Identifying an essential package for school-age child health: economic analysis
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Author(s)
Fernandes, M
Aurino, E
Type
Chapter
Abstract
his chapter presents the investment case for providing an
integrated package of essential health services for children
attending primary schools in low- and middle- income
countries (LMICs). In doing so, it builds on chapter 20 in
this volume (Bundy, Schultz, and others 2017), which
presents a range of relevant health services for the school-
age population and the economic rationale for adminis-
tering them through educational systems. This chapter
identifies a package of essential health services that low-
and middle-income countries (LMICs) can aspire to
implement through the primary and secondary school
platforms. In addition, the chapter considers the design
of such programs, including targeting strategies. Upper-
middle-income countries and high-income countries
(HICs) typically aim to implement such interventions on
a larger scale and to include and promote additional health
services relevant to their populations. Studies have docu-
mented the contribution of school health interventions to
a range of child health and educational outcomes, partic-
ularly in the United States (Durlak and others 2011; Murray
and others 2007; Shackleton and others 2016). Health
services selected for the essential package are those that
have demonstrated benefits and relevance for children in
LMICs. The estimated costs of implementation are drawn
from the academic literature. The concept of a package of
essential school health interventions and its justification
through a cost-benefit perspective was pioneered by
Jamison and Leslie (1990). As chapter 20 notes, health services for school-age
children can promote educational outcomes, including
access, attendance, and academic achievement, by mitigat-
ing earlier nutrition and health deprivations and by
addressing current infections and nutritional deficiencies
(Bundy, Schultz, and others 2017). This age group is partic-
ularly at risk for parasitic helminth infections (Jukes, Drake,
and Bundy 2008), and malaria has become prevalent in
school-age populations as control for younger children
delays the acquisition of immunity from early childhood to
school age (Brooker and others 2017). Furthermore, school
health services are commonly viewed as a means for build-
ing and reinforcing healthy habits to lower the risk of non-
communicable disease later in life (Bundy 2011).
This chapter focuses on packages and programs to reach
school-age children, while the previous chapter, chapter 24
(Horton and Black 2017), focuses on early childhood inter-
ventions, and the next chapter, chapter 26 (Horton and
others 2017), focuses on adolescent interventions. These
packages are all part of the same continuum of care from
age 5 years to early adulthood, as discussed in chapter 1
(Bundy, de Silva, and others 2017). A particular emphasis
of the economic rationale for targeting school-age children
is to promote their health and education while they are in
the process of learning; many of the interventions that are
part of the package have been shown to yield substantial
benefits in educational outcomes (Bundy 2011; Jukes,
Drake, and Bundy 2008). They might be viewed as health
interventions that leverage the investment in education. Schools are an effective platform through which to
deliver the essential package of health and nutrition ser-
vices (Bundy, Schultz, and others 2017). Primary enroll-
ment and attendance rates increased substantially during
the Millennium Development Goals era, making schools
a delivery platform with the potential to reach large num-
bers of children equitably. Furthermore, unlike health
centers, almost every community has a primary school,
and teachers can be trained to deliver simple health inter-
ventions, resulting in the potential for high returns for
relatively low costs by using the existing infrastructure.
This chapter identifies a core set of interventions for
children ages 5–14 years that can be delivered effectively
through schools. It then simulates the returns to health and
education and benchmarks them against the costs of the
intervention, drawing on published estimates. The invest-
ment returns illustrate the scale of returns provided by
school-based health interventions, highlighting the value
of integrated health services and the parameters driving
costs, benefits, and value for money (the ratio of benefits to
costs). Countries seeking to introduce such a package need
to undertake context-specific analyses of critical needs to
ensure that the package responds to the specific local needs.
integrated package of essential health services for children
attending primary schools in low- and middle- income
countries (LMICs). In doing so, it builds on chapter 20 in
this volume (Bundy, Schultz, and others 2017), which
presents a range of relevant health services for the school-
age population and the economic rationale for adminis-
tering them through educational systems. This chapter
identifies a package of essential health services that low-
and middle-income countries (LMICs) can aspire to
implement through the primary and secondary school
platforms. In addition, the chapter considers the design
of such programs, including targeting strategies. Upper-
middle-income countries and high-income countries
(HICs) typically aim to implement such interventions on
a larger scale and to include and promote additional health
services relevant to their populations. Studies have docu-
mented the contribution of school health interventions to
a range of child health and educational outcomes, partic-
ularly in the United States (Durlak and others 2011; Murray
and others 2007; Shackleton and others 2016). Health
services selected for the essential package are those that
have demonstrated benefits and relevance for children in
LMICs. The estimated costs of implementation are drawn
from the academic literature. The concept of a package of
essential school health interventions and its justification
through a cost-benefit perspective was pioneered by
Jamison and Leslie (1990). As chapter 20 notes, health services for school-age
children can promote educational outcomes, including
access, attendance, and academic achievement, by mitigat-
ing earlier nutrition and health deprivations and by
addressing current infections and nutritional deficiencies
(Bundy, Schultz, and others 2017). This age group is partic-
ularly at risk for parasitic helminth infections (Jukes, Drake,
and Bundy 2008), and malaria has become prevalent in
school-age populations as control for younger children
delays the acquisition of immunity from early childhood to
school age (Brooker and others 2017). Furthermore, school
health services are commonly viewed as a means for build-
ing and reinforcing healthy habits to lower the risk of non-
communicable disease later in life (Bundy 2011).
This chapter focuses on packages and programs to reach
school-age children, while the previous chapter, chapter 24
(Horton and Black 2017), focuses on early childhood inter-
ventions, and the next chapter, chapter 26 (Horton and
others 2017), focuses on adolescent interventions. These
packages are all part of the same continuum of care from
age 5 years to early adulthood, as discussed in chapter 1
(Bundy, de Silva, and others 2017). A particular emphasis
of the economic rationale for targeting school-age children
is to promote their health and education while they are in
the process of learning; many of the interventions that are
part of the package have been shown to yield substantial
benefits in educational outcomes (Bundy 2011; Jukes,
Drake, and Bundy 2008). They might be viewed as health
interventions that leverage the investment in education. Schools are an effective platform through which to
deliver the essential package of health and nutrition ser-
vices (Bundy, Schultz, and others 2017). Primary enroll-
ment and attendance rates increased substantially during
the Millennium Development Goals era, making schools
a delivery platform with the potential to reach large num-
bers of children equitably. Furthermore, unlike health
centers, almost every community has a primary school,
and teachers can be trained to deliver simple health inter-
ventions, resulting in the potential for high returns for
relatively low costs by using the existing infrastructure.
This chapter identifies a core set of interventions for
children ages 5–14 years that can be delivered effectively
through schools. It then simulates the returns to health and
education and benchmarks them against the costs of the
intervention, drawing on published estimates. The invest-
ment returns illustrate the scale of returns provided by
school-based health interventions, highlighting the value
of integrated health services and the parameters driving
costs, benefits, and value for money (the ratio of benefits to
costs). Countries seeking to introduce such a package need
to undertake context-specific analyses of critical needs to
ensure that the package responds to the specific local needs.
Editor(s)
Bundy, DAP
De Silva, N
Horton, S
Jamison, DT
Patton, GC
Date Issued
2017-11-26
Citation
Child and Adolescent Health and Development, 2017, 3, 8, pp.355-368
ISBN
978-1-4648-0423-6
Publisher
The World Bank
Chapter
25
Start Page
355
End Page
368
Is Part Of Series
Disease Control Priorities
Journal / Book Title
Child and Adolescent Health and Development
Disease Control Priorities
Volume
8
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Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions:
Attribution—Please cite the work as follows: Bundy, D. A. P., N. de Silva, S. Horton, D. T. Jamison, and G. C. Patton, editors. 2017. Child and Adolescent Health and Development.
Disease Control Priorities (third edition), Volume 8. Washington, DC: World Bank. doi:10.1596/978-1-4648-0423-6 License: Creative Commons Attribution CC BY 3.0 IGO
Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and
should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in this translation.
Adaptations—If you create an adaptation of this work, please add the following disclaimer along with the attribution: This is an adaptation of an original work by The World
Bank. Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by The World Bank.
Third-party content—The World Bank does not necessarily own each component of the content contained within the work. The World Bank therefore does not warrant that
the use of any third-party-owned individual component or part contained in the work will not infringe on the rights of those third parties. The risk of claims resulting from such
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Source Volume Number
8
Edition
3
Article Number
25