Pre dissemination meeting report

SCHOOL HEALTH AND NUTRITION SITUATION ANALYSIS IN PUNJAB AND BARRIERS TO INSTITUTIONALISATION OF SCHOOL HEALTH PROGRAMME

PRE-DISSEMINATION CONSULTATIVE MEETING REPORT

Nur Center for Research and Policy, Endowed by Nur Foundation

NUR CENTER FOR RESEARCH AND POLICY

PROVINCIAL PRE-DISSEMINATION CONSULTATIVE MEETING A PROJECT FUNDED BY DFID-ILM IDEAS NCRP- Ilm Ideas Project Office November, 2014

PROVINCIAL PRE-DISSEMINATION CONSULTATIVE MEETING- PUNJAB

CONTENTS

Introduction ..................................................................................................................... 2 Objective of provincial inception and orientation meeting ......................................................... 2

Participant Profile ............................................................................................................ 3 Meeting Methodology ...................................................................................................... 3 Proceedings .............................................................................................................................. 3 Discussion ................................................................................................................................ 3 Recommendations.................................................................................................................... 6 Closing ..................................................................................................................................... 7 Annex 1- Participant List ............................................................................................................................. A Annex 2- Meeting Agenda .......................................................................................................................... E Annex 3- Meeting Presentation ................................................................................................................. F Annex 4- Pictures from the Provincial Pre-dissemination Consultative Meeting .......................................H Annex 5- Newspaper Clippings ……………………………………………………………………………………………………………….I

INTRODUCTION Nur Center for Research & Policy (NCRP), endowed by Nur Foundation, is a policy think tank that offers research, policy advice, technical assistance and capacity enhancement across the health, education and social sectors through a consortium of consultants and public health experts. NCRP is currently implementing a Voice and Advocacy Fund Project, awarded by Ilm Ideas (a DFID funded project). The evidence generated through research activities is expected to identify gaps and make a compelling case for strengthening the existing School Health Program in Punjab. The project hereby has policy implications and is fortunately being undertaken at an opportune time when the Government of Punjab is working on fine-tuning the School Health Program while looking at multiple facets of health, nutrition, education and interlinking these facets through a multi-sectoral approach.

The Provincial Pre-dissemination Consultative Meeting is a part of project titled ‘Evidence Generation and Advocacy for Institutionalization of School Health Program in the Punjab Province ‘, funded by the Ilm Ideas (a DFID funded project). The technical assistance for the project is being provided by the Principal Investigator and the technical experts in Statistics, Qualitative Research and Monitoring and Evaluation. The project further has support of an entire panel of health and education experts on board of Nur Center for Research and Policy and Fatima Memorial Hospital.

OBJECTIVE OF PROVINCIAL INCEPTION AND ORIENTATION MEETING i.

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To share the findings of the research study with the participants

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ii.

To gather recommendations to strengthen the Punjab Health and Education strategies for addressing school environment issues and challenges confronted by the running School Health Programme To gather recommendations to advocate the institutionalization of the School Health Programme in place

iii.

PARTICIPANT PROFILE Participants included senior health professionals, academicians, health and education consultants, public health experts, UNICEF, MNCH, PSPU, other Provincial Program representatives, policymakers, activists, healthcare workers, and senior level staff of local, national, regional and international NGOs and CSOs working for health and education. For more information, please refer to Annex 1.

MEETING METHODOLOGY 

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Power Point Presentation on the grantee i.e. Nur Center for Research and Policy, project background, the research problem, qualitative and quantitative data collection framework, methodology and process, and NCRP’s experiences from the field. The presentation lasted between 15-20 minutes Power Point Presentation to disseminate the findings of the research study and share the recommendations proposed by the Principal Investigator Discussion during which participants discussed the role of various stakeholders in the School Health Programme and research finding and gave recommendations for effective institutionalization of the School Health Programme

PROCEEDINGS The meeting was chaired by Mrs. Shahima Rehman, President, Nur Foundation. The meeting commenced with the recitation of Holy Quran. Dr. Haroon Ihsan, Chief Executive Officer, Nur Foundation, gave the welcome note. This was followed by an introduction to the organization and the project itself by the Project Director, Dr. Roomi Aziz.

The meeting proceedings comprised of presentations and a concluding group discussion. Please find the agenda in Annex 2 and meeting presentations in Annex 3.

The project goals, geographical scope, sampling criteria, rationale, data collection methodology and framework, and findings were shared with the participants.

DISCUSSION On the basis of the evidence generated through quantitative data collection from students, findings were discussed in the meeting, followed by recommendations:-

Mr. Muhammad Muzammil, Research Officer, Democratic Commission for Human Development, highlighted the funding limitation issue and mentioned the need to relax the load of Nutrition Supervisor as they are overburdened. He added that this burden can be shifted to school teachers, but not entirely as they

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are already assigned responsibilities other than teaching. He suggested that a specific programme and team should be hired for this purpose.

Mr. Saleem Khizar, Pakistan Poverty Alleviation Fund, identified education and health department as major stakeholders for the School Health Programme and stressed upon the need to undertake steps to minimize the communication gap between the two departments. He stated that screening school children is not a problem, referring and treatment is. He further added that the SH&NS are overburdened and hence unable to perform their duties efficiently. More SH&NS should be hired to resolved this issue. Instead of shifting the burden to school teachers, communities and school councils should be tapped into and mobilized.

Mr. Safyan Jabbar from Pakistan Coalition of Education highlighted lack of awareness amongst parents as the major issue in children’s health. However, he suggested that this issue of lack of awareness can be solved by mobilizing the School Management Council (SMC)/ School Council (SC), as they not only help improve school facilities but generate funds for schools as well. Furthermore, a few health-related topics should be added to the already existing teacher’s curriculum, apart from revising it to equip them to act as source of information. Different organisations who are already working in different schools to improve their facilities should be tapped.

UNICEF has already incorporated this in the multi-sectoral nutrition policy draft.

Mr. Iftikhar Mubashir, Advocacy and Policy Manager, Plan International, expressed his concerns regarding using Zakat money for improving health status of school children as most people might hesitate taking Zakat, even for generalized purposes. Furthermore, he shared that Inter-departmental coordination has never yielded much fruitful results. In order to ensure results, one has to make sure that there is sufficient legislative backing. He strongly stressed upon third party evaluation of the SHP to make it more effective.

Dr. Naila Shahid, Health Officer, UNICEF, congratulated NCRP on conducting such an amazing research. She mentioned that some of the things at the policy or strategy level are already in place. The education, health and agriculture department along with WASH are in the final stages of drafting a policy to include different health and education related activities as part of the school curriculum. Furthermore, to help fund this programme and show support, each sector or department is going to pledge some money towards this programme. She shared that according to the latest National Nutrition Survey, 39 % of the children die as a result of chronic malnutrition. So our main focus should be to reduce malnutrition and increase awareness of importance of school health meals in parents. In this regard, the entire health force including LHWs, LHVs, SH&NS, and School Teachers should join hands to screen children. Instead of shifting the burden from one entity to another, it should be shared.

Dr. Hassan Raza, USAID, congratulated the entire team of NCRP for arranging such an informative meeting. He mentioned that proposed recommendations need to be practical and their implementation cannot be possible without promoting coordination between the health and education department. He stressed upon the need and importance of triangulating our recommendations with the objectives and strategies of PSPU, Health and Education department, as this will help take things in a positive way and in the right direction. He was of the view that since the study focuses on assessment of health status and knowledge of students of public school, ideally private schools should also be targeted as a huge chunk is going to private schools.

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Ms. Maha Rehman, M&E Expert, Ilm Ideas Project, mentioned that the lack of awareness of low cost alternatives for high nutritious value items among the parents and community members and availability of fried and junk food at school canteens is a contributing factor towards poor health status of school going children. In this regard, check on canteen food, and alternatives to fried, oily and spicy foods should be provided to canteens. Instead of toffees, carrots can be made available in school canteens to children. First aid training to teachers and principals should also be provided so that immediate first aid can be given to school going children in case of a medical emergency.

Mr. Syed Jawad Bukhari, Former District Manager Kasur, Ilm Ideas Project, sharing his experience with the students, parents, school teachers during the data collection phase mentioned that there exist lack of interest and awareness regarding improvement of health status of students among teachers and parents. He shared that the currently implemented programme is not properly advertised, parents are not even aware of any health activities in their child’s school.

Mr. Tuqeer Ahmad Wahgra, Former District Manager Okara, Ilm Ideas Project, mentioned that coordination between the health and education department is almost non-existent. He shared that there exist lack of a proper monitoring system for the currently implemented programme. Sharing of detailed travel plan of SH&NS with the concerned department would help strengthen the monitoring of the programme.

Lt. Col. Irfan Sadiq (R), Area Manager, The Citizens Foundation, strongly appreciated and supported the research findings and the recommendations proposed by Dr. Tasleem and said that he looked forward seeing their practical implementation. He shared that being able to achieve even 15 % of the recommendations proposed would be a huge achievement.

Mr. Iftikhar Ahmad, Former Secretary Establishment, Dean National School of Public Policy, shared that lack of management and adequate funding results in the effective implementation of many social sector programmes.

Unlike Pakistan, the social sector in countries like Zambia, Sweden, and Tanzania etc. have little dependency on foreign funding. Thus, we need to formulate and encourage programmes that are self-sustainable and independent of foreign funding. In Tanzania, School Management and Health Councils were mobilized at each UC or BHU level. These councils were given the responsibility to run and monitor the BHUs. As Principal of DPS, Gujranwala, Mr. Iftikhar introduced a model in which the responsibility of cleaning the school was given to students and teachers were made to check the hygiene of the students. This model used zero money, and was highly effective in improving the overall health environment in the school. He shared that he had initiated a programme by the name Adoptive School Programme in which members of the chamber were requested to adopt a school, any school, and then provide furniture facilities to that school. He was of the view that in order to get things done, all we have to do is Improve governance and management.

Mrs. Zareen Arif Ijaz, Director, Nur Student Leadership Progarm-FMH, agreed with the recommendations suggested by other participants and added that involvement of too many people reduces the chances of corruption. She stated that the strategy should be to devise a plan that is neither be too complicated nor too simple.

Ms. Saba Sheikh, Advocacy Expert, Ilm Ideas Project, agreed with Mrs. Zareen and shared that the recommendation suggested by everyone will help her devise the advocacy plan more efficiently. She further

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added that a comprehensive over-arching child related policy in Punjab is missing, thus all NGOs should need to promote for a child welfare policy. We need to think from the government’s point of view, we need to formulate polices that utilize fewer resources.

Dr. Shabnum Sarfraz, Senior Technical Advisor Pakistan, Marie Stopes Society, agreed that task sharing is indeed a very important recommendation but it needs to be taken forward very carefully, as we should be very clear on who should be doing what and how. She shared that school children are effective communication channels for the community. If tapped correctly, these children can be used as vehicles for advocating voice at the community level. She congratulated the team on getting a great job done and said that she looked forward to moving into advocacy phase.

Mr. Anwer Saeed, District Support Manager PRSP, highlighted the need to bridge the increasing communication gap between the health and education department and school administration. He added that moderators should be hired to bridge this gap.

Mr. Malik Riaz Hussain, Director Public Instructions (Elementary Education), Education Department Punjab, expressed his concerns regarding the decreasing quality of health of school going children and stressed on the need to bridge the gap between the students and teachers. He assured NCRP of his full support in this matter.

Prof. Dr. Aman Ullah, Professor Emeritus, FMHCM&D and Former Dean Institute of Public Health, mentioned how the focus has shifted from longevity of life to improving the quality of life, and in order to achieve good quality of life we need to improve the quality of education and health care in the country. Citing the findings of his research study he shared that the academic performance was improved by 70 % in the students if their health was screened properly and on regular basis. He further added that policy makers have to look at things more deeply and schematically.

Ms. Soha Riaz, Research Assistant, Idara-e-Taleem o Agahi, stressed on the need to train teachers how to utilize the first aid box and give first aid to students in case of emergencies.

Ms. Sahar, Research Assistant, Idara-e-Taleem o Agahi, highlighted how increased parental involvement was vital to improving the health status of school children as unlike teachers, parents only have to deal with their children.

RECOMMENDATIONS 1.

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Student health must become an integral part of provincial education policy A coordination mechanism between Health and Education department must be established To solve the finding issue, Zakat and Social Welfare departments and other NGOs who are working on the same agenda could be tapped Nutrition supervisors are overburdened. Teachers and other health professionals like LHWs, LHVs, etc should be trained to take on some of their responsibilities Need and importance of triangulating our recommendations with the objectives and strategies of the Government and Health and Education department School children de worming campaigns are needed

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CLOSING Mrs. Shahima Rehman, President, Nur Foundation gave the closing remarks and appreciated the presence of all dignitaries in the meeting. She expressed her concerns regarding the increasing disparity in the country, where on one extreme we have students who are scoring 11’As while on the other we have children with chronic malnutrition. Nearly 60 % of the malnutrition adolescent girls are living in the richest province. She appreciated the level of interest shown by all key stakeholders in betterment of the society especially young students, who are the future of Pakistan. She said that we need to join hands with other NGOs and organizations to work for the betterment of all.

The meeting closed formally with a note of thanks to all participants and a group photograph.

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ANNEX 1- PARTICIPANT LIST

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B

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C

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D

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ANNEX 2- MEETING AGENDA

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ANNEX 3- MEETING PRESENTATION

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G

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ANNEX 4 - PICTURES FROM THE PROVINCIAL PRE-DISSEMINATION CONSULTATIVE MEETING

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I

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J

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K

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