Children need more than books to flourish at school. De-worming may be one of the most cost-effective ways to increase school participation in Africa.
COMMENT
More than 30-million primary and lower-secondary school-age children with disabilities in developing countries are out of school, according to an estimate in a 2016 Education Commission report.
Many of them aren’t able to attend because of common health problems, such as worm infections, visual impairment and poor nutrition. For example, research shows that refractive error — the need for glasses — affects one out of every 10 schoolchildren in developing countries, limiting their opportunities in school.
Like refractive error, intestinal worms, scientifically known as soil-transmitted helminths, make it hard for pupils to achieve their potential.
These parasites are a leading cause of stunted growth in children, according to a 2015 progress report by the London Declaration on Neglected Tropical Diseases.
Infections with these parasites can also exacerbate malnutrition, lead to anaemia, impaired intellectual development and increased susceptibility to other infectious diseases. Stunting is associated with reduced school participation and achievement, and research shows that it can reduce income in adulthood by as much as 22%.
More than 876-million school-age children are at a high risk of being infected with intestinal worms because they live in contaminated areas, according to the London Declaration’s progress report.
Children affected by such common health ailments either never start school or risk dropping out. If they do attend school, they find it much more difficult to learn because they can’t read the text books, they’re hungry and exhausted, or because they are in pain.
Solving intestinal worms and refractive error is relatively cheap and can drastically improve educational outcomes for children.
Deworming is one of the most cost- effective ways to increase school participation. For just $0.50 a child a year, school-based deworming can reduce both the rate of infection and school absenteeism by a quarter, according to research presented to an evidence-based education conference in Ghana in 2012.
Properly fitted glasses cost less than $5 a pair and can make the difference between a child absorbing information on the blackboard or missing out on lessons entirely.
But children are going to miss out as long as we continue to expect common health problems to be spotted and tackled by a separate, siloed health system.
In areas where some of the poorest families are struggling to get by, getting access to basic healthcare is far from straightforward. Many families simply can’t afford to pay for healthcare or glasses, even when they do know their child has a problem.
On top of this, there is a shortage of eye doctors in low-income countries.
But we can tackle this if we make health solutions accessible by building them into educational plans and budgets from the beginning.
This hasn’t happened yet because education departments, health departments and finance ministries struggle to address huge needs with limited resources. They are unlikely to consider funding issues that might be seen as somebody else’s job.
In truth, government departments can deliver far better services by breaking out of their silos and co-operating on a child-focused approach. By training teachers to screen their pupils, instead of relying entirely on highly trained medics, we could make health systems more effective. This would save time and money and, ultimately, many more children could be reached.
At Sightsavers and Partnership for Child Development (PCD), we have tested this theory by working with governments to produce health solutions through schools in Cambodia, Senegal, Ethiopia and Ghana. From this October to November, teachers around Africa are screening more than 30 000 children for glasses in pilot projects and we expect to provide health solutions to more than 40 000 children worldwide.
This pilot project is designed to reach hundreds of thousands more children. It will provide a much-needed blueprint for governments to increase this kind of programme.
We are already finding that very simple things can make our approach more effective. For example, training teachers for just two days during the summer holidays minimises term-time disruptions and means we can cover eye screening and deworming.
Teachers and trainers have responded well to this and the timing means future training could more easily be combined with summer holiday refresher courses or teacher college curriculums.
This kind of important consideration was made more effective by involving ministries of education and health right from the beginning during the early planning stages. It’s vital that these governments are able to own and drive the process forward.
In the case of Cambodia, where the initiative began, the ministry of education is far enough along that Sightsavers, the PCD and other partners now only play supportive roles. We’re seeing progress also in Ghana, Ethiopia and Senegal as ministries begin to lead the way in implementing school health themselves.
We need large funding bodies to step up to the challenge and offer the right support to committed governments to plug the inevitable gaps in funding — as the World Bank and the Global Partnership of Education have done for this pilot scheme.
Improving and investing in education systems will not be enough to get all children into school and learning unless it is also combined with health interventions. Quality education can only be achieved when we start seeing the solution in a holistic way, as a jigsaw of factors that must all come together.
Imran Khan is the chief global technical lead of Sightsavers, a charity that works in more than 30 developing countries to prevent blindness, restore sight and advocate the equal rights of people with disabilities.
