Monitoring and Evaluation of School-Based

Health and Nutrition Programmes:

A Participative Review

Assessing the need for a generic framework and identifying

good practices and limitations in existing resources

Zero Draft for consideration

Review conducted on behalf of the FRESH partners

for the ‘FRESH Partners Meeting’
held on 8th − 9th of September 2008

Zero Draft: 11 Aug 2008

Table of Contents
List of Boxes, Figures and Tables .............................................................................. ii
Acknowledgements ................................................................................................... iii
List of Abbreviations and Acronyms .......................................................................... iv
Glossary .....................................................................................................................v
Executive Summary .................................................................................................. vi
1. Introduction ........................................................................................................... 1
2. Purpose and Methodology..................................................................................... 3
2.1 Purpose ........................................................................................................... 3
2.2 Methodology .................................................................................................... 3
2.2.1 Key informant responses ........................................................................... 4
2.2.2 Literature review of M&E resources ........................................................... 4
3. Results .................................................................................................................. 5
3.1 Need for a generic M&E framework for SHN programmes ............................... 5
3.1.1 Usage of minimum standards .................................................................... 5
3.1.2 Reasons for common minimum standards for SHN programmes and
important considerations for their development ........................................ 5
3.1.3 Usage of core indicators ............................................................................ 7
3.1.4 Reasons for core indicators for SHN programmes and important
considerations for their development........................................................ 7
3.1.4 Dissemination of the generic M&E framework ......................................... 10
3.2 Literature review of M&E resources ............................................................... 11
3.2.1 Logical framework ................................................................................... 11
3.2.2 Minimum standards ................................................................................. 11
3.2.3 Core indicators ........................................................................................ 16
4. Discussion and Conclusions ................................................................................ 21
5. List of Resources................................................................................................. 24
6. List of References ............................................................................................... 32
7. List of Annexes .................................................................................................... 32
Annex A: List of priority areas for SHN programmes ............................................ 32
Annex B: List of key open-ended questions to key informants ............................. 33
Annex C: Details of key informants and their offices/organizations ...................... 34
Annex D: Profile of offices represented ................................................................ 36

i
LIST OF BOXES, FIGURES AND TABLES
Boxes
Box 1 Documents explicitly containing standards for SHN programmes .............. 13
Box 2 Examples of standards and sources for skills-based health education....... 13
Box 3 Examples of standards and sources for school health-related policies ...... 14
Box 4 Examples of standards and sources for supportive partnerships and
participation ............................................................................................... 14
Box 5 Examples of standards and sources for a safe and sanitary school
environment............................................................................................... 15
Box 6 Examples of standards and sources for school-based health services ...... 15
Box 7 Number of sources containing 'core indicators' .......................................... 16
Box 8 Examples of indicators for different priority areas that are similar under each
process ...................................................................................................... 17
Box 9 Examples of SHN-related process indicators in National School Census
Reports ...................................................................................................... 18
Box 10 Indicators common across the five programmatic processes that
complement FRESH activities ................................................................... 18
Box 11 Examples of process indicators specific to water, sanitation and hygiene .. 19

Figures
Figure 1 Relation between logical frameworks, minimum standards and indicators ... 4
Figure 2 The main reasons for having common minimum standards ......................... 6
Figure 3 Important considerations for the development of common minimum
standards..................................................................................................... 7
Figure 4 The main reasons for core indicators ........................................................... 8
Figure 5 Important considerations for the development of core indicators ................. 9
Figure 6 Responses on the level at which core indicators would be useful .............. 10
Figure 7 Number of reviewed documents containing indicators on priority areas ..... 17
Figure 8 Pictorial example of the generic M&E framework for SHN programmes .... 23

Tables
Table 1 Summary of logical frameworks from organizations implementing SHN-
related programmes .................................................................................. 12
Table 2 Number of documents with at least one defined indicator ......................... 18
Table 3 Examples of the connection between a standard and an indicator ............ 19
Table 4 Examples of internationally agreed indicators and their data sources ....... 20

ii
ACKNOWLEDGEMENTS
This report was written by Mohini Venkatesh and Kristie Neeser from the Partnership
for Child Development. We are very grateful to key resource people who provided
valuable contributions to the development of tools, collation of data, and reviewed
drafts of this report. The key resource people include: Natalie Roschnik (Save the
Children USA); Claire Risley and Aulo Gelli (Partnership for Child Development).

The report would not have been possible without the contributions of key informants
from the 24 organizations involved in the school-based health and nutrition
programmes. The key informants include: Dan Abbott (Save the Children USA);
Carmen Aldinger (Education Development Center); Désiré Aroga (Ministry of
Education, Cameroon); Kishor Aryal (World Food Programme); Camara Balla
(Ministry of Education/Ministry of Health, Guinea); Elisa Bosqué-Oliva
(Schistosomiasis Control Initiative); Don Bundy (World Bank); Giovanna Campello
(UNODC); Greg Carl (Thai Red Cross); Kreankrai Chaimuangdee (Lifeskills
Development Foundation, Thailand); Therese Dooley (UNICEF); Lesley Drake
(Deworm the World); Fiona Fleming (Schistosomiasis Control Initiative); Amaya
Gillespie (UNICEF); Gaston de la Haye (Education International); Anna Maria
Hoffmann (UNICEF); Grace Igweta (World Food Programme); Sharlene Johnson
(Ministry of Education, Guyana); Moussa Kabore (Fondation de Dévelopement
Communautaire, Burkina Faso); Tashmin Khamis (Child-to-Child Trust); Elizabeth
Kristjansson (University of Ottawa); Rebecca Lamade (World Food Programme);
Amicoleh Mbaye (Department of State for Education, The Gambia); Edwin Michael
(Imperial College, London); Z. Momodu (Ministry of Education, Nigeria); Antonio
Montresor (WHO); Sofialetecia Morales (WHO); Joviah Musinguzi (World Food
Programme); Amado Parawan (Save the Children USA); Anthi Patrikios (Partnership
for Child Development); Jenny Renju (MEMA kwa Vijana); Leanne Riley (WHO);
Mbabazi Pamela Sabine (WHO); Mariëlle Snel (IRC International Water and
Sanitation Centre); K.C. Tang (WHO); Alice Woolnough (Partnership for Child
Development); Richard Yakubu (Catholic Relief Services); and Ekua Yankah
(UNESCO). We are very grateful for their time spent in responding to our questions
and for providing useful information and references within this report.

Our gratitude further extends to Michael Beasley, Celia Maier and Lucinda Johnson
(Partnership for Child Development) who also provided invaluable comments to
drafts of this report. Editorial assistance was provided by Anastasia Said (Partnership
for Child Development).

Correspondence should be directed to the authors Mohini Venkatesh and Kristie

Neeser at: The Partnership for Child Development, Department of Infectious Disease
Epidemiology, Imperial College London, Faculty of Medicine, St Mary’s Campus,
Norfolk Place, London W2 1PG.
Email: [email protected] and [email protected]

iii
LIST OF ABBREVIATIONS AND ACRONYMS
AED Academy for Educational Development
AIDS Acquired Immune Deficiency Syndrome
ARQ Annual Reports Questionnaire
CASP Common Approach to Sponsorship-Funded Programming
CDC Centers for Disease Control and Prevention
EDC Education Development Center
EFA Education for All
EMIS Education Management Information System
ESART EduSector AIDS Response Trust
ESSAPR Education and Sports Sector Annual Performance Report
FAO Food and Agricultural Organization of the United Nations
FFE Food for Education
FHI Family Health International
FRESH Focusing Resources on Effective School Health
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
IATT Inter-Agency Task Team on HIV and Education
INEE Inter-agency Network for Education in Emergencies
IIEP International Institute for Educational Planning
INGO International Non-Governmental Organization
IPPF International Planned Parenthood Federation
IRC IRC International Water and Sanitation Centre
ISESCO Islamic Education, Scientific and Cultural Organization
M&E Monitoring & Evaluation
MDGs Millennium Development Goals
MEASURE DHS Monitoring and Evaluation to Assess and Use Results, Demographic
and Health Surveys
MICS Multiple Indicator Cluster Survey
NGO Non-Governmental Organization
PAHO Pan American Health Organization
PCD Partnership for Child Development
RAAPP Rapid Assessment and Action Planning Process
RBM Roll Back Malaria
SC/USA Save the Children USA
SCN Standing Committee on Nutrition
SHN School Health and Nutrition
SHAPE School-Based Healthy Living and HIV/AIDS Prevention Education
SMART Specific, Measurable, Attainable, Relevant and Time-Bound
STI Sexually Transmitted Infection
UN United Nations
UNAIDS United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
UNESCO United Nations Educational, Scientific and Cultural Organization
UNFPA United Nations Population Fund
UNGASS United Nations General Assembly Special Session on HIV/AIDS
UNICEF United Nations Children’s Fund
UNODC United Nations Office on Drugs and Crime
USAID United States Agency for International Development
WASH Water, Sanitation and Hygiene
WFP World Food Programme
WHO World Health Organization
WHO WPRO World Health Organization Regional Office for the Western Pacific

iv
GLOSSARY
Core indicators Indicators that are recommended for reporting by all
countries. (See definition of ‘Indicators’ below.)

Evaluation The assessment of the impact of a programme on desired

outcomes.

Indicators Quantitative and qualitative measures/variables that are used

to assess the status of progress towards goals, objectives,
outputs, activities or standards. In order to access uniform
data on core indicators, they must be accompanied by tools –
from data collection to analysis, dissemination and use.
These may be special surveys or routine collection efforts,
with specific questionnaires, guidelines, reporting formats and
databases.

Logical framework A logical framework (also called results framework) is the

starting point for generating an M&E framework for
development programmes. It presents programme activities
and outputs to address priorities (e.g. worms and nutrition),
as well as long-term objectives and goals (e.g. improvements
in health and education), each with their associated
indicators, so that they may be monitored and evaluated.

Minimum standards The minimum standards of programme activities and outputs

are used to outline what should be provided and what should
exist in schools as a minimum for the health, nutrition and
well-being of children. They are used to set a benchmark for
programmes and to assist in the measurement of comparable
features across programmes in different situations through
common indicators.

Monitoring The continuous assessment of programme processes (i.e.

activities and outputs).

Priority areas Specific aspects addressed by various school-based health

and nutrition programmes. The priority areas defined in this
report are: education; HIV; malaria; water, sanitation and
hygiene; worms; nutrition; sexual health; violence against
children; substance abuse (i.e. tobacco, alcohol and drugs);
physical activity; mental and psychosocial health; life skills;
first aid; vision, hearing, dental and skin (see Annex A).

v
EXECUTIVE SUMMARY

Over the past two decades, many governments and organizations have renewed
efforts to develop more effective school-based health and nutrition programmes in
low income countries. In large part, this has resulted from the growing body of
evidence linking children’s health and education; and the impact of school health and
nutrition (SHN) programmes on improving these outcomes and contributing to
Education for All (EFA) and the Millennium Development Goals (MDGs)1.
A major breakthrough on the international consensus for SHN programming was
achieved in April 2000 at the World Education Forum, where key international
agencies agreed on a common framework for SHN programmes, called Focusing
Resources on Effective School Health (FRESH). The FRESH framework promotes
cost-effective programming by calling for the integrated implementation of a core
group of four health-related approaches for schools in low income countries:
1. Health-related school policies;
2. school-based delivery of health services;
3. safe and sanitary school environment; and
4. skills-based health education.
The period since 2000 has witnessed a dramatic increase in countries adopting SHN
policies and organizations implementing comprehensive SHN programmes.
Effective monitoring and evaluation (M&E) is considered essential if comprehensive
SHN programmes are to be scaled up and sustained. Many resources have been
developed by organizations to assist the M&E of SHN programmes in low income
countries. The diversity of M&E resources that exists reflects the fact that SHN
programmes are contextual and no one size fits all. Increasingly, however,
stakeholders have wondered whether a generic M&E framework, adaptable to the
local settings of different programmes, would synergise existing resources and avoid
duplication that exists between different guidelines.
Thus, a review was undertaken to investigate the international consensus on the
development and dissemination of a generic M&E framework for SHN programmes in
low income countries. The Partnership for Child Development (PCD) and Save the
Children USA (SC/USA) with the participation of the FRESH partners and a range of
key informants representing: governments; United Nations (UN) agencies;
international non-governmental organizations (INGOs)/non-governmental
organizations (NGOs) and academic institutes, undertook this review to determine
whether or not there is a need for a generic M&E framework; as well as identify good
practices and limitations in existing resources.
The aim of this review is to form a starting point for discussions on how to develop
and disseminate a future generic M&E framework. Such discussions are expected to
be initiated at a meeting with the concerned 24 organizations to be held at the
headquarters of the World Health Organization (WHO) in Geneva in September
2008.
The key findings of the review were:
• There is a strong demand for a generic M&E framework for SHN
programmes, which is supported and recognized by different partners,
especially national governments and stakeholders. Such a framework should
be provided as a hard copy resource kit and through face-to-face training.
• Common health, education, and nutritional outcomes and programmatic
processes based on the ‘FRESH core activities’ should form the basis of a
generic M&E framework.
vi
 Executive Summary

• Common minimum standards for SHN programmatic processes are required

so that standardized guidance is provided to organizations and so that
comparability of programmes is increased. Guidance for particular contexts
should be provided in specific modules of the framework.
• Core indicators for SHN programmes are required. Those indicators that are
already internationally agreed upon and reported by ongoing tools are strong
candidates for ensuring that the generic M&E framework for SHN
programmes complements and fits within existing structures for data
management.

Based on the information gathered from the review, a pictorial first draft of the
generic M&E framework for SHN programmes is provided in Figure 8 (see page 23).
The FRESH partners are requested to discuss the findings presented in this review in
the meeting to be held at WHO Headquarters, Geneva in September 2008 to develop
and disseminate such an M&E framework.

vii
1. INTRODUCTION
Over the past two decades, many governments and organizations have renewed
efforts to develop more effective school-based health and nutrition programmes in
low income settings. In large part, this has resulted from the growing body of
evidence linking children’s health and education; and the impact of school health and
nutrition (SHN) programmes on improving these outcomes and contributing to
Education for All (EFA) and the Millennium Development Goals (MDGs). The 1990s
were characterized by the promotion of good practices in SHN through various
agency initiatives1.
In recognition of the benefits of SHN programmes and based on good practices of
organizations, a major breakthrough on the international consensus for SHN
programming was achieved in April 2000 at the World Education Forum in Dakar,
where a joint partnership effort by the United Nations Educational, Scientific and
Cultural Organization (UNESCO), the United Nations Children’s Fund (UNICEF), the
World Health Organisation (WHO) and the World Bank led to the framework
Focusing Resources on Effective School Health (FRESH). The FRESH framework
calls for an initial set of four core activities to be comprehensively implemented in all
schools in order for low income countries to meet the health needs of school-age
children. As opposed to health interventions that are implemented separately, this
approach is more effective and cost-effective when delivered as a package, and
provides a basis to scale up efforts and increase the quality and equity of education.
The four core activities endorsed by the framework are: school-based health policies;
skills-based health education; school-based health services; and the promotion of a
safe and sanitary school environment. These activities must be supported by
partnerships at different levels – between teacher and health workers, the education
and health sector, and schools and communities – and the full participation of all
children (in particular girls and orphans and vulnerable children).
Since 2000, there has been a substantial increase in the number of comprehensive
and holistic SHN programmes in low income countries. A survey of international
development agencies in 2006 showed that the percentage of organizations that
promoted school-based health services, skills-based health education and a safe
school environment increased over the period from 46% to 76%2. In order to further
scale up, systematise and sustain the good practices in SHN programming at project,
country and global levels, there is a growing need for more effective monitoring and
evaluation (M&E) of these programmes3. Monitoring is the continuous assessment of
programme processes, while evaluation is the assessment of the impact of a
programme on desired outcomes. Consistent and standardized M&E is essential for
decision makers to address programme concerns where they exist and commit
necessary funds to further improve health and education.
Many resources have already been developed by key agencies and countries to
assist the M&E of specific SHN interventions. For example, the WHO has specific
guidelines for the M&E of school-based deworming4 programmes, which are being
used by countries to monitor their national school-based deworming programmes.
Other existing resources within the wider health and education sector (e.g. Family
Health International’s Behaviour Surveillance Surveys) also contain valuable
information for SHN programmes. Many more resources are currently being
developed for specific health concerns. For example, the United Nations (UN)
Standing Committee on Nutrition is developing nutritional indicators for programmes
in several sectors including education5; the United Nations Programme on HIV/AIDS
(UNAIDS) Inter-Agency Task Team (IATT) on HIV and Education is developing
methods and instruments to measure the impact of education on HIV&AIDS6; and
UNICEF and WHO are identifying indicators to monitor violence against children in
different settings, including schools. Additionally, different organizations have their

1
 Introduction

own M&E systems, which may or may not be linked with national systems for M&E.
This could lead to a proliferation of systems and duplication of efforts.
As SHN programmes have become more comprehensive, it has been suggested that
there is a need for a generic M&E framework for SHN, which is equally
comprehensive as FRESH. Such a framework would synergise existing resources
and avoid any duplication that exists. The framework would also simplify M&E for
SHN practitioners and serve as a ready resource kit that may be used directly or
adapted to expand the evidence-base of their programmes. It would also assist in
reducing costs, and increase the effectiveness of ongoing efforts in the M&E of SHN
programmes. For example, international agreement on a core indicator on malaria
prevention through schools might allow the collation or comparison of data across a
country or countries, with only marginal cost implications.
However, as SHN programmes are contextual and no one size fits all, consensus on
a generic framework for M&E that is adaptable to the local settings of these
programmes is needed. There has been a call for coordinated efforts in the M&E of
SHN programmes at a number of recent meetings, such as the Islamic Education,
Scientific and Cultural Organization (ISESCO), UNESCO and WHO “First Regional
Conference on Health Promoting Schools in the Eastern Mediterranean Region” in
2007; and the FRESH Partners Forum in 2006. At the WHO Technical Meeting on
“Building School Partnerships for Health, Educational Achievement and
Development” in Vancouver, June 2007, stakeholders identified that concerted efforts
in international collaboration on M&E of SHN programmes should be made.
Following on from this meeting, the WHO offered to co-host a meeting on behalf of
the FRESH partnersa in order to gain consensus on the need for a generic M&E
framework for SHN programmes and to agree on the next steps for its development.
In preparation, the Partnership for Child Development (PCD), with support from Save
the Children USA (SC/USA), and in full consultation with all key partners, conducted
a participative review of the M&E of SHN programmes, for discussion at the meeting,
scheduled in Geneva for September 2008.

a
FRESH partners are: Child-to-Child Trust, EDC, Education International, FAO, IRC, PCD, RBM
Partnership, UNAIDS, UNESCO, UNICEF, UNODC, WFP, WHO and the World Bank.
2
2. PURPOSE AND METHODOLOGY

2.1 Purpose
The purpose of the participative review was to assess the need for a generic M&E
framework from a range of key informants; and to conduct a literature review of
existing M&E resources, identifying good practices and limitations.
The aim of the participative review is to provide the background to guide an
international consensus on the development, agreement and dissemination of a
generic M&E framework for SHN programmes in low income countries.

2.2 Methodology
In order to inform consensus for the generic M&E framework, the review was
conducted using participatory methods involving key informants on SHN,
representing governments, UN agencies, INGOs/NGOs and academic institutions,
working at both the national (including sub-national) and international levels. The key
informants were selected from: the FRESH partner organizations; a list of
organizations working in SHN2; and Networks of Ministry of Education SHN and HIV
Focal Points in sub-Saharan Africa and the Caribbean7. These key informants work
in one or more priority areas relevant to SHN programmes (see the complete list of
priorities in Annex A) and provided their opinion on the need for a generic M&E
framework of SHN programmes; key considerations for its development and
dissemination. The key informants also provided resources related to potential
elements of the M&E framework to identify good practices and limitations (i.e.
inconsistencies and gaps) and thus, areas for consensus.
The potential elements reviewed for consideration in the M&E framework of SHN,
and reasons for their selection, were as follows:

• Logical Framework: A logical framework (also called results framework) is the

starting point for generating an M&E framework for development programmes8.
It presents programme activities and outputs to address priorities (e.g. worms
and nutrition), as well as long-term objectives and goals (e.g. improvements in
health and education), each with their associated indicators, so that they may
be monitored and evaluated.

• Minimum Standards: Minimum standards of programme activities and outputs

are used to outline what should be provided and what should exist in schools
as a minimum for the health, nutrition and well-being of children. They are used
to set a benchmark for programmes and to assist in the measurement of
comparable features across programmes in different situations through
common indicators.

• Core Indicators: Indicators are quantitative and qualitative measures/variables

that are used to assess the status of progress towards goals, objectives,
outputs, activities or standards. Core indicators are those that are
recommended for reporting by all countries. In order to access uniform data on
core indicators, they must be accompanied by tools – from data collection to
analysis, dissemination and use. These may be special surveys or routine
collection efforts, with specific questionnaires, guidelines, reporting formats and
databases.

In summary, the potential elements would relate to each other in the M&E framework
as illustrated in Figure 1.

3
 Purpose and Methodology

LOGICAL FRAMEWORK
Goal and Objectives Core Indicators
(including information on tools for data on
indicators)

Goal Core Indicator (1)

Objective 1 Core Outcome Indicator (2)
Objective 2 Core Outcome Indicator (3)
Programmatic Outputs and Activities
for Priorities

Output/ Activity 1
Core Process Indicator (4)
Minimum Standard

Output/ Activity 2

Minimum Standard Core Process Indicator (5)

Figure 1. Relation between logical frameworks, minimum standards and

indicators

2.2.1 Key informant responses

From 24 organizations, 38 informants responded to the review, either directly through
telephone interviews or via emails (see Annex B for the list of key open-ended
questions asked). Since some informants were from the same organization but
worked in different offices at different levels, and because there were joint interviews
with informants from one office, in some cases, the unit of analysis was the office
they represented. A total of 35 offices were represented, with 17 working at national
level and 18 at international level (see Annex C for the details of the key informants,
their offices and organizations, and Annex D for the profile of offices represented).

2.2.2 Literature review of M&E resources

In total, 125 resources (100/125 were recommended by key informants), including
documents and web-based resources, were short-listed for review around the
potential elements for the M&E framework (see List of Resources). To aid the review,
literature review templates were used in Microsoft Excel, which assisted in sorting
and analysing the documents.

The literature review primarily focused on resources relevant to SHN programmes in

low income countries, and those that may concern school-age children and youth
aged between 5 to 24 years. While resources of high income countries were not
reviewed, they may provide lessons and good practices during the development of
the M&E framework. Materials on community-based schools were accessed, but
specific guidelines for addressing the non-formal education sector and its M&E were
not reviewed. Overall, the literature review is an initial assessment of resources
where illustrations of some of the findings are provided. However, a more detailed
analysis of all documents and all programme priorities may be required during the
development of the M&E framework.

4
3. RESULTS

3.1 Need for a generic M&E framework for SHN programmes

Key informants from the 35 offices provided their opinion on the generic M&E
framework for SHN programmes, with specific information in relation to minimum
standards and indicators. Overall, there was a high demand for the framework, with
34 out of 35 offices mentioning the need for either common minimum standards or
core indicators for SHN programmes.

3.1.1 Usage of minimum standards

Twenty-seven out of 35 offices said they were aware of and/or used minimum
standards for SHN programmes. However, in open-ended responses 9 out of the 27
offices said that these standards were general guidelines for SHN programmes. They
had not been “institutionalized” and explicitly defined as minimum standards. The
examples of standards provided varied, some relating to the overall package of
interventions and others to specific interventions:

• Nine out of 27 offices quoted comprehensive frameworks for SHN programmes

e.g. FRESH, Child-Friendly School, the World Food Programme (WFP)
Essential Package and Health Promoting Schools, as minimum packages.
• Fifteen out of 27 offices mentioned standards for school-based health services
of deworming, and/or nutrition and/or water and sanitation.
• Four out of 27 offices mentioned curricular and/or health education standards.

These documents and resources were short-listed for the review (see List of
Resources).

3.1.2 Reasons for common minimum standards for SHN programmes and important
considerations for their development
Thirty-three out of the 35 offices reported the need for common minimum standards
for SHN programmes that can be referred to and adapted at the local level. As open-
ended responses, the main reasons provided by more than one office (see Figure 2)
were that it would:

• Guide SHN programmes: On the type and level of activity and output to be
attained, and make it easier to “provide advice” to programme implementers.

• Lead to more standardized and unified programmes: Those aspects that

are common between programmes and priorities can be “unified and
standardized”. This will “facilitate a common understanding”.

• Make it easier to compare and monitor programmes: Common minimum

standards will make it “easier to compare programmes” implemented by
different organizations. They will also make it easier to monitor programmes
(e.g. for “quality assurance” by the education inspectorate).

• Lead to better coordination between different programmes, and the

priorities they address:. Links between programmes/different priorities (e.g.
worms and micronutrient supplementation) through common minimum
standards “will increase the synergistic effect” of comprehensive programmes.

5
 Results

Useful programme guide of the level to be

19/33
attained in order to achieve target outputs

Standardized and universal approach 12/33

Easier to compare (& monitor)

8/33
programmes

Better coordination 3/33

0 4 8 12 16 20
Number of key informant offices

Figure 2. The main reasons for having common minimum standards

Similarly, in open-ended responses the main considerations for the development of

minimum standards that were suggested by one or more offices (see Figure 3) were
that they should be:

• Adaptable to local context and based on local capacity: The minimum

standards should be flexible so that they can be adjusted according to the
“local context” culture; capacity (which may be high or low); health; and
nutritional needs. Government lead is essential to provide agencies a context
specific framework.

• Based on evidence and operational experience: To “assess the evidence” in

the priority area (e.g. sanitation standards) alongside the current situation to
develop minimum standards.

• Participatory methodology for development: Discussion with stakeholders

at both national (including teacher representatives) and international levels is
crucial in order to develop a coordinated product, which is supported and
funded. To use existing coordinating mechanisms that are already in place (e.g.
“school sanitation thematic group coordinated by the IRC”).

• Possible to monitor: Minimum standards should not be too general that they
cannot be monitored, and used for comparing programmes. It can be “written
as a curriculum document” to be relevant; and be accompanied by a set of core
indicators, to measure that the desired output has been attained. To link the
minimum standards with programme impact on education, health and nutrition.

• Use FRESH/comprehensive SHN framework: There is “consensus on the

FRESH framework” at the World Education Forum, and this can be revisited as
an organizing framework for the minimum standards. To address main aspects
of a comprehensive SHN programme.

• Key domains are covered using a modular (menu of options) approach: In

order to address local issues and priorities, “a modular approach” is needed to
give “options for implementation”. The menu can also depend on the different
levels of capacity and resources available.

• Simple messages in user-friendly format: The standards need to be simple

and well-organized and presented as a “user-friendly” resource, available in
different languages.

6
 Results

Adaptable to local context and capacity 17/35

Based on evidence and operational experience 10/35

Participatory methodology for development 10/35

Should be possible to monitor 9/35

Use FRESH/ comprehensive SHN framework 6/35

Key domains covered using modular approach 3/35

Simple messages and user-friendly format 2/35

0 6 12 18

Number of key informant offices

Figure 3. Important considerations for the development of common minimum

standards

3.1.3 Usage of core indicators

Thirty-one out of 34 offices mentioned that they use a set of indicators for SHN.
Fewer offices (24 out of 33) mentioned referring to or using indicator guides or
publications specific to SHN. The publications mentioned by 11 offices were
organizational documents, while 4 offices referred to international sources containing
core indicators.

3.1.4 Reasons for core indicators for SHN programmes and important considerations for their
development
Thirty-two out of the 35 offices reported the need for core indicators for SHN
programmes. Such a set of core indicators would be internationally agreed, and
presented with clear definitions, guidelines on calculation and interpretation, and
tools for accessing data. As open-ended responses, the main reasons provided by
more than one office (see Figure 4) were that core indicators would help to:

• Compare and aggregate data: The comparison and aggregation/compilation

of data from organizations for national analysis would be easier with core
indicators. This would help in understanding the overall national or international
picture and influence policy. Core indicators would also allow “comparison over
time”. The increased comparability of data due to core indicators would also
reduce costs for M&E (by not needing to do special surveys) and increase
efficiency.

• Show commitment and concentrate efforts on SHN programmes: The

presence of core indicators that are used for M&E will help to “build a strong
case for school health issues”. The evidence of “the impact of SHN
programmes is a given”, however, this needs to be demonstrated in order to
sustain interest and advocate at all levels (e.g. “funding and commitment from
donors”) and keep programmes at scale. Core indicators will also help ensure
this accountability.

• Provide guidance to organizations in countries: Core indicators will provide

guidance on how to measure “the standards countries are trying to achieve”. It
will help “demystify M&E”, and provide “guidance to programmes on what
measures they should use”. Although there are core indicators and different
guidelines for some SHN priorities (e.g. HIV and worms), they “need to be
compiled in to one set” and presented for SHN as a whole.
7
 Results

• Measure the impact on benchmarks and targets: Core indicators help to

monitor the status and measure the change a programme has had towards a
set benchmark or target. They are a “common link to minimum standards” and
important for measuring impact and for determining a “causal link between
actions and school health outcomes”.

• Access better data: Core indicators are “important to provide stronger” and
more accurate data to show better association between actions and outcomes.
Data captured will be more useful to demonstrate the impact, and can be used
for policymaking. It will also add to the authenticity of data.

• Reduce the number of indicators: Currently there are far “too many
indicators” which make it very “burdensome” for implementers (e.g. teachers) to
report. A set of core indicators will make it easier to report and use data.

Comparability and aggregation of data 12/32

Show commitment & concentrate on SHN 9/32

Provide guidance to organization in countries 9/32

Measure impact (on benchmarks and targets) 9/32

Better data is available 5/32

Reduce the number of indicators 2/32

0 4 8 12
Number of key informant offices

Figure 4. The main reasons for core indicators

Similarly in open-ended responses, the main considerations for the development of

core indicators that were suggested by more than one office (see Figure 5) were that
they should be:

• Specific, Measurable, Attainable, Relevant and Time-Bound (SMART):

Twelve offices mentioned one or more of the following as important for core
indicators: specific (and sensitive), measurable, attainable, relevant (and
realistic) and time-bound (SMART). It must be feasible (attainable) to collect
and analyse data for core indicators. They need to be “measurable in a cost-
effective manner” using existing structures in place. They need to be “simple,
understandable and practical” as well as “valid and reliable”. The “data
collection frequency for the core indicator should be practical”, and, as far as
possible, should be “collected as part of regular work” (but not creating
additional work).

• Supported and recognized by different partners: The core indicators need

to be developed in consultation with and supported by national government
organizations, NGOs, and other national and sub-national stakeholders. All
stakeholders (including those that will use tools for measuring indicators) need
to be involved during the development, during follow-up guidance, and during
training support. This will increase ownership and “buy-in of indicators”.

• Consult existing indicators, tools (surveys) and structures: As a large

number of data and indicators already exist, these must be consulted and,
where possible, “tools (e.g. surveys) need to be coordinated”. This is needed
8
 Results

“to enable integration (of indicators) in existing mechanisms”. The “evidence of

success of existing indicators” and “links to existing sources of data” are strong
criteria for selecting core indicators. Organizations “have already bought into
(some impact indicators for) EFAs and MDGs, so these should be used where
possible”. If “there are good routine data collection systems such as Education
Management Information Systems” that include SHN indicators, these should
be considered.

• Linked to minimum standards/programme activities and outputs: Core

indicators “need to be available for process evaluation”. They “should be linked
to minimum standards”. They should be covered “within FRESH” activities.

• Applicable to different contexts: Core indicators should be “usable in

different contexts”, with “targets for indicators different for different countries”.
The indicators “should be adapted and validated for each country”. While core
“indicators should remain the same to be comparable, the context must be
considered when interpreting them”. “A guide to use these indicators in different
settings is needed”.

• Linked to goals and objectives: Core indicators should be linked with “health
and education impact” in the programme “log-frame”.

• Additional/optional indicators: As each country’s context is different, there

should be some “optional indicators” that countries could “pick and choose”
from. The core indicators list “should not be too restrictive”.

SMART 12/29

Support/ recognition from different partners 11/29

Consult existing indicators, tools (survey ) & structures 9/29

Linked to minimum standards/ activities& outputs 6/29

Applicable to different contexts 6/29

Linked to goals/objectives 4/29

Additional/ optional indicators 3/29

0 4 8 12

Number of key informant offices

Figure 5. Important considerations for the development of core indicators

Twenty-nine offices further gave their opinion on the administrative level at which the
core indicators would be useful. Twenty-eight offices mentioned that they would be
useful at the national level, while 24 offices mentioned that they would be useful at
the sub-national level, and 21 offices mentioned they would be useful at the
international level. Offices working at both the international and national levels had
similar responses on the level at which core indicators would be useful (see Figure
6).

9
 Results

15

Number of Key Informant Offices

10

0
Sub-National National International
Level at which core indicators useful
Offices at national level Offices at international level
Figure 6. Responses on the level at which core indicators would be useful

In open-ended responses, offices reported that core indicators would be most useful:

• At all levels: “Once the indicator is clearly defined, it can be used at all levels”
(e.g. the percentage of children dewormed). “Some activities are done only at
sub-national level” (e.g. teacher training and blood sample collection), therefore
after raw data are collected and analysed, data on the indicator should be
aggregated at different administrative levels for both national, and “international
comparisons”. Disaggregate values of core indicators should be available as far
as possible (e.g. percentage of teachers trained by district) to note differences
and “to interpret and use data”, especially “in large and heterogeneous states”.

• If linked between different levels: The level at which a core indicator would
be most useful “would depend on what is being measured” (e.g. children or a
school policy), and “the level of decision making” (e.g. at district or at national
levels). “Indicators for different levels should be interlinked and
complementary”, so that “decision makers at each level can use that
information”. “In-country indicators can be linked up to the international level”.

3.1.4 Dissemination of the generic M&E framework

Twenty-eight informant offices also provided their opinion on the usefulness of
different formats for the dissemination of the generic M&E framework. The overall
comment was that the format would depend on target users. The formats most
preferred by the offices were hard copy resource kits and face–to-face training
programmes (median rank: 5/5). Specific comments on this were that “face-to-face
should use a peer education approach, where peers teach peers and the training is
cascaded”. A hard copy resource kit would “need to be user-friendly, well laid out,
and translated”.
Web-based kits, email lists and CDs were not as preferred a format (median rank:
4/5) due to poor internet connections and lack of access to computers in low income
and rural settings. However, it was mentioned that in order to adapt materials “it is
important to have a CD version”.

Online training programmes and access to experts by phone were least preferred
(median rank: 3/5) due to similar reasons of poor internet connections, lack of access
to computers, as well as “high costs associated with phone calls”.
10
 Results

3.2 Literature review of M&E resources

Resources were reviewed in a stepwise method, by first identifying documents that
included logical frameworks, core indicators and minimum standards by priority area.
This was followed by a more detailed collation of individual logical frameworks,
standards and indicators from different documents into a template, and an analysis
and summary of the collated findings. The main good practices and limitations
identified in the review of resources are presented below. Details of how this
information may be used for the generic M&E framework are discussed along with
recommendations by key informants in Section 4.

3.2.1 Logical framework

A review of the logical frameworks for programmes implemented at country level
found that at times the frameworks were not just limited to SHN programmes, and
that priorities varied greatly between organizations. Out of the 7 offices that provided
their logical frameworks for their programmes in low income countries, 2 were on
general SHN, 2 were on nutrition, 2 were on education and 1 was on HIV prevention.
Subsequently, their goals and objectives also varied. However, some common
outcomes (i.e. goals and objectives) identified between different offices were either
an improvement in: health and nutrition; education; or in health-related knowledge,
attitude, behaviour and skills of school-age children relating to EFA or MDGs (see
Table 1). The activities and outputs also varied greatly between organizations
depending on their priority, the context, their mandate and the level at which they
work. However, for SHN programmes implemented at national or sub-national levels,
some common activities and outputs for these levels can be summarized as:
1. Development and promotion of school-health related policies.
2. Provision of skills-based health education.
3. Provision of school-based health services.
4. Promotion of a safe and sanitary school environment.
5. Promotion of supportive partnerships and participation.
These five areas complement the ‘FRESH core activities’, on which there is
international consensus, therefore making the five areas good practice.

3.2.2 Minimum standards

Fifty-one documents were identified to contain standards relevant to SHN
programmes (see List of Resources). In most documents (46/51), standards were
presented in the form of guidelines, principles, checklists or essential criteria; only a
few contained explicit standards (see Box 1). Minimum standards were found to be
explicitly listed in only 2 documents, namely the School Feeding Handbook and
Minimum Standards for Education in Emergencies, Chronic Crises and Early
Reconstruction. Given this limitation, standards (explicit or otherwise) as opposed to
minimum standards alone were reviewed. Only 7/51 documents were M&E guideline
documents, while the rest were documents containing SHN programme information
on priority areas (e.g. worms and malaria).
On reviewing 28 documents in more detail, it was found that some standards were
common for different priority areas, especially under the three programmatic
processes of: provision of skills-based health education; development and promotion
of school health-related policies; and promotion of supportive partnerships and
participation, as illustrated in Boxes 2 to 4. A good practice identified was that
standards were common between documents, many of which were inter-agency
publications. This makes it easier to agree on common standards and minimum
standards which cover all priorities for the M&E framework.

11
 Results

Standards that may be specific to priority areas under these three programmatic
processes (e.g. HIV prevention education should include information on both, how
the virus can and can not spread) are not illustrated below.

Table 1. Summary of logical frameworks from organizations implementing

SHN-related programmes*
Catholic
Education Ministry of
Common Logical World Food Relief
Development Education,
Framework Programme Service,
Center Kenya
Ghana
PRIORITY AREAS
General SHN intervention Nutrition Worms HIV Education
OUTCOMES Goals
(Goals and Objectives)** Meet MDGs Improved Prevention of Ensure
through food educational new HIV equity of
1. Improved Educational assisted attainment infections access to
Outcomes (e.g. in access, interventions among basic
equity, attainment, and learners education
cognitive and Objectives
psychoeducational
outcomes) 1. Increased 1. Health and 1. Learners 1. Quality of
enrolment, nutritional acquire skills learning
2. Improved Health and attendance, status of in HIV and environment
Nutrition Outcomes capacity to primary STI in schools
3. Improved Health-related concentrate school prevention improved
Knowledge, Attitude, and learn students 2. Improved
Behaviour Skills Outcomes 2. Reduced improved health for
gender 2. Health primary
disparity behaviours school pupils
among and teachers
primary
school
children
improved
PROGRAMMATIC Expected Outputs and Activities
PROCESSES 1. Timely 1. Increased 1. Adapted 1. National
(Outputs and Activities)** provision of capacity of interactive standards,
1. Development and food to teachers to learning guidelines
promotion of school health- improve deliver school experiences and
related policies access to health suited for procedures
2. Provision of skills-based education in messages local learner for the
health education schools and 2. Increased HIV provision of
3. Provision of school- non-formal availability of education primary
based health services education micronutrients 2. Train school
centres and teachers and infrastructure
4. Promotion of a safe and
sanitary school deworming learners 2. Establish
environment drugs in district
school coordination
5. Promotion of supportive unit
partnerships and 3.
participation Sensitization
campaigns on
school health
* The logical frameworks were adapted from the original documents.
** Outcomes and processes are general and can be adapted to a programme context. Accompanying
indicators not displayed.

12
 Results

Box 1. Documents explicitly containing standards for SHN programmes

Department of Mental Health, Thai Ministry of Public Health. 2005. Teacher Manual: Student
Care and Support System.
INEE. 2004. Minimum Standards for Education in Emergencies, Chronic Crises and Early
Reconstruction.*
Senderowitz, J, et al. 2006. Standards for Curriculum-Based Reproductive Health and HIV
Education Programs.
UNICEF. 2008. Life Skills-Based Education: Concepts and Standards.
WFP. 2000. School Feeding Handbook.*

* Documents explicitly stating minimum standards for SHN programmes.

Box 2. Examples of standards and sources for skills-based health education

Standards Sources (and priorities under which the standard was discussed)*
Health education General
should be WHO, WPRO. 1996. Regional guidelines: Development of health-
combined with promoting schools- A framework for action.
building children's
life skills HIV
Aldana, S, et al. 1999. Preventing HIV/AIDS/STI and Related
Discrimination: An Important Responsibility of Health-Promoting Schools.
Senderowitz, J, et al. 2006. Standards for Curriculum-Based
Reproductive Health and HIV Education Programs.
Skills-based
health promotion Malaria
and disease Clarke, N, et al. 2007. Malaria Prevention and Control.
prevention should
be integrated in Water, sanitation and hygiene
the curriculum IRC. 2008. Monitoring and evaluation - WASH in Schools.
van Hooff, I, et al. 1998. Towards Better Programming: A Manual on
School Sanitation and Hygiene.
Education
Nutrition
materials should
Save the Children. 2007. CASP: The Common Approach to Sponsorship-
be culturally and
Funded Programming.
locally relevant
UNESCO, et al. FRESH School Health Tool Kit.

Prevention of violence against children

Pigozzi, MJ, et al. 2005. Inter-Agency Peace Education Programme:
Skills for Constructive Living.
Teachers
expected to teach Substance abuse
about health and UNODC. 2004. School-based education for drug abuse prevention.
nutritional
concerns should Life skills
receive training INEE. 2004. Minimum Standards for Education in Emergencies, Chronic
and accurate Crises and Early Reconstruction.
information Peppler Barry, U. 2000. The Dakar Framework for Action. Education for
All: Meeting our Collective Commitments.
UNICEF. 2008. Life Skills-Based Education: Concepts and Standards.
* Documents cover one or more standard listed.

13
 Results

Box 3. Examples of standards and sources for school health-related policies

Standards Sources (and priorities under which the standard was discussed)*
Government level HIV
policy should Aldana, S, et al. 1999. Preventing HIV/AIDS/STI and Related
inform the SHN Discrimination: An Important Responsibility of Health-Promoting
programme Schools.
Monasch, R, et al. 2005. Guide to Monitoring and Evaluation of the
National Response for Children Orphaned and Made Vulnerable by
Schools should HIV/AIDS.
implement policies
to support health, Water, sanitation and hygiene
nutrition and well- van Hooff, I, et al. 1998. Towards Better Programming: A Manual on
being of teachers School Sanitation and Hygiene.
and learners Nutrition
School policies Government of Brazil, et al. 2007. Nutrition Friendly Schools Initiative.
should meet local
needs and be WFP. 2000. School Feeding Handbook.
developed in Substance abuse
consultation with UNODC. 2003. School-based Drug Education: A guide for practitioners
the community and the wider community.
Policies to Mental and psychosocial health
increase
inclusiveness and INEE. 2004. Minimum Standards for Education in Emergencies, Chronic
protect vulnerable Crises and Early Reconstruction.
groups should be Skevington, S, et al. 2003. Creating an Environment for Emotional and
in place Social Well-Being.
Life skills
Harris, R, et al. 2004. Embracing Diversity: Toolkit for Creating
Inclusive, Learning-Friendly Environments.
* Documents cover one or more standard listed.

Box 4. Examples of standards and sources for supportive partnerships and

participation

Standards Sources (and priorities under which the standard was discussed)*
Children, teachers General
and communities Jones, JT, et al. 1998. Health-Promoting Schools: A healthy setting for
should be living, learning, and working.
involved in the Save the Children. 2007. CASP: The Common Approach to
SHN activity Sponsorship-Funded Programming.
Children, teachers HIV
and community Aldana, S, et al. 1999. Preventing HIV/AIDS/STI and Related
members should Discrimination: An Important Responsibility of Health-Promoting
be trained to Schools.
promote SHN
Water, sanitation and hygiene
programmes
van Hooff, I, et al. 1998. Towards Better Programming: A Manual on
Both the Ministries School Sanitation and Hygiene.
of Education and IRC. 2008. Monitoring and evaluation - WASH in Schools.
Health should be Roschnik, N. 2008. Monitoring School Health and Nutrition programs:
involved in the Guidelines for program managers.
SHN programme
Political leaders at Nutrition
all levels should Government of Brazil, et al. 2007. Nutrition Friendly Schools Initiative.
be involved in WFP. 2000. School Feeding Handbook.
supporting SHN Mental and psychosocial health
programmes INEE. 2004. Minimum Standards for Education in Emergencies,
Chronic Crises and Early Reconstruction.
* Documents cover one or more standard listed.

14
 Results

Some standards were specific to a priority area, especially under the two
programmatic processes of: provision of school-based health services; and
promotion of a safe and sanitary school environment as illustrated in Boxes 5 and 6.

Box 5. Examples of standards and sources for a safe and sanitary school
environment
Standards Sources*
Priority area: Water, sanitation and hygiene
Schools should have adequate quantities of water van Hooff, I, et al. 1998. Towards
Better Programming: A Manual on
School Sanitation and Hygiene.
INEE. 2004. Minimum Standards for
Schools should have gender segregated latrines
Education in Emergencies, Chronic
along with hand washing facilities
Crises and Early Reconstruction.
IRC. 2007. Towards Effective
Schools should dispose refuse safely Programming for WASH in Schools: A
manual on scaling up programmes for
water, sanitation and hygiene in
schools.
There should be activities for maintenance of
IRC. 2008. Monitoring and evaluation
hygiene facilities
- WASH in Schools.
Roschnik, N. 2008. Monitoring School
Health and Nutrition programs:
Guidelines for program managers.
WFP. 2000. School Feeding
Handbook.
WFP, et al. The Essential Package:
Twelve interventions to improve the
health and nutrition of school-age
children.
* Documents cover one or more standard listed.

Box 6. Examples of standards and sources for school-based health services

Standards Sources
Priority area: Worms
If the prevalence of Montresor, A, et al. 2002. Helminth control in school-age children:
soil-transmitted A guide for managers of control programmes.
helminths is more Montresor, A, et al. 1998. Guidelines for the Evaluation of Soil-
than 50%, treat all Transmitted Helminthiasis and Schistosomiasis at Community
school-age children Level.
Priority area: Nutrition
Schools should
maintain minimum Government of Brazil, et al. 2007. Nutrition Friendly Schools
food safety standards Initiative.
School feeding and Nepal. 2005. National School Health and Nutrition Strategy.
micronutrient
supplementation UNESCO, et al. FRESH School Health Tool Kit.
should depend on the
WFP. 2000. School Feeding Handbook.
prevailing nutrition
situation and needs
Priority area: Physical activity
Schools should Ministry of Public Health and Sanitation and Ministry of Education.
provide physical 2008. Kenya National School Health Policy.
health services
UNICEF. The Learning Plus Index.

15
 Results

Therefore, the M&E framework could present modules on minimum standards for
programmatic processes which address specific priority areas (e.g. water and
sanitation).

Standards that may be common for priorities under these two programmatic
processes (e.g. ensuring the learning environment is safe and free of dangers is
common for priorities of mental and psychosocial health and violence against
children) are not illustrated.

A limitation found was that details on the standards were not uniform across
documents. This included the length of explanatory notes on the standard and the
requirements stipulated by the standard. For example, there were differences on the
quantity of water that should be available in schools in Water, Sanitation and Hygiene
(WASH) in Schools and the School Feeding Handbook.

Another finding was that standards may be met at one or more administrative levels.
For example, the standard that teachers receive training for skills-based health
education, may be met at national and sub-national levels, while the standard that
schools have adequate water is met only at the school level. This may be an
important consideration to be addressed by the M&E framework.
3.2.3 Core indicators
Fifty-eight documents and web-based resources were identified to contain indicators
(i.e. measures) relevant to SHN programmes (see List of Resources). Most
documents (54/58) explicitly called them indicators, while in a few they were
presented as measures but not called indicators. Seven other documents – most of
which were SHN documents – used the term ‘indicators’, however, these referred to
an increase or decrease in a qualitative behaviour or other programme aspect. Since
these did not coincide with the working definition for indicators used for the review
(see purpose and methodology) they were not included in the list of documents
containing indicators. This difference in the terminology of indicators was seen as a
potential limitation for M&E, and it is therefore recommended that this is clarified in
the M&E framework. Only 10 documents mentioned the term ‘core indicators’ (see
Box 7); therefore, indicators as opposed to only core indicators were reviewed.

An initial review of the 58 resources containing indicators showed that the number of
resources containing SHN-related indicators for some priority areas such as
education, HIV, nutrition, deworming, water and sanitation, sexual health and life
skills were far greater than for first aid, malaria, violence against children, physical
activity and mental and psychosocial health (see Figure 7).

Box 7. Number of sources containing 'core indicators'

Gyorkos, T. W. 2003. Monitoring and evaluation of large scale helminth control programmes.
Meusel, D, et al. 2006. Global Strategy on Diet, Physical Activity and Health: A framework to monitor
and evaluate implementation.
Monasch, R, et al. 2005. Guide to Monitoring and Evaluation of the National Response for Children
Orphaned and Made Vulnerable by HIV/AIDS.
Montresor, A, et al. 2002. Helminth control in school-age children: A guide for managers of control
programmes.
Pisani, E, et al. 2000. National AIDS Programmes: A Guide to Monitoring and Evaluation.
UNAIDS, et al. 2004. National AIDS Programmes: A guide to indicators for monitoring and evaluating
national HIV/AIDS prevention programmes for young people.
USAID, et al. HIV/AIDS Survey Indicators Database.
Warner-Smith, M, et al. 2007. Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on
Construction of Core Indicators. Geneva: UNAIDS.
WFP. Standardised School Feeding Survey.
WHO. STEPwise approach to surveillance.

16
 Results

Education
Nutrition
HIV
Worms
Sexual health
Life skills
Water, sanitation and hygiene
Substance abuse
Vision, hearing, dental, & skin
Malaria
Mental and psychosocial health
Physical activity
Violence against children
First aid

0 5 10 15 20 25 30 35
No. of documents reviewed with indicators for SHN programmes

Figure 7. Number of reviewed documents containing indicators on priority

areas

Programmatic process indicators

A closer analysis found that many of the SHN-related indicators for the different
priority areas were similar for programme outputs and activities under each of the
processes complementing FRESH (see Box 8 for illustrations of summary indicators).
However this was not initially evident for two main reasons. First, the indicators were
named differently and had varying emphasis in the different sources (e.g. percentage
schools with at least one policy publicized and enforced and percentage of schools
with published physical activity school policy). Second, in many cases, indicators
were not accompanied with definitions on how they are calculated in order to assess
if the indicators were similar or the same (see Table 2). Certain qualifiers in an
indicator such as ‘functioning’ in number (%) of schools with functioning SHN
committee also need to be explained (see Box 10).

Box 8. Examples of indicators* for different priority areas that are similar
under each process

Provision of skills-based health education

Number (%) of schools providing skills-based health education to students
Existence of school health and well-being awareness programmes

Provision of school-based health services

Number (%) of schools providing a SHN service
Number (%) of school-age children receiving drugs (i.e. drug coverage)

Development and promotion of school health-related policies

Existence of national policies to promote health, nutrition and well-being of school-age
children
Percentage of schools with a published school health-related policy
* These indicators are summaries of those indicators that were found to be similar.

17
 Results

Some indicators were common across all SHN programmatic processes and even to
those unrelated to SHN, as illustrated in the summary indicators in Box 10. This good
practice of indicators that are similar across the programmatic processes and
common across priority areas for a particular process provides a strong foundation
for agreement and inclusion in the M&E framework. Where international agreement
and data on indicators already exists, those indicators are good practices. For
example, the percentage of schools providing skills-based HIV education to students
is disaggregated for HIV and internationally agreed by the UN General Assembly as
a core indicator. Government National School Census Reports in some countries are
beginning to include SHN-related programme information, and these also present
good practices as the indicators have already been incorporated into the
government’s reporting systems.

Table 2. Number of documents with at least one defined indicator

Document type Number of Number of documents with at least
documents one defined indicator
containing (%)
indicators
M&E guideline documents 21 16 (76%)
Documents with databases 11 7 (64%)
SHN document 13 3 (21%)
Total* 45 26 (58%)
*The document total does not include those which contain logical frameworks and policies.

Box 9. Examples of SHN-related process indicators in National School

Census Reports

Nigeria
No (%) of schools with anti-AIDS clubs
No (%) of schools with information on HIV provided
No (%) schools with health workers trained in HIV

Where indicators are defined and found to be similar but not the same, an agreement
on a core indicator for the M&E framework is needed in order to reduce the number
of indicators. For example, drug coverage may include the number of enrolled and
un-enrolled school-age children dewormed in one programme (e.g. as reported on
the WHO Global Databank on Schistosomiasis and Soil-Transmitted Helminths),
while in another programme it may include the percentage of enrolled children
dewormed (e.g. as reported in the School Feeding Handbook). Similarly, some
indicators are similar because they are tracking a particular aspect, and a choice
needs to be made on a core indicator. For example, the number of schools with a
trained teacher, the number of teachers trained and the number of teacher training
sessions, all look at the presence of trained teachers.
Links were identified between some indicators, which may be used for monitoring at
different administrative levels. For example, data on the existence of school health
and well-being awareness programmes (see Box 8), which are collected at the
school level, may be used for an indicator to monitor the percentage of schools
participating in a programme at both the district and national levels (see Box 10).

Box 10. Indicators common across the five programmatic processes that
complement FRESH activities

Number (%) of schools participating in a programme

Number (%) of schools with a trained teacher
Number (%) of schools with functioning SHN committee
Number (%) of teachers trained
Number (%) of teacher training sessions

18
 Results

Some of the indicators were specific to a priority area, as illustrated in Box 11. Those
indicators particular to a priority area may be presented in the M&E framework in a
module specifically addressing that priority area.

Box 11. Examples of process indicators specific to water, sanitation and

hygiene

Number (%) of schools with access to safe water

Number (%) of schools with functional latrines
Number (%) of schools with separate latrines for girls
Number (%) of schools with functional hand washing facilities

The indicators on water, sanitation and hygiene closely connect to some of the
standards for water and sanitation under promotion of a safe and sanitary school
environment (see Table 3). Such a connection between the minimum standard and
the indicators for its monitoring is a good practice and is important to present in the
M&E framework.

Table 3. Examples of the connection between a standard and an indicator

Standard Indicator
Schools should have adequate quantities of Number (%) of schools with access to safe
water water
Number (%) of schools with separate latrines
for girls
Schools should have gender segregated Number (%) of schools with hand-washing
latrines along with hand washing facilities facilities

Outcome indicators

Some indicators for measuring goals and objectives of SHN programmes were
internationally agreed either by a declaration or an international goal such as the
MDGs and EFA, or the UN General Assembly Special Session (UNGASS) on
HIV&AIDS, and reported by all countries. These are core indicators. There are other
indicators that are internationally agreed, although through processes other than
declarations (e.g. inter-agency documents or surveys), and may not be reported by
all countries. Both sets of indicators are good practices because there is consensus
from national governments and international agencies on them.

Further, data on some indicators are collected through ongoing surveys or routine
collections and are available on open-source databases or other open-sources of
published data (see Table 4). These may or may not be available across all low
income countries (e.g. percentage of students who were physically active for a total
of at least 60 minutes per day on all 7 days during the last 7 days is available for 36
low income countries). These indicators are also good practices because data as
well as tools (e.g. surveys) and institutional structures for these indicators already
exist.

Data on some indicators were reported by more than one survey (tool), such as
attendance rate reported in the National School Census Surveys and Multiple
Indicator Cluster Survey (MICS). Although this is a good practice, there are
differences in the survey methodologies (e.g. MICS is a household survey, while the
National School Census Surveys are school-based). Therefore, data from these two
surveys cannot be compared.

The presence of aggregate (e.g. net enrolment rate) and composite indicators (e.g.
percentage of youth with comprehensive knowledge of HIV) is a good practice and
19
 Results

important to adopt in the M&E framework. This will limit the number of indicators to
the main comprehensive measures in the framework.

Table 4. Examples of internationally agreed indicators and their data sources

Outcomes Indicator Database or data International
source agreement
Improved Enrolment rate (gross and net) UNESCO Institute of MDGs and EFA
Educational by gender Statistics Database
Outcomes National School World Summit
Census Survey for Children,
Reports, Multiple MDGs, World Fit
Indicator Cluster for Children
Attendance rate Survey database Declaration
UNESCO Institute of World Summit
Statistics Database, for Children,
Multiple Indicator MDGs, World Fit
Cluster Survey for Children
Primary completion rate Database Declaration
Improved HIV prevalence among youth AIDS Indicator UNGASS
Health and aged between 15 to 24 years Survey Database
Nutrition WHO Vitamin and
Outcomes Mineral Nutrition
Proportion (%) of population with Information System
haemoglobin below 110 g/l Database
Improved HIV and Sexual health AIDS Indicator UNGASS
Health- Percentage of youth with Survey Database
Related comprehensive and correct (DHS)
Knowledge, knowledge about AIDS
Attitude, and Percentage of young people AIDS Indicator UNGASS
Behaviour, aged between 15 to 24 years Survey Database
Skills who have had sex before the (DHS)
Outcomes age of 15
Physical activity
Percentage of students who
were physically active for a total Global School
of at least 60 minutes per day on Health Survey
all 7 days during the last 7 days Country Fact Sheets
Substance abuse Global Youth
Percentage of children aged 12 Tobacco Survey
to 16 years that smoked before
the age of 10
Percentage of youth aged Behaviour
between 15 to 24 years who Surveillance Survey
ever consumed alcohol Report
Violence against children Global School
Percentage of students who Health Survey
were physically attacked one or Country Fact Sheets
more times during the past 12
months
Hygiene Global School
Percentage of students who Health Survey
never or rarely washed their Country Fact Sheets
hands after using the toilet or
latrine during the past 30 days
Mental and psychosocial Global School
health Health Survey
Percentage of students who Country Fact Sheets
seriously considered attempting
suicide during the past 12
months

20
4. DISCUSSION AND CONCLUSIONS
The review found that there is a strong demand for a generic M&E framework for
SHN programmes from 34 out of the 35 key informant offices. A general finding of
the literature review was that there are several resources that could be used to
inform the M&E framework. Eighteen of the 35 key informant offices recommended
that it is very important that the development of the framework is supported and
recognized by different partners, especially national governments and stakeholders
with national SHN policies and systems having an important role in the dissemination
of the M&E framework as well as harmonization of resources used for M&E of SHN.
Formats most preferred for disseminating the framework were a hard copy resource
kit and face-to-face training.
The literature review of logical frameworks found that organizational priorities and
activities varied greatly. Therefore, in order to develop a generic M&E framework, a
common logical framework would be required, on which core indicators and minimum
standards would be based. The common outcomes, and programmatic processes
based on the ‘FRESH core activities’ – identified by key informants and the resource
review would provide a strong basis to gain consensus on a logical framework.
Thirty-three of the 35 key informant offices stated the need for common minimum
standards on SHN programmes. Both key informants and the resource review
identified that in general there were standards and guidelines for SHN programmes,
however these have not been institutionalized as minimum standards and have not
been used uniformly by all organizations. Disparities between standards (e.g.
quantity of water available in schools) need to be addressed in the framework.
Informants felt minimum standards need to be specific enough “to allow monitoring”,
while flexible to provide opportunity for “local adaptation” and contextualization.
Some standards for programmatic processes were common for the different priority
areas (e.g. violence against children and substance abuse). These standards,
especially if mentioned in inter-agency publications and if based on evidence and
operational experience, would need to be included in the generic M&E framework.
Standards that are specific to a priority area would need to be presented with
indicators in specific modules, as mentioned by key informant offices. Some
minimum standards could be met at a particular administrative level. Therefore
guidance on the level that is targeted would need to be provided. This would also
make monitoring easier.
Thirty-two of the 35 key informant offices stated the need for core indicators on
SHN programmes. On reviewing resources provided by key informants, it was found
that the use of the term ‘indicators’ varied between M&E and SHN documents. It is
therefore recommended that the terminology is clarified in the M&E framework. The
review also found that some resources did not define the indicators, and this, as
mentioned by key informants, needs to be addressed in the M&E framework, so that
the measures are ‘SMART’.
Both the resource review and key informants identified that some process and
outcome indicators are already internationally agreed as core indicators or are being
collected by ongoing tools. These indicators are strong candidates for ensuring the
M&E framework for SHN programmes complements and fits within existing structures
(e.g. government systems) for data management, and builds on existing resources.
Existing data on these indicators can be used secondarily for situation analyses prior
to programme planning. This may be followed by primary data collection during the
programme. Data on some indicators are only available in some countries; some of
these may be presented in the framework as “optional indicators”, as suggested by
key informants.
Data for some indicators which are collected and monitored at one administrative
level were also found to be linked to indicators at a higher administrative level.
21
 Discussion and Conclusions

Informants recommended that the framework should try and ensure that indicators
for different administrative levels are “interlinked and complementary”.
A good practice that was identified in some cases was the use of aggregate and
composite indicators, which provide a comprehensive picture of the aspect
measured. These should be used in the framework, in order to “reduce the number of
indicators”. However, it is very important to explain the levels of disaggregation (e.g.
by age and gender) so that the data collected are rich for decision making. Specific
questions which are asked for information on the different aspects of composite
indicators need to be maintained.
Last but not least, informants recommended that the good practice of links between
standards and process indicators identified in the resource review needs to be
evident in the M&E framework.
Based on the information gathered from the review, a pictorial first draft of the
generic M&E framework for SHN programmes is provided in Figure 8. The FRESH
partners are requested to discuss the findings presented in this review in the meeting
to be held at WHO Headquarters, Geneva in September 2008 to develop and
disseminate such an M&E framework.

22
 Discussion and Conclusions

Figure 8. Pictorial example of the generic M&E framework for SHN programmes

LOGICAL FRAMEWORK*

Outcomes Core Indicators

(including information on tools for data on
indicators)

Improved Education Enrolment rate (gross and net, by

gender)
Improved Health and Nutrition

Improved Health-Related Knowledge, Percentage of students who

Attitude, Behaviour Skills never/rarely washed hands after using
the toilet in the past 30 days
Programmatic Outputs and Activities
for Priorities

Minimum standards for the

development and promotion of school-
health related policies
General school health-
related policy indicators
-National level
General module of minimum -Sub-national level
standards -School level

Minimum standards for the provision of

skills-based health education

Minimum standards for the provision of

school-based health services

Minimum standards for the promotion of

a safe & sanitary school environment Water, sanitation and hygiene
indicators
-National and sub-national levels
Number (%) of schools with hand
washing facilities
Water, sanitation and hygiene module
Schools should have hand washing
facilities

Minimum standards for the promotion of

supportive partnerships & participation

* Boxes with italicised text are only examples.

23
5. LIST OF RESOURCES
Key: § Resource contains log frame; † Resource contains standards;
* Resource contains indicators.

Adamchak, S., K. Bond, L. MacLaren, et al. 2000. A Guide to Monitoring and Evaluating
Adolescent Reproductive Health Programs. FOCUS on Young Adults: Tool Series.
Washington, DC: Pathfinder International.
http://www.pathfind.org/site/PageServer?pagename=Pubs_Focus. *
Aldana, S. I., and J. T. Jones. 1999. Preventing HIV/AIDS/STI and Related Discrimination: An
Important Responsibility of Health-Promoting Schools. Information Series on School
Health. Geneva: WHO, UNAIDS, UNESCO.
http://www.who.int/school_youth_health/resources/information_series/en/. †
Aldinger, C. E., and C. Vince-Whitman. Skills for Health. Skills-based health education
including life skills: An important component of a Child-Friendly/Health-Promoting
School. Information Series on School Health. Geneva: WHO, UNICEF, EDC,
Education International, UNESCO, UNFPA, World Bank, PCD.
http://www.who.int/school_youth_health/resources/information_series/en/. † *
Aldinger, C. E., C. Vince-Whitman, and P. Scattergood. Family Life, Reproductive Health, and
Population Education: Key Elements of a Health-Promoting School. Information
Series on School Health. Geneva: WHO, UNICEF, EDC.
http://www.who.int/school_youth_health/resources/information_series/en/.
Aldinger, C. E., and J. T. Jones. 1998. Healthy Nutrition: An Essential Element of a Health-
Promoting School. Information Series on School Health. WHO, FAO, Education
International.
http://www.who.int/school_youth_health/resources/information_series/en/. *
Attig, G., and J. Hopkins. 2006. Assessing Child-Friendly Schools: A Guide for Programme
Managers in East Asia and the Pacific. Thailand: UNICEF.
http://www.unicef.org/eapro/Assessing_CFS.pdf.
Awartani, M., C. Vince-Whitman, and J. Gordon. 2007. The Voice of Children: Student Well-
Being and the School Environment. Ramallah, Palestine: Universal Education
Foundation. http://www.uef-eba.org/documents/VoC Middle East Pilot_Preliminary
Survey Results_Full Report.pdf.
Bergeron, G., and J. Miller Del Rosso. 2001. Food for Education Indicator Guide. Washington,
DC: AED. http://www.pronutrition.org/files/Food for Education Indicators
Measurement Guide.pdf. *
Birdthistle, I. 1999. Improving Health Through Schools: National and International Strategies.
Information Series on School Health. WHO.
http://www.who.int/school_youth_health/resources/information_series/en/. †
Birdthistle, I., E. De Vos, C. Lang, et al. 1999. Violence Prevention: An Important Element of a
Health-Promoting School. Information Series on School Health. Geneva: WHO,
UNESCO, Education International.
http://www.who.int/school_youth_health/resources/information_series/en/. *
Bundy, D. 2001. School Health at a Glance. World Bank. *
Bundy, D., A. Tembon, A. Valerio, et al. 2003. The HIV/AIDS Response by the Education
Sector: A Checklist. UNAIDS Interagency Task Team for Education.
http://www.schoolsandhealth.org/documents/hivaids%20response%20by%20the%20
education%20sector%20-%20a%20checklist.doc. †
Burnett, N., N. Bella, A. Benavot, and M. Buonomo. 2007. EFA Global Monitoring Report.
France: UNESCO.

24
 List of Resources

http://unesdoc.unesco.org/images/0015/001547/154743e.pdf. † *
Cameron, L. 2004. Indicator Handbook for Primary Education: Abridged. USAID.
http://www.epdc.org/static/MissionHandbookV1_FINAL.pdf. *
Catholic Relief Services. CRS School Health Education Program. (unpublished) § *
Cavicchioni, V., R. Cusso, R. Safadi, W. Renkema, and G. Nascimento. Gender-Sensitive
Education Statistics and Indicators: A practical guide. UNESCO. *
CDC. 2005. The Handbook for Evaluating HIV Education.
http://www.cdc.gov/HealthyYouth/publications/hiv_handbook/index.htm.
Clarke, N., J. Jones, P. Smith, M. Aregawi, and C. Delacollette. 2007. Malaria Prevention and
Control: An important responsibility of a Health-Promoting School. Information Series
on School Health. WHO.
http://www.who.int/school_youth_health/resources/information_series/en/. † *
Clarke, S. E., M. C. H. Jukes, J. K. Njagi, et al. 2008. Effect of intermittent preventive
treatment of malaria on health and education in schoolchildren: a cluster-randomised,
double-blind, placebo-controlled trial. Lancet 372, no. 9633 (July 12): 127-138. *
Cogill, B. 2003. Anthropometric Indicators Measurement Guide. Washington, DC: AED.
http://www.fantaproject.org/downloads/pdfs/anthro_2003.pdf. *
Cohen, S. 1996. Research to Improve Implementation and Effectiveness of School Health
Programmes. Geneva: WHO. † *
Crompton, D. W. T. 2006. Preventive chemotherapy in human helminthiasis. France: WHO.
http://whqlibdoc.who.int/publications/2006/9241547103_eng.pdf. † *
Crouch, L., M. Enache, and P. Supanc. 1999. Education Management Information Systems:
Guidelines and References for Putting Information Systems to Work in Education.
World Bank.
van den Cruijsem, M., L. Peters, G. Buijs, and J. T. Jones. 1998. Tobacco Use Prevention: An
Important Entry Point for the Development of Health-Promoting Schools. Information
Series on School Health. Geneva: WHO, UNESCO, Education International.
http://www.who.int/school_youth_health/resources/information_series/en/. †
Department of Educational Planning and Training (DEPT), Myanmar. SHAPE Trial Toolkit.
(unpublished) †
Department of Mental Health, Thai Ministry of Public Health. 2005. Teacher Manual: Student
Care and Support System.
http://www.dgroups.org/groups/LSNet/docs/Counseling_Teacher_Manual.pdf?ois=no.
†
Drake, L., and A. Patrikios. 2006. Global School Health Policy Checklist. London: Partnership
for Child Development.
http://www.schoolsandhealth.org/documents/global%20school%20health%20policy%
20checklist.doc.
EDC. EFAIDS Logframe. (unpublished) § *
EFA Fast Track Initiative. 2004. Education for All- Fast Track Initiative: Accelerating progress
towards quality universal primary education.
http://www.efafasttrack.org/library/FrameworkNOV04.pdf. § *
---. 2006. Guidelines for Appraisal of the Primary Education Component of an Education
Sector Plan.
http://www.efafasttrack.org/library/Appraisal_guidelines_March_2006.pdf. *
Family Health International. 2007. Global Database Bulletin.
http://www.fhi.org/NR/rdonlyres/e2eh7c6dsxmjncqeynkcvqulmmphkrmgucxnup7ad6m
44juk5hjytlfnjmiyefsfnuxtlbihaaqomj/GlobalDatabaseBulletinHV.pdf.
Fountain, S., and A. Gillespie. 2003. Assessment Strategies for Skills-based Health Education
25
 List of Resources

with a focus on HIV prevention and related issues. New York: UNICEF Education
Section. http://www.ibe.unesco.org/uploads/media/HIV_AIDS_186_03.pdf.
Furniss, E. Assessing Learning Achievement. New York: UNICEF.
http://www.unicef.org/lifeskills/files/AssessingLearningAchievement.doc.
Gelli, A. 2006. Food for Education Works: A review of WFP FFE programme monitoring and
evaluation 2002-2006. WFP. *
Goodman, D., H. van Norden, M. Snel, and K. Shordt. 2005. Water, Sanitation and Hygiene
Education for Schools: Roundtable Meeting. UNICEF, IRC.
http://esa.un.org/iys/docs/san_lib_docs/SSHE_OxfordRoundTable.pdf.
Government of Brazil, Government of Finland, Food Safety Authority Ireland, UNICEF, WFP,
United Nations Standing Committee on Nutrition (SCN), FAO, UNESCO, WHO, World
Bank, Education Development Center (EDC), PCD, Save the Children USA,
University of Teesside, United Kingdom. 2007. Nutrition Friendly Schools Initiative. †
Gyorkos, T. W. 2003. Monitoring and evaluation of large scale helminth control programmes.
Acta Tropica 86: 275-282. *
Haffner, D. W., and W. L. Yarber. 2000. Developing Guidelines for Comprehensive Sexuality
Education. New York: Developing Guidelines for Comprehensive Sexuality Education
. http://www.siecus.org/pubs/guidelines/guideintl.pdf.
Harper, S., E. Rehfuess, and J. Jones. 2002. Sun Protection: An Essential Element of Health-
Promoting Schools. Information Series on School Health. Geneva: WHO, UNESCO.
http://www.who.int/school_youth_health/resources/information_series/en/. †
Harris, R., S. Miske, and G. Attig. 2004. Embracing Diversity: Toolkit for Creating Inclusive,
Learning-Friendly Environments. UNESCO Bangkok.
http://eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED496
229. †
van Hooff, I., T. V. Luong, and E. Bolt. 1998. Towards Better Programming: A Manual on
School Sanitation and Hygiene. Water, Environment and Sanitation Technical
Guidelines Series. UNICEF, IRC International Water and Sanitation Centre.
http://www.unicef.org/wes/files/Sch_e.pdf. †
INEE. 2004. Minimum Standards for Education in Emergencies, Chronic Crises and Early
Reconstruction. http://www.ineesite.org/standards/MSEE_report.pdf. †
Inter-Agency Standing Committee. Education Action Sheet. (unpublished) †
Inter-Agency Standing Committee. Education Indicators (HIV and Education in Emergencies).
(unpublished) *
International Planned Parenthood Federation. 2006. IPPF Framework for Comprehensive
Sexuality Education. London. http://www.ippf.org/NR/rdonlyres/CE7711F7-C0F0-
4AF5-A2D5-1E1876C24928/0/Sexuality.pdf. †
IRC International Water and Sanitation Centre. 2007. Towards Effective Programming for
WASH in Schools: A manual on scaling up programmes for water, sanitation and
hygiene in schools. Technical Paper Series. Delft, The Netherlands.
http://www.irc.nl/redir/content/download/128071/348559/file/TP%2048%20WASH%20
Schools_07.pdf. †
---. 2008. Monitoring and evaluation - WASH in Schools. WASH in Schools.
http://www.schools.watsan.net/page/231. †
Ives, R., G. Campello, G. Babbar, M. Nkowane, and S. Saxena. 2006. Monitoring and
Evaluating Youth Substance Abuse Prevention Programmes. Vienna: UNODC, WHO.
http://www.unodc.org/pdf/youthnet/action/planning/m&e_E.pdf. *
Jones, J. T., and M. Furner. 1998. Health-Promoting Schools: A healthy setting for living,
learning, and working. Information Series on School Health. Geneva: WHO.
http://www.who.int/school_youth_health/resources/information_series/en/. †
Jukes, M. C. H. Malaria Project Concentration Tests (unpublished)
26
 List of Resources

Komrower, J., and B. Andrew. Monitoring and Evaluation Tools for the Health Component:
The MEMA kwa Vijana (phase 2) Experience. MEMA kwa Vijana. (unpublished)
Kwan, S., and P. E. Petersen. 2003. Oral Health Promotion: An Essential Element of a
Health-Promoting School. Information Series on School Health. Geneva: WHO,
UNESCO, EDC.
http://www.who.int/school_youth_health/resources/information_series/en/.
Lansdown, G. 2007. A Human Rights-Based Approach to Education for All: A framework for
the realization of children's right to education and rights within education. UNESCO,
UNICEF.
http://unesdoc.unesco.org/images/0015/001548/154861E.pdf. †
MEASURE DHS. Demographic and Health Surveys. http://www.measuredhs.com/. *
Meusel, D., C. Höger, C. Pérez-Rodrigo, et al. 2006. Global Strategy on Diet, Physical Activity
and Health: A framework to monitor and evaluate implementation. Geneva: WHO.
http://www.who.int/dietphysicalactivity/Indicators English.pdf. *
Miedema, E. 2007. A curriculum response to HIV/AIDS. UNESCO, IIEP, ESART.
http://prof.estat.com/cgi-
in/ft/233033148987?class=IIEP_PDF_pubs&page=HIVMod4_1&estat_url=http://www.
unesco.org/iiep/eng/focus/hiv/PDF/4_1.pdf. †
Ministries of Education and Health of the Government of Eritrea and the Partnership for Child
Development. School Based Health and Nutrition Services: A Manual. (unpublished) *
Ministry of Education and Sports, Uganda. 2007. Uganda Education and Sports Sector
Annual Performance Report (ESSAPR).
http://www.education.go.ug/Review_TOR1.htm. *
Ministry of Education, Guyana. Education Sector School, Health, Nutrition and HIV&AIDS
Strategic Plan 2008-2012. (unpublished) § *
Ministry of Education, Nigeria. Indicators for Education Sector Response to HIV&AIDS.
(unpublished) *
Ministry of Public Health and Sanitation and Ministry of Education. 2008. Kenya National
School Health Policy. Republic of Kenya. †
Monasch, R., K. Spring, and M. Mahy. 2005. Guide to Monitoring and Evaluation of the
National Response for Children Orphaned and Made Vulnerable by HIV/AIDS. New
York: UNICEF, UNAIDS, USAID, MEASURE DHS, FHI, World Bank, Save the
Children, Alliance.
http://www.aidsalliance.org/graphics/OVC/documents/0000300e00.pdf. † *
Montresor, A., D. W. T. Crompton, T.W. Gyorkos, and L. Savioli. 2002. Helminth control in
school-age children: A guide for managers of control programmes. Geneva: WHO.
http://www.who.int/wormcontrol/documents/helminth_control/en/index.html. † *
Montresor, A., D. W. T. Crompton, A. Hall, D. A. P. Bundy, and L. Savioli. 1998. Guidelines
for the Evaluation of Soil-Transmitted Helminthiasis and Schistosomiasis at
Community Level. WHO, PCD, World Bank, UNICEF.
http://www.who.int/wormcontrol/documents/publications/en/98_1.pdf. † *
Montresor, A., T. W. Gyorkos, D. W. T. Crompton, D. A. P. Bundy, and L. Savioli. 1999.
Monitoring Helminth Control Programmes: Guidelines for monitoring the impact of
control programmes aimed at reducing morbidity caused by soil-transmitted helminths
and schistosomes, with particular reference to school-age children. WHO, McGill
University, University of Glasgow, World Bank.
http://whqlibdoc.who.int/hq/1999/WHO_CDS_CPC_SIP_99.3.pdf. *
Ndanyi, M., and D. Mutahi. 2004. National Worm Control in School-Age Children: Guide for
District Level Managers. Ministry of Education, Science and Technology and Ministry
of Health, Republic of Kenya.

27
 List of Resources

http://portal.unesco.org/education/en/files/37451/11030404223Guide_district_level.pd
f/Guide_district_level.pdf. † *
Nepal. 2005. National School Health and Nutrition Strategy. (unpublished) § †
Northrop, D., C. Lang, and C. Vince-Whitman. Local Action: Creating Health Promoting
Schools. Information Series on School Health. WHO, UNESCO, EDC.
http://www.who.int/school_youth_health/resources/information_series/en/. †
PAHO. 2002. Health Promoting Schools, Questionnaires for Networks and Schools.
http://www.paho.org/.
Partnership for Child Development. 1999. School Health Programmes in Ghana and
Tanzania.
---. 2001. How to treat schoolchildren with urinary schistosomiasis and intestinal helminth
infection through a school-based health programme. (unpublished)
Peppler Barry, U. 2000. The Dakar Framework for Action. Education for All: Meeting our
Collective Commitments. France: UNESCO.
http://www.unesdoc.unesco.org/images/0012/001211/121147e.pdf. †
Periasamy, A. Management and monitoring of SSHE in Tamil Nadu, India. UNICEF India.
Pevzner, E. 2005. Teachers Confronting the HIV Epidemic: Skills for Teaching and Survival.
University of North Carolina at Chapel Hill.
http://www.hhd.org/documents/EIProject-Evalu.pdf.
Pigozzi, M. J., and M. Kamara. 2005. Inter-Agency Peace Education Programme: Skills for
Constructive Living. France: UNHCR, UNESCO, INEE.
http://ineesite.org/uploads/documents/store/doc_1_Overview_of_the_Programme.pdf.
†*
Pisani, E., T. Boerma, B. Schwartländer, et al. 2000. National AIDS Programmes: A Guide to
Monitoring and Evaluation. Geneva: WHO, UNICEF, World Bank, European
Commission, USAID, Policy Project, Synergy Project, MEASURE Evaluation, Impact,
MEASURE DHS+, CDC.
http://www.who.int/entity/hiv/pub/epidemiology/en/JC427-Mon_Ev-Full_en.pdf. *
Postma, L., R. Getkate, and C. van Wijk. 2004. Life Skills-Based Hygiene Education: A
guidance document on concepts, development and experiences with life skills-based
hygiene education in school sanitation and hygiene education programmes.
Technical Paper Series. Delft, The Netherlands: IRC International Water and
Sanitation Centre.
http://www.irc.nl/content/download/11504/168690/file/life_skills.pdf.
Ramage, A. K.. 2007. SHN Knowledge, Attitudes, and Practice Indicators and Questions.
Save the Children USA. (unpublished) *
Rimer, W., D. Llewellyn, and S. Anderson. Toolkit for Assessing and Promoting Equity in the
Classroom. Washington, DC: Creative Associates International.
http://www.unicef.org/lifeskills/files/AssessingEquity-EIC_Toolkit.pdf.
Roschnik, N. 2008. Monitoring School Health and Nutrition programs: Guidelines for program
managers. Save the Children USA. † *
Saitoti, G., B. Mugo, and K. Mwiria. 2005. Kenya Education Sector Support Programme 2005-
2010. Ministry of Education, Science and Technology, Republic of Kenya.
http://www.education.nairobi-unesco.org/. § *
Samkrange, S., and S. Wickrema. 2005. Strategic Plan 2006-2009. WFP.
http://www.wfp.org/eb/docs/2005/wfp050757~2.pdf. § *
Save the Children. 2007. CASP: The Common Approach to Sponsorship-Funded
Programming. † *
Senderowitz, J., and D. Kirby. 2006. Standards for Curriculum-Based Reproductive Health
and HIV Education Programs. Arlington, VA: Family Health International, USAID,

28
 List of Resources

YouthNet.
http://www.fhi.org/NR/rdonlyres/ea6ev5ygicx2nukyntbvjui35yk55wi5lwnnwkgko3touyp
3a33aiczutoyb6zhxcnwiyoc37uxyxg/sexedstandards.pdf. †
Skevington, S., and M. Puitandy. 2003. Creating an Environment for Emotional and Social
Well-Being: An important responsibility of a Health-Promoting and Child Friendly
School. Information Series on School Health. Geneva: WHO, UNICEF, EDC,
UNESCO, World Bank, Education International, PCD.
http://www.who.int/school_youth_health/resources/information_series/en/. †
St. Leger, L.. Protocols and Guidelines for Health Promoting Schools. International Union for
Health Promotion and Education.
http://www.vhetta.com.au/downloads/PG_HPS_v11.pdf. †
UNAIDS, WHO. Global HIV/AIDS Online Database.
http://www.who.int/globalatlas/default.asp.
UNAIDS, WHO, UNICEF, UNFPA, USAID, UNESCO, World Bank, MEASURE DHS, FHI.
2004. National AIDS Programmes: A guide to indicators for monitoring and evaluating
national HIV/AIDS prevention programmes for young people. France: WHO.
http://data.unaids.org/Publications/IRC-pub06/JC949-NAP-YoungPeople_en.pdf. *
UNESCO Institute for Statistics. Education Indicators: Technical Guidelines.
http://www.uis.unesco.org/file_download.php?URL_ID=5202&filename=10526426091
UIS_education_indicator_definitions_EN.pdf&filetype=application%2Fpdf&filesize=13
9152&name=UIS_education_indicator_definitions_EN.pdf&locatio=user-S/. *
UNESCO, UNICEF, World Bank, WHO, FAO, WFP, UNAIDS, Roll Back Malaria, UNODC,
Education International, EDC, PCD, Child-to-Child, IRC. FRESH School Health Tool
Kit. UNESCO. http://www.unesco.org/education/fresh/. †
UNICEF. Indicators for Global Reporting. Multiple Indicator Cluster Survey.
http://www.childinfo.org/files/MDG_MICS3Appendix1_Indicators_for_GlobalReporting
.pdf. *
---. Life skills: Child friendly schools. http://www.unicef.org/lifeskills/index_7260.html. †
---. Life Skills-based Education for Drug Use Prevention: Training Manual.
http://www.unicef.org/lifeskills/files/DrugUsePreventionTrainingManual.pdf.
---. The Learning Plus Index. (unpublished) †
---. 2002. Program Evaluation: Life skills-based education. Measures and Indicators.
http://www.unicef.org/lifeskills/files/MeasuresAndIndicatorsLifeSkills.doc. *
---. 2006. UNICEF water, sanitation and hygiene strategies for 2006-2015.
http://www.unicef.org/about/execboard/files/06-6_WASH_final_ODS.pdf.
---. 2008. Life Skills-Based Education: Concepts and Standards. †
United Nations Development Group. 2003. Indicators for Monitoring the Millennium
Development Goals: Definitions, Rationale, Concepts, and Sources. New York:
United Nations.
http://www.mdgs.un.org/unsd/mdg/Resources/Attach/Indicators/HandbookEnglish.pdf
*
UNODC. 2003. School-based Drug Education: A guide for practitioners and the wider
community. http://www.unicef.org/lifeskills/files/School-basedDrugEducation03.doc. †
---. 2004. School-based education for drug abuse prevention. New York: United Nations.
http://www.unodc.org/pdf/youthnet/handbook_school_english.pdf. †
---. 2007. Annual Reports Questionnaire (ARQ) for 2007.
http://www.unodc.org/unodc/en/commissions/CND/10-GlobalData.html.
USAID, UNAIDS, UNICEF, WHO, CDC, US Census Bureau, MEASURE DHS. HIV/AIDS
29
 List of Resources

Survey Indicators Database. http://www.measuredhs.com/hivdata/ind_tbl.cfm. *

Vince-Whitman, C., S. Pulizzi, P. Scattergood, et al. Rapid Assessment and Action Planning
Process (RAAPP): A Method and Tools to Enable Ministries of Education and Health
to Assess and Strengthen their Core Elements of Capacity to Promote Health
Through Schools. EDC, WHO.
http://www.who.int/school_youth_health/media/en/454.pdf. †
Wargo, J. The Physical School Environment: An Essential Component of a Health-Promoting
School. Information Series on School Health. Geneva: WHO, UNESCO, UNICEF,
EDC, World Bank, PCD, Education International.
http://www.who.int/school_youth_health/resources/information_series/en/.
Warner-Smith, M., D. Rugg, and P. De Lay. 2007. Monitoring the Declaration of Commitment
on HIV/AIDS: Guidelines on Construction of Core Indicators. Geneva: UNAIDS.
http://data.unaids.org/pub/Manual/2007/20070411_ungass_core_indicators_manual_
en.pdf. *
WFP. Standardised School Feeding Survey. School Feeding.
http://www.wfp.org/food_aid/school_feeding/WFPInAction_monitoring_baseline.asp?s
ection=12&sub_section=3. *
---. 2000. School Feeding Handbook. † *
---. 2005. Indicator Compendium. *
WFP, UNICEF. The Essential Package: Twelve interventions to improve the health and
nutrition of school-age children.
http://www.schoolsandhealth.org/sites/ffe/Key%20Information/The%20Essential%20P
ackage.pdf. †
WHO. Global Databank on schistosomiasis and soil-transmitted helminths.
http://www.who.int/wormcontrol/databank/en/. *
---. Global school-based student health survey. http://www.who.int/chp/gshs/en/. *
---. STEPwise approach to surveillance. http://www.who.int/chp/steps/en/. *
---. Vitamin and Mineral Nutrition Information System. World Health Organization.
http://www.who.int/vmnis/en/. *
---. WHO Global InfoBase. http://www.who.int/infobase/report.aspx. *
---. 1997. Strengthening Interventions to Reduce Helminth Infections: As an Entry Point for
the Development of Health-Promoting Schools. Information Series on School Health.
Geneva. http://www.who.int/school_youth_health/resources/information_series/en/. †
---. 2008. WHO Statistical Information System. http://www.who.int/whosis/en/. *
WHO Regional Office for the Western Pacific. 1996. Regional guidelines: Development of
health-promoting schools- A framework for action. Health-Promoting Schools Series.
WHO. †
WHO, CDC. Global School Personnel Survey. http://www.who.int/tobacco/surveillance/en/.
---. Global Youth Tobacco Survey. http://www.who.int/tobacco/surveillance/gyts/en/index.html.
*
---. 2004. Global Health Professional Survey.
http://www.who.int/tobacco/surveillance/ghps/en/index.html.
WHO, Education International, UNESCO, UNICEF, World Bank, EDC. 2004. Teachers'
Exercise Book for HIV Prevention. Information Series on School Health. Geneva.
http://www.who.int/school_youth_health/resources/information_series/en/.
World Bank. Ed Stats. http://www.go.worldbank.org/47P3PLE940. *
---. 2005. Toolkit on Hygiene Sanitation & Water in Schools.
http://www.schoolsanitation.org/index.html. † *
30
 List of Resources

World Health Assembly. 2001. Schistosomiasis and soil-transmitted helminth infections.

http://www.who.int/wormcontrol/about_us/en/ea54r19.pdf. †
Zomerplaag, J., and A. Mooijman. 2005. Child-Friendly Hygiene and Sanitation Facilities in
Schools: Indispensable to effective hygiene education. Delft, The Netherlands: IRC
International Water and Sanitation Centre.
http://www.irc.nl/content/download/10474/154194/file/TP44_Child_Friendly.pdf. †

31
6. LIST OF REFERENCES
1. Bundy D. A. P. et al. (2006). Chapter 58. Disease control priorities in developing
countries. Second edition. World Bank: Washington D.C.
2. PCD (2007). Directory of support to school-based health and nutrition
programmes. PCD: London.
http://www.schoolsandhealth.org/Documents/Directory%20of%20Support%20
to%20School-Based%20Health%20and%20Nutrition%20Programmes.pdf
3. WHO (2007). First regional conference on health promoting schools in the Eastern
Mediterranean region. WHO: Geneva.
4. WHO (2002). Helminth control in school-age children. WHO: Geneva.
5. http://www.unsystem.org/SCN/Publications/html/task_forces.htm
6. http://portal.unesco.org/en/ev.php-URL_ID=41892&URL_ DO=DO_TOPIC&URL_
SECTION=201.html
7. http://www.schoolsandhealth.org/Pages/MinistryofEducationHIVAIDSNetworks
.aspx
8. UNDP (2002). Handbook on monitoring and evaluating for results. UNDP: New
York.

7. LIST OF ANNEXES
Annex A: List of priority areas for SHN programmes

Priority areas
Education
HIV
Malaria
Water, sanitation and hygiene
Worms
Nutrition
Sexual health
Violence against children
Substance abuse (tobacco, alcohol and drugs)
Physical activity
Mental and psychosocial health
Life skills
First aid
Vision, hearing, dental and skin

32
 List of Annexes

Annex B: List of key open-ended questions to key informants

Q1. Are you/your organization involved in school-based interventions to improve children's
health, nutrition and ability to learn?

Q2. Do you have a log-frame (logical framework) for your school-based health and nutrition
activities? If Yes, kindly share a copy of the latest log-frame or goals, objectives, expected
outputs of the programme.

Q3. Are you aware of any minimum standards for school-based programmes in general, OR for
elements of these programmes? (e.g. deworming, HIV prevention, life skills education, etc).

Q4. Are you aware of any reference documents that might contain minimum standards for
school health programmes? If Yes, please provide the names.

Q5. Do you think there is a need for common minimum standards for school health programmes
that one can refer to, and adapt to their context? Why/why not? What might be some of the
important considerations for the development of common minimum standards for school health
programmes?

Q6. Do you have a set of indicators for your school health programmes (e.g. deworming,
nutrition, HIV and malaria prevention) which you use to measure:
a) the impact on children; OR
b) whether the programme was implemented as planned.
If Yes, please provide a list of the indicators.

Q7. Are you aware of indicator guides/publications specific to school health programmes? If
Yes, please provide the names of the references.

Q8. Do you think there is a need for a common set of core indicators for school health
programmes? Why/why not? At what level would such core indicators be useful? What other
important considerations are required for their development?

Q9. From where do you get data to monitor and evaluate your school health programmes (e.g.
on nutrition, deworming, and HIV prevention)? Is there an existing system for school health data
collection? Please explain.

Q10. Is there a standardized database within your organization for storing and accessing the
data?

Q11. Is the data entered in to any other database system? e.g. EMIS or a HMIS?

Q12. Do you have any data collection and analysis tools/guidelines for your school health
programmes?

Q13. Is there a standard reporting system in your organization that school health programmes
follow?

Q14. What are the main challenges which you face during the monitoring and evaluation of your
school-based health interventions? Or (if not linked to a specific programme) what are the main
challenges or barriers to effective M&E of school-based health, nutrition and HIV prevention?

Q15. Do you have successes or good practices relating to monitoring and evaluation of your
school-based health interventions, which you could share with us?

Q16. Do you have any other suggestions or comments on improving the monitoring and
evaluation of interventions on school health programmes?

33
 List of Annexes

Annex C: Details of key informants and their offices/organizations

Catholic Relief Services 9. Partnership for Child Development

1. Monitoring and Evaluation Alice Woolnough, Programme Manager
Richard Yakubu, Monitoring and Anthi Patrikios, Operations Manager
Evaluation Manager
10. Schistosomiasis Control Initiative
Elisa Bosqué-Oliva, West Africa Regional
Child-to-Child Trust Programme Manager
2. Child-to-Child Trust Fiona Fleming, Country Programme
Manager
Tashmin Khamis, Director

IRC International Water and

Department of State for Education,
Sanitation Centre
The Gambia
11. IRC International Water and Sanitation
3. HIV/AIDS Unit
Centre
Amicoleh Mbaye, Sub-Saharan Africa
Mariëlle Snel, Programme Officer
Focal Point

Lifeskills Development Foundation,

Deworm the World
Thailand
4. Deworm the World
12. Lifeskills Development Foundation,
Lesley Drake, Executive Director Thailand
Kreankrai Chaimuangdee, Director
Education Development Center
5. Health and Human Development MEMA kwa Vijana
Carmen Aldinger, Project Director 13. Clinical Research Group
Jenny Renju, Research Fellow
Education International
6. Education International Ministry of Education, Cameroon
Gaston de la Haye, Senior Consultant 14. SHN & HIV Unit
Désiré Aroga, Focal Point for
HIV/Education and Coordinator of Network
Fondation de Dévelopement
of Focal Points for Central Africa
Communautaire, Burkina Faso
7. School Health and Nutrition
Ministry of Education/Ministry of
Moussa Kabore, Monitoring and
Health, Guinea
Evaluation Manager
15. SHN & HIV Unit
Camara Balla, Focal Point for
Imperial College, London
HIV/Education and Coordinator of National
8. Division of Epidemiology, Public Health SHN Program
and Primary Care
Edwin Michael, Senior Lecturer
Ministry of Education, Guyana
16. SHN & HIV Unit
Sharlene Johnson, HIV&AIDS Focal Point
34
 List of Annexes

Ministry of Education, Nigeria UNODC

17. HIV&AIDS Unit 26. Prevention, Treatment & Rehabilitation
Unit
Z Momodu, HIV&AIDS Focal Point
Giovanna Campello, Programme Officer

Save the Children USA

World Bank
18. Office of Health, Development
Programs for Children 27. School Health and Nutrition
Dan Abbott, SHN Specialist Don Bundy, Lead SHN Specialist
19. Philippines Country Office
Amado Parawan, Child Health & Nutrition World Food Programme
Specialist
28. World Food Programme, Headquarters
Rebecca Lamade, Monitoring and
Thai Red Cross Evaluation Programme Officer
20. AIDS Research Centre 29. World Food Programme, Kenya
Greg Carl, Officer for Psychosocial Grace Igweta, Monitoring and Evaluation
Development Programme Officer
30. World Food Programme, Nepal
UNESCO Kishor Aryal, Programme Officer
21. Division for UN Priorities in Education 31. World Food Programme, Uganda
Section/HIV
Joviah Musinguzi, Food for Education
Ekua Yankah, Programme Specialist in Programme Assistant
HIV and Focal Person for School Health

World Health Organization

UNICEF
32. Department of Chronic Diseases and
22. Secretariat of SG’s Study on Violence Health Promotion
Against Children
K.C. Tang, Senior Professional Officer
Amaya Gillespie, Director
Leanne Riley, Team Leader for Global
23. Education Section (PD) School Health Survey
Anna Maria Hoffmann, Education 33. Department of Neglected Tropical
Specialist, HIV/AIDS and Life Skills Diseases
Education
Mbabazi Pamela Sabine, Medical Officer
24. Water & Environmental Sanitation and Epidemiologist
Therese Dooley, Senior Advisor for 34. Malaria, Vector Control and Other
Hygiene & Sanitation Parasitic Diseases
Antonio Montresor, Public Health
Specialist
University of Ottawa
35. Pan American Health Organization
25. School of Psychology
Sofialetecia Morales, School Health and
Elizabeth Kristjansson, Associate
MDG Focal Point
Professor

35
 List of Annexes

Annex D: Profile of offices represented

5 5

Government
INGO/NGO
United Nations
14 11 Academic Institute

Office Profile Administrative Level Represented

National International
Government 5 N/A
INGO/NGO 6 5
United Nations 4 10
Academic Institute 2 3
Total 17 18

36