This document discusses comprehensive school health in Kenya. It notes that while infrastructure expansion is necessary, it is not sufficient, and that governance systems, recurrent costs, monitoring and evaluation are also important elements. The challenges include a major backlog of infrastructure, existing infrastructure in poor condition, pressure from free primary education increasing class sizes, and arid/slum areas being worst hit. An enabling policy environment is needed to coordinate interventions, ensure sustainability, facilitate M&E, and mobilize resources. Current interventions are vertical, uncoordinated, and interventions are not sustainable. Key challenges include poor coordination, duplication, lack of information sharing and reporting, and increasing disease prevalence affecting school performance. The document outlines an implementation cycle and governance structure for

1. Comprehensive School Health in
Kenya: Moving beyond
Infrastructure
December 2012

2. Background and Context
Total population 40,863,000
School aged population 10,624,380
School going children 8,661,333
Children out of school 1,963,047
Population at risk of STH 9,108,952
School aged 2,368,237

3.  Vision 2030 guides Kenya’s development path in the long-term. The
Vision is being implemented through three pillars namely economic,
social and political.
 The social pillar aims to create a just, cohesive and equitable social
development in a clean and secure environment.
 Education and Training; Health and the Economy; Water and
Sanitation are three of eight key sectors under the social pillar.
 Poor primary school infrastructure is one of the major barriers to
improving access to primary education in Kenya.
 Empirical data show that physical facilities are an important factor in
both school attendance and achievement.
 Currently, Kenya has over 18,000 public primary schools and a large
number of non-formal schools.

4. The Challenges of School Health Infrastructure
• Major backlog of
infrastructure provision
• Existing infrastructure are
generally in poor condition
due to lack of investment
capital, poor construction
standards and inadequate
maintenance.
• FPE has added pressure on
existing infrastructure.
• ASAL areas and urban slums
are worst hit.
• Maintaining school health
infrastructure and quality of
learning environment
• Deepening knowledge on
approaches that work
• Transmitting policy goals,
approaches and action down to
the school level
• Capacity at all levels
• Recurrent costs are significant
• Addressing comprehensive
health needs for pupils
The Old
Challenges………..
………….New
challenges

5. In School Health, a major lesson from the past is that paying
emphasis to infrastructure expansion is necessary but not
sufficient…
Goal: Ensure equity
of access to basic
education
Improved participation, quality of
learning environment and health
for pupils in primary schools
Facility
expansion..
Governance
systems..
Recurrent
costs..
M&E
Systems..
..there are many
more elements

6. Providing Policy Support
7%
49
%
22
%
75
%
69
%
33
%
Under Kenya’s new constitutional dispensation, improved water, sanitation
and hygiene helps fulfill every child’s constitutional right to health and
education.
Devolution and emphasis on self-local government at county level is a
new variable.
Stand alone interventions in school health – WASH, nutrition, disease
control, special needs etc is not sustainable and increases waste.
Resources mobilization is still a major challenge at all levels.
Despite the FPE initiative, an estimated 1.7 million children and youth for
various socio-economic reasons are still unable to access education through
formal school delivery channels.
The political and policy environment is therefore getting
increasingly complex, untested and unpredictable, hence
more demanding.

7. An enabling policy environment for sustainable
school health interventions is an important
prerequisite for:
7%
49
%
22
%
75
%
69
%
33
%
• Strengthening coordination of school health interventions by
relevant Ministries, communities and other stakeholders
• Ensuring mechanisms are put in place for sustainability of school
health programmes
• Facilitating effective monitoring and evaluation of school health
interventions.
• Adequate resources mobilization
• Creating school environments that encourage pupils especially girls
to complete their education. This has far-reaching implications for
women’s health and Kenya’s economy.

8. Current situation in School Health
Interventions
7%
49
%
22
%
75
%
69
%
33
%
WHO UNICEF
Partne
rs
GoK WB WFP
NGO
s
SchoolSustainability??
Vertical
Interventions
Poor
Coordination…
No reports…
Duplication
School Managers are
overwhelmed

9. The policy environment
• Momentum behind education
• Current and planned investments in school
WASH
• Interested development partners
• Many excellent policies
• Low capacity for implementing them

10. Key Challenges
 Poor coordination
 Duplication of activities
 Interventions not sustainable
 Wastage of resources
 Lack of sharing of information
 Poor reporting
 Increasing disease prevalence of other
health related conditions leading to poor
school performance.

11. Implementation Cycle of CSH at
school level
Monitoring
Policy and
Guidelines
SMC
Implementation
Situation Analysis
Make Action
Plan
Evaluation
Review
1. Values and Life-skills
2. Gender
3. Child rights, protection and
responsibilities
4. Water, Sanitation and
Hygiene
5. Nutrition
6. Disease prevention and
control
7. Special Needs, Disability
and Rehabilitation
8. School infrastructure and
Environmental safety

12. Ministry of Education
National School Health Inter-Agency
Coordination Committee
National School Health Technical Committee
Provincial School Heath Committee
Ministry of Public Health and Sanitation
District School Health Committee
Divisional Health Committee
Zonal School Heath Committee
School Management Committee
Health Facility
Committee

13. Advocacy
3 High-Level Objectives:
1. Increase funding for operations and
maintenance costs in schools
2. Improved monitoring and evaluation for
accountability
3. Increase knowledge and improve behaviors

14. Sustainability at Scale: Research to Advocacy

15. Budget Needs

16. Specific Policy Goals
1. Increase O&M Funding $3.30/pupil/year
2. Improve M&E Downward, decentralized and
supportive
3. Knowledge and behavior New curriculum (co-developed
with CDC)
4. Better coordination Integration of WASH
interventions in wider policy
making processes

17. Outcome Mapping
Boundary Partners Primary actors

18. Results to Date
• Doubling of operations funds for school WASH ($840,000/year)
with potentially more to come
• Funds allocated for sanitary pads for school girls last year
• Agreement to develop a school health sustainability charter
inclusive of school WASH
• Agreement on need to improve M&E systems, including on
need for unified monitoring tool between ministries
• Adoption of WASH curriculum and materials by Kenyan
Institute of Education