5) Description of health product/service offering: The prevailing health conditions in Pakistan are appalling. At least 40% of children under the age of five are malnourished and the infant mortality rate in the country is 8.4%. The general health of Pakistan’s 150 million citizens is amongst the poorest in the world and these health problems seem to be accelerating due to inadequate health knowledge.

Once a system is created that can explain and define the causes as well as the symptoms of common infectious diseases, people’s awareness will gradually increase, leading them to live a healthier lifestyle. For instance, if a child is told how to brush his or her teeth or use miswaak properly, he or she will avoid bleeding gums as well as dental caries. Many children have weak eyesight due to unhealthy reading habits and poor nutrition. If they are encouraged to eat a balanced diet and taught how to take proper care of their eyes they will not develop serious eye diseases. Small negligence can become life threatening. Schools provide an ideal opportunity to work with children to promote the health of the children and their families as well as to prepare them for their future lives.

The majority of health problems occur due to poor hygiene and illiteracy. Teachers can affect lives in a community if they are equipped with the knowledge on how to educate children about cleanliness and its benefits.

Our focus of work is health education and promotion through schools. We are working with variety of schools i.e. public, private, NGO, community, to promote health in urban and rural areas. We work with teachers to develop their capacity to teach health education by using Child-to- Child (CtC) Approach.

6) Description of innovation: We work with teachers to develop their capacity to teach health education by using Child-to-Child (CtC) Approach. The CtC approach enables children to become health promoters in their homes, schools and communities by providing an approach to teaching health that links the learning place (school) with the living place (home and community). This approach to teaching health education is flexible and can therefore be used to introduce health education in schools. CtC approach to teaching health education seems most successful especially in small poorly resourced schools. It shows that health education and promotion activities in schools have significantly impact on the overall quality of primary education. The schools are able to create an enabling environment to help teachers teach better and gain greater confidence in their work. This leads to the students’ active participation, building up of a positive relationship between teachers and students, creating stronger linkages between school and communities as well as enhancing of the overall quality of primary education and increasing health knowledge and self-esteem of all students and teachers. In some cases it also led to higher attendance of children in schools. This all contributes effectively to the better health conditions of children, their families and communities.

7) Operational model: We work for the professional development of the teachers in health education and Child-to-Child (CtC) Approach. Our training help teachers to improve general teaching methodologies to teach health education, as well as other subjects by appreciating the benefits of using child- centred, active methods to make learning interesting, relevant and enjoyable for students.

We have developed health curriculum fro class 1-5, this is under publication and will be our within next couple of months. The curriculum is developed through practical experience of working with teachers at school level. After the curriculum will be published the teachers will have access to the curriculum to provide them with guidance and support in planning their health topics using the Child-to- Child approach. The curriculum is based on contextually appropriate topics from class 1 to 5 based on active methods of teaching for improving of the quality of education

The CtC approach to teach health education improves children's knowledge, skills and attitudes related to important health issues. The use of child-centred teaching ensures that the rights of children to actively participate in a child friendly environment are met, which builds their ‘self-esteem’. These methods ensure that the children are empowered and skilled to become true decision makers and problem solvers. The active methods used in the Child-to-Child approach encourage children‘s attendance in school especially in areas where truancy is common. Children disseminates health messages they learn at school to their families and community through CtC step approach.

8) Human resources: We have a team of four team members. An Instructor and team leader, two tutors and one researcher. The Instructor and team leader have a degree in medicine and masters in education. She is working with the team for more than three years. Both the tutors have Masters degrees in Education and are working in the team for more than 4 and 2 years respectively. The researcher have a degree in social science and education and also working with the team for around four years. All the team have a reasonable background of field work as well as documentation, training and research.

9) Key operational partnerships: We have variety of partners in out project. We have a small number of schools as our direct intervention partners. These schools are from public, private, NGO and community based school systems. We have our partner schools in urban, semi urban and rural areas. We also work with organizations to provide them occasional support of training, material development and monitoring. We have also formed an association with membership of more 25 schools and organizations. We offer sessions and workshops for teachers of our partner schools on health education and promotion.

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: We have a funding from international donor.

          • Earned incomes as a percentage of operating costs: 0

          • Other funding sources: We have a funding from an international donor, as well as our own Institute for Educational Development of the Aga Khan University provides funds.

          • Strategy for long-term sustainability: Our institute has identifies health education as a priority area of the work for next phase and is willing to support health education and promotion intervention in future also.

11) Current and Future Impact

          • Total number of clients: 10000

          • Clients in the past year: 500

          • Percentage of low-income clients: 80

          • Impact: More than 80% of our clients belong to low income and marginalized areas. These are teachers and children in semi urban, rural and remote areas. Our partner NGOs have schools in very remote and underprivilaged areas, where there is lack of education and health facilities. We are working in those areas to bring health awareness for the children and communities.

          • Overall "market": The majority of health problems in Pakistan occur due to poor hygiene and illiteracy. Teachers can affect lives in a community if they are equipped with the knowledge on how to educate children about cleanliness and its benefits.

By implementing the Child-to-Child approach, the health education and promotion activities make a remarkable contribution to the development of active learning approaches for school health education. The Health Education and Promotion Project through its commitment to on-going learning can continue to play a major role in promoting children’s participation and active learning for health. We feel that every school of Pakistan should work for health education and promotion, because we believe that healthy children are happy and they learn better and they are future of our society, if children of today are healthy our future will be healthy also. But due to lack of resources we could not reach to thousands of schools, who need support to become health promoting schools.

12) Scaling up strategy

          • Stage of the initiative: Scaling Up stage.

          • Expansion plan: We keep working with our partner schools and organizations and will identify more partners also. We will be launching out health curriculum this year and we wil training the teachers of our partner schools and organizations to use the curriculum effectively. We are also in process of developing more material for teachers and children . health education. We are also planning to conduct research on the impact of our work at school level.

13) Policy change: We are planning an policy dialogue in near future. Through that event we will try to influence the policy to adopt our curriculum and make health education as a compulsory subject in all primary schools of the country.

14) Origin of the initiative: Our project is based on the success of a pilot project. Health Action School (HAS) research project was launched at Aga Khan University, Institute for Educational Development (AKU-IED) in April 1998 as a three-year pilot project in collaboration with Save the Children (UK). The aim of the project was to develop health-promoting schools, which integrated health education with school environment and health services provided for and by the school, using CtC approach.

Contact Information:
Parvez Ahmed  Pirzado
Research Associate
The Aga Khan University - Institute for Educational Development
(University)
The Aga Khan University - IED-PDC, 1-5/B VII F.B.Area, Karimabad, Karachi
Pakistan
Tel: 92-21-6347611-4
Fax: 92-21-6347616
Email: parvez.pirzado@aku.edu
Website: http://aku.edu/