models (e.g. USA, Japan).

Discussion moved to focus on the benefits and drawbacks of school-gardens for nutrition education and food production, as well as discussion about capacity building and exit strategies.

School gardens: A representative from FAO gave an overview of the activities related to school gardens that the agency supported. While some voiced their concern that children could be exploited as labourers, other claimed to have had good experiences with the use of school gardens, arguing that the main objective for such an approach was for teaching children about food and nutrition-related issues rather than food production, and that it is crucial to involve community members so that they too are aware of the purposes of having a school garden.

Capacity building: The important role played by parents, teachers and community members in the management of programmes was emphasized. For example, in Gambia parents had requested skills training to help them in the management of the feeding programmes.

Exit strategies: Parental and community involvement from the earliest stages of programme implementation aid the phasing over of programme management to the community. There was a call for making exit strategies explicit in earliest design phases for programmes.

Private sector: There is a potential role for the private sector in ensuring sustainability of programmes, for example in Chile an excellent model of public-private partnership in school feeding can be found. WFP is working with the Chilean government and the American School Food Service Association to establish an independent, membership-financed and managed Latin America School Feeding Network to support school feeding in the region. The Network will provide opportunities for information sharing, technical assistance and training, leadership development, etc. The Network is open to all interested parties, including individual members, governments and the private sector. One topic of the conference to launch the new Network will be the responsible involvement of the private sector in public school feeding activities.

HIV/AIDS: The impact on of HIV/AIDS on school-aged children takes many forms: children are becoming orphans and they have greater responsibilities in the home, both in caring for sick relatives and helping to earn a living, all of which may prevent them from going to school. Possible ways of dealing with this enormous problem were improving flexibility of school hours, an emphasis on basic numeracy and literacy skills, as well as finding alternative community-based care facilities that would free up children's time. The HIV/AIDS epidemic has lead to the loss of teachers, adversely affecting education capacity and outcomes. While school feeding may encourage children to come to school, it's crucial to ensure that learning takes place once they are there. There is a need for governments to plan ahead in order to cope with this escalating problem. Dr Maier referred to the Ed-CIDA initiative as a tool for this purpose. It was asserted that external assistance will be required for governments to deal with this problem.

Other issues that were raised in the discussion included:

• Cost analysis: the need for cost-analysis of different school health interventions. Cost analysis is already underway for each part of the WFP-UNICEF school-health package, for example.
• Challenges of school feeding in the US: there was concern about the growing problem of obesity in conjunction with increasing availability of unhealthy alternative foods.
• Local purchasing of food for school feeding programmes was called for, to boost local economies.
• The non-payment of teachers' salaries was seen as a real problem that undermines school-based health intervention programmes.
• Security for girls: schools and travelling to/from school can be a high-risk environment for adolescent girls. There is was the suggestion of having at least one person in each school that girls can trust and talk to about such problems.
• School feeding can be used as a starting point, expanding the use of the school infrastructure to reach other population groups and for other activities (e.g. HIV related education and or community feeding programs).
• Caution about making school-based programs too big and "do-all". There is value in starting with small, doable activities and building up.