[Journal of Public Health in Africa 2014; 5:313] [page 43] Kenya comprehensive school health policy: lessons from a pilot program Job Wasonga, Betty Ojeny, Gordon Oluoch, Ben Okech CARE International in Kenya, Kisumu, Kenya Abstract The study assessed the implementation of Kenya comprehensive school health pilot intervention program. This pilot program has informed the Kenya Comprehensive School Health Policy which is a critical document in the achievement of Millennium Development Goals relating to child health, gender equality, universal education and environmental sus- tainability. The study was based on focus group discussions, field observations and in-depth interviews with government officers who implemented the pilot program. The findings were categorized into implementation process, what is working well, what is not working well and lessons learned. During the course of the study, it was noted that involvement of all stakeholders enhances program ownership and sustainability but if they are not well coor- dinated or where supportive supervision and monitoring is not carried out, then some com- ponents of the comprehensive school health program may not be sustainable. We learnt that comprehensive school health program increases students’ enrolment, attendance and retention, factors that are very important in a country’s human resources development. The study has shown that although the formulation of a policy may be participatory and bottom-top, the implementation requires allocation of enough resources and coordination to bridge the gap between policy formulation and imple- mentation. Introduction The Kenya comprehensive school health policy is based on the realization that educa- tion as a social determinant is affected by health and vice versa. It follows on the global spirit of health in all policies movements which articulates that public health communi- ty should not only be concerned with policies that shape health, but also with those that shape the primary determinants of health such as social, cultural, economical and environ- mental. 1,2 The policy came as realization that good health is essential for the success of the implementation of any educational program in order to achieve desirable quality learning out- comes. 3 The holistic approach to improvement of health in schools is aimed at achieving access, retention, inclusion, equity and com- pletion of learners so as to achieve sustainable development as part of a wider strategy to achievement of vision 2030, a policy road map to make Kenya a middle income state by the year 2030 through implementation of projects touching on the economic, social and political aspects of the country. 4 As a commitment to achieving Millennium Development and Education for All Goals, the government of Kenya piloted comprehensive school health program in two model districts in the coastal region of the country targeting thir- ty primary schools. This pilot program, which was funded through the support of Japan International Cooperation Agency (JICA) later on, gave birth to comprehensive school health policy and was adopted after a wide consulta- tion and contribution from different stakehold- ers both in government and other development agencies. The aim of this policy is to ensure that health of children including those of ado- lescent is taken care of in school and in the community. 5 The policy covers a wide range of issues and tries to address different components of health which have been clustered into eight thematic areas, namely: i) values and life skills; ii) gen- der issues; iii) child rights, protection and responsibilities; iv) water, sanitation and hygiene; v) nutrition; vi) disease prevention and control; vii) special needs, disabilities and rehabilitation; viii) school infrastructure and environmental safety. The policy is envisioned to meet greater pro- portion of health and psychosocial needs of children in the school and community. 3 To achieve this, the government of Kenya has come up with National School Health Guidelines and Kenya Comprehensive School Health Handbook to operationalize the policy by ensuring that school age children, teachers, support staff and community access quality and equitable services for improved health. 3,5 The guideline and handbook is also to offer framework for school administrators, teachers, health workers and community leaders to guide ideas and organize activities so as to identify health issues in their schools and community in order to mitigate against factors which may hamper health and learning. The policy background The Kenya Comprehensive School Health Policy was developed after a pilot and practical experiences in Kilifi and Msambweni districts in the coastal region. The policy is to enable government to utilize available resources in an effective and efficient manner towards child health and provides coordination mechanism that enhances the roles of various ministries, institutions and stakeholders in tackling the inequality that exists in health provision espe- cially preventive and promotive aspect of health. 6 Kilifi is one of the districts in Kilifi County with a total population of 1.1 million. Females form 52% of the entire population while the school going children including under five form 47% of the entire population. 7 There are 160 primary and 23 secondary schools with pupil enrolment of 154, 848 in pri- mary and 61, 112 in secondary schools respec- tively, making it one of the counties with low- est transition from primary to secondary level and completion rates despite the teacher to pupil ratio of 1:36 in primary schools and 1:30 in secondary schools. 7 The residents of this county are generally poor, 68.5% based on Kenya poverty line 7 and engage in subsistence farming as one of the major economic activi- ties. There is a high prevalence of malaria, gastro enteritis and diarrheal diseases among the communities residing in this area. There are different ethnic communities with diverse cultural practices some of which impact nega- tively on education and health. On the other hand, Msambweni district is situated in the southern part of the coastal region in Kwale County. Like the sister Kilifi County, Kwale is one of the counties with high poverty rates, estimated at 74.6% according to Kenya poverty line and over 40% of the population live in absolute poverty. 7 The population stands at 649,931 with females making 51% of the total Journal of Public Health in Africa 2014; volume 5:313 Correspondence: Job Wasonga, CARE International in Kenya, Box 88 Kisumu, Kenya. Tel. +254723686375. E-mail: wasonga@ksm.care.or.ke Key words: Kenya, school health, policy, compre- hensive school health policy. Acknowledgements: the authors would like to thank the Medical Officers of Health, District Public Health Officers and the School Health Coordinators of Kilifi and Msambweni Districts, Ministry of Public Health and Sanitation, Kenya. The learning and sharing visit was made possible through SWASH+ program which is funded by Bill and Melinda Gates Foundation. Received for publication: 24 December 2012. Revision received: 19 December 2013. Accepted for publication: 4 February 2014 This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BY- NC 3.0). ©Copyright J. Wasonga et al., 2014 Licensee PAGEPress, Italy Journal of Public Health in Africa 2014; 5:313 doi:10.4081/jphia.2014.313