Author: Aondofe Iyo, J. E.
School Health and Physical Education Services (SHAPES) Program was inaugurated in February 1999 as a multi-ministerial program to address health education and improve the accessibility of health services in schools, including nutrition and food safety. It aims to promote Physical Education and Sports in both primary and secondary schools. In addition, the program strives to promote healthy school environment. SHAPES is, therefore, an integrated approach to target pre-primary and primary school children in the country, especially those most vulnerable to poor health and poor health conditions. SHAPES' program strategy is to employ a multi-sectoral and multi-disciplinary approach in the execution of its four main components: Services, Environmental Health, Health Education, and Physical Education and Sports.
Purpose / Objective
To conduct an impact assessment that will document the activities of SHAPES, using the Strategy Document as a point of reference to determine the extent to which the program has been meeting its objectives.
Documents associated with SHAPES such as minutes of meetings, reports and other relevant documents were reviewed to determine the scope of the program. By interviewing most of the stakeholders and caregivers/service providers, and conducting semi-structured interviews with principals, teachers, pupils, food handlers and parents in a sample of 12 pilot schools, the consultant was able to determine the level of implementation of the four-point program objectives in schools.
Cluster probability and stratified random sampling of schools countrywide was adopted to evaluate how the four program components of SHAPES are being implemented in the selected schools on one hand, and measuring the impact of the four program components in the selected schools on the other. Cluster sampling selected units within the six districts of Belize. Stratified random sampling divided the population into strata based on the following characteristic variables: location - rural/urban, school size, type of funding available, number of meals per week, and other variables that were deemed important to the impact assessment.
Output indicators involved a two-tier approach: cross checking and verifying the outputs earmarked in the School Health and Physical Education Services Program Strategic Plan against records (where available) and on-site evaluation in the schools and conduct of oral interviews with key informants.
Key Findings and Conclusions
There have been no follow-up meetings of the tripartite Ministers (MOES, MOH, and MHD) or their representatives since the signing of the Ministerial Commitment. There has been no meeting of the stakeholders to specifically determine the success, limitations and failures of the strategic plan since SHAPES' inception in 1999. Public awareness campaigns have not been systematic.
Some of the expected outputs based on measurable indicators that should come out of the MOE may not be achievable due to problems associated with data collection and management (which, in most cases, is not disaggregated). The verification exercise proposed, based on Annual Reports, cannot give an accurate picture of the state of SHAPES' programs in the schools. There is a lack of monitoring and evaluation machinery with respect to all programs (some monitoring and evaluation is done but on an ad hoc basis).
Total coverage of the programs countrywide may not be feasible based on logistical problems, lack of manpower and inadequate financing of all the programs.
SHAPES has worked closely with QADS, MOH (particularly with the Public Health Bureau, the Maternal Child Health, and the Nutrition Unit) and with the Human Rights Commission in the development of the integrated curriculum for Primary Schools. SHAPES has also worked closely with some NGOs. There is weak coordination and supervision of strategic planned programs by SHAPES. SHAPES has not been able to network with the agencies responsible for the provision of services (this was established by the survey) and the link between SHAPES and the other agencies has been missing. SHAPES is perceived by some of the partners as competing and taking away what they consider to be rightly or wrongly theirs. Weak communication between SHAPES and service providers/care givers.
There is also poor coordination between SHAPES and service providers/care givers. For example, SHAPES has minimal contact with Sports Council even though the two are under the same ministry. One of the criticisms leveled against the feeding program has been the view that managers of the program have viewed it as a business venture rather than a model -- i.e. the provision of nutritious meals. Should the feeding program be a not-for-profit or a profit-making venture? Currently, the Principals manage donations (cash and kind) and there are accusations of abuse and profiteering. There are accusations of personal profits being made, and teachers made to prepare and serve meals, and wash dishes.
Physical Education and Health Curriculum has been integrated into the curriculum under Healthy Lifestyle, Health, and Physical Education from pre-primary to all levels of primary. Teachers nationwide are still struggling with the actual implementation of the curriculum due in part to the speed with which the project was implemented, and partly due to the fact that the idea of change and new concepts, together with the philosophical orientation of some teachers, run counter to the ideals of the new curriculum.
Teachers try to cover what is in the curriculum but not many of them have received training. Training in the new curriculum is deemed inadequate (based on the survey result). The training on P. E. provided by Teachers College appears inadequate. When teachers are not properly trained, they may conduct exercises that may injure pupils unintentionally. Many teachers do not know that P.E. includes warm up, stretching, etc. (refer to survey data). Others improvise as they lack recommended tools and equipment. Pupils, on the other hand, want more time allotted for P. E. and Sports.
Teachers are neither equipped nor do they have the resources to implement some aspects of the curriculum. For example, not many teachers are adequately trained/prepared to teach sensitive subjects such as HIV/AIDS, sex education and sexuality. The same holds to subjects such as drugs, crime and violence. Schools tend to rely on resource persons on sensitive subjects: the police visit schools during Police week, NDACC has been very active in schools, and NOPCA is mainly concerned with the "Rights of a Child" and only visits when invited. Most schools do not have teachers that are trained to identify pupils with minor clinical, psychological and physiological problems. Schools rely on teachers trained in Special Education where such teachers are available.
It is difficult to assess the success of the health education program because pupils' responses to such questions have been mixed. In most of the schools sampled, either the principals are directly involved in selling junk food (snacks) and beverages (ideal and soft drinks) or encourage their sale within the school premises. Variety, especially seafood (fish), is practically absent on all the menus of the schools sampled and surveyed. Most of the food handlers have not received training and have no manuals or menus to follow (many simply provide the typical Belizean Creole, Maya/Mestizo cuisines). The feeding program is excluding majority of needy pupils due to lack of information, or misinformation that the program is designed for the "poor" and, in many other cases, due to lack of finances to pay for the meals.
Appoint a representative national advisory committee (comprising experts from the key providers) to ensure implementation, evaluation and monitoring of SHAPES' strategic objectives as proposed in the strategic plan.
Provide SHAPES with adequate, well-trained personnel to enable it to execute its highly specialized strategic plan. Provide SHAPES with a core technical team to effectively implement the Strategic Plan. SHAPES should request for four coordinators for the 4-point program: health education and promotion; health services; physical education and sports; and monitoring and evaluation.
SHAPES needs to develop a monitoring and evaluation instrument (with technical assistance from QADS) to measure the performance of its programs in schools (ask the curriculum coordinators, community health nurses, and other relevant officers in the districts to assist in conducting periodic monitoring and assessment).
SHAPES needs to produce relevant and culturally-sensitive teaching and learning materials. Need for a follow up on some aspects of the curriculum -- especially those areas that deal with sex education and sexuality, child abuse and child neglect, drug use and drug abuse, and P. E. Select and train teachers in health education and physical education to ensure sufficient and adequate attention on these important aspects of education.
The whole concept of the feeding program needs an overhaul. More sessions on healthy lifestyle including hygiene, food nutrition and nutritious meals. SHAPES should go beyond supplying equipment for the feeding program to include clinics on special education, P. E. and Sports, and other areas that teachers are still struggling with. There is need for a sustained awareness campaign by SHAPES on the new curriculum and programs. Select and include maybe one teacher per district on SHAPES' committee who would liaise with teachers/colleagues during Saturday meetings.
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