National

nutrition and
school health 04/16/2024
strategy 2006

Prepared By:
Sabina Chaudhary and
Amrita Shah
BPH 8th sem
KHSC, Brt.
1
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Contents:
 Introduction
 Rational of the Program
 Goals
 Strategic Objectives
 Strategies
 Activities
 Critical Analysis
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Introduction:
 Health and education are interdependent and schools provide a
unique opportunity to improve health and education status of school
age children. Diseases related to lack of hygiene, malnutrition is still
the leading causes of death for children in Southeast Asia including
Nepal.
 Integration of education and health services to ensure better health
and improved learning is increasingly realized worldwide.
 Due to the high vulnerability of the under- five year children,
school-age children (5-17 yrs) are not given adequate priority in
Nepal yet.
 In order to achieve the twin goals, “Education for All” and “ Health
for All” the role of school health and nutrition is undoubtedly
imminent.
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 This National Strategy on School Health and Nutrition

focusing the school children through synergetic efforts of the
Ministries of Education and Sports (MOES), the Ministry of
Health and Population (MOHP) and other allied ministries
with the support of I/NGOs, bilateral, multilateral and UN
agencies.

 The MOES and the DOE to realize the goal of SHNP in Nepal,
will adopt this strategy.

 The existing constitution, government acts, laws and

provisions, education and health policies and periodic plans
have provided the rational for developing the National strategy
on the SHNP.
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 The Government of Nepal is committed to make progress

towards improving the health status, including school health,
of its citizens. In this regard, in 2006 School Health and
Nutrition Strategy (SHNS) was developed by the Ministry of
Health and Population (MoHP) and Ministry of Education
(MoE) reflecting the need to address the high burden of
diseases in school age children.

 Subsequently, a workshop was conducted in Japan in October

with Japan International Cooperation Agency (JICA) support
and participation of key personnel of both Ministries to
develop a five-year 2008/2009– 2013/2014 (2065/66-2070/71)
JAP document.
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 The Government implemented a pilot SHN project in primary

schools based on the JAP in Sindhupalchowk and Syangja
districts with support from JICA. The project was
implemented for four years from 2008 to 2012.

 In order to update the JAP, CHD and DoE decided to review

and develop a revised 5-year 2014/15-2019/2020 (2071/72-
2075/76) JAP with the goals of assisting in the development
of physical, mental, emotional and educational status of
school children through effective implementation and scaling
up of SHN programs in the country.
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Rational of SHNP:
 About 41% of Nepal’s population (45,00,000) is below the age
of 16. High prevalence of Anemia (78% in Pre-school children
and 64% in school girls of 14 yrs of age), total Goiter Rate
(40% in school children), helminthes infestations (66%), Vit A
Deficiency in Pre-school children with sub-clinical Vit A
Deficiency (32%), night blindness (1.2% in school children),
lack of water and sanitation facilities all indicate the poor
health indicators among school children in Nepal.
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 It is only through comprehensive and coordinated education

and health services, which could create an enabling
environment to ensure better learning achievement and
improved health of the school children. SHNP can be the cost-
effective and easiest way in improving students’ health and
academic performance.

 Not only to the students and school personnel but also to the
family, community and nation, promoting health through
school is financially, socially, economically and politically
desirable.
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 Nepal faces a high burden of childhood diseases, which

includes diarrhea, respiratory tract infections, worm
infestations, malnutrition and oral diseases.

 Preventable diseases burden school age children, due to poor

coverage of school health and nutrition services and poor
hygiene and sanitation facilities.

 From the summary highlights of preventable disease 5 burden

in school children presented below, it is evident that health
and education goals can only be met with effective
implementation and coverage of SHN programs in the
country.
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Goal
Goal-Develop physical, mental, emotional and
educational status of school children.

Sub-Goal- Improve health and nutrition status of

school children
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Strategic Objectives
SO: 1 Improve use of SHN services by school children.

SO: 2 Improve healthful school environment.

SO: 3 Improve health and nutrition behaviours and habits.

SO: 4 Improve and strengthen community support systems and

policy environment.
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S.O.1 To improve use of SHN services by school children.

Strategy 1: Building Capacity of the key players from the DOE

(MOES), CHD/ Nutritional Section, NHEICC, School
Management Committees, teachers, DDC, DEO, DSHNCC,
SHN Committee, VDCs, child clubs and health workers.

Strategy 2: Increasing use of SHN services.

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Activities:

1. Deworming program
• Process monitoring of deworming program
• Impact study
• Strengthen proper recording/reporting system through HMIS
data collection system
• National representative Prevalence study
• Campaign with key messages to create demand.
• Implementation mechanism (operational guideline)
• Presence of local health worker in schools during deworming
or training to teachers before deworming programs in schools
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2. First aid kit distribution program

• Develop a system for timely procurement and refilling

• Mechanism for refilling drugs those are free of cost and
budgeting for refilling other consumable items at school level.
• Reporting on use and refilling.
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3. Annual Health Screening and referral services

• Provision of essential equipment to schools for conducting

annual health screening as defined by basic package
• Establish proper recording and reporting system
• Training to focal teachers
• Annual health screening conduction by focal teachers
• Monitoring visit of Health workers in schools of respective
VDC
• Establish referral mechanism to local health facility
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4. Midday meal promotion program

• Review the best modality for delivering midday meal (cash,

kind and tiffin box) program so that students can have access
to local nutritious (homemade) food
• Review the current guidelines based on Quantity, Quality,
Variety, Nutrition Value based on locally produced nutritious
food

5. Iron folate distribution

• National guideline for iron folate distribution for school
going children from grade 6-10
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S.O.2 Improve Healthful School Environment :

Strategy 1: Provision of adequate and safe water supply and

sanitary facilities.

Strategy 2: Revisit, update and implement standard regulations

and norms by the Ministries of Education and Health for
school construction and maintenance and operation (e.g.
school area, school building, classroom, space, ventilation,
furniture, water supply including tube wells, toilets, drainage,
lighting, fencing, school remodeling, structural adjustment for
inclusion of children with disabilities.

Strategy 3: Minimizing risk environment

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Activities:

 Construct/Maintain/Repair Toilets, Urinals & Safe Drinking

Water taps based on the guidelines of DoE.
 Construct and repair child friendly furniture, classroom and
school building with adequate light and ventilation in
classrooms.
 Provision of hand washing with soap
 Orientation training to school teacher
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S.O.3 Improve health and nutrition behaviour and habits.

Strategy 1: Enhancing Knowledge and skills through behavior-

centred and skill based health education.

Strategy 2: Introduce Child-to-child and child- to Parent and

community approach for the acquisition of knowledge
necessary for the health promotion, development of attitudes,
values and ideas that motivate each individual to promote
health and establishment of essential health practices.
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Activities:

 Work with Curriculum Development Center (CDC) to

incorporate skill based health, hygiene and nutrition topics.
 Develop guideline for child club mobilization
 Media campaign on SHN
 Child club mobilization in schools for personal hygiene
management
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S.O. 4 Improve and strengthen community support systems

and policy environment

Strategy 1: Strengthen the linkage and, networking between

MOES and MOHP and build on partnership with government
line agencies, non-governmental and private sectors the
national, regional, district and school level.

Strategy 2: Improving policy environment.

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Activities:

 Revise SHN strategy to incorporate roles and responsibilities

of NPC, MoFALD, DDC and VCD.
 Institutionalized in the health and education system.
 Strengthen School management committee for SHN related
activities
 Incorporation of SHN in School Improvement Plan
 Legal provision for mandatory implementation of minimum
package
 SHN program in the country.
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Critical Analysis:
 Strength:
 In 2012, the JICA evaluation study reported positive changes
in health related behaviours and decrease in intestinal worm
infestation as compared to the 2008 baseline survey.

 National level School Health and Nutrition Network (SHNN)

works closely with government and concerned stakeholders
for advocating various issues related to SHN.

 Nepal Demographic Health Survey (NDHS) 2011 and 2016,

reported 41% and 36% of children under five years were
affected by stunting, 29% and 27% were underweight and 11%
and 10% were wasted respectively, which shows declining %
of stunting, underweight and wasting.
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 In 2016, Sponsorship-funded SHN programming directly

reached over 283,000 children in Nepal.

 The SHN program worked to improve access to safe drinking

water, functional toilets, and hand washing facilities in the
schools as well as drinking water testing, corrective measures
for coliform and arsenic contamination, and provision of waste
disposal systems.
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 Weakness:
 According to CHD, the SHN minimum package is implemented in total
52 districts only and the program will be scaled up in the remaining 23
districts.

 Only 8.8% of the school surveyed had CGD friendly WASH facilities.

 According to NDHS 2011 the prevalence of anemia in adolescent girls

was 39% but in NDHS 2016 it was 44%.

 Data from Save the children 2017 shown that in Nepal Primary Schools
with an Annual SHN Plan was 83% and a Functional SHN Committee
was 28%.

 Coverage of school deworming tablet distribution was only 29% in

Annual report 2073/74.
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Reference:
 National school health and nutrition strategy 2006
 Joint Action Plan 2071/72-2076/77 for SHN
 Annual report 2073/74
 NDHS 2011
 NDHS 2016
 SHN program update 2016-2017 of Save the
Children
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THANK YOU