Mainstreaming Health

and Inclusion in Education in Uruguay

Sergio Meresman

VANCOUVER, June 2007

Uruguay

• 3.3 million people• 4000 Primary schools (1000

rural)• Strong and prestigious

education sector, nearly universal coverage in primary education

• 98 percent of the population has access to potable water

• Increasing equity and quality issues: underprivileged schools accumulating problems, demands and services.

• Teacher training and practice deteriorating

• 15% decrease of GDP (estimated 2002)

• 55% of Uruguayan children are poor

• 25% unemployment (April

2003)

• 18 million living under the poverty line (50% of total population)

• In 2002 Uruguay had a population decrease: births were 30.000, deaths 20.000 and migrants 30.000

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

Health situation for school-age children in brief

•Deterioration of the living conditions for many families

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

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

Highlights of schools’ situation

• Schools are the last places where state presence still exists

• Aggregation of problems leads to an aggregation of services. In vulnerable areas schools have to provide basic nutrition, health and social services

• In Montevideo, school feeding program expanded from 40.000 to 90.000 children

• That situation tend to reinforce structural disadvantage of children, who receive poorer education

•New government (left wing coalition)

•A slow but steady economic recovery

•Unemployment still high (around 11 percent)

•Poverty close to 30 percent (National Institute of Statistics, provisory data, 2005).

After the Crisis: what is the situation?

School Health: future directions

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

Emerging Issues

• Food security• Epidemiological

“accumulation” (infectious + chronic diseases)

• Violence• Mental health problems

Tuning health promotion approaches with on-going health and education policies and local develop-ment resources

Challenges

Operational strengths and problems

Some Strengths• Long standing tradition

of preventive health interventions in schools

• Remarkable enthusiasm of children and teachers about environmental and health education

• Increasing participation of CSO on environmental education

Some Problems• Most school health activities

have traditionally “targeted” rather than “engaged” schools (delivered vertically from MoH, NGOs). Schools “used” as a captive target.

• Lack of educational rationale. Dispersion of initiatives.

• Limited training of teachers. Lack of continuous training mechanisms (supportive monitoring, systematization of good practices, evaluation)

• Tendency of intersectorial collaboration to become too bureaucratic, formal, restrictive of participation.

• Lack of supportive policy to assist schools in networking, resource mobilization.

Project Overview

•Education for Life and Environment (Educación para la Vida y el Ambiente-EVA) introduced between 2002-04 as part of a World Bank-supported wider strategy to improve basic education.  

•EVA projects were piloted in 75 schools in the first year and after that targeted 150 primary schools per year.

•Resources were allocated as part of a demand-oriented fund that provided small grants directly to schools.

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

The Objectives– To strengthen and revitalize environmental and health

education in schools.

– To pilot inclusive education approaches

The approach– To promote schools and communities active and

participatory learning of health and environmental topics that where relevant to local development.

– Stimulate inclusive dynamics in schools and communities

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

What did the project offered to schools– Technical assistance to schools and teachers:

training, supervision, a teachers’ manual, educational materials,

development of a “community of practices”, electronic bulletin.

– Funding (between 3,000 and 5,000 dollars) in upto 100 schools every year

             school infrastructure renovation and development to create healthier,

safer and more inclusive environments

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

Operational rationale– All schools were invited to participate (quota was

assigned according to socio-educational profile)

– Participating schools were required to identify a specific health and inclusion-related issue they wanted to change

– Selected schools received technical assistance and funding to tackle their problem.

– Assistance comprised of resources that were meant to benefit the quality of education in general, not just health and inclusion objectives.

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

Currentsituation

challenges

desiredscenario

. A natural solution to rural sanitation

. A contribution to local development

. An entry point for environmental and health education

. Bullrushes are natural purifiers of sewage. They enhance soil´s aerobic conditions and kill any pathogenic organisms. At the end of the treatment the water is usable for irrigation or to refill toilet cisterns.

One example of EVA projects: school bullrush gardens

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

1 Educational focus• The goal was to influence long term education

policies, institutions and leaders, mainstreaming HP concepts and practice into the education sector objectives.

• Health, environment and inclusion projects have high educational value. Help to address relevant and tangible situation related to living conditions. Facilitate meaningful learning.

• Active teaching and learning, school-family links, project-based and life skills-oriented curiculum are all recomendations within quality education initiatives.

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

1 Education focus II• Implementation strategy sought to collaborate as

much as possible with other components of the education strategy and all technical teams involved.

• Avoid the perception that HP in school is an “additional” programme which increases the teachers´ workload.

• Active citizenship is important for personal development and taking responsibility for the determinants of health.

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

2 Multi-sectoral approach and permanent dialogue• Moving from inter-sectoral collaboration to mobilizing

all possible parties and resources.

• Promoting permanent dialogue and “collaborative management agreements” rather than establishing bureaucratic partnerships/commissions.

• Engage teacher unions.

• Foster children representatives as advocates and stakeholders in school health dialogue.

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

3 Local ownership, autonomy, contribution to local development:

• The fact that schools had to administrate their funds, prioritise problems and decide which one they wanted to address, was in itself a learning and motivational experience.

• The whole school community absorbed a methodology to understand problems and challenges, made autonomous decisions and planned responses on the basis of their own culture, resources and skills.

• To optimise sustainability, the project encouraged schools to identify and mobilize professional expertise that was available in the local community.

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

4 Participation:• The project firmly advocated on the

educational value of active involvement of children. A range of specific opportunities were highlighted:

– Producing a situation analysis of school and community through consultation with other children and the community

– Mapping issues affecting health and well-being through problem trees

– Identifying things that can be changed in their school and planning strategies for change

Education for Life and Environment KEY IMPLEMENTATION ASPECTS

4 Participation II:• Still genuine participation didn't

go beyond sporadic and punctual opportunities. Participation brings additional complexity. “When resources (personnel, support, etc) are limited and issues multiple, better keep things under control as usual”.

• Teachers and headteachers overwhelmed and time is limited.

• Are schools a good environment for genuine participation?

How do you build a bridge?

What do you need to build a bridge?

– Standing points– Plans, design– Materials– People, labour,

dialogue

What´s progressive is not the substance of an idea but rather

the dialogue of ideas…being very clear that the results of such a dialogue are always uncertain.

Edgar Morin