Evaluation of a comprehensive school health programme in Zambia

对赞比亚综合学校卫生计划的评估

• 批准号: MR/Y019857/1
• 负责人: Mylene Lagarde
• 金额: $ 241.01万
• 依托单位: London School of Economics and Political Science
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FY019857%2F1
• 关键词: Evaluation; comprehensive; health; programme; Zambia

Compared to children under 5, the needs of aged 5 to 14 years have been historically overlooked. Yet these children also face high levels of health-related challenges, caused or compounded by inadequate access to prevention and treatment, during a period critical for their development. When ill, school-age children are less likely than other age groups to seek treatment, and when they do, less likely to seek care from formal providers. In turn, lack of access of school-aged children to prevention and treatment has detrimental effects on a range of short- to long-term health, education, and economic outcomes. The World Health Organization recommends the implementation of comprehensive school health programmes (SHP), but these recommendations remain hardly implemented in low- and middle-income countries.Since 2015, an NGO called Healthy Learners (HL) has partnered with the government of Zambia to develop such a comprehensive SHP centred on the concept of "School Health Workers": a few teachers in each school trained and equipped to provide health education, coordinate the delivery of preventative services with clinics, and make preliminary diagnoses thanks to a tablet-based clinical decision tool, allowing them to refer severe cases to clinics, where learners receive priority treatment.This project aims to rigorously assess the impact of the SHP on a range of health and education outcomes and better understand the indirect effects of the program on teachers and clinics. We will rely on a cluster-randomised controlled trial, in six districts of the Copperbelt and Luapula provinces. 225 schools will be randomly selected and randomized to receive one of three interventions: (1) a comprehensive SHP (n=90 schools) corresponding to the full model developed by and implemented HL; (2) a limited range of school health activities (n=75) provided and implemented by the government, as per the current situation; (3) an enhanced range of health activities (n=60) where HL will support the government to ensure the reliable and regular provision of planned activities (mainly deworming and vitamin A).The study will draw on a range of methods and data sources. Implementation, uptake and cost of the program will be assessed through administrative data from the program itself, and qualitative interviews with members of the school communities. To assess the causal impact of the program on health and education outcomes, we will select 60 learners in each school, and conduct surveys before and 12 and 24 months after the start of the SHP, with objective health outcomes measured at endline. We will use pictorial health diaries to collect detailed and reliable data on illness spells and health-seeking behaviours. We will explore potential indirect effects on teachers through three school surveys and on clinics capacity, through health facility assessments. Finally, we will test if the program can lead to improved human capital accumulation in the longer-term, through positive changes in educational aspirations, well-being and sexual and reproductive health outcomes.The results of the study will contribute to the limited evidence base on school health programs in LMICs and will inform the scale-up of the SHP in Zambia and similar settings. The impact in Zambia will be facilitated by the strong links between the research team and the Ministry of Health and Ministry of Education, who have been involved in the planning of the project. Finally, the project will also have a strong capacity-building component, through the participation of several young researchers (most of whom will be from Zambia) supported and mentored by the senior members of the team, and the organisation of training workshops in Zambia aiming to strengthen evaluation skills of members of all partner organisations.

与5岁以下儿童相比，5至14岁儿童的需求历来被忽视。然而，这些儿童在其发展的关键时期，也面临着与健康有关的严重挑战，这些挑战是由于预防和治疗不足造成的或加剧的。学龄儿童生病时，与其他年龄组相比，寻求治疗的可能性较小，而当他们生病时，寻求正规医疗机构护理的可能性也较小。反过来，学龄儿童缺乏获得预防和治疗的机会，对一系列短期到长期的健康、教育和经济成果产生不利影响。世界卫生组织建议实施全面的学校卫生计划（SHP），但这些建议在低收入和中等收入国家几乎没有得到实施。自2015年以来，一个名为“健康学习者”（HL）的非政府组织与赞比亚政府合作，以“学校卫生工作者”的概念为中心，制定了这样一个全面的SHP：每所学校的一些教师经过培训并配备了设备，可以提供健康教育，与诊所协调预防服务的提供，并通过平板电脑临床决策工具进行初步诊断，使他们能够将严重病例转介到诊所，该项目旨在严格评估SHP对一系列健康和教育成果的影响，并更好地了解该方案对教师和诊所的间接影响。我们将依赖于一个集群随机对照试验，在铜带省和卢阿普拉省的六个地区。225所学校将被随机选择并随机接受三种干预措施之一：（1）全面的SHP（n=90所学校）与HL制定和实施的完整模式相对应;（2）根据当前情况，政府提供和实施的学校卫生活动范围有限（n=75）;（3）扩大卫生活动范围（n=60），HL将支持政府确保可靠和定期提供计划活动（主要是驱虫和维生素A）。该计划的实施，吸收和成本将通过该计划本身的行政数据进行评估，并与学校社区成员进行定性访谈。为了评估该计划对健康和教育成果的因果影响，我们将在每所学校选择60名学生，并在SHP开始之前和之后的12个月和24个月进行调查，并在终点测量客观的健康成果。我们将使用图画健康日记来收集有关疾病发作和寻求健康行为的详细且可靠的数据。我们将通过三次学校调查探讨对教师的潜在间接影响，并通过卫生设施评估探讨对诊所能力的潜在间接影响。最后，我们将测试该计划是否可以通过教育愿望，福祉以及性健康和生殖健康结果的积极变化，在长期内改善人力资本积累。研究结果将有助于LMICs学校健康计划的有限证据基础，并将为赞比亚和类似环境中的SHP的规模扩大提供信息。研究小组与参与项目规划的卫生部和教育部之间的密切联系将有助于在赞比亚产生影响。最后，该项目还将有一个强有力的能力建设组成部分，由小组高级成员支持和指导的几名年轻研究人员（其中大多数来自赞比亚）参与，并在赞比亚组织培训讲习班，旨在加强所有伙伴组织成员的评价技能。