Mainstreaming Health and Inclusion in Education

1
Mainstreaming Health and Inclusion in Education
in Uruguay
Sergio Meresman VANCOUVER, June 2007
2
Uruguay

• 3.3 million people
• 4000 Primary schools (1000 rural)
• Strong and prestigious education sector, nearly
  universal coverage in primary education
• 98 percent of the population has access to
  potable water
• Increasing equity and quality issues
  underprivileged schools accumulating problems,
  demands and services.
• Teacher training and practice deteriorating

3
Impact of the 2002-03 crisis (selected social
indicators)

• 15 decrease of GDP (estimated 2002)
• 55 of Uruguayan children are poor
• 25 unemployment (April 2003)
• 18 million living under the poverty line (50 of
  total population)
• In 2002 Uruguay had a population decrease
  births were 30.000, deaths 20.000 and migrants
  30.000

4
Health situation for school-age children in brief

• Deterioration of the living conditions for many
  families

• Deterioration of the quality of the environment
  especially for children exposure to
  pre-transitional risks

• Epidemiologic regression re-emergence of
  pre-transicitional morbidity, communicable
  diseases

5
Highlights of schools situation

• Schools are the last places where state presence
  still exists
• Aggregation of problems leads to an aggregation
  of services. In vulnerable areas schools have to
  provide basic nutrition, health and social
  services
• In Montevideo, school feeding program expanded
  from 40.000 to 90.000 children
• That situation tend to reinforce structural
  disadvantage of children, who receive poorer
  education

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After the Crisis what is the situation?
7
School Health future directions

• Context
• Exclusion (youth)
• Poverty, Inequity
• Minimal public sector
• Migration, loss of human capital
• Descentralization, democratization. Opportunities
  for local development
• Uncertainty, political unestability

• Emerging Issues
• Food security
• Epidemiological accumulation (infectious
  chronic diseases)
• Violence
• Mental health problems

Challenges
Tuning health promotion approaches with on-going
health and education policies and local
develop-ment resources
8
Operational strengths and problems

• Some Strengths
• Long standing tradition of preventive health
  interventions in schools
• Remarkable enthusiasm of children and teachers
  about environmental and health education
• Increasing participation of CSO on environmental
  education

• Some Problems
• Most school health activities have traditionally
  targeted rather than engaged schools
  (delivered vertically from MoH, NGOs). Schools
  used as a captive target.
• Lack of educational rationale. Dispersion of
  initiatives.
• Limited training of teachers. Lack of continuous
  training mechanisms (supportive monitoring,
  systematization of good practices, evaluation)
• Tendency of intersectorial collaboration to
  become too bureaucratic, formal, restrictive of
  participation.
• Lack of supportive policy to assist schools in
  networking, resource mobilization.

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Project Overview

• Education for Life and Environment (Educación
  para la Vida y el Ambiente-EVA) introduced
  between 2002-04 as part of a World Bank-supported
  wider strategy to improve basic education.  
• EVA projects were piloted in 75 schools in the
  first year and after that targeted 150 primary
  schools per year.
• Resources were allocated as part of a
  demand-oriented fund that provided small grants
  directly to schools.

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Education for Life and Environment Educación
para la Vida y el Ambiente (EVA)

• The Objectives
• To strengthen and revitalize environmental and
  health education in schools.
• To pilot inclusive education approaches
• The approach
• To promote schools and communities active and
  participatory learning of health and
  environmental topics that where relevant to local
  development.
• Stimulate inclusive dynamics in schools and
  communities

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Education for Life and Environment Educación
para la Vida y el Ambiente (EVA)

• What did the project offered to schools
• Technical assistance to schools and teachers
• training,
• supervision,
• a teachers manual,
• educational materials, development of a
  community of practices, electronic
  bulletin.
• Funding (between 3,000 and 5,000 dollars) in upto
  100 schools every year
•              school infrastructure renovation
  and development to create healthier, safer
  and more inclusive environments

12
Education for Life and Environment Educación
para la Vida y el Ambiente (EVA)

• Operational rationale
• All schools were invited to participate (quota
  was assigned according to socio-educational
  profile)
• Participating schools were required to identify a
  specific health and inclusion-related issue they
  wanted to change
• Selected schools received technical assistance
  and funding to tackle their problem.
• Assistance comprised of resources that were meant
  to benefit the quality of education in general,
  not just health and inclusion objectives.

13
Education for Life and Environment Educación
para la Vida y el Ambiente (EVA)

• Current
• situation
• challenges
• desired
• scenario

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. A natural solution to rural sanitation. A
contribution to local development. An entry
point for environmental and health education.
Bullrushes are natural purifiers of sewage. They
enhance soils aerobic conditions and kill any
pathogenic organisms. At the end of the treatment
the water is usable for irrigation or to refill
toilet cisterns.
One example of EVA projects school bullrush
gardens
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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• 1 Educational focus
• The goal was to influence long term education
  policies, institutions and leaders, mainstreaming
  HP concepts and practice into the education
  sector objectives.
• Health, environment and inclusion projects have
  high educational value. Help to address relevant
  and tangible situation related to living
  conditions. Facilitate meaningful learning.
• Active teaching and learning, school-family
  links, project-based and life skills-oriented
  curiculum are all recomendations within quality
  education initiatives.

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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• Education focus II
• Implementation strategy sought to collaborate as
  much as possible with other components of the
  education strategy and all technical teams
  involved.
• Avoid the perception that HP in school is an
  additional programme which increases the
  teachers workload.
• Active citizenship is important for personal
  development and taking responsibility for the
  determinants of health.

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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• 2 Multi-sectoral approach and permanent dialogue
• Moving from inter-sectoral collaboration to
  mobilizing all possible parties and resources.
• Promoting permanent dialogue and collaborative
  management agreements rather than establishing
  bureaucratic partnerships/commissions.
• Engage teacher unions.
• Foster children representatives as advocates and
  stakeholders in school health dialogue.

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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• Local ownership, autonomy, contribution to local
  development
• The fact that schools had to administrate their
  funds, prioritise problems and decide which one
  they wanted to address, was in itself a learning
  and motivational experience.
• The whole school community absorbed a methodology
  to understand problems and challenges, made
  autonomous decisions and planned responses on the
  basis of their own culture, resources and skills.
  
• To optimise sustainability, the project
  encouraged schools to identify and mobilize
  professional expertise that was available in the
  local community.

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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• 4 Participation
• The project firmly advocated on the educational
  value of active involvement of children. A range
  of specific opportunities were highlighted
• Producing a situation analysis of school and
  community through consultation with other
  children and the community
• Mapping issues affecting health and well-being
  through problem trees
• Identifying things that can be changed in their
  school and planning strategies for change

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Education for Life and Environment KEY
IMPLEMENTATION ASPECTS

• Participation II
• Still genuine participation didn't go beyond
  sporadic and punctual opportunities.
  Participation brings additional complexity. When
  resources (personnel, support, etc) are limited
  and issues multiple, better keep things under
  control as usual.
• Teachers and headteachers overwhelmed and time is
  limited.
• Are schools a good environment for genuine
  participation?

21
How do you build a bridge?

• What do you need to build a bridge?
• Standing points
• Plans, design
• Materials
• People, labour, dialogue
• Whats progressive is not the substance of an
  idea but rather the dialogue of ideasbeing very
  clear that the results of such a dialogue are
  always uncertain.
• Edgar Morin