"When you are healthy, your mind is healthy": An Evaluation of Save the Children's School Health and Nutrition Program in Nairobi,Kenya Open Access

Juhnke, Andrew (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/tb09j585v?locale=en


Background: Kenya continues to face challenges with the health of schoolchildren due to poor management and dissemination of guidelines and services. The 2009 National School Health Policy provided a building block for improvements in health programming in schools, but much progress has been stymied due to lack of resources, a failure to focus on WASH as the root cause of many health issues, and programming that promotes unsustainable health activities and practices. School Health and Nutrition programs are essential to addressing these issues and improving children's abilities to learn effectively, stay in school, and contribute to their communities.

Objective: This project evaluated Save the Children's School Health and Nutrition program implemented in Nairobi, Kenya from 2013 to 2015 to determine the success of indicators, goals, and objectives. The purpose of this project was to determine the potential effects of the SHN program on schoolchildren's knowledge, attitudes, and practices, as well as the state of health in schools in Nairobi. This project sought to use findings to make recommendations to all stakeholders, as this was the first complete endline evaluation done for a Save the Children SHN program in Kenya.

Methods: The endline evaluation was performed using a cross-sectional study design. Endline data was collected at one point in time for each sampled school using student questionnaires, head teacher questionnaires, facility observations, and school records. The endline evaluation design measured differences between baseline and endline for stated objectives and indicators and stratified results to find correlations. The evaluation was carried out in the same fashion as the baseline evaluation conducted in 2013.

Results: School attendance rate increased and diarrhea incidence decreased among schoolchildren in program schools over the two-year period. Gaps between knowledge and behaviors, such as handwashing, were still found to exist. Stratified results found correlations between rural or urban school location and certain measured factors. Further, results comparing students in School Health Clubs and those not in SHCs showed that while that status may play a factor in health, the peer-to-peer trickle down effect caused equality among many SHN elements.

Discussion: Despite limitations due to issues with baseline evaluation and program implementation in 2013, this endline evaluation found positive effects of the program on a range of health topics. Students and teachers reported program activities as positive influences on overall school health. Lastly, sustainability efforts have provided an avenue for schools to continue SHN activities, and lessons learned will be used in the implementation of future Save the Children SHN programs in Kenya.

Table of Contents

Chapter 1: Introduction 1

1.1 Introduction and Rationale 1 1.2 Problem Statement 1 1.3 Purpose Statement 3 1.4 Objectives 3 1.5 Significance 4

Chapter 2: Literature Review 5

2.1 Background of SHN/WASH in Kenya 5 2.1.1 History 5 2.1.2 Current state and policy 6

2.2 Empirical Necessity of the Save the Children SHN Program 7

2.2.1 Schoolchildren's health 7 2.2.2 WASH-related issues in LMICs 8

2.3 Empirical Foundation of SHN and the Save the Children SHN Program 9

2.3.1 Health and nutrition in school settings 11

2.3.2 FRESH framework 12

2.3.3 Life-skills based education/Life-skills training/QLE 13

2.3.4 The use of peer-to-peer education and SHCs 14

2.4 Evaluation of Interventions 16 2.4.1 WASH interventions in Kenya 16 2.4.2 Non-WASH SHN interventions 21 2.5 Necessity of this Evaluation 22

Chapter 3: Methodology 23

3.1 Context 23 3.1.1 Stakeholders 24 3.1.2 Intended uses/users 25 3.1.3 Evaluation objectives 26 3.2 Intervention 27 3.2.1 Program goal 27 3.2.2 Program objectives 28 3.2.3 Program activities 28 3.3 Evaluation Details and Processes 32 3.3.1 Evaluation design 32

3.3.2 Program sites and target population 34

3.3.3 Sample size 35

3.3.4 Participants/Evaluation population 36

3.3.5 Indicators 37 3.3.6 Instruments 39 3.3.7 Procedures 42 3.4 Ethics 43

Chapter 4: Results 45

4.1 Introduction to Findings 45 4.2 Intervention Exposure 45 4.2.1 Activity completion 45 4.2.2 Attendance/Participation 49

4.2.3 Definition of what constitutes exposure 50

4.3 Characteristics of Endline Participants 51

4.4 Findings 52 4.4.1 Baseline results 53 4.4.2 Endline results and analysis 55 Indicators 55 Explanations of results for goals and objectives 57

4.4.3 Changes from baseline to endline 70

4.4.4 WASH-specific results 72 4.4.5 Demographic variation 75 Location (Rural vs. Urban) 75 Sex (Male vs. Female) 76 Grade (Standard 6 vs. Standard 7) 77

4.4.6 SHC comparison 79 4.4.7 School observation results 83 4.5 Summary 85

Chapter 5: Discussion and Conclusion 87

5.1 Contribution 87 5.1.1 Program satisfaction 88 5.2 Evaluation of Criteria 89 5.2.1 Efficiency 89 5.2.2 Relevance 89 5.2.3 Potential for sustainability 90 5.2.4 Effectiveness 97 5.2.5 Impact 101 5.3 Broad Implications 102 5.3.1 For SHN in Kenya 102 5.3.2 For SHN at SCI 102

5.3.3 For peer-to-peer education and WASH in SHN programming 103

5.4 Lessons Learned 104 5.5 Limitations 107 5.6 Recommendations 109 5.7 Discussion Summary 114 5.8 Conclusion 116 References 117

Appendix A: Student Questionnaire 121

Appendix B: Head Teacher Questionnaire and Interview Guide 127

Appendix C: School Facility/Observation Checklist 135

Appendix D: Education Data Chart 138

Appendix E: Student Focus Group Discussion Guide 139

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