​​Schoolchildren in IndiaThe framework described here is the starting point for developing an effective school health component in broader efforts to achieve more child-friendly schools.  Much more could be done, but if all schools implement these four interventions then there would be a significant immediate benefit, and a basis for future expansion.  In particular, the aim is to focus on interventions that are feasible to implement even in the most resource poor schools, and in hard-to-reach rural areas as well accessible urban areas, that promote learning through improved health and nutrition. 

These are actions known to be effective, and actively endorsed by all the supporting agencies: this is a framework from which individual countries will develop their own strategy to match local needs.

Core framework for action: four components that should be made available together, in all schools.

Health policies in schools, including skills-based health education and the provision of some health services, can help promote the overall health, hygiene and nutrition of children.  But good health policies should go beyond this to ensure a safe and secure physical environment and A positive psycho-social environment, and should address issues such as abuse of students, sexual harassment, school violence, and bullying.  By guaranteeing the further education of pregnant schoolgirls and young mothers, school health policies will help promote inclusion and equity in the school environment.  Policies that help to prevent and reduce harassment by other students and even by teachers, also help to fight against reasons that girls withdraw or are withdrawn from schools.  Policies regarding the health-related practices of teachers and students can reinforce health education: teachers can act as positive role models for their students, for example, by not smoking in school. The process of developing and agreeing upon policies draws attention to these issues.  The policies are best developed by involving many levels, including the national level, and teachers, children, and parents at the school level.

The school environment may damage the health and nutritional status of schoolchildren, particularly if it increases their exposure to hazards such as infectious disease carried by the water supply.  Hygiene education is meaningless without clean water and adequate sanitation facilities.  It is a realistic goal in most countries to ensure that all schools have access to clean water and sanitation.  By providing these facilities, schools can reinforce the health and hygiene messages, and act as an example to both students and the wider community.  This in turn can lead to a demand for similar facilities from the community.  Sound construction policies will help ensure that facilities address issues such as gender access and privacy.  Separate facilities for girls, particularly adolescent girls, are an important contributing factor to reducing dropout at menses and even before.  Sound maintenance policies will help ensure the continuing safe use of these facilities.

This approach to health, hygiene and nutrition education focuses upon the development of knowledge, attitudes, values, and life skills needed to make and act on the most appropriate and positive health-related decisions.  Health in this context extends beyond physical health to include psycho-social and environmental health issues.  Changes in social and behavioural factors have given greater prominence to such health- related issues as HIV/AIDS, early pregnancy, injuries, violence and tobacco and substance use. Unhealthy social and behavioural factors not only influence lifestyles, health and nutrition, but also hinder education opportunities for a growing number of school-age children and adolescents.  The development of attitudes related to gender equity and respect between girls and boys, and the development of specific skills, such as dealing with peer pressure, are central to effective skills based health education and positive psycho-social environments.  When individuals have such skills they are more likely to adopt and sustain a healthy lifestyle during schooling and for the rest of their lives.

Schools can effectively deliver some health and nutritional services provided that the services are simple, safe and familiar, and address problems that are prevalent and recognized as important within the community.  If these criteria are met then the community sees the teacher and school more positively, and teachers perceive themselves as playing important roles.  For example, micronutrient deficiencies and worm infections may be effectively dealt with by infrequent (six-monthly or annual) oral treatment; changing the timing of meals, or providing a snack to address short term hunger during school – an important constraint on learning - can contribute to school performance; and providing spectacles will allow some children to fully participate in class for the first time.​