Fit for School program

In the Philippines the FRESH approach has been introduced through a program called 'Fit for School'. It promotes an essential health-care package and addresses the diseases most prevalent among children in the Philippines. Recent studies show:
- nearly all children suffer severe tooth decay,
- two thirds are infected with intestinal worms, and
- one third has a body mass index categorized as below normal.

So far, these important issues were neglected by the Philippines health care system, and the related health problems were socially accepted as normal. Nonetheless, they have a huge impact on the physical and mental development of children, their school attendance, their quality of life and their ability to resist to other serious and potentially life threatening diseases. Worm infections for instance cause anaemia, reduced physical growth, delayed motor activity and poor mental development. In other words: malnourished children become even more malnourished. Children who suffer from toothache cannot eat, sleep or concentrate at school and their growth and development are affected.

Interventions
Costs and effectiveness
Scope and significance




Interventions
Poverty is a key determinant of people's health. Whether at school or at home, overcrowded buildings, lack of clean water and sanitation facilities are the root causes of many diseases, and so is lack of healthy and appropriate food.  Problematic environments keep children trapped in a cycle of poverty for a lifetime.
The Fit for School programme accordingly intervenes in common routines through 
- daily supervised hand washing with soap prior to recess,
- daily supervised tooth brushing  with fluoride toothpaste, and
- bi-annual de-worming of all children.
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Costs and effectiveness
The costs for the programme are comparably low. The necessary materials (toothbrushes, toothpaste, soap and de-worming drugs) are available at less than half a Euro per child and year. If properly implemented, the programme's health benefits are tremendous. Research conducted through a selected health outcome evaluationof school health programs confirms similar findings published in international literature:
- infectious diseases including diarrhoea and respiratory infections are reduced by 30 to 50 %,
- the progression of caries is reduced by 40 to 50 %,
- the prevalence of helminth infections sinks by 80 %,
- the number of children with below-normal height and weight is reduced by 20 %, and
- school attendance rises by 20 to 25 %
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Scope and Significance
The innovative element of the Fit for School Program is that it is implemented by teachers and school administrators - and not by health professionals or community health workers. They in turn were involved in the training of the education staff. Of course, health programs in schools also need the active involvement of parents. In the broader context the entire community assumes responsibility for improving access to water and sanitary facilities in schools.

Schools are indeed good entry points for facilitating community action: Nearly all villages have elementary schools, and nearly all village people are in some way members of the school community, either as students, teachers, parents or relatives. Children spend most of their day at school, and they can become "agents of change" because they bring home knowledge that potentially affects family behaviour. The Fit for School Program thus creates opportunities to improve water and sanitation matters beyond the school. Currently the program is implemented by the Philippines' Department of Education in close cooperation with 20 different units of local government. Some provinces are running the program on a pilot level, others have already implemented it in all schools of the province.
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