PROJECT PROPOSAL FUND TO IMPROVE CHILD

HEALHT CARE, EDUCATION AND NITURATION

PROMOTER: -TSEHAY ASSOSATION

Oromia National Regional State / East Shoa Zone / Bishoftu city /

Hora Hadho (Gerbicha)

March, 2021
Bishoftu,Ethiopia
 This Tsehay association project to Improve Health Literacy seeks to engage organizations,
professionals, policymakers, communities, individuals, and families in a linked, multisector effort
to improve health literacy. The plan is based on the principles that (1) everyone has the right to
health information that helps them make informed decisions and (2) health services should be
delivered in ways that are understandable and beneficial to health, longevity, and quality of life. The
vision informing this plan is of a society that: A focus on select programs in which Tsehay
association has extensive experience and expertise, and that coincide with the age range of Fund
children . These are called the sponsorship “core programs”2 and consist of:

■ Provides everyone with access to accurate and actionable health information

■ Delivers person-centered health information and services

■ Supports lifelong learning and skills to promote good health

■ Early Childhood Care and Development

■ Basic Education
■ School Health and Nutrition
■ Adolescent Development
■ Guidance and tools for each of these programs documented in core program modules, including this
one.
Standard supporting guidance and tools for design, monitoring and evaluation, which are summarized
in this module (detailed guidance can be found in the Common Approach DM&E Module).
 Adherence to a common program cycle.
 The provision of consistent, quality program technical assistance (TA) by the members of the
Sponsorship Technical Working Group.
 Mechanisms through which we can learn from experience and use this information to make
program improvement.
 Use of a proven approach for mobilizing communities, documented in the Sponsorship
Community Mobilization Compendium: Mobilizing Communities for Education, Health and
Social Change.
 This module draws on all seven of these components and provides guidance on how to design,
implement, monitor and evaluate your sponsorship-funded SHN program.
 How to Use this Module?
The module is divided into two main sections:
 About School Health and Nutrition Programs: This section provides the rationale for
SHN and introduces the Focusing Resources on Effective School Health international
framework for SHN programming. It also includes Tsehay’s association experience and approach
to SHN programming; outlines key principles that should guide all Save the Children SHN
programs; and highlights the important links SHN programs must make with Save the
Children’s other sponsorship-funded programs as well as programs outside Tsehay
association.
 The Common Approach to School Health and Nutrition Programming: This
second section walks you through each of the seven steps of the Common Approach program
cycle (see Figure 1), with SHN-specific guidance provided for each step. Particular emphasis is
placed on the situational analysis and program design steps. The seven steps are
summarized below:
 Step 1: Situational Analysis. A situational analysis must be conducted prior to designing an
SHN program in an impact area. It involves collecting and analyzing information to identify and
define key problems that can be addressed by an SHN program.
 Step 2: Program Design. Once information on the needs and resources of the target
communities are available from the situational analysis, this information should then be used
to design an SHN program.To help design the SHN program, the SHN results framework in this
module can be used to help determine the end results you seek from SHN programming in
your country context. Once you’ve identified the results you seek, you’ll need to select the
strategies (interventions) for achieving those results. The Key Strategies Matrix in this module
will help you
 weigh options and choose the interventions appropriate for your country context. As a last
step to completing the program design, a Summary Implementation Plan must be prepared.

 Step 3 & 4: Monitoring and Evaluation (M&E) Plan Design and Baseline Data
Collection. Prior to implementation, draft an M&E plan based on the program design, identify
key indicators to measure program progress over the life of the program, and document your
Impact Area Presence Plan. Collect baseline data and produce a comprehensive baseline report.
Step 5: Implementation and Monitoring. In this step you will undertake all activities
required to implement and monitor the SHN program. A Results Review should be organized
every six months so that program staff and implementing partners can discuss program
progress, identify gaps and plan next steps to improve the program accordingly. Key references
are provided to help you with this step

Step 6 & 7: Evaluation and Lessons Learned. Midway through the program, and close to
the end of the planned presence in the impact area, a program evaluation must be conducted to
assess if the program has been effective in improving the health, nutritional and educational
outcomes of children. Every program follows a different timeline for when evaluations take
place; however, every three to four years is recommended for most SHN programs. A Lessons
Learned workshop should be conducted after each evaluation at least, and most importantly,
close to the end of the program, prior to phase-in to a new impact area. A Lessons Learned
workshop provides all stakeholders associated with the program the opportunity to discuss
program results, identify key successes and challenges faced during the life of the program, as
well as strategies that worked well and should be continued.

This module is intended to serve as a reference and guide for CO program

technical staff and is to be supplemented by technical assistance from the CO’s
STWG TA providers. In addition, the Common Approach DM&E Module and the
Sponsorship Community Mobilization Compendium should be read alongside this core
program module.The DM&E Module contains many helpful tools and in-depth explanations
about each step of the program cycle, with a particular emphasis on the steps that follow the
situational analysis and program design.The Sponsorship Community Mobilization
Compendium provides detailed guidance on how to implement the Community Action Cycle
(CAC).The phases of the CAC, and how they relate to each program cycle step, are presented in
abbreviated form in this core program module.

Figure1: The Common Approach Program Cycle

Situational Analysis

Lessons Learned Program Design

The
Program
 M&E Plan Design

Implementation
Baseline
& Monitoring
The Common Approach emphasizes that programs must be designed, monitored and evaluated according to a standard process. This process is guided by
adherence to a standardized program cycle.

What are School Health and Nutrition Programs?

School Health and Nutrition programs are health and nutrition interventions that are
implemented through schools and targeted at school-age children (approximately five to 12
years) so that they improve their health and nutritional status, behaviors and skills, and are
able to participate in and complete their education.
Why invest in School Health and Nutrition Programs?
To improve children’s health, their learning in school and educational outcomes. School-
age children are often thought of as healthy, but studies have shown that they face high levels of
illness and malnutrition as they go through these crucial growing years. In some of the neediest
countries, school-age children face high morbidity from preventable diseases, which decrease their
cognitive development, intellectual capacity, and overall growth (see Box 1 on the burden of ill-
health in school-age children). Children are sometimes too weak or sick to go to school and often
cannot pay attention during a full schedule of classes. Many perform poorly on school tests, repeat
grades or drop out of school altogether, failing to attain the basic skills that may help them lead
healthier and more productive lives in the future. The World Declaration on Education for All
identifies poor health and malnutrition as one of the key challenges to promoting quality
primary education for all children.
Maintaining children’s health is therefore essential for their cognitive development, growth, and
learning, and for ensuring quality Education for All. Research has shown that school-based health
and nutrition programs improve children’s health and nutrition, in turn leading to increased
enrollment, attendance, reduced class repetition and increased educational attainment. For example,
micronutrient supplementation and deworming have been shown to improve school performance
and restore intelligence quotient (IQ) losses of up to 21 points. Hygiene and sanitation promotion in
schools is known to improve children’s health, boost school attendance and improve gender

equity.3

To meet children’s basic rights to education and health.

SHN programs support the basic human rights included in the Convention on the Rights of the
Child (CRC), especially those related to the highest attainable standard of health (Article 24) and the
right to education for the development of children to their fullest potential (Articles 28 and 29).
Children have rights to information, education and services; to the highest attainable standard of
physical and mental health; and to formal and non-formal education about population and health
issues, including sexual and reproductive health issues. Access to clean water and adequate
sanitation facilities is also a fundamental right to safeguard health and human dignity. SHN
programs offer a unique opportunity to help meet these rights. Effective SHN programs ensure that
schools are safe and protected (free from abuse, corporal punishment and harassment) and
ensure children’s participation in education at all levels.
To meet new opportunities and unfulfilled needs.

Global and national initiatives to improve child survival and achieve universal access to basic
education mean that more children now have the opportunity to go to school. As a result, schools
are now a key setting where the education and health sectors can jointly take action to improve
and sustain the health, nutrition and education of children previously not reached, especially
girls.

To enhance equity in education.

Children who begin school with the worst health status have the most to gain from health and
nutrition programs. They also have the most to gain educationally, since they show the greatest
improvement in cognition as a result of health interventions. Thus, SHN programs particularly benefit
the poor and the disadvantaged. These children are increasingly accessible through schools as a
result of universal education strategies.
Although girls are more disadvantaged than boys in terms of school enrollment and completion,
more girls attend schools than ever before. School-based health interventions have the capacity to
reach more girls than are being reached through existing health services thus improving their
health. Moreover, education in general protects girls from risky behaviors, delays their pregnancy,
prevents HIV/AIDS and improves their overall health, and SHN programs ensure that they are able
to complete schooling and improve educational performance. Similarly, improvements to sanitation
facilities in schools, such as separate latrines for girls, attract more girls to school since schools are
perceived as safer and more adapted to their needs, encouraging parents to enroll and keep
their daughters in school.

To build on investments in early childhood.

An increasing number of countries have recognized the need to ensure good health and
development during the most vulnerable early years of life. Integrated management of childhood
illness, early childhood development, and growth monitoring and promotion programs all help to
ensure that a child enters school fit, well and ready to learn. But the school-age child continues to
be at risk of ill health, and the health of children often deteriorates during the school years. SHN
programs ensure that children remain healthy during the years that are critical for
education.
To promote adolescent development.
Children form attitudes and beliefs early in life and are more likely to practice healthy behaviors
if they are established as habits at an early age. Schools offer the best venue to reach young
children and youth with age-appropriate messages on healthy behaviors in order to tackle some
major problems of adolescence: violence, substance abuse, teenage pregnancy and sexually
transmitted diseases, including HIV/AIDS. As primary education enrollment rates rise, schools are
also an effective venue for communicating messages which can be disseminated throughout
the entire community.

To invest cost-effectively in health and education.

SHN programs help link the resources of the health, education, nutrition and sanitation sectors in an
infrastructure – the school – that is usually already in place. The school system’s coverage is
extensive and it has a skilled workforce that already works closely with communities. The existence
of this infrastructure means program costs can be low, and if well-designed, SHN programs can be
amongst the most cost- effective of public health interventions. Generalized treatment approaches
such as mass deworming or micronutrient supplementations, which do not rely on selective
treatment based on individual diagnosis, are particularly cheap: annual deworming is estimated to
cost only US$0.20-$0.30 per child per year; vitamin A supplementation, US$0.04; and a course of
iron folate supplements only US$0.10.
 The International Framework for School Health and Nutrition Programs

In view of the evidence and arguments in support of SHN programs, international organizations
including the WHO, UNICEF, UNESCO, and the World Bank agreed at the Dakar World
Education Forum in 2000 that SHN was essential to reaching the global Education for All (EFA)
Goals. The Focusing Resources on Effective School Health (FRESH) framework was developed to
outline an initial set of four core activities, called pillars, which need to be comprehensively
implemented in all schools in order to meet the health needs of school- age children and to ensure
that programs go to scale. The FRESH pillars capture the best practices from program experiences
and should be the starting point for designing effective SHN programs and the basis for scaling
up country programming. The four pillars of the FRESH framework are:

1. Safe school environment: This includes the provision of safe water, adequate sanitation and
promotion of hygienic practices for a safe and healthy school environment.

2. School health and nutrition policy: This includes advocacy, support and promotion of
national and school-level SHN policies.

3. School-based delivery of health services: Examples of these services are micronutrient

supplementation, deworming, vision and hearing screening, school-based management of minor
illnesses and injuries.

4. Skills-based health education: This component is centered on a behavior change approach to

the promotion of good health, nutrition and hygiene and prevention of HIV.

In addition, the success of the program and sustainability of its achievements hinges on some key
supporting strategies:

 Effective partnerships between teachers and health workers, and between the education and
health sectors.

 Effective community partnerships.

 Pupil awareness and participation.

Tsehay ’s association Approach to School Health and Nutrition

Tsehay association works at various levels to address the health and nutrition problems of
school-age children (ages 5-12), which align with Save the Children’s Theory of Change (see Box 2
for more information on the theory of change):
At the community level, Tsehay association mobilizes and supports community and parent
partnerships with schools for the delivery of school-based health and nutrition services and
the promotion of healthy behaviors. SHN programming is delivered in areas where Save the
Children has a pre-existing base often through its Basic Education program. This joint
approach has created tremendous synergies, both in terms of resources expended, and in terms
of education and health services working together to serve children. Save the Children also
creates partnerships with governments, through memoranda of understanding with ministries
of education and health, to ensure cooperative work in schools. Partnerships with other national
and international development agencies are also very important to promoting SHN and Save
the Children contributes to the various working groups on SHN internationally and within
program countries.

In our program work with communities, Save the Children contributes to the evidence
base for SHN by teaming up with researchers in public health and education to undertake
operational research projects that help measure the impact of Save the Children’s efforts (so
we are accountable for results) and identify and test innovative approaches to programming. As
a result, Save the Children continues to innovate and refine its approaches to improve
program effectiveness within each context. For example, based on the evidence, deworming
followed by vitamin A and iron supplementation is now provided across all of our programs as
a means to reduce worm burden as well as associated anemia in school children. Through
regular assessments and monitoring and evaluation, SHN programs also demonstrate how
investments and interventions are contributing to improvements in outcomes.

Box 2: The Theory of Change

Box 2: The Theory of Change

 TSEHAY’s ASSOSATION Theory of Change

We will… … be the voice

advocate and campaign for better practices and policies to fulfil children’s
rights and to ensure that children’s voices are heard

(particularly those children most marginalized or living in poverty).

… be the innovator
develop and prove evidence-based, replicable breakthrough solutions to problems facing children.
build partnerships
collaborate with children, civil society organizations,
communities, governments and the private sector to
share knowledge to ensure children’s rights are met.

… achieve results at scale

support effective implementation of best practices,
programs and policies for children, leveraging our
knowledge to ensure sustainable impact at scale.
Tsehay ’s association Theory of Change describes how we will work to create impact
for children. The schematic above describes the four elements to the Theory of
Change, which should help guide the planning and implementation of all
sponsorship-funded programs.
At the national level, Tsehay association uses the evidence from its model of
delivering SHN through community and formal schools to advocate for the
establishment of policies for a
national SHN program. Depending on the context, policies may also include the
introduction of new SHN interventions on a wider scale; modernization of existing
SHN programs; integration of other programs with SHN; or giving support to school
children and/or SHN through a financing scheme. For example, in Nepal Save the
Children worked closely with the ministries of health and education to provide
technical assistance for the development of a coherent national SHN strategy. Save
the Children is also the current rotating coordinator of the national SHN network in
Nepal, comprised of government ministries, donors and other NGOs, which advocates
for the scale up of SHN programs nationally.
Over the years, Tsehay ’s association SHN programs have contributed to reaching
results at scale both within countries and globally. Over the past five years, the
number of children who have benefited from our SHN programs has grown fivefold,
from nearly 400,000 children annually in 2004 to over 2 million in 2021. Many more
children have benefited indirectly from the establishment of national or sub-national
SHN programs by governments following Save the Children’s advocacy and
partnership.
Key Principles of School Health and Nutrition Programming
There are several key principles that guide and are evident in Tsehay’s approach to SHN
programs described above. Several have already been discussed in the previous sections,
and are summarized again below. A star (*) identifies the principles that are being
introduced in this module for the first time.
*SHN programs mobilize communities. Community mobilization (CM) is an
essential part of sponsorship-funded program development, planning,
implementation, monitoring and evaluation, and it is necessary for long-term
sustainability of activities and their impact once programs phase out. A sound
community mobilization approach means not only consulting with communities
and schools, but creating an environment in which individuals and the community
are empowered to take collective action towards education and/or health goals. Key
elements of community mobilization include participation, ownership, equality,
sustainability, community and dialogue of knowledge.
Community mobilization is also one of the three key cross-cutting strategies within
the international FRESH framework. Save the Children’s SHN programs promote the
meaningful participation of not only children but also their families and
communities in the process of learning and the organization of the school. Programs
are family-focused, working to enable parents to support both their children’s
individual education as well as the overall school. Programs are community-based,
encouraging local partnership in education through local school boards, parent-
teacher associations or school management committees (SMC) acting in the best
interests of children.
*SHN programs are sustainable. It is critical that local governments,
communities and other stakeholders continue to maintain and expand SHN
programs beyond Save the Children’s
 intervention. From the beginning, programs are developed in line with
government standards and norms. Programs are designed with time and
resource limits, and develop strategies to ensure that communities and
institutions do not become exclusively dependent on Tsehay association and
its resources. A key strategy to ensuring that communities maintain program
ownership is to involve them in the program throughout, as outlined in the
community action cycle.
 SHN programs are flexible, relevant and appropriate. While the state-of-
the-art is documented in the Common Approach core program modules,
programs are flexible and should be adjusted to ensure they are relevant to
children’s needs and country contexts, now and for the future. Programs should
derive strategies from local culture.This involves identifying positive and
determining acceptable ways to introduce new activities and practices.
 SHN programs are participatory. It is important that SHN programs are
child-centered and promote children’s meaningful participation in all aspects of
the program. Children should be included from situation analysis, to program
design, to monitoring and evaluation of programs. SHN programs must
promote and enable children to be agents of change.
 SHN programs are gender sensitive and inclusive of all children. SHN
programs promote gender equity in enrollment and achievement, eliminate
gender stereotypes, and promote girl- friendly facilities. SHN programs do not
exclude or discriminate on the basis of difference. Instead, all children are
welcomed, treated equitably and given equal opportunities.
 SHN programs are safe and protective of children. SHN programs ensure
healthy and safe learning environments with adequate water and sanitation
facilities. Programs promote the healthy physical, social and emotional
development of children in environments (including on the way to and from
school) that are free from abuse, corporal punishment, and harassment.
 SHN programs are accountable for results. Through regular assessment,
monitoring and evaluation, SHN programs demonstrate how investments and
interventions are contributing to improvements in health, learning, inclusion,
safety and protection.
 SHN programs are innovative. SHN programs develop, test and refine new
and/or better ways to address the key health, educational and developmental
needs of children. Investing in innovation and documentation is critical to
achieving positive, lasting change at scale.
  SHN programs are integrated across sectors. SHN interventions are
not implemented in isolation but are linked as appropriate to other programs
and sectors. In particular, SHN programs should be linked to existing BE
programs.
 SHN programs collaborate and partner. Programs work with governments
at the local and national level, as well as other partners to ensure that they
complement and strengthen the government system and are not offered
merely as substitutes.
 SHN programs are cost-effective. SHN programs identify and prioritize
interventions that produce the greatest impact for the least amount of
resources. That is, program outcomes justify the level of expenditure necessary
to achieve them. This includes applying relevant evidence-based strategies and
conducting operations research to compare and test different approaches. Cost
effective programming is a key element in program sustainability.
 SHN programs seek to scale up. Programs will test, monitor, evaluate,
document and disseminate lessons learned and best practices in SHN
programming in preparation to scale-up through partners and/or other funding
sources. Replication and expansion of quality programs and/or interventions
will be a priority to increase coverage and reach more children.
 SHN programs advocate for change. Based on evidence and the unmet
needs in countries, SHN program advocate for changes in national level policies
as well as local level implementation of programs, so that the health needs of
children are met in the most appropriate and cost
School Health and Nutrition and Links to Other Programs
Given the target age-group of five to 12 year olds, SHN programs normally operate within
Tsehay’s association Basic Education programs as a key component of ensuring
quality basic education. However, in order to extend the health, nutritional and
education benefits to children who are both under and above this age
bracket, opportunities should be sought for creating stronger links with our programs in
Early Childhood Care and Development and Adolescent Development. There are also
opportunities for SHN programs to link more closely with national health programs as
they are key contributors to implementing the health strategies and achieving health
targets. In countries where natural or man-made emergencies are common, schools also
have a role in emergency response. These are discussed in more detail below:

Links with Early Childhood Care and Development

Given the school-based delivery model, our SHN experience is primarily relevant to early
childhood care and development (ECCD) services that are provided through ECCD

centers12 such as preschools that typically reach children of ages three to five years.
Examples of interventions that SHN programs could extend to ECCD centers are as
follows:
 In terms of health services, deworming would be relevant to preschoolers where
the worm prevalence is greater than 20 percent (a recommendation by WHO).
Deworming and vitamin A is often provided to children under five years by the
health sector during child health days, but if not, these could be provided by
trained ECCD teachers or local health nurses. Micronutrient supplementation
can also be added to deworming. Iron is particularly important since the
prevalence and consequences of anemia amongst preschoolers are high. Delivery
strategies must be adapted to the younger child, for example, to prevent choking
when providing tablets. Simple screening tests for health concerns such as
hearing could also be done in ECCD centers to help identify children who
need special medical attention.
 SHN programs can promote a safe environment in ECCD centers by ensuring
toilets and hand- washing facilities are child-friendly. Latrine holes should be
small so they aren’t intimidating; latrines could have a hand-rail to hold on to
if children are squatting or lower toilet bowls for sitting. Hand-washing
stands/sinks need to be low enough and not too wide for small children to
reach. Similarly, all handles and locks need to be within reach and easy to open.
 SHN programs can start providing simple and age-appropriate health and
hygiene education to younger children in ECCD centers. A focus on proper
latrine use and hand-washing would be an ideal place to start. A greater focus
on complementary parent education will be needed as the children may not
understand some of the health messages or lack the ability to act on them.
Parenting education also offers an opportunity to improve caring practices
amongst the younger siblings/children (zero to three years). Another
consideration is the education level and capacity of ECCD teachers/facilitators,
since they may be volunteers who have less training than primary school
teachers with which the SHN program usually works.
 SHN programs can also involve parents and communities in addressing health
concerns of younger children. For example, parent-teacher associations (PTA)
could be involved in ECCD center site selection to ensure that it has adequate
water, sanitation and hygiene facilities for the children. PTAs can also help to
develop and enforce health policies at the center, such as a policy restricting
tobacco use near the ECCD center.
Links with Adolescent Development Programming and HIV/AIDS
Prevention
Adolescent Development (AD) is another sponsorship-funded core program, focusing
on the life-skills, values, education and livelihoods development of in- and out-of-school
youth aged ten to eighteen. AD includes Adolescent Reproductive and Sexual Health
(ARSH) as well as non-formal education and adolescent development programming.
Clearly there are some programmatic overlaps between AD and SHN given the multi-
dimensional (physical, social and emotional) changes in young adolescents, especially
those 10-12 years of age – a common target group for both programs. Young people
who have the information and resources to deal with these changes before puberty
will be better prepared for this transition. SHN programs can contribute to AD in
the following ways:
SHN interventions such as skills-based health education aims at promoting
skills in relation to overall health and hygiene, of which sexual and reproductive
health is an element. As the age of sexual maturity is well under 12 years of age in
many countries now, for young people who may not attend beyond school primary
school, skills-based health education may be the only opportunity they have to
learn about protecting themselves from risky sexual practices. Therefore, when
developing health education activities, be it curriculum or peer-based, it is
important that SHN program managers ensure sexual and reproductive health
concerns are addressed adequately and in an open and age-appropriate manner.
Activities on gender, sexuality, sexually transmitted infections and HIV/AIDS
prevention should a) answer young people’s questions about body changes, b)
reduce teasing and encourage boys to respect girls as their bodies mature, c)
remove misconceptions about HIV and discriminatory attitudes towards people
living with HIV and d) plant seeds for positive and responsible sexual health
behavior as children move into adolescence.
Program managers should seek input from their AD colleagues and STWG TA
providers to help ensure this takes place.
Girls are more vulnerable to absenteeism and drop out, partly due to their
reluctance to attend school during menstruation, particularly when latrines and
washing facilities are not private, safe or are simply not available. While
establishing latrines in schools, SHN interventions should ensure separate latrines
for girls with washstands to ensure menstrual hygiene, so that they feel
comfortable and encouraged to continue to attend school when they would
otherwise stay home. Health education should also cover menstrual hygiene
information and support for girls so that they will be able to manage the
challenges and fears associated with menstruation.
 In places where iron deficiency anemia is an endemic problem and can
compromise the health of adolescent girls of reproductive age, iron
supplementation to these girls can be provided as part of SHN’s extended

support to secondary schools (where applicable), in cooperation with the AD

program.
2.Links with existing national health programs
SHN programs play a key role in implementing the strategies outlined by
national health programs and in helping them meet their targets. It is therefore
important that Save the Children is seen as a key partner and our efforts in
SHN are counted towards the national program:
 National neglected tropical disease programs are seeking alternative
delivery systems for achieving mass coverage for the most common NTDs
(trachoma, soil-transmitted helminths or STH, schistosomiasis and the
education system offers a highly cost-effective system to reaching school-
age children (which often represent one-third of the overall population)
and promoting treatment in the community. Specifically, the WHO has set a
target for all national deworming programs for STH and schistosomiasis
to reach at least 75 percent of school-age children in endemic areas with
regular deworming. Given that school- based deworming contributes to this
coverage target, SHN programs must coordinate with the government while
deworming and subsequently report program coverage to the ministry of
health (MoH) annually.
 UNAIDS has recognized curriculum-based HIV prevention education and
peer education as key strategies for national HIV/AIDS control programs.
Given Tsehay’s efforts in providing skills-based health and HIV prevention
education in and outside classrooms, SHN programs should forge stronger
links with national AIDS control programs.
 Schools can play a key role in achieving the national malaria program goals,
particularly in promoting bed net use amongst the school-age population,
and through them, the wider community. An increasing number of
countries are moving toward universal coverage of bed nets, which includes
school-age children who are both the population group that is the most
likely to be infected with malaria and least likely to use a bed net.
  Similarly, SHN programs should also link with national health programs
that contribute to the control of other health problems (e.g. malnutrition),
which are also addressed by Save the Children. Creating these links is
important to maximize synergy with national efforts, especially in places
where resources are limited.
Links with emergency response programs
In countries where human-induced and/or natural emergencies are common, schools and
SHN programs can play a role in the different stages of disaster risk reduction.
 In terms of disaster prevention and mitigation, specific standards for school
infrastructures are being put into place to ensure the safety and security of
school children and their teachers during disasters. SHN programs may
contribute to a safe school by teaching children about ways to avoid death and
mitigate injuries during emergencies such as fire, floods, earthquakes and
typhoons/hurricanes/cyclones. These messages can be provided using a peer-
to-peer approach to reach out-of-school children who may be more severely
affected
 Schools are often used as evacuation centers for displaced families and
populations to ensure their well-being as they await further humanitarian
response efforts. Knowing that facilities may be used in emergency situations,
SHN programs could, as a disaster preparedness measure, plan facilities so that
water and toilet facilities in schools are adequate and user-friendly.
 During emergency response, SHN programs could link up with makeshift
schools or Child Friendly Spaces to introduce health and nutrition
interventions to ensure that children remain healthy and well-nourished
during their displacement.
This is the end of the first section. The next section leads you through
the steps of the Common Approach program cycle.
The Common Approach to School Health and Nurition Programming
The following section provides step-by-step guidance on how to design, implement,
monitor and evaluate your sponsorship-funded SHN program. The section is organized
around the seven steps of the program cycle, with SHN-specific guidance provided at each
step. Particular emphasis is placed on the situational analysis and program design steps. As
noted above, additional guidance can and should be obtained from the Common Approach
DM&E Module and the Sponsorship Community Mobilization Compendium, as well as
from your STWG TA provider.
The purpose of a situational analysis
Save the Children believes no one model works well everywhere, since values, expectations,
needs and realities vary considerably in different locations. Thus, despite being structured
around the four FRESH pillars, SHN programs vary in nature based on specific needs and
strengths in a community. Some programs may emphasize mitigation of arsenic in drinking
water as part of ensuring a safe school environment, while in others provision of gender
segregated latrines may be a top priority. Understanding the child rearing, health and
education beliefs, practices, and concerns of a community is critical for truly effective
programming.
Before planning an SHN program, program staff must ask questions that will inform the
specific content, breadth and depth of such an effort in a particular context. This is
more broadly the purpose of the situational analysis. The situation analysis helps identify
priority problems in each context and also considers the underlying dynamics with a view
toward identifying potential points of intervention. It focuses on capacities and identifies
not only current policies and relevant services but current and potential stakeholders as
well. The information gathered and analyzed is used to facilitate the process of planning
systematic, strategic and integrated collaborative responses that successfully address the
health and nutritional needs and rights of all children in the impact area.
When designing a program, it is very easy to make assumptions on the problems in the
community.
A situational analysis ensures that the community communicates their needs. The
situational analysis is a critical step in establishing a relationship with the community
based on mutual understanding, and in promoting the involvement of community
members in the planning and management of any program. Aside from community
involvement, inquiry into local SHN needs and options should be conducted in tandem
with national educators, health personnel, social welfare officers and others who have
information regarding the local issues that may influence the provision of services.
How to do a situational analysis
Step 1: Review the questions in the Situational Analysis Matrix
In the Situational Analysis Matrix below, you will find a list of questions which the
situation analysis should
address. For each question, information sources and data collection methods are
suggested to help you gather information to complete the situation analysis. Review the
matrix first and select the questions, data sources and methods that seem most relevant to
your impact area and program needs. Make a plan for the data collection and a report
outline. As you undertake this step, keep in mind that the situational analysis should be
conducted in collaboration with the other core program teams; it should not be done
separately.
Step 2: Gather information
Gather the information you will need to answer the questions you identified in Step 1
from the suggested sources of information. The main data sources include:
 Review of secondary data: A review of documents – including reports,
policies, communiqués,
and surveys such as the demographic and health surveys (DHS) – and published
papers specific to your country and issues. These documents can be obtained from
from government agencies in your country (including district and national levels),
such as the ministry of education (MoE) or the ministry of health (MoH) and
development partners .
Key informant interviews: Conducted at the national and district levels, these will
include interviews with national level experts, national program managers and
development partners involved in SHN related activities (such as deworming/NTD
control, HIV/AIDS prevention, nutrition, malaria, trachoma, etc.), in addition to
Save the Children program staff. The choice of key informants will vary by
country and will depend on the program focus and existing connections with
Save the Children. Key informant interviews should also be used to create and
strengthen
 connections with partners, make sure they are aware of Save the Children’s
activities, identify possible links and gather recommendations for Save the
Children’s program focus (e.g. what role should Save the Children play to
contribute to the national SHN – or other – strategy?).
 Primary data collection at school and community level using
participatory methods, including focus group discussions (FGD) and in-
depth interviews: A small number of schools/communities (five to eight
maximum) should be selected for primary data collection to allow more time
to gain a better understanding of the needs and issues at the school and
community level in each community within Tsehay’s impact area. The main
data collection method will be focus group discussions with children
(separately for girls and boys as well as younger and older children); parents
(mothers and fathers separately); school management committees and other
community associations; and in-depth interviews with key community/school
members, including teachers, school directors, community leaders, health
extension workers and local government health and education officials.
 Assistance from a qualitative research expert may be needed to help gather and
analyze the primary data at school and community level. However, the key
informant interviews and review of secondary data should ideally be conducted
by Save the Children staff to strengthen our relationships with partners and
awareness of SHN-related documents in-country. Box 3 below outlines some
important considerations for data collection and management.
 Process the information and summarize findings in a report
The information gathered must be processed and summarized into a report. Findings
from the review of secondary data, key informant interviews and primary data
collection should be reported under separate sections and then pulled together in
the conclusion with programmatic recommendations. A suggested outline of a
situational analysis report can be found in Annex 1. The Situational Analysis
Summary Tool in the Common Approach DM&E module can be used to prioritize
the important findings from the situation analysis and to begin to identify
appropriate strategies and interventions to address these findings.
Share findings and use for program design
The final and most important step is to share the findings of the situational analysis
with Save the Children staff and district level partners and use those results to guide
the program design and baseline. Some of the key decisions that need to be made
as a result are as follows:
a. Can all the concerns that have been identified be addressed under the four
FRESH pillars? If not, what additional areas need to be considered?
b. What are the cross-cutting issues/concerns (e.g. motivation of the SMC and
teachers) that need to be addressed more generally in the SHN program? Are
these issues in the other core programs, and can resources be pooled in
addressing them jointly? Specifically, what are the key issues for community
mobilization that need to be considered during program design?
c. Which key SHN concerns have been identified and can be addressed by Save
the Children’s SHN strategies (see Step 2 above)? Which SHN concerns have
not been elaborated in Save the Children’s SHN strategies as outlined in this
module, and which SHN concerns require additional guidance/TA support?
d. For which SHN concerns are there either insufficient local data or a need for
school/local level data to be collected through the baseline study?
Key questions to guide a situational analysis
This section contains a set of guiding questions divided up by six broad topics, which are
presented in the matrix below. The first five topics correspond to the results framework
you will construct in the next step of the Common Approach process. The sixth topic
examines Tsahey’s association capacity to implement an SHN
program in your impact area.
You should select the guiding questions from each topic that are most relevant to your
impact area. Some questions listed below may not be relevant for you, and you may
decide to include other questions based on your experience and understanding of the
local context.
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information

The education situation Methods Secondary Data

• Review of secondary data and a) Do schools suffer from low enrollment, high absenteeism, high
SHN’s goal is to improve published papers repetition and drop out, and/or low school performance? How
education. It is therefore essential does this break down by age, sex and other socio-demographic
• Key informant interviews
to understand the wider issues determinants? Provide national and district level data if
facing the education system and • School/community level FGDs
available, and show how district level statistics compare to
the part that health plays within national level.
the broader educational context. Sources of information • Enrollment rate by sex
• ECCD and BE data (avoid • Retention/completion rate by sex and age/grade
Note:The situational analysis duplicating data collection)
• School attendance/absenteeism by sex and age/grade
should be coordinated across all • MoE statistics (national and • Drop out rates by grade
sponsorship-funded programs. Data district level) • Transition rate to secondary school
related to education should not be • Education reports published • Teacher/student ratio (include the range)
collected twice and unpublished (MoE and • Percent of orphans and vulnerable children (OVC)
partners) attending/not attending school
• Interviews with MoE personnel
at district and regional level b) What are the main factors contributing to low enrollment
• School level statistics in sample rates, low retention rates, high repetition rates etc. Do these
schools factors vary by sex, age, ethnicity and other socio-
• FGDs with children, teachers, demographic determinants?
school management • Are schools accessible to most of the school-age population?
committees and parents If not, what are the main factors preventing some children
from attending school (e.g. long distances from home; social,
cultural, health or economic reasons)?
• Are certain children more likely to drop out of school than
others (e.g. girls)? If so, why and what is being done to
address this (at national and district level)?

c) Are children safe at and on their way to school?

• Is corporal punishment common practice?

• Are other types of violence, including bullying and sexual

abuse common between students, and/or students and teachers?

• How are these affecting children’s school participation

(attendance and learning)?
• Are certain children more likely to be targeted by abuse (e.g.
girls, OVCs, younger/older children, certain ethnic groups,
poorer children)?

Key informant interview

As above (especially c) since it will be difficult to obtain
answers to these questions using secondary data.

Community/school level FGDs

As above (especially c) since it will be difficult to find in
secondary data.
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information

The health and nutritional Methods Secondary Data

status of school children • Secondary data a) What is the prevalence of key health problems among school-
• Key informant interviews age children and other age groups, nationally and at the district
What are the most significant level, if available. Are certain children more likely to be
health and nutrition problems • FGD with children, teachers
and community members affected than others (age, sex, social/ethnic status)? Specifically,
facing school-age children and are what is:
these affecting their ability to • Baseline survey can confirm
findings and fill missing gaps in • The prevalence of worms (soil-transmitted helminths and
attend and learn in school?
info schistosomiasis)?
• The prevalence of malaria, trachoma and other infectious
diseases? For malaria also note the peak season for
Sources of information transmission and infection.
• Published papers (search
• The prevalence of HIV/AIDS among all age groups?
websites such as:
http://www.ncbi.nlm.nih.gov/ • The prevalence of micronutrient deficiencies: anemia,
sites/entrez) vitamin A and iodine deficiency?
• The prevalence of general malnutrition: stunting,
• MoH statistics, DHS, agency underweight, wasting?
reports and unpublished
• The prevalence of other health problems: dental caries,
survey reports
vision and hearing problems?
• Interviews with national level • Mortality rate amongst school children and the main
experts (nutritionists, causes of mortality?
parasitologists, malaria etc.),
development partners and Report differences between the sexes, age groups and other socio-
academics working in the field demographic determinants, if available. If no information is
• Interviews with regional, available for school-age children, report findings from other age
district and community level groups (e.g. under fives, pregnant women), and use as an indicator of
health workers likely health problems amongst school-age children. Note the gaps
• FGDs with teachers, parents, in information which can be completed during the baseline
school management survey.
committees and children
b) Is there any country level evidence of the
impact/associations between health and education?

Key informant interview

As above and below.

Community/school level FGDs

What are the most common health problems faced by school
children and are they affecting their ability to attend and
participate in school? How do these manifest themselves at the
school level? Are deaths common amongst school children?
What are the most common causes of death?
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information

School children’s access Methods Secondary Data

to and use of health • Secondary data a) What school-based health services are being provided in schools
services • Interviews with key informants nationally and at district level (e.g. deworming, micronutrient
• FGD with school and supplements, school feeding, vaccinations, first aid kits,
Do school-age children have access counseling, etc.)? Specifically list:
to basic health services to address community members
• Agencies/ministries (MoH, MoE, NGOs, UN) supporting
the most common health problems
these interventions and districts targeted.
identified? Are any of these health Sources of information • Coverage rates of these interventions by sex and grade if
services provided at school? Are • School health policy/strategy available (e.g. percentage of children dewormed by sex), or
these services being used? document and program number of schools included in the national deworming
reports program.
• NTD program strategy and
report and other national b) What other health services are available to school
programs which include a children?
school-based element
• Community or health center based health campaigns targeting
• School health statistics if school-age children, such as deworming, vaccination, voluntary
available counseling and testing for HIV/AIDS, insecticide-treated bed
• Interview with national net distributions, malaria treatment
program coordinators: SHN, • Other health services such as sexual and reproductive
NTD/Schisto or STH control health services
• Review of school level SHN
statistics (if available)
Key informant interview
• FGDs with teachers, parents, a) What school-based health services are being provided in
school management schools nationally and at the district level?
committees and children
• What are the main successes and challenges faced with the
implementation of school-based health services at school,
community, district and national level?
• Do all school-age children use these services or are
certain children less likely to use them (e.g. girls,
younger/older children, children from certain socio-
economic groups)?
• Are out of school children also targeted? If so how are
they targeted?

Community/school level FGDs

As above, plus the following:
• Check school level statistics for data on use
coverage/use of health service by sex and grade.
• Are children using and benefiting from these services? If
not, why not? Are certain groups of children less likely to
use them (children living far from service delivery;
girls/boys; younger/older children; children from certain
socio-economic groups; OVCs)?
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information
The health and safety of Methods Secondary Data
the school environment • Review secondary data a) What proportion of schools have basic water and sanitation
available facilities nationally and at district level? Check statistics
Are schools safe and healthy or available and find out the:
• Interviews with key informants
are aspects of the school
• FGD with school and • Percent of schools with separate latrines for girls and boys
environment contributing to
community members • Percent of schools with safe drinking water
children’s health problems or
• Percent of schools with hand-washing
their participation in school?
Sources of information These statistics are likely to be reported differently in each country,
• MoE statistics and/or SHN so include what is available. It’s also useful to know what indicators
are tracked through the education M&E system.
statistics
• Reports (qualitative and
b) Do national standards exist for school safety and for
quantitative) on water and
water and sanitation? If so, what do they include/not
sanitation and hygiene (WASH) in
include?
schools (e.g.WASH in school
reports) c) Is child safety at and on their way to school an issue and if so, is
it preventing children (particularly girls) attending and
• Reports on school safety (e.g.
participating in school? Safety can relate to physical, sexual or
violence in schools, road safety)
mental violence by a range of people including teachers and
• Interview with SHN fellow students. It can also relate to environmental safety linked
coordinator and water and to road traffic or other hazards near or on the way to
sanitation experts at national schools.
and district level
Summarize any findings of reports (qualitative or quantitative) found
• Interview with partner on the health and safety of school environments at national or
agencies focusing on school district level.
safety and WASH
(e.g. UNICEF)
• School observation Key informant interview
As above, plus the following:
• FGDs with students, teachers,
a) To what extent do schools meet the national standards for
school management
safety and water and sanitation? What are the main challenges
committees and parents
faced by schools in meeting these standards?
b) Are schools safe for all children at school or on their way
to school? Are certain children (girls, OVCs, children from
certain ethnic groups, etc.) less likely to be safe at school?
If so, why? What are the main risks faced and what is
currently being done (or should be done) to address
these issues?
c) Are the water and sanitation facilities in schools child-
friendly (e.g. adapted to younger children’s and girls’
needs)? Are they conducive to health, or on the contrary,
contributing to the transmission of disease (e.g. Are soap and
water available and are the latrines cleaned daily? Is the
drinking water potable?) How is the water kept clean?
d) How are the water and sanitation facilities managed at the
school level? What are the main challenges faced in ensuring
well maintained and user-friendly facilities at all times?

Community/school level FGDs

As above, plus the following:
• Observe the school environment (using a checklist) to
assess safety and quality of water and sanitation facilities.
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information
Community support and Methods Secondary Data
school health policy • Review secondary data • Does a national school health policy or strategy exist? If so,
• Key informant interviews what are the main elements of this policy and what are the
Without a supportive community gaps? Use the international FRESH Framework and/or Save
and school health policies (from • FGDs with teachers, the
school management the Children’s results framework as a reference point. Check
national to school level), none of whether the policy addresses all the key health problems
the other elements of school health committees, children and
parents identified in the previous sections.
can be sustained.This section
• Are school-based strategies included in other national
focuses on national level school
program strategies (e.g. malaria, HIV/AIDS, NTD, water and
health-related policies, as well as Sources of information sanitation)? If so, summarize the recommended strategies
school level policies and community • National SHN policy or listed in each one.
support for school health. strategy document or other
• What is the coordinating mechanism for the national SHN
related documents (meeting
strategy at national, regional, district and school level? Have
reports, draft documents, etc.)
the roles of each stakeholder been clearly defined? Have the
• National program strategies communities role been defined and a mechanism identified
(10 year plans) for malaria, to engage communities?
HIV/AIDS, NTDs, water and
sanitation
• Interviews with national Key informant interview
program coordinators (SHN, National level:
Malaria, NTDs, HIV/AIDS) • If there is a national SHN policy/strategy, what elements of
• Interviews with development this strategy are being implemented by the government (or
partners involved in the other partners) at scale? What is the history to developing
development of the national this policy/strategy? Which ministry has led this effort and
SHN strategy which partners have been involved? What is the main
funding source for implementing the strategy? What are the
• FGDs with students, teachers
main strengths and the gaps of this strategy? What is
and parents
preventing the strategy (or some of its elements) from
being implemented?
• If there is no SHN policy/strategy, is there an effort to draft
one? Which ministries and partners are involved in this
effort, and what are the next steps?
• Has the national SHN policy been disseminated to the
district and schools? If not, why not? If so, is it being used
by the schools, and how? What have been the main
challenges with implementing a SHN policy in schools?
• What is the community’s role in supporting the school
health strategy and how is their participation being
encouraged? What have been the main challenges?
• What could be Save the Children role in supporting the
implementation of the national SHN strategy (e.g.
drafting of strategy, coordinating partners, conducting
operational research, build capacity at national, regional,
district and school leve1?
District level:
• Has the national SHN strategy/policy been disseminated
at district level? Do district level health and education
partners know the main elements of the SHN strategy and
their role in implementing it? Has training been provided
for district health and education staff? What elements of the
national SHN strategy have been implemented at district
level? Which ones haven’t and why? What are the main
challenges faced?

Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions
Sources of Information

The health knowledge, skills, Methods Secondary Data

attitudes and behaviors of • Secondary data review • Focusing on each disease separately, what behaviors are
school children and their • Key informant interviews contributing to these diseases? What are the known
communities • FGDs with school and (documented) barriers and motivations for practicing the
community members recommended health behaviors? Identify gaps in
Are children practicing the key information for further research.
health behaviors to ensure that
• What health topics does the existing health curriculum include?
they stay healthy? What are Sources of information Through which subject(s) are these health topics addressed? What
schools doing/not doing to provide • Reports of health behavioral health messages are being transmitted and how? Are the health
children with the knowledge, skills studies, including DHS messages clear? Are the lessons participative, adapted to the context
and attitudes needed to practice • School curriculum and and skills-based? What are the main gaps in the existing school
these behaviors? information education and curriculum, in terms of health subjects covered and teaching
communication materials approach?
(including by development • What other health materials exist/are being used in schools to
partners) used in schools support the curriculum? What other extra curricular activities
• Interviews with national level are schools encouraged to organize to promote healthy
experts (malaria, HIV/AIDS, behaviors?
hygiene, nutrition) and • How much HIV/AIDS and sexual health is included in the
development partners current curriculum? In which grade are these subjects
• FGDs with student, teachers, taught?
school management
committees and community
members Key informant interview
As above if there is insufficient information from the
secondary data, plus:
• What are the strengths and weaknesses of the existing
school curriculum and system in promoting healthy
behaviors amongst school children, including HIV/AIDS
prevention? What effort is being made to improve it or add
extra curricular health promoting activities to the school-
agenda?
• Are teachers trained in skills-based health education,
particularly sexual education and HIV/AIDS prevention? Is it
included in the pre- or in-service teacher training? What
are the plans or needs for improving teachers’ capacity to
provide skills-based health education?

Community/school level FGDs

• Do children, teachers and community members know
what health behaviors they should practice to stay healthy
(e.g. to avoid getting HIV/AIDS, malaria, diarrhea)?
• Are children learning how to prevent these diseases in
schools? Is it effective or could schools (and school
children and teachers) do more to promote healthy
behaviors? If so, what support do they need?
• Do teachers feel they have enough training and materials to
promote healthy behaviors, including sexual health? If not,
what do they need?
Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions

Sources of Information
Community support and Methods Secondary Data
school health policy • Review secondary data • Does a national school health policy or strategy exist? If so,
• Key informant interviews what are the main elements of this policy and what are the
Without a supportive community gaps? Use the international FRESH Framework and/or Save
and school health policies (from • FGDs with teachers, the
school management the Children’s results framework as a reference point. Check
national to school level), none of whether the policy addresses all the key health problems
the other elements of school health committees, children and
parents identified in the previous sections.
can be sustained.This section
• Are school-based strategies included in other national
focuses on national level school
program strategies (e.g. malaria, HIV/AIDS, NTD, water and
health-related policies, as well as Sources of information sanitation)? If so, summarize the recommended strategies
school level policies and community • National SHN policy or listed in each one.
support for school health. strategy document or other
• What is the coordinating mechanism for the national SHN
related documents (meeting
strategy at national, regional, district and school level? Have
reports, draft documents, etc.)
the roles of each stakeholder been clearly defined? Have the
• National program strategies communities role been defined and a mechanism identified
(10 year plans) for malaria, to engage communities?
HIV/AIDS, NTDs, water and
sanitation
• Interviews with national Key informant interview
program coordinators (SHN, National level:
Malaria, NTDs, HIV/AIDS) • If there is a national SHN policy/strategy, what elements of
• Interviews with development this strategy are being implemented by the government (or
partners involved in the other partners) at scale? What is the history to developing
development of the national this policy/strategy? Which ministry has led this effort and
SHN strategy which partners have been involved? What is the main
funding source for implementing the strategy? What are the
• FGDs with students, teachers
main strengths and the gaps of this strategy? What is
and parents
preventing the strategy (or some of its elements) from
being implemented?
• If there is no SHN policy/strategy, is there an effort to draft
one? Which ministries and partners are involved in this
effort, and what are the next steps?
• Has the national SHN policy been disseminated to the
district and schools? If not, why not? If so, is it being used
by the schools, and how? What have been the main
challenges with implementing a SHN policy in schools?
• What is the community’s role in supporting the school
health strategy and how is their participation being
encouraged? What have been the main challenges?
• What could be Save the Children role in supporting the
implementation of the national SHN strategy (e.g.
drafting of strategy, coordinating partners, conducting
operational research, build capacity at national, regional,
district and school leve1?
District level:
• Has the national SHN strategy/policy been disseminated
at district level? Do district level health and education
partners know the main elements of the SHN strategy and
their role in implementing it? Has training been provided
for district health and education staff? What elements of the
national SHN strategy have been implemented at district
level? Which ones haven’t and why? What are the main
challenges faced?

Situational Analysis Matrix

Broader Topic Data Collection Methods & Guiding Questions
Sources of Information

School/community level:
• Has the community ever worked with the school on health
issues before? Which issues? What were the results? What
links does the community have with the school and to
external political systems outside of the community (e.g.
health system)?
• What is the level of capacity/skills for supporting health
activities in school (any participation or experience with
assessing, planning, action, monitoring/evaluation, decision-
making)?
• What policies or school rules exist within the schools (e.g.
anti-bullying, anti-smoking, etc.)? How and by whom are
these developed? How are they disseminated and enforced?
What difference do these policies/rules make? What are the
main challenges in enforcing them?
• What is the role of communities in supporting school
health activities? At what stages are they involved
(planning, implementation, monitoring, supervision and
evaluation of activities)? What are the main successes and
challenges in involving community members?
• What is the role of students supporting school health
activities? Do they participate in the planning,
implementation and monitoring of activities? What are the
main benefits and challenges in ensuring student
participation in all activities?

Tsahay’s association Methods: Interviews with Save • Has Save the Children already implemented SHN in the
Capacity the Children staff and document country? Does the capacity (staff) still exist?
revision. • Does Save the Children support education projects with
An awareness of Tsahay s SHN elements that this program can learn from?
capacity and experiences in the
Key Informants: Save the • Are there existing programs or potential partners who
specific context can help plan
Children staff and other Save the Children can work with?
effectively using existing
resources. documents that record the • How can sponsorship-funded SHN activities link with
organization’s experiences in the other core programs?
community. • Does Save the Children staff have adequate training in SHN
as well as in health, nutrition and education, and an
understanding of the other core programs?
• Does Save the Children staff have adequate training and
capacity to work with government officials and
stakeholders to advocate for policy change and to
collaborate with national governments and
stakeholders?
• What is Save the Children’s capacity to mobilize the
community? Are relationships with community actors
strong?
Step 2: Program Design

Goal of this step:

Understand the Save the Children SHN results framework and document your
own. Choose strategies that will best address the needs you identified in your
situational analysis and enable the program to achieve the desired results.
Develop a summary implementation plan.
• This module
What you will need:
• The DM&E module
The situational analysis report
• outputs
The of this step will
be: A results framework for your program
•
• A summary and/or detailed implementation
plan
Now that you’ve gathered information about the needs and context of your impact area, you are
ready to begin using that information to design your program. The two central elements of this
are documenting your results framework and selecting the strategies that best address the gaps
between what you found in your situational analysis and what you are seeking to achieve as
reflected in the results framework.

What is a results framework?

The program design process begins with documenting your results framework (RF). A
RF is a diagram which shows how a program will reach its goal of bringing about
positive change for children, by identifying its long- term or strategic
objectives (SO) and intermediate results (IRs).

The RF helps your team build consensus around the expected outcomes of the
program and communicate those ideas to partners. As you implement your
program, the RF will also help you gauge your progress towards the expected
outcomes and adjust activities that are not producing the results you hoped for.
It is therefore important that the expected outcomes of the program, as
outlined in the RF, do not change significantly over the life of the
program.

The four major pieces in an RF, from top to bottom are outlined below
and in the SHN Results Framework diagram displayed in Figure 2. Save the
Children’s “generic” SHN Results Framework is consistent with the
international FRESH framework and is widely used across all of Save the
Children’s SHN programs. That said, programs can adjust the framework
depending on local needs and priorities on the ground. Annex 2 presents
an example from a country office where the RF integrates the SHN and
BE program into one diagram.

The Goal: At the top of the RF, the goal is the “big picture” positive
change you want. The broad goal for most SHN programs is usually an
overall improvement in the health and educational status of school-age
children.

Strategic Objective: The strategic objective is the measurable behavior

change that is needed to reach your goal. For an SHN program, a general
strategic objective is to ensure improved use of key school-based health
and nutrition services and practices/behaviors.

Intermediate Results: Intermediate results are measurable, lower-level

results that must occur in order to reach the Strategic Objective. The four
main IRs identified by Save the Children’s SHN program are as follows:

IR 1 – Increased availability of school-based health, hygiene and nutrition

services. IR 2 – Improved quality of the school environment.

IR 3 – Improved knowledge, attitudes and interest towards using health

services and health- protective behaviors.

IR 4 – Improved policy environment for SHN and community support for

SHN.

You will notice that the situational analysis matrix shows which result(s) is
addressed by each category of questions. This should help you begin to
consider the findings of your situational analysis and choose
strategies/interventions for each IR that best match the needs and
resources of your impact area.

Indicators: Indicators are measures used to assess progress made towards

achieving the goal, strategic objective and IRs. The indicators, however, are
not displayed in the SHN Results Framework below. A list of
recommended results-level indicators for SHN programs can be found in
Annex 3 of this module.

On the pages following the results framework diagram, you will find a
more detailed description of each IR and the kinds of strategies that are
recommended to achieve each IR. The strategies that are selected must
address the unique contexts, issues and needs of your impact area.

Figure 2: School Health and Nutrition Results Framework

TSEHAY ASSOSATION SHN Goal:

Improved health and educational status of school-age
children.

Strategic Objective:
Improved use of key school-based health and nutrition services and
practices/behaviors.

Intermediate Results (IR)

IR One: Availability of IR Two: IR Three: IR Four: Policy &
Services Quality of school Knowledge, Attitudes Support
environment and Interest
Increased availability of Improved policy
school-based health, Improved quality of the Improved knowledge, environment for SHN and
hygiene, and nutrition school environment attitudes and interest community support for
services towards using health SHN
services and health-
protective behaviors
Intermediate Result One: Availability of services

The first intermediate result ensures there is an increase in the availability of

school-based health, hygiene and nutrition services. The services that are
provided will be directly linked to the situational analysis findings of health
problems. The simplest and most cost-effective services that teachers can
administer include mass deworming to treat worm infections and
micronutrient supplementation (e.g. vitamin A and iron) to improve
children’s health and nutritional status. These must only be done if the
prevalence of worms and anemia is high enough to warrant such an
intervention (see WHO recommendations in key strategies matrix). Deworming
is inexpensive and has an immediate impact on children’s health and
nutritional status and consequently their ability to concentrate and learn
in school. Micronutrient supplementation should be provided a week or so
after deworming so that intestinal absorption of nutrients is effective. Usually
vitamin A supplementation is provided a week after deworming, followed by
weekly or twice weekly iron supplementation for a period of twelve to
sixteen weeks. Other services that are provided through schools could
include iodine supplementation if absolutely necessary; treatment of health
problems such as malaria and injuries using first aid kits; vision and hearing
screening; and psychosocial counseling. For more information on these
strategies refer to the Key Strategies Matrix in Annex 4. SHN also works to
link the health system to schools to improve health services to school
children by the health system.

Strategies for IR 1 may include:

 Mass supplementation of iron, vitamin A or multiple

micronutrients.
 Routine mass treatment of soil-transmitted helminths and
schistosomiasis, which make up four of the seven most common
NTDs.

 Screening and classroom remediation for vision and hearing

impairments.

 School-based access to sexual/reproductive health and HIV

counseling.

 Distribution of long lasting insecticide impregnated nets (LLINs)

and/or school-based malaria treatment.

 Issues related to IR 1 include:

 For many of these activities, effort should be made to reach all

school-age children regardless of whether or not they are enrolled in
school. Many of these activities (e.g. deworming) are more effective
when more children participate.

 Some activities may target specific children who need additional

services such as psychosocial support for children affected by
HIV/AIDS or conflict and emergencies.
  About Intermediate Result Two: Quality of the school
environment

A quality school environment significantly reduces hygiene-related disease,

increases student attendance and learning achievement, and contributes to
dignity and gender equality. It depends on the availability of safe water for
drinking and hand-washing as well as access to sanitary latrines and hand-
washing facilities. Safe drinking water is water which does not contain
harmful pathogens and which does not contain chemicals above the
recommended dose for safety. A sanitary latrine is a latrine where human
excrement is disposed into a closed space which does not come in contact with
open air or contaminate the environment. There should be an adequate
number of separate child-friendly latrines for girls and boys, and separate
facilities for teachers in schools. An appropriate hand-washing facility is
easily accessible to children, has proper drainage of water and includes
soap, ash or similar cleansing agent.

In addition, a safe school environment should be clean, secure and free from
risks or dangers, and conducive to learning. Waste must be safely disposed;
and the environment should protect children from abuse and exclusion.

2 may include:

 Provision of appropriate hand-washing facilities.

 Separate child-friendly and sanitary latrines for girls and boys,

and separate facilities for teachers.

 Provision of potable water in schools

 Solid waste and environment management to prevent diseases

such as dengue.
Issues related to IR 2 include:
The success of these strategies relies on the development of a system (e.g.
school hygiene committees) for maintaining SHN facilities (see IR 4 in
Annex 4), and the promotion of hygiene practices (see IR 3 in Annex 4).

About Intermediate Result Three: Knowledge, Attitudes and Interest

Improvements in knowledge, attitudes and interest towards using health

services and health-protective behaviors can be brought about through skills-
based health education. Classroom-based health education sessions should
be designed such that health information for children is incorporated or
linked to existing grade-specific curriculum. The education should be behavior
and child-centered; so that as a result school children are motivated to
change their attitudes and practices towards personal hygiene, water and
sanitation, food and nutrition, first aid treatment and HIV/AIDS. Schools
offer the best venue for reaching large numbers of young children and youth
with accurate HIV/AIDS and sexual and reproductive health information.
Children form attitudes and beliefs early in life and are more likely to
practice healthy behaviors if they learn them before they have already
adopted unhealthy ones.
In addition to in-class health education, peer education could also take place
in primary schools. Peer education involves students in peer groups
demonstrating and promoting healthy practices among themselves in order
to support healthy behaviors in the school and in the community. The child-
to-child approach, which follows the same principals, encourages school
children to take responsibility for their own health and that of their
community and find solutions to address the health problems. With these
approaches, students learn from each other and share their knowledge and
awareness with their non-school peers, families and other community
members, while developing a range of essential skills (critical and creative
thinking, decision making, problem solving, communication, leadership, etc.).
Peer education creates a bridging relationship between schools and the
community, increasing the value of the school within the broader goal of
community development.

Strategies for IR 3 may include:

 In-class skills-based health education to enable children to stay

healthy and avoid risky behaviors.

 Peer education to encourage children’s participation in health

education.

 Teacher training on skills-based health and nutrition education,

including HIV/AIDS prevention and sexual and reproductive
health.

 Training of health workers and community participants on the different elements

of SHN services.

 Parental education.
These strategies may happen in combination and are therefore jointly discussed in the Key
Strategies Matrix.

include:

There are four elements that lead to behavior change which is the goal of health
education. First, it is important that children have the knowledge of health
concerns, services and health-protective behaviors. Second, we know that changes
in knowledge do not always translate into changes in practice, therefore, building
knowledge should be accompanied by efforts to build children’s skills so that they
can take action for their own health. Third, children should feel inspired or
motivated to act on the information or skills they have acquired. So creativity is
required in designing health education programs. Fourth, there should be an
enabling environment – not just in terms of the physical infrastructure – but also
an environment where adults respect children and provide them the support
they need to resolve health problems.

3 Programs must develop comprehensive behavior-centered strategies, based on a

sound understanding of the target population. Formative research on attitudes
and practices in relation to healthy behaviors can help in developing an
appropriate behavior change strategy. It is difficult to measure behavior change
in a short period of time. Monitoring and evaluation methods and tools should
therefore be reliable and consistent to be able to measure behavioral change.

4 Tsehay’s association skills-based health education activities should support

national level efforts in strengthening the curriculum. Program staff should
collaborate with the MoE and partners regarding their roles and
responsibilities in strengthening the curriculum.
About Intermediate Result Four: Policy & Community Support

As an NGO, one of Tsehay’s association roles is to advocate and facilitate the development
of a national SHN policy that can inform SHN programs throughout the country. Save the
Children should participate in the national SHN working group and present evidence from
its program in order to inform policy and for the development of a long-term strategic plan.
The SHN program manager should participate in policy development and review workshops
in order to voice and address the concerns of communities, NGOs and other district level
implementers.

Once the national SHN policy and the strategic plan are developed, Tsehay project should
support the district level to disseminate and implement the policy at both the district and
school levels. We should be part of the district level SHN committee, which is responsible for
ensuring the implementation of the SHN program in the district, partnering with NGOs and
safeguarding the welfare of school-age children. Save the Children must also support effective
partnerships between the education (e.g. teachers), health (e.g. health workers) and water (e.g.
engineers) sectors; engage the community in the program; and encourage pupilparticipation in
the program.

Strategies for IR 4 may include:

 Advocating for and supporting the development and implementation of SHN

policies at national, district and school levels in order to scale-up to national-
level SHN programming or modernize or upgrade an existing SHN program.This
includes participating in coordinating meetings between education and health
officials from the community up to the national level, through SHN working groups
and otherwise, to ensure effective program management, increased sustainability,
and an environment favorable to meeting the health and nutrition needs of
school-age children.

 Capacity building of the school structures, including the teachers, parent-teachers

associations and school management committees, to ensure ongoing support for
SHN activities.

Issues related to IR 4 include:

  It is critical to work with stakeholders in the formal schooling system (official,
government schools) and in non-formal schools (community-based and -
managed), if both exist in your impact area.

 Efforts to scale-up programs often take many months and years so results may
be difficult to observe.

 Certain policies may prove to be controversial or difficult to advocate (e.g. policies

on reproductive health, corporal punishment, sexual harassment and allowing
pregnant students to attend school).

Step 3: Monitoring and Evaluation Plan Design

Goal of this step:

Develop a monitoring and evaluation plan after careful selection of
SHN indicators.
What you will need:
• This module
• The DM&E module
• The completed Results Framework The Summary
• Implementation Plan
• The Common Approach SHN Indicator Reference Sheets
The outputs of this step will
be:
• A Results Indicator Planning Tool (RIPT) for your program
• A completed Process Indicator Tool (PIT)

It is now time to design a monitoring and evaluation (M&E) plan for your SHN
program, determining which process and results indicators you will track.

 Process indicators measure progress in program implementation,

to assess whether activities are being implemented as planned.
 Process indicators and targets are set every year, based on your
implementation plans, and are documented and submitted annually
with the Country Annual Plan (CAP) using the Process Indicator Tool
(PIT). Process indicators relate to program inputs (materials, goods
or actions to carry out the program) and outputs (services provided).
For SHN programs, process indicators typically include:
Supplies data (e.g. number of tablets, SHN manuals, first aid kits, vision
and hearing materials)
Services data (e.g. number of schools providing deworming)

 School level data (e.g. percentage of schools with latrines, hand-

washing facilities, water supplies, functional SMC)
 Child level data (e.g. percentage of children dewormed,
supplemented or screened)
 Results indicators measure higher-level changes that we believe
our program activities contribute to. Results indicators should be
the same from year to year: they are established when a program or
new intervention is designed. The Results Indicator Planning Tool
(RIPT) is the template for sponsorship results indicator planning, and
includes the information usually contained in a monitoring and
evaluation plan. It contains the definition for the indicator and how
it is calculated, as well as the source, data collection tool, the
 frequency of data collection and a target. It also names who is
responsible for ensuring that the data are collected. When you are
filling out the RIPT, it is important to consult the SHN Indicator
Reference Sheets in Annex 3 of this module, which contain the
recommended indicators for Common Approach SHN programs.
 Most results indicators should be tracked on an annual basis,
although some (e.g. those related to behavior change) may be tracked
less frequently. SHN indicators should be recorded annually in a
 document which allows program staff and STWG TA providers to
view the trend in results year after year.These data should link into
the agency global monitoring and data collection efforts. More
guidance on selecting results and process indicators and reporting
on them, as well as the tools used for M&E planning, can be found
in the Common Approach DM&E module.
 Beyond the process and results indicators described above, it is
important to consider the evaluation design and plan for your
program. The minimum requirement for all sponsorship-funded
programs is a baseline to end line evaluation. In addition to this,
there are other possible approaches that program teams can
consider in light of their evaluation capacity, available resources, and
evaluation objectives. In all cases, technical assistance must be
sought.

Goal of this steprocess Indicator Report (RPIR) and Progress NarrativImplementing

your program

You are now ready to implement the SHN program. For more guidance on how to
implement the various interventions and recommended strategies, refer to the strategies
matrix and the list of resources organized by each IR in Annex 5. The Bangladesh and
Malawi country offices have developed the following program implementation guides for
their SHN program. These serve as a ready reference for information on how to
implement SHN interventions and strategies used, and can be accessed at the following
links or from the STWG:

Monitoring and reporting on your progress

During implementation, you will regularly monitor both process and results indicators,
according to the plans and timeframes set out in your PIT and RIPT. All SHN indicators
should be tracked in a program database and should be reported on in a summary
document which allows program staff and STWG TA providers to view current values and
trends over time. A Results Review should be held at least every six months to discuss if
the program is on track and to identify areas for improvement.

The Results Review offers the opportunity to examine questions such as:

 Do you need to adopt different strategies to more effectively achieve your

objectives? Do the strategies complement each other in achieving your
results?

 Are there barriers to achieving results that are not addressed in the program
design, which must be addressed to make the program successful?

 Do you need to reorganize the field team or make other changes to Save the
Children/partner implementation to better achieve targets? For example, are
there adequate supervision and quality assurance mechanisms?

 Detailed guidance on how to conduct a Results Review can be found in the

Common Approach DM&E module.

 Both process and results indicators are reported through the Country Annual
Report (CAR) once a year using a Results and Process Indicator Report (RPIR)
along with an explanation of the findings, which is called the Progress Narrative.
Please note that results level indicators for ECCD, BE and SHN are reported
through the global indicator reporting mechanism, rather than through the RPIR,
so as to avoid duplication of effort. The Progress Narrative and process
indicators are still reported through the RPIR.
 Step 6:
Evaluation
Goal of this step:
Evaluate the program to assess its
effectiveness.
What you will need:
• This module
• The DM&E module
• Guidance from your STWG TA provider and an M&E specialist
The outputs of this step will
be:
• An evaluation report

The minimum requirement for the evaluation of a sponsorship-funded

program is baseline to end line, including a mid-term evaluation, with annual
monitoring of key indicators. Other evaluation designs may also be
considered. For example, evaluations may seek to examine both program
processes (the quality of implementation) and impact (what changes result
from the program). When you enter into a new impact area, you will need to
establish your approach to evaluation as you design the program, so that
the methodology and baseline allow for a strong evaluation. Generally
speaking, program results should be evaluated at three to four- year
intervals (baseline, mid-term and end line).
Evaluations allow implementers to observe any changes that have occurred
throughout the course of implementation and in some cases to assess
whether this change was a result of Save the Children programming. For
SHN evaluations we are particularly interested in the following questions:
  Are children healthier than at baseline/versus comparison group?
 Have children’s school performance/literacy rates improved since
baseline/versus comparison group?
 Are more children reporting practicing healthier behaviors than at
baseline/versus comparison group?
 Do more schools have adequate water, hand-washing and latrine
facilities in the area covered by the program/versus in
comparison group?
 Are communities and parents more involved in and supportive of
their children’s health and education than at baseline/versus
comparison group?
Alternatively, you may wish to evaluate the impact of particular interventions
as you design and test new and innovative approaches. This may be done at
a different interval from the impact area evaluation cycle. In this case, we
recommend working closely with a researcher and/or your STWG TA
provider to come up with the best evaluation design possible. The evaluation
design should be tailored to help you answer specific questions and to
generate the evidence needed for advocacy and replication of the approach.
Conducting a longitudinal study, which tracks a cohort(s) of children over time,
is another evaluation option that sponsorship-funded programs can
consider undertaking.

Executive Summary: A two to three-page summary providing a brief

background on Save the Children’s sponsorship program in country, the
objective of the situational analysis, methodology used, key findings relevant
to each core program, along with conclusions and recommendations
for each core program.

Background: Brief background on Save the Children’s sponsorship program

so far in the country (e.g. phase-over from the old impact area and why
the new impact area was selected).
Objectives: Brief statements on the key topics to be assessed during the
situational analysis under each core program.

Methodology: An overview of the how secondary and primary data was

collected and analyzed. This can include information on how geographic
areas, schools, key informants were selected in order to provide a
representative view of the situation.

Findings: The findings can be divided by key sub-headings, and then within
each sub-heading data collected from different methods (e.g. secondary data;
national and district level key informant interviews; and local/ school-level
information) should be presented separately. The key sub-headings can
be:

1. The general context: To include geographical location (location

versus key cities, terrain, climate), socio- political and socio-economic
situation (poverty levels, rural-urban mix, occupations, housing and
shelter, political situation, other key societal concerns), and
demographics (population density, size, age structure, numbers of men
versus women).
2. Early Childhood Care and Development: To include information on
the ECCD system in the country and impact area, covering all
government, informal, private, and NGO sectors. The key health,
development, and other early childhood concerns can also be
included here.
3. Basic Education and School Health and Nutrition: To include
details on the education and health system for school-age children
in the country/impact area. Secondary data (e.g. on education
performance, and health knowledge, attitude, behavior and status
indicators) should also be presented as must information from key
informant interviews that provide an understanding of the
education and SHN situation.
4. Adolescent Development: To include details on the key health,
development, livelihoods development concerns for adolescents.
Information on the key players, and the situation/system for
adolescent development needs.
5. Policy environment and coordination at different levels
(from national to local):
To include information on the relevant policies that are either in
draft or complete form, that need to be advocated, amended, or
disseminated. Also includes the structures in place to allow
coordination between various stakeholders. This sub-heading could also
be covered under sub-headings B, C and D above.
Tsehay Capacity: To include the human (technical, managerial and
support), financial, and other material capacity that exists in order
for Save the Children to implement its core programs.
Other cross-cutting areas: Other issues not covered under the
above areas can be addressed here.They can include teacher’s
capacity, school infrastructure, functionality of the SMC and
partnership between health, education and other relevant social
sectors.
Conclusions and programmatic recommendations:
Conclusions should synthesize the information from the different
data collection methods to provide an overview of the overall
situation and it should be followed by specific recommendations. This
section can include a sub-heading for each of the core programs-
ECCD, BE, SHN and AD. The overall situation under each core
program should focus on the strengths and the areas for
improvement/gaps to be filled. Under SHN, information can be
presented under the six broad topics identified for collecting data.
 Step 7: Lessons
Learned
Goal of this step:
To reflect and learn from program implementation and evaluation, in order to
inform future programming and improve effectiveness.
What you will need:

• This module
• The Lessons Learned guidance in the DM&E module
The outputs of this step will
be:
• Documented Lessons Learned

Sponsorship-funded programming constantly generates learning that is

relevant to future implementation and to other non-sponsorship programs.
This learning may be technical – for example, which strategies are most
effective to accomplish an objective – or they may be related to partnering
or reaching a particular target population. It is critical to take the time to
reflect on and document this learning, so that it can feed into future
programming.

In order to document and use this information, you should undertake a

Lessons Learned process after each evaluation (i.e. mid-term, endline), at

least.13 Here, Save the Children staff, government officials, program

participants and donors have the opportunity to reflect on past
programming and provide feedback to inform future work. This review
should look at both the strengths of the program and areas that need
improvement. By the end of the session, there should be a common
understanding of and agreement on the lessons learned. Lessons should be
clearly documented and widely shared, so that they can be used to improve
current and future programming. Documenting and sharing evaluation results
and lessons learned enable sponsorship- funded programs and innovative
practice to be leveraged to achieve impact at a larger scale. More
information for conducting a Lessons Learned workshop can be found in
the Common Approach DM&E Module.

Suggested Outline for a Situational Analysis Report

The following is a suggested outline for an integrated situational analysis report covering all core
sponsorship-funded