69893 Strengthening the Education Sector Response to School Health, Nutrition and HIV/AIDS in the Caribbean Region: A Rapid Survey of 13 Countries Antigua, the Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Anguilla (Joint British & Dutch Overseas Caribbean Territories), St. Kitts & Nevis, St. Lucia, St. Vincent & the Grenadines, and Trinidad & Tobago March 2009 IBRD 36789 FEBRUARY 2009 The map on the cover was produced by the Map Design Unit of the World Bank. The boundaries, colours, denominations and any other information shown on this map do not imply, on the part of The World Bank Group,any judgement on the legal status of any territory, or any endorsement or acceptance of such boundaries. Strengthening the Education Sector Response to School Health, Nutrition and HIV/AIDS in the Caribbean Region: A Rapid Survey of 13 Countries Antigua, the Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Anguilla (Joint British & Dutch Overseas Caribbean Territories), St. Kitts & Nevis, St. Lucia, St. Vincent & the Grenadines, and Trinidad & Tobago March 2009 Edited by: Tara O'Connell, Mohini Venkatesh and Donald Bundy. Coordinated by: EduCan, EDC, PCD, The World Bank and UNESCO Table of Contents List of Tables and Figures ii Acknowledgements iii List of Abbreviations and Acronyms iv Executive Summary v 1. Introduction 1 1.1 Health, nutrition and HIV of Caribbean school-age children 1 1.2 Education sector role in health, nutrition and HIV 1 1.3 Non-Communicable diseases 1 1.4 HIV and education 1 1.5 The education sector response to HIV in the Caribbean 2 2. Objectives and Methodology 5 2.1 Objectives 5 2.2 Methodology 5 3. Results and Discussion 7 3.1 Health-related school policies 7 3.2 Safe and supportive school environment 9 3.3 Skills-based health education 10 3.4 School-based health and nutrition services 13 3.5 Support to MoE SHN and HIV responses 14 4. Conclusion and Recommendations 15 5. List of References 17 6. Annexes 19 6.1 Port-of-Spain action framework 19 6.2 School Health, nutrition and HIV/AIDS in the Caribbean Region questionnaire 23 6.3 Education sector HIV/AIDS coordinator network (EduCan) list of HIV focal points 29 CONTENTS List of Tables and Figures Tables Table 1. List of EduCan Network countries 5 Table 2. Policies and strategies for SHN and HIV 7 Table 3. Support for orphans and vulnerable children 8 Table 4. Education sector planning and management for SHN and HIV 9 Table 5. National policies for safe and sanitary school environment 10 Table 6. Presence of skills based health education including HIV prevention 11 Table 7. Presence of teacher training for HIV and life skills education 12 Table 8. Health and nutrition services offered for school-age children and teachers 13 Table 9. Sources of support for MoE SHN and HIV responses 14 Table 10. MoE budget allocated for SHN and HIV responses (in US$) 14 Figures Figure 1. Number of countries with SHN and safe workplace policies 8 Figure 2. Number of countries offering pre-service or in-service training on life skills and HIV for teachers 12 LIST OF TABLES AND FIGURES II Acknowledgements This report is a product of discussions with the Caribbean Education Sector HIV and AIDS Coordinator Network (EduCan) and their partners in the health sector and in civil society who participated in the School Health, Nutrition and HIV/AIDS in the Caribbean Region Questionnaire exercise, the results of which are presented in this report. The Questionnaire was implemented by the World Bank, Partnership for Child Development (PCD), Education Development Center (EDC), and UNESCO and administered through EduCan in early 2008. Development and coordination of the report was supervised by Donald Bundy (World Bank) and coordinated by Tara O’Connell (World Bank) with: Yuki Murakami (World Bank); Lesley Drake, Michael Beasley, Mohini Venkatesh, Anthi Patrikios, Kristie Neeser (PCD); Paolo Fontani and Jenelle Babb (UNESCO); and Connie Constantine and Arlene Husbands (EDC). The report was edited by Tara O’Connell (World Bank), Mohini Venkatesh (PCD) and Donald Bundy (World Bank). The team benefited from the valuable input of two peer reviewers: Mary Mulusa and Harriet Nannyonjo of the World Bank. The team is also grateful to World Bank staff including Chingboon Lee, Shiyan Chao, Angela Demas, Cynthia Hobbs, Christine Lao Pena, Andy Tembon, Stella Manda and Fahma Nur who provided guidance and support at different stages and throughout the preparation process of this work. Other important contributions to the report were made by government officials and other individuals at the national level. They include the following HIV&AIDS Coordinators in Caribbean Ministries of Education: Sandra Fahie (Education Officer, Curriculum and HIV/AIDS Focal Point, Department of Education, Anguilla, Joint British and Dutch Overseas Caribbean Territories); Maureen Lewis (Education Officer, Ministry of Education, Sports and Youth, Antigua); Glenda Rolle (Senior Education Officer, Ministry of Education, Youth, Sports and Culture, Commonwealth of the Bahamas); Hughson Inniss (HIV/AIDS Coordinator, Ministry of Education, Youth Affairs and Sports, Barbados); Patricia Warner (Education Officer, Ministry of Education and Human Resource Development, Barbados); Carolyn Codd (National HFLE Coordinator, Ministry of Education, Belize); Thomas Holmes (Guidance Counselor, Ministry of Education, Human Resource Development, Sports and Youth Affairs, Dominica); Arthur Pierre (HIV/AIDS Response Coordinator, Ministry of Education and Human Resource Development, Grenada); Patrick Thompson (HIV/AIDS Focal Point, National AIDS Directorate, Grenada); Michelle Greaves-Warrick (HIV/AIDS Coordinator, Ministry of Education, Grenada); Sharlene Johnson (HIV/AIDS Focal Point, Ministry of Education, Guyana); Christopher Graham (National Coordinator, HIV/AIDS , Ministry of Education and Youth, Jamaica); Ruby Thomas (Counselor, Ministry of Education, St. Kitts and Nevis); Sophia Edwards Gabriel (HIV/AIDS Focal Point, Ministry of Education, St. Lucia); Abner Richards (Curriculum Support Officer, Ministry of Education, St. Vincent and the Grenadines); Patricia Downer (HIV/AIDS Coordinator, Ministry of Education, Trinidad and Tobago). iii ACKNOWLEDGEMENTS List of Abbreviations and Acronyms AIDS Acquired Immune Deficiency Syndrome ART Anti-retroviral therapy ARV Anti-retroviral CARICOM Caribbean Community EDC Education Development Center EduCan Caribbean Education Sector HIV and AIDS Coordinator Network EFA Education for All FRESH Focusing Resources on Effective School Health HFLE Health and Family Life Education FTI Fast Track Initiative HIV Human Immunodeficiency Virus IADB Inter-American Development Bank MoE Ministry of Education MoEs Ministries of Education MoH Ministry of Health MDGs Millennium Development Goals NCDs Non-communicable Diseases OVC Orphans and vulnerable children PCD The Partnership for Child Development SHN School Health and Nutrition STI Sexually Transmitted Infection UN United Nations UNAIDS United Nations Programme on HIV and AIDS UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children’s Fund VCT Voluntary Counseling and Testing WB The World Bank WHO World Health Organization LIST OF ABBREVIATIONS AND ACRONYMS iv Executive Summary Globally, the education sector has come to play an increasingly and supportive school environment; skills-based health education; important role in the health and nutrition of the school-age school-based health and nutrition services; and support to MoE child. This is largely in response to research conducted over SHN and HIV responses. Of the 14 countries and territories the past two decades which has shown that poor health and represented in the EduCan Network, the 13 countries malnutrition are critical underlying factors for low school of Antigua, the Bahamas, Barbados, Belize, Dominica, Grenada, enrolment, absenteeism, poor classroom performance and Guyana, Jamaica, Anguilla (Joint British and Dutch Overseas dropout; all of these outcomes act as important constraints in Caribbean Territories), St. Kitts and Nevis, St. Lucia, St. Vincent countries’ efforts to achieve Education for All (EFA) and their and the Grenadines, and Trinidad and Tobago responded to education Millennium Development Goals (MDGs). the questionnaire. Caribbean governments have identified nutrition, infectious diseases including HIV, non-communicable diseases, and violence as Key findings of the survey are as follows: priority areas to address in meeting the health and nutrition needs of school-age children in the region. They have also recognized that, Health-related school policies as elsewhere in the world, some of the major causes of death in the adult population, including diabetes, hypertension and heart • Nine of the 13 MoEs have policies, strategies and work plans in disease, have their roots in behaviour patterns established during place, demonstrating their commitment to SHN and HIV childhood and youth. Furthermore, schoolchildren in the emerging response. middle income countries of the Caribbean face the dual burden of diseases of prosperity, including obesity and diabetes, alongside • Ten of the 13 MoEs have a national policy on free and universal diseases of poverty and social deprivation, such as malnutrition. The primary education to reduce financial barriers of education for Caribbean is also challenged as being, according to UNAIDS, the orphans and vulnerable children. second most HIV-affected region of the world, with sub-Saharan Africa being the most affected. • Ten out of 13 countries have an existing management framework in place for MoEs to manage and mainstream their In response to these challenges, education and health sector response to SHN and HIV. Such a framework may include a leadership in the Caribbean has committed to addressing the health SHN/HIV unit within the MoE, seen in seven countries; an inter- and nutrition needs of school-age children through a broad school departmental coordination committee on SHN/HIV, in seven based health and nutrition (SHN) program that specifically includes countries; and a HIV/AIDS coordinator at national and sub- HIV prevention and mitigation initiatives. At the Caribbean national level, in 10 and three countries respectively. Community (CARICOM) Council on Human and Social Development The national HIV/AIDS coordinator is financed by the MoE in six (COHSOD) high-level meeting held in Port-of-Spain, Trinidad in June countries, and by the Ministry of Health (MoH) in two countries. 2006, the Caribbean Ministers of Education and representatives of the National AIDS Authorities identified a need for education • Twelve out of the 13 MoEs collect some data to facilitate ministries to each appoint a focal person for school health activities, ongoing monitoring and evaluation of their SHN programs. and for the creation of a regional mechanism for the sharing of This data may include information on teacher training, school school health information, with a focus on HIV. The resulting sanitation and teacher attrition. Caribbean Education Sector HIV and AIDS Coordinator Network (EduCan) was tasked with promoting the sharing of information and Safe and supportive school environment capacity building on national education sector responses to HIV throughout the Caribbean, with the overall goal of strengthening • All 13 countries have a mechanism in place to ensure that there the role of the education sector in preventing HIV in the region. is a safe and healthy environment in schools. This includes the presence of policies and practices to ensure that schools have The overall objectives of this rapid survey undertaken by EduCan in safe water and sanitation, as found for eight and 10 countries early 2008 are to inform the development of both regional and respectively; are hygienic, reported by all countries; and national level education sector policies and strategies on school promote the psychosocial well-being of teachers and students, health, nutrition and HIV in the Caribbean region. The survey also as reported by 10 countries. aims to describe the current situation of education sector response to school health, nutrition, HIV and stigma, and to provide a base- • Six of the 13 MoEs conduct annual sanitation surveys in all line for monitoring progress. It also aims to provide data on the schools as a means of monitoring the implementation of safe allocation and mobilization of resources used in such education school environment policies and improving and scaling up sector responses across the region. interventions. Ministry of Education (MoE) HIV/AIDS coordinators1 answered a questionnaire covering issues on health-related school policies; safe 1 This includes MoE Health and Family Life Education (HFLE) coordinators, education officers and guidance counsellors who also serve as HIV/AIDS coordinators. EXECUTIVE SUMMARY v Skills-based health education Conclusions and recommendations drawn from the survey are as follows: • In all 13 countries, to varying degrees, the education sector is involved in providing skills-based health education including HIV Overall, the rapid survey found that Government leaders of the prevention to staff and students. Schools generally utilize both Caribbean are committed to reaching children and adolescents a curricular and a peer-education approach in order to deliver with information as well as training in life skills with the knowledge, important life skills education. Under the curricular approach, attitudes, and values needed to make sound health and HIV prevention education is generally taught as part health-related decisions that promote lifelong healthy behaviours of health and family life education (HFLE), which provides A majority of MoEs have established effective policies and strategies information on many different health concerns, such as for addressing SHN, HIV and other infectious diseases. hygiene, nutrition, and disease prevention. Ten countries also As such since common NCDs (e.g. obesity and type 2 diabetes) are deliver HIV prevention education in the non-formal setting. emerging areas of concern in the region, greater policy emphasis on NCDs may prove beneficial. • In 12 of the 13 countries, teachers are trained in life skills At this stage, the focus might effectively shift from creating a policy education. Teacher training on life skills and HIV is provided environment to implementing strategies. Questionnaire responses more often in-service than pre-service. In all 13 countries reveal that in all countries the education sector response to school teachers are trained to teach HIV prevention education. health, nutrition and HIV is underway and is being further developed and refined to more effectively address the health conditions specific School-based health and nutrition services to Caribbean school-age children. • All 13 countries, to varying degrees, are involved in providing The findings identify areas where a strong education sector school health and nutrition services to school-age children and health and HIV response is already present, such as the provision of teachers. Vaccinations and hearing and sight examinations take skills-based health education through HFLE and the school-based place in all 13 countries; school feeding takes place in 12 provision of vaccinations, as well as areas that might benefit from countries; iron and vitamin A supplementation take place in further strengthening, such as monitoring the impact of programs. four and two countries respectively. Deworming for school-age School feeding is near universal in the 13 countries and territories children takes place in eight countries. Reproductive health while micro-nutrient supplementation is, however, very focal. services are provided to youth in 11 countries; while in 12 Anecdotal experience suggests that there may be need for greater countries counseling is provided to teachers and other focus on the quality of food consumed by school-aged children. In education employees. the context of the region's growing epidemic of common NCDs, there is opportunity to consider the coverage of micro-nutrient • Vaccinations and hearing and sight examinations is provided by supplementation and to assess the quality of food provided through MoH employees in all countries providing these services. school feeding programs and accessed through food vendors in schools. • Where school feeding is provided, it is administered by teachers, There is clear evidence that schools have placed strong emphasis on except for the Bahamas where it is provided by MoH employees. ensuring a hygienic and safe environment with psychosocial support Deworming in six of the eight countries is administered by MoH for students in school. This survey did not assess the availability of employees. exercise facilities in schools but this may be an important factor for consideration given the emergence of common NCDs in Caribbean Support to MoE SHN and HIV responses school-age children. • Ten of the 13 MoEs receive external support for education There is generally a high level of teacher training provided in the sector responses to SHN and HIV. This support is derived from countries of the Caribbean. This typically includes training in life various sources including the private sector, NGOs and UN skills education and in relation to delivering HIV prevention agencies (including World Bank). Seven MoEs contract or messages. Teacher training, however, is primarily provided in-service partner with NGOs to assist in the implementation of HIV and not as a substantive component in preparing teachers pre- prevention education. Separately, eight MoEs work with the service for teaching careers. This might indicate a need to focus on private sector for support to HIV prevention education. Guyana ensuring skilled teachers equipped with sexuality training. is the only country eligible for EFA Fast Track Initiative (FTI) Thus, by providing a comparative perspective across the region on funding; funds are used for SHN activities such as provision of both education sector responses to school health, nutrition and HIV, water and sanitation in schools. and on the allocation and mobilization of resources used in such responses, the rapid survey is intended to inform policy makers and to enhance the quality and outcomes of subsequent investments and future programs. It is anticipated that the findings of this rapid survey will be presented at the next CARICOM COHSOD meeting scheduled to be held in Jamaica in early June 2009 for consideration by the Ministers of Education and National AIDS Authorities, and will feed into discussions of the way forward. vi EXECUTIVE SUMMARY Introduction 1 1.1 Health, nutrition and HIV of Caribbean The four core components of an effective school health program, as suggested by FRESH are as follows: school-age children 1. Health-related school policies: including those that address HIV Recent studies point to a number of current and emerging concerns issues, and gender. in the health and nutrition of school-age children in the Caribbean region. Critical among them are: infectious diseases including HIV 2. Safe and supportive school environment: including access to and other sexually transmitted infections (STIs); non-communicable safe water, adequate sanitation and a healthy psychosocial diseases (NCDs); and violence. Common health conditions including environment. diabetes, hypertension and heart disease in the adult population can be positively linked to unhealthy lifestyles in youth. 3. Skills-based health education: including curriculum development, life skills training, teaching and learning These health challenges, combined with a large school-age materials. population, which in some countries may be a sizable third of the overall population, make a strong national response to the health 4. School-based health and nutrition services: including and nutritional needs of school-age children particularly vital. As deworming, micronutrient supplementation, school lifelong patterns of behaviour and thinking are established during feeding, dengue prevention and psychosocial counseling. youth, it is critical to ensure early and widespread promotion of healthy practices related to sexual behaviour, nutrition and a healthy These components can be implemented effectively only if supported lifestyle in general in the school-age population, resulting in a by strategic partnerships between: the health and education sectors healthier adult population in the future. (especially teachers and health workers), schools and communities, and pupils and stakeholders (Jukes et al., 2008). 1.2 Education Sector Role in Health, Nutrition and HIV 1.3 Non-Communicable Diseases Recognizing that the health of an adult population has direct links There is increasing recognition of the importance of NCDs for to lifestyle and behavioural choices cultivated in childhood, the school-age children, and the importance of school health programs education sector in low-income countries has come to play an in promoting the healthy life styles that help avoid NCDs in later increasingly important role in the health and nutrition of the school- years. This is true for all countries, but is particularly apparent in aged child. Evidence suggests that school-based health and nutrition countries that are developing economically. With economic growth (SHN) programs delivered through the education sector have a dual there are often improvements in sanitation and health services role to play: first, in affecting positive behaviour change for a and concomitant reductions in infectious diseases, giving greater healthier lifestyle and, second, in promoting better learning relative importance to NCDs. At the same time, growth is often outcomes. This is supported by research over the past two decades associated with dietary changes and increasingly sedentary life-styles which has shown that poor health and malnutrition are critical that can drive an epidemic of obesity and type two diabetes in underlying factors for low school enrolment, absenteeism, poor school children, and lead to increased rates of cardiovascular and classroom performance and dropout; all of which act as important other non-communicable diseases in adulthood. To address these constraints in countries’ efforts to achieve Education for All (EFA) issues, SHN programs seek to promote life-long healthy habits and their education Millennium Development Goals (MDGs). by providing effective life-skills programs, by enhancing the quality of the diet available at school, especially Thus, programs have focused on improving health and nutrition for that provided by school feeding programs, and by providing school all children, particularly for the poor and disadvantaged, in order to children with the time and facilities to encourage regular exercise. reap education and subsequent economic gains. In the 1990s, when EFA was launched, SHN programs became increasingly incorporated 1.4 HIV and Education in education sector responses to ill health among school-age children, as part of EFA programs. A major step forward in There has been a strong focus on HIV both globally and in the international coordination was achieved at the World Education Caribbean region within the context of education. in recent years, Forum in Dakar in April 2000, where a joint partnership effort by the education sector has played an increasingly important role in UNESCO, UNICEF, WHO and the World Bank led to Focusing preventing HIV as key events around the millennium leading up to Resources on Effective School Health (FRESH). Based on good the Dakar World Education Forum, such as the advocacy by Michael practice recognized by all the partners, the FRESH framework Kelly of Zambia at the 1999 Lusaka International Congress on suggests a core group of cost effective activities which can form HIV/AIDS and STIs in Africa, have given new impetus to the HIV the basis for effective implementation of comprehensive SHN response of the education sector. programs. FRESH’s consensus approach has increased significantly the number of countries implementing school health reforms. INTRODUCTION 1 School-age children have the lowest HIV infection rates of any primary schools. In 1996 Education Ministers requested all population sector. Globally and throughout the Caribbean, even in CARICOM states to develop national HFLE policies and prepare the worst affected countries, the vast majority of schoolchildren are plans to translate that policy into action. not infected. For these children, there is a ‘window of hope’, a chance to live a life free from AIDS, if they can acquire knowledge, • Guidance and counseling units have worked to promote safe skills, and values that will help to protect them as they grow up. behaviour through HFLE, build the capacity of teachers and guidance counsellors, support awareness raising activities, and Education contributes to the attainment of knowledge, skills and develop community networks of parents, communities and the values essential for the prevention of HIV. It protects individuals, public. families, communities, institutions and nations from the impact of HIV. Young people, and particularly girls, who fail to complete a • The Caribbean Network for health promoting schools was basic education, are more than twice as likely to become infected, established in 1998. Issues relating to HIV were part of this and some seven million cases of AIDS could be avoided by the broader health initiative. achievement of EFA (GCE, 2004). Providing young people with the ‘social vaccine’ of education offers them a real chance at a • In addition to the above, some HIV-specific education initiatives productive life. were also implemented at national level on a country-to-country basis. Education has also been shown to increase understanding and tolerance, dramatically reducing levels of stigma and discrimination In November 2002, recognizing the potential of HIV to deplete against vulnerable and marginalized communities and people living human resources throughout the Caribbean, Ministers of Education with HIV (CARICOM et al. UNESCO, 2007; World Bank, 2002). in a regional meeting in Havana committed to a more Additionally, education has an important role to play in providing comprehensive response to the epidemic. This included prevention access to care, treatment, and support for teachers and staff – a education, care and support of educators and learners, and group that represents a significant portion of the public sector measures to reduce the impact of the epidemic on education; workforce in many countries. all of these bring greater attention to the need for a systematic education sector response to the epidemic. It is, however, important to ensure that adolescents and young people are accessing education with appropriate and actionable HIV An assessment of the Caribbean education sector conducted in prevention messages. Simply supplying facts about sex and HIV is 2006 found that countries were at different stages in developing a not enough to alter risky behaviour. Information must be comprehensive response to HIV (Whitman & Oommen, 2006): supplemented with training in life skills, such as critical and creative • Only two countries had put in place an HIV or school health thinking, decision-making and self-awareness, and with the policy. Other countries were in the process of drafting such knowledge, attitudes, and values needed to make sound health- policy. related decisions that promote lifelong healthy behaviours. To this end, governments have made efforts to strengthen the education • All 12 countries assessed were implementing HFLE, but had sector response to HIV throughout the Caribbean region. variable concerns such as teacher training and timetabling of the curriculum. 1.5 The Education Sector Response to HIV in the Caribbean • Eight of the 12 countries assessed reported having a policy for a safe and healthy school environment. However, they reported The Caribbean is the second most-affected region in the world with that discrimination against people living with HIV was a severe respect to HIV, after sub-Saharan Africa, with an HIV prevalence of issue despite some efforts to sensitize the MoE staff. 1.6%. Data indicate that figures for the prevalence of HIV for the less than 15 years population measure 7% of total infections, and • The provision of services, care and support was limited. Most other STIs, early pregnancy and multiple partners are on the rise Ministries did not provide any information about voluntary among Caribbean youth. While prevalence in the Caribbean remains counseling and testing. HIV coordinators reported the need for relatively low, evidence suggests that youth may be engaging in risky more knowledge and skills in this area. behaviour, and that stigma and discrimination are quite high (PAHO et al. 2006). The Caribbean Community (CARICOM) recognizes the During a high level meeting of Ministers of Education and National education sector as a key partner within the multi-sectoral response AIDS Authorities, under the auspices of the Caribbean Community to HIV. (CARICOM) Council on Human and Social Development (COHSOD) held in Trinidad & Tobago in June 2006, the Governments of For two decades, similar to patterns of response globally, the CARICOM and the Dominican Republic developed and endorsed Caribbean response to the HIV/AIDS epidemic was largely focused two documents identifying HIV as a key issue to be addressed within within the health sector. Initial activities by the education sector to the education sector2. The documents were later presented to the respond to HIV were concentrated on the provision of HIV July 2007 CARICOM meeting of heads of governments: education, and strengthening guidance and counseling within schools (Kelly & Bain, 2003): 1. The Port-of-Spain Declaration, which signified the commitment of CARICOM Ministers of Education and other participants at • The Health and Family Life Education (HFLE) initiative in the early the COHSOD meeting to review efforts to accelerate the 1990s was a CARICOM multi-agency activity in response not education sector response to HIV in the Caribbean. only to HIV but more broadly to health and social problems such as pregnancy, violence, substance abuse, and nutrition among adolescents (Kelly & Bain, 2004). The program was first introduced in secondary schools, but was later extended to 2This identification exercise involved a broad base of stakeholders including a number of UN agencies including the World Bank (WB), international development partners and civil society organizations. 2 INTRODUCTION 2. The Port-of-Spain Action Framework, which codified an responses to HIV throughout the Caribbean. The overall goal of this emerging consensus among participants in the COHSOD Network is to strengthen the role of the education sector in meeting around a core set of areas, listed below, to strengthen preventing HIV in the region. The Network was established at the national HIV responses by the education sector (see Annex 6.1). specific request of CARICOM and was formally presented to the a. Policy Caribbean Ministers of Education and National AIDS Authorities at b. Planning and Management the CARICOM COHSOD meeting. c. Prevention d. Orphans and Vulnerable Children In March 2008, the EduCan Network organized a five-day annual- general meeting and capacity building workshop, bringing together Through these documents, CARICOM made clear the intent to HIV/AIDS coordinators from 13 of the 14 Ministries of Education it strengthen the multi-sectoral response to HIV in the Caribbean represents. This meeting focused on capacity building, including region. At the centre of the CARICOM plan for action is the monitoring and evaluation (M&E) skills, and was part of a larger development of a regional strategy as well as national strategic plans effort to understand the education sector responses of HIV in the that emphasize quality EFA and lifelong learning experiences as Caribbean region. central to the education sector response to the epidemic. To develop a cross-sectional overview of education sector HIV Later, in an effort to strengthen and harmonize education sector responses at both national and regional level, a questionnaire survey responses to HIV across the region, the Caribbean Ministers of was conducted prior to the meeting. As HIV prevention education is Education and National AIDS Authorities during the June 2006 integral to comprehensive SHN programming, the rapid survey also COHSOD meeting endorsed the establishment of the Education collected information on the overall SHN response in Network Sector HIV and AIDS coordinator Network (EduCan) 3. The countries. The responses from countries were discussed at the establishment of EduCan was facilitated by the Education meeting. This report presents the findings of this rapid survey and is Development Center (EDC), supported by the Inter-American intended for presentation to the Ministers at the CARICOM Development Bank (IADB) and with UNESCO and the World Bank. COHSOD Meeting scheduled for early June 2009. The EduCan Network is tasked with promoting the sharing of information and capacity building on national education sector 3Article 17 of the Declaration. The 14 countries and territories with representation in the EduCan Network are: Antigua, the Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, Joint British and Dutch Overseas Caribbean Territories, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, and Trinidad and Tobago. INTRODUCTION 3 Objectives and Methodology 2 2.1 Objectives • Health-related school policies (which included issues on This rapid survey has been conducted to inform the development of planning and management, and orphans and vulnerable both regional and national level education sector policies and children) strategies on school health, nutrition and HIV in the Caribbean region. It aims to provide policy makers and practitioners with a • Safe and supportive school environment comparative perspective of education sector activities and initiatives implemented across the region to address school health, nutrition, • Skills-based health education (which included questions on HIV and stigma. It also aims to provide data on allocation and curriculum and teacher training) mobilization of resources used in the response to school health, nutrition and HIV across the region. • School-based health and nutrition services The specific objectives of the survey are to: Information on resources available in countries to support SHN and HIV responses was an additional area of assessment. • Allow the education sector in participating countries to monitor their progress against the core set of actions to strengthen The information in this survey mostly pertains to primary and national SHN and HIV responses by the education sector, as secondary education. Information on HIV prevention activities in the outlined in the Port-of Spain Action Framework and FRESH. non-formal education sector is also included because the sector provides a means of reaching out-of-school youth who might be • Identify priority areas in SHN and HIV in each country, enabling more vulnerable to HIV. government officials to concentrate resources and programming in these areas. Table 1. List of EduCan Network countries • Identify good practice in SHN and HIV specific to the Caribbean Antigua context. The Bahamas • Aid in future planning both within each country and collectively Barbados across the region. Belize Dominica Grenada 2.2 Methodology Guyana Jamaica Ministries of Education in the 14 EduCan countries (see Table 1) Joint British and Dutch Overseas Caribbean Territories were contacted for the survey and were asked that their HIV/AIDS St. Kitts and Nevis coordinators4 complete a questionnaire about national responses to St. Lucia SHN and HIV5 (see Annex 6.2). A 93% response rate to the questionnaires was achieved. No response was received from St. Vincent and the Grenadines Suriname and the HIV/AIDS focal point for Suriname was not able to Suriname attend the March 2008 EduCan meeting. One-on-one discussion Trinidad and Tobago with each HIV/AIDS coordinator attending the EduCan meeting followed submission of responses, and was used to clarify responses as needed. There are some important considerations regarding the analyses and interpretation of the survey data. First, percentages are calculated The questionnaire was guided by the FRESH framework on SHN and for countries that reported a response activity out of the total 13 the Port-of-Spain Frameworks on HIV. Responses related to similar countries that responded to the survey. Percentages have not been issues in both frameworks (e.g. health-related school policies in statistically analyzed because of the small denominator in the FRESH and the Sector Policy in the Port-of Spain Framework), were Network. Second, the interpretation of results sometimes proved analyzed under the more generic FRESH component. Responses difficult because either there were no responses to questions, or which covered aspects of the Port-of Spain Frameworks while follow up information about the program was not available. There is complementing a FRESH component (e.g. information on Prevention also a margin of error to consider in the completion of the overlapped with Skills-based health education) were also analyzed questionnaire. Last, the fact that the data collected were in relation under the broader FRESH component. The key areas thus analyzed to national SHN and HIV responses precludes their use to indicate during the rapid survey fell under the four main components of program coverage and success at sub-national level. As information FRESH, as follows: on the extent of activities at country level is also not captured as part of this survey, it needs further investigation. 4 This includes MoE Health and Family Life Education (HFLE) coordinators, education officers and guidance counsellors who also serve as HIV/AIDS coordinators. 5 Anguilla responded on behalf of the Joint British and Dutch Overseas Caribbean Territories (OCTs). Henceforth, responses will be referred to as Anguilla so as not to generalize national data with data for the collective OCTs. OBJECTIVES AND METHODOLOGY 5 Results and Discussion 3 3.1 Health-related school policies Tobago also have a draft nutrition policy which is implemented by the MoE. Policies for SHN and HIV interventions are important because they demonstrate leadership commitment, and provide a framework to On HIV prevention and mitigation, although 12 countries (excluding ensure that the health and education needs of children are Anguilla) have a national HIV strategy, only six (46%) countries holistically and systematically met in all schools. Table 2 displays reported having an education sector HIV strategy (see Table 2), policies and strategies relevant to education sector activities on which has also been incorporated in to action plans for health, nutrition and HIV that exist in the 13 EduCan countries that implementation. In Trinidad and Tobago, the strategy recently responded to the survey. expired. The Bahamas, St. Lucia, and St. Vincent and the Table 2. Policies and strategies for SHN and HIV Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Policy and Strategies Belize Education Policy within MoE       NR       Education Strategy within MoE           NR   National SHN Policy         NR     National SHN Policy implemented by MoH NA NA NA  NA NA NA  NR  NA NA  National SHN Policy implemented by MoE NA NA NA  NA NA NA  NR  NA NA  National HIV Strategy              Education Sector HIV Strategy              Education Sector HIV Action Plan              National Workplace Policy            NR  HIV issues addressed in National Workplace Policy NA NA NA NR  NA     NA NR  Education Sector HIV Policy that includes Workplace Regulations  NR   NA  NA NA NA  NR   = yes, = no, NA= not applicable, NR= no response to the question Seven (54%) countries have a national education policy, while six Grenadines have education sector HIV action plans, but do not have (46%) have a national education strategy (see Table 2). long-term strategies in place. As the ‘internal’ role of the education sector in mitigating the impact of HIV on its staff becomes ever more Four (31%) countries have a national policy on SHN, which is recognized, workplace policies are seen as essential to ensure a safe either published or in draft form. In St. Kitts and Nevis and Trinidad and inclusive work environment. Seven (54%) countries reported and Tobago the SHN policy is implemented by the Ministry of Health. having a national workplace policy. Six of these countries reported In Barbados and Guyana the SHN policy is implemented jointly by that this policy, which is applicable to the education sector, both the Ministries of Education and Health. Belize has a Family Life addresses HIV-related concerns. In three countries reportedly lacking and Health Education (HFLE) policy and is implemented by the national workplace policies, the Bahamas, Barbados and St. Vincent Ministry of Education. Six additional countries without a specific and the Grenadines, HIV/AIDS coordinators report the existence of national SHN policy reported that their national education policy workplace regulations within education sector HIV policies. advocates for child-friendly schools (see Section 3.3). St. Lucia is the Therefore the total number of MoEs with workplace arrangements only country without either policy, while information for Jamaica that ensure an inclusive environment for those affected by HIV is was not available. Therefore the total number of countries with nine (69%) (see Figure 1). policy arrangements for SHN is 11 (84%) (see Figure 1). Trinidad and RESULTS AND DISCUSSION 7 Figure 1: Number of countries with SHN and safe (UNAIDS, 2004). Only two (15%) countries, Barbados and St. Kitts workplace policies and Nevis, reported having programs targeted to boost girls’ enrolment and attendance. It is important to note, however, that there is relative parity between boys and girls access to primary Policy to ensure a education in the Caribbean. When transitioning to the secondary safe and inclusive 9 (69%) level, though, there is some attrition in the number of boys, resulting workplace in a reverse gender gap and making a strong emphasis on girls’ education less urgent in the Caribbean region. Data on the number of orphans and vulnerable children is important A policy for SHN 11 (84%) for identification of children needing support and for estimating whether affirmative action programs have the desired impact on reducing inequities and achieving Education for All. Three (23%) 0 2 4 6 8 10 12 countries collect data held by the MoE on orphans and vulnerable Number (%) of countries children and their participation in schools. Data on orphans and vulnerable children in some countries, such as Belize, is indeed collected nationally, but it is held by another ministry. 3.1.1 Orphans and Vulnerable Children 3.1.2 Planning and Management An essential HIV mitigation strategy is the removal of financial In most countries, a management framework exists for MoEs to barriers that may prevent orphans and vulnerable children, manage and mainstream their response to SHN and HIV. Seven out particularly girls, from accessing education. The commitment of all of 13 countries have an SHN and/or an HIV unit in their MoE. An states to offer free compulsory primary education, reaffirmed at the SHN unit exists in five (39%) national MoEs and there is a full-time 2000 Dakar Forum, contributes to achieving this. Among the 13 coordinator in four of these units (see Table 4). In Trinidad and Network countries, 10 (77%) reported the presence of a national Tobago, the SHN unit in the MoE primarily focuses on school policy to promote free primary Education for All (see Table 3). In nutrition; a separate unit for school health is present in the MoH. In another 10 (77%) countries, orphans and vulnerable children do not Barbados, Guyana, and Trinidad and Tobago the SHN units are free- have to pay school tuition fees. standing and not part of a directorate. Six (46%) countries either have an HIV section within their SHN unit or a separate HIV unit within the MoE. In the case of Belize, an HFLE unit in the MoE addresses SHN-and HIV-related activities. Table 3. Support for orphans and vulnerable children Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Orphans and Belize Vulnerable Children National policy of free primary school EFA       NR  NR     OVCs do not pay school tuition/fees   NR           Program for conditional cash transfers    NR NR NR NR       Affirmative action to boost enrolment/attendance           of girls NR NR  MoE keep data on OVC              = yes, = no, NR= no response to the question All six countries with an established HIV section in the MoE have a But ensuring that orphans and vulnerable children are able to attend designated national HIV/AIDS focal point or coordinator. Four school is only the beginning; they also require support to remain in additional countries, Grenada, St. Kitts and Nevis, St. Lucia, and school. Cash transfers conditional upon attendance have been Trinidad and Tobago, lack an HIV section in the MoE but have a shown an effective method in other regions. None of the countries designated HIV/AIDS coordinator. The HIV/AIDS coordinator in reported to have programs of conditional cash transfers for orphans Trinidad and Tobago is attached to the Student Support Services and vulnerable children. Division. Thus, 10 (77%) of the MoEs have a HIV/AIDS coordinator. In Belize, HIV initiatives are part of the responsibility of an HLFE Encouraging girls to attend school is essential for gender equity and coordinator. The HFLE coordinator is a full-time staff member, with for addressing the increasing feminisation of the HIV/AIDS epidemic an official job-description. In eight out of the 10 MoEs with a in the Caribbean context. Young girls have been found more likely HIV/AIDS coordinator, these are full-time positions (see Table 4). to be infected with HIV than boys in some countries in the Six of these eight MoEs with full-time HIV/AIDS coordinators have an Caribbean, making them more vulnerable to dropping out of school official job description for the position. In six countries, namely 8 RESULTS AND DISCUSSION Anguilla, Antigua, Grenada, Jamaica, St. Kitts & Nevis, and Trinidad 3.2 Safe and supportive school & Tobago, the MoE finances the HIV/AIDS coordinator. In Guyana and St. Lucia the HIV/AIDS coordinator is financed by the MoH. environment Information on Bahamas and Barbados is not available. Details on A safe and supportive school environment is essential for promoting the sources of funding for financing the coordinator were the health, dignity and well-being of children and staff, and thus not collected. effective learning. Ten (77%) MoEs have national policies or regulations that ensure a safe and child-friendly environment in At sub-national level, education sector coordinators for SHN and/or schools. St. Lucia reported no such policy. Information on Jamaica HIV/AIDS are present in only three countries, namely Barbados, and St. Kitts and Nevis was not available. Jamaica and Trinidad and Tobago. In Belize, the HFLE coordinators at district level are responsible for SHN-and HIV-related activities. In relation to the promotion of a safe environment, many MoEs have policies or regulations that require schools to provide safe water and SHN and HIV inter-departmental committees in MoEs are important sanitation facilities for their students and staff, and ensure a clean mechanisms to facilitate joint coordination and involvement of all environment (see Table 5). In eight (62%) countries, schools are education sub-sectors in the planning, management and required to provide potable drinking water and hand-washing mainstreaming of programs. Seven (54%) countries have an SHN facilities. Similarly, gender-segregated latrines in schools are and/or HIV inter-departmental committee within their MoE. In Belize mandated in 10 (77%) countries. These same 10 countries also the HFLE steering committee is responsible for responses relating mandate separate latrines for students and teachers. All 13 (100%) to HIV. countries have established school hygiene and cleaning regimens that include scheduled rubbish removal. All countries also reported Monitoring of programs and measuring of SHN and HIV related that these regimens include maintenance of school buildings and outcomes is fundamental to good planning and management and facilities in all schools. helps support the scale-up of activities. Seven (54%) countries reported collecting outcome data on health-related teacher attrition and absenteeism at least once per year. Table 4. Education sector planning and management for SHN and HIV Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Planning and Belize Management SHN Unit in the MoE              Full-time SHN Unit Coordinator  NA NA  NA NA NA   NA NA NA  Free-standing SHN Unit  NA NA  NA NA NA  NR NA NA NA  HIV part of the SHN Unit     NA         Separate HIV Unit in the MoE NA   NA    NA   NR   HIV/AIDS Coordinator in the MoE               Full-time HIV/AIDS Coordinator     NA NA      NA  Official Job Description for HIV/AIDS Coordinator     NA NA      NA  SHN and/ or HIV/AIDS Coordinators at     NA       NR  Sub-national Level SHN and/or HIV/AIDS Interdepartmental Committee within     NA         the MoE MoE collects data at least annually on health related attrition and absences of teachers         NR     = yes, = no, NA= not applicable, NR= no response to the question RESULTS AND DISCUSSION 9 Table 5. National policies for safe and sanitary school environment Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana School Environment Belize National policies that promote a safe, child-friendly school environment         NR NR    National policies that require schools to provide safe,         NR NR  potable drinking water   National policies that require schools to provide hand- washing facilities         NR NR    National policies that require schools to provide separate latrines for boys and girls         NR NR    National policies that require schools to provide separate latrines for students and teachers         NR NR    Established school hygiene regimen including scheduled              rubbish removal Established school hygiene regimen including maintenance of school buildings and facilities              Annual sanitation surveys conducted in all schools         NR     National policies that require schools to provide psychosocial support for students         NR     = yes, = no, NA= not applicable, NR= no response to the question Monitoring the implementation of safe school environment policies All 13 responding countries reported that health education is taught is important for improving and scaling up interventions. Existing as part of a separate subject generally called health and family life tools for routine data collection provide an avenue for incorporating education. In Guyana, health education is infused in carrier subjects school sanitation and other SHN information to aid monitoring in such as science and social studies from grade three onwards. this area. This allows SHN information to be available frequently Hygiene education takes place in primary and secondary schools in without greatly adding to resources required to collect data. The all countries; however data on the extent of activities within coverage of annual sanitation surveys in schools is low, with six countries was not collected. Nutrition education also takes place in (46%) countries reporting completion of surveys in all schools (see all 13 countries, in primary and/or secondary schools. Dengue Table 5). prevention education was reported to take place in ten (77%) countries. Provision of psychosocial support to students is an important aspect of ensuring a healthy and secure school environment. Ten (77%) All 13 responding countries reported having HIV prevention countries reported having policy regulations that ensure schools education in schools, which is infused in a carrier subject (e.g. health provide psychosocial support to students. Details of psychosocial and family life education). Ten (77%) countries indicated that HIV support provided were not available. prevention education takes place in primary as well as secondary schools. Twelve (92%) countries reported using a life-skills approach for HIV prevention education in primary and secondary schools. 3.3 Skills-based health education 3.3.2 Peer Education Approach Experience suggests that SHN and HIV prevention activities are most effective when presented as part of skills-based health education, Peer education, such as on HIV, involves students undertaking which is provided using a curricular and/or peer education approach. sensitization activities among their friends and classmates to increase their knowledge and motivate them to adopt healthy behaviours. Eleven (85%) countries reported adopting peer education within the 3.3.1 Curricular Approach education sector. All of these eleven countries reported that peer education takes place in secondary schools; while three (23%), To ensure health messages delivered through schools are both namely Guyana, St. Kitts and Nevis, and St. Lucia, mentioned that it consistent and relevant, a national health curriculum that is also takes place in primary schools. adaptable at local level is important. Twelve (92%) countries have a national health education curriculum (see Table 6). Ten (77%) of these countries also reported that the curriculum can be locally adapted for teaching at sub-national level. In St. Lucia, aspects of health are taught in some form at primary and secondary levels, but there is no national curriculum to support widespread inclusion. 10 RESULTS AND DISCUSSION Table 6. Presence of Skills-Based Health Education including HIV Prevention Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Skills-Based Health Belize Education National health education curriculum              National health education curriculum which is  NR       NR  NA   adaptable at sub-national level Health education taught as separate subject              Nutrition education in primary schools              Nutrition education in secondary schools         NR     Hygiene education in primary and              secondary schools Dengue prevention education in schools         NR     Peer education within the education sector              Peer education in primary schools NA NA  NR  NR   NR     Peer education in secondary schools NA NA            HIV prevention education in schools in any form              HIV prevention education in primary and secondary schools     NR NR NR       HIV prevention education in the non-formal setting      NR NR       HIV education infused in a carrier subject              HIV taught using a life skills approach in             primary and secondary schools  HIV taught using a life skills approach in the      NR NR     NR  non-formal setting = yes, = no, NA= not applicable, NR= no response to the question 3.3.3 HIV Prevention in the non-formal setting Questionnaire responses indicate that, in 12 (92%) countries, teachers are trained on life skills education (see Table 7). This The non-formal education sector has an important role to play in HIV training, however, is primarily delivered in-service as opposed to pre- prevention education to out-of-school youth who may be more service (see Figure 2). Training of teachers to teach issues on HIV vulnerable to infection. Ten (69%) countries reported the delivery of reportedly takes place in all 13 countries. As with training related to HIV prevention education in the non-formal setting. Five of the 10 life skills, training in HIV is more likely to be delivered in-service, as countries reported using a life skills approach for the HIV prevention reported in 12 (92%) countries, rather than pre-service, as reported education in the non-formal sector (see Table 6). in seven (54%) countries (see Figure 2). All 13 responding countries provide training to teachers on how to protect themselves from HIV 3.3.4 Teacher Training infection. Teachers are uniquely placed – due to their contact hours with To support training of teachers for primary and secondary schools, students and social status within society – to affect the knowledge, 11 (85%) MoEs reported having teacher training materials. Data attitudes and behaviour of school-age children. Quality teacher collection on both teacher training and training materials distributed training is a critical component in preparing and supporting is important for program monitoring and planning. Eight (62%) educators and education personnel to address issues relating to SHN countries reported collecting such data. and HIV, and in implementing and sustaining an effective school health program. Without this training, teachers may be unable and unwilling to teach sensitive content in lessons (e.g. messages on HIV). RESULTS AND DISCUSSION 11 Table 7. Presence of teacher training for HIV and life-skills education Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Teacher Training Belize Teacher training curriculum includes SHN              Teachers given health education training              Teachers given health education training pre-service NA   NR  NR   NR     Teachers given health education training in-service NA        NR     Teachers trained in life skills education              Teachers trained in life skills education pre-service NA   NR  NR   NR     Teachers trained in life skills education in-service NA   NR          Teachers taught to protect themselves from HIV/AIDS              Teachers taught to protect themselves from HIV/AIDS      NR        pre-service Teachers taught to protect themselves from NR             HIV/AIDS in-service Teachers given HIV training              Teachers given HIV training pre-service NR     NR        Teachers given HIV training in-service              Teaching training materials for the primary           level available  NR  Teaching training materials for the secondary      NR     NR   level available Data collection on teachers trained and training           materials in learning institutes NR   = yes, = no, NA= not applicable, NR= no response to the question Figure 2. Number of countries offering pre-service or in-service training on life skills and HIV for teachers Teachers given 13 (100%) HIV/AIDS training 6 (46%) Teachers taught to 12 (92%) protect themselves from HIV/AIDS 7 (54%) Teachers trained in 10 (77%) life skills education 4 (33%) In-service 0 2 4 6 8 10 12 14 Pre-service Number (%) of countries 12 RESULTS AND DISCUSSION 3.4 School-based health and nutrition Deworming programs for school-age children are taking place in eight (62%) countries, with six of these countries reporting that services deworming is being delivered by MoH staff (information on Anguilla and Trinidad and Tobago is not available). In Guyana, teachers are School-based health and nutrition services offer schools an effective not involved in deworming. way of improving the health and nutritional status of children, as well as a means to mitigate the impact of HIV. Health and nutrition services delivered through schools link resources in the health and When micronutrient supplementation is carried out as a component education sectors in the existing infrastructure of the school with its of deworming programs, it can lead to a greater improvement in skilled workforce (teachers and administrators), and can be cost- child health and education; for example iron supplementation effective compared to some services provided by medical teams reduces anaemia caused by worms. The Bahamas, Belize and St. (World Bank & OUP, 2006). Especially in the Caribbean where school Vincent and Grenadines (23%) carry out iron supplementation as a enrolments are high, these services when provided through schools component of their deworming programs. Two (15%) countries, allow for a higher coverage than through health systems. namely Belize and St. Vincent and Grenadines, reported administering Vitamin A supplements to school-age children. In Common services provided by countries to school-age children are: Belize, vitamin A supplementation is given in conjunction with vaccinations and hearing and sight examinations in all 13 countries; deworming by a Belizean initiative (funded by Vitamin Angels) and school feeding in 12 (92%) countries; and dengue prevention in 11 it is done specifically in the southern districts where worm (85%) countries (see Table 8). Vaccinations and hearing and sight prevalence and vitamin deficiency are known to be the highest. examinations are administered by MoH staff in all countries providing these services. In Antigua, it is noted that the government As early pregnancy and sexually transmitted infections including HIV also pays for spectacles for children. School feeding services in these have been identified as issues of growing concern to school-age countries are administered by teachers, with the exception of the children in the Caribbean, the development and implementation of Bahamas, where it is provided by MoH staff. relevant and responsive reproductive health services in schools has been seen as important. The survey found that 11 (85%) countries If parasitic worms are prevalent in an area, deworming programs for are currently involved in providing reproductive health services to school-age children are recommended, the frequency of which school-age children. depend on the level of worm prevalence. Teachers can be easily trained to distribute deworming tablets, which are very safe and With counseling and access to free anti-retroviral therapy (ART) simple to administer, and schools offer a cost-effective delivery becoming more easily accessible, Ministries are encouraged to mechanism to carry out such deworming programs, reaching large advocate for greater access and usage of these services by teachers. numbers of children though an already-established network. Twelve (92%) countries reported access to counseling services for teachers and other education employees. Table 8. Health and nutrition services offered for school-age children and teachers Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Health and Nutrition Belize Services Vaccinations for school-age children (SAC)              School feeding provided for SAC              Vitamin A capsules provided for SAC      NR   NR     Iron supplementation program for SAC      NR   NR     Deworming programme for SAC         NR     Dengue prevention services for SAC         NR  NR   Medical examinations for SAC       NR       Hearing and sight examinations for SAC              Reproductive health services for SAC              Counselling services for teachers         NR     = yes, = no, NR= no response to the question RESULTS AND DISCUSSION 13 3.5 Support to MoE SHN and HIV HIV allocation in the MoE budget. This information indicates that funding for HIV may be received from sources other than MoE. It responses also indicates that there may be a need for internal advocacy for HIV in the MoEs. There are a range of sources supporting education sector responses to SHN and HIV in the Caribbean region including national The Fast Track Initiative (FTI) is a global partnership to assist low- governments, development partners, civil society organizations and income countries to meet the education MDGs and the EFA goal others. In six countries, namely the Bahamas, Barbados, Grenada, that all children can access primary education by 2015. Guyana is Guyana, Jamaica and Trinidad and Tobago, support is given to a the only country in the region currently eligible for funding from FTI. Sector Wide Approach (SWAP) in education with one national Funds from the FTI are used for SHN activities in Guyana, such as sectoral plan including all education sub-sectors in a country. The provision of water and sanitation in schools. SWAP brings together different partners such as donors and other stakeholders in the sector under a single government-led program. Non-governmental organizations and private companies that work in education, child health, or, more specifically, SHN and HIV Budgetary information gathered through the questionnaire is not prevention, can be an additional source of resources to education deemed reliable and clarification on information relating to financial sector SHN and HIV responses. Seven (54%) MoEs reported allocation by MoEs for their SHN and HIV responses is still required. contracting or partnering with non-governmental organizations Of the eight (62%) countries for which budget data has been (NGOs) to assist in the implementation of HIV prevention education provided, St. Kitts and Nevis reported the highest level of ministerial (see Table 9). Separately, eight (62%) MoEs reported working with allocation for SHN with a 4.44% allocation from its budget (see the private sector for support to HIV prevention education. Table 10). Of these eight countries, five reported the absence of an Table 9. Sources of support for MoE SHN and HIV responses Trinidad & Tobago St. Kitts & Nevis & Grenadines The Bahamas St. Vincent Barbados Dominica Grenada St. Lucia Anguilla Antigua Jamaica Guyana Support to MoE SHN and Belize HIV/AIDS Responses MoE implements a Sector Wide Approach (SWAP)              Receive Fast Track Initiative (FTI) funding         NR    NR MoE contracts or partners with NGOs to support              HIV education Private Sector working with MoE to support HIV             education  = yes, = no, NR= no response to the question Table 10. MoE budget allocated for SHN and HIV responses (in US$) Trinidad & Tobago & Grenadines The Bahamas St. Vincent Barbados St. Lucia Anguilla St. Kitts Antigua Support to MoE SHN and HIV Responses $ $ $ $ $ $ $ $ MoE budget for 2008 8,149,301 28,240,940 236,893,665 50,000,000 16,518,854 42,030,215 30,850,806 1,113,601,690 SHN budget as percentage NR 0.23% 0.00% 0.07% 4.44% 0.10% 2.49% of MoE budget 0.01% HIV budget as percentage 0.00% 0.00% 0.04% 0.00% 0.00% 0.00% 0.02% of MoE budget 14 RESULTS AND DISCUSSION Conclusions and Recommendations 4 CONCLUSIONS Safe and supportive school environment The rapid survey and this resulting report contribute to the collection • All 13 countries have a mechanism in place to ensure that there of locally relevant evidence, as well as regional information relevant is a safe and healthy environment in schools. This to SHN and HIV, to build a sound evidence base at both country and includes the presence of policies and practices to ensure regional levels to inform policy and strategy. It has further that schools have safe water and sanitation, as found for application as a resource for knowledge sharing as it provides a eight and 10 countries respectively; are hygienic, reported comparative perspective on activities and initiatives thus far by all countries; and promote the psychosocial well-being of implemented throughout the Caribbean region, and on the teachers and students, as reported by 10 countries. allocation and mobilization of resources used to support these activities and initiatives. • Six of the 13 MoEs conduct annual sanitation surveys in all schools as a means of monitoring the implementation of safe school environment policies and improving and The overall picture derived from this exercise is a positive one. The scaling up interventions. rapid survey reports that the education sector response to SHN and HIV throughout the Caribbean region is well underway. A number of Skills-based health education countries have responded to the HIV/AIDS epidemic with collaborative efforts between the Ministries of Health and • In all 13 countries, to varying degrees, the education sector is Education, and have put in place sustainable activities to mitigate involved in providing skills-based health education including HIV the impact of HIV on the education sector, while also addressing prevention to staff and students. Schools generally utilize both other health issues relevant to school-age children in the Caribbean a curricular and a peer-education approach in order to deliver context. The governments of the CARICOM countries are well important life skills education. Under the curricular approach, placed to collaborate effectively to address challenges which persist health and HIV prevention education is generally taught as – including stigma – through the education sector. part of health and family life education, which provides information on many different health concerns, such Survey responses indicate that the majority of the participating MoEs as hygiene, nutrition and disease prevention. Ten countries have in place a policy and management framework for SHN and HIV also deliver HIV prevention education in the non-formal programming and a safe school environment. In many countries, the setting. education sector is already involved in providing health education to staff and students, and a range of health and nutrition services. The • Twelve of the 13 countries have teachers are trained in life skills extent of the SHN and HIV response varies between MoEs and is education. In all 13 countries teachers are trained to teach HIV country-specific. Highlights of the response are as follows: prevention education. Teacher training on life skills and HIV is provided more often in-service than pre-service. Health-related school policies School-based health and nutrition services • Nine of the 13 MoEs have policies, strategies and work plans in • All 13 countries, to varying degrees, are involved in p r o v i d i n g place, demonstrating their commitment to SHN and HIV health and nutrition services to school-age children and response. teachers. Vaccinations and hearing and sight examinations take place in all 13 countries; school feeding takes place in 12 • Ten of the 13 MoEs have a national policy on free and universal countries; iron and vitamin A supplementation take place in primary education to reduce financial barriers of education for four and two countries respectively. Deworming for school-age orphans and vulnerable children. children takes place in eight countries. Reproductive health services are provided to youth in 11 countries; while in 12 • Ten out of 13 countries have an existing management countries counseling is provided to teachers and other framework in place for MoEs to manage and mainstream their education employees. response to SHN and HIV. Such a framework includes a SHN/HIV unit within the MoE, seen in seven countries; an inter- • Vaccinations and hearing and sight examinations is provided by departmental coordination committee on SHN/HIV, in seven MoH employees in all countries providing these services. countries; and a HIV/AIDS coordinator at national and sub- national level, in 10 and three countries respectively. The national HIV/AIDS coordinator is financed by their MoE in six countries, and by the MoH in two countries. • Twelve out of the 13 MoEs collect some data to facilitate ongoing monitoring and evaluation of their SHN programs. This data may include information on teacher training, school sanitation and teacher attrition. CONCLUSIONS AND RECOMMENDATIONS 15 • Where school feeding is provided, it is administered by teachers, A majority of MoEs have established effective policies and strategies except for the Bahamas where it is provided by MoH employees. for addressing SHN, HIV and other infectious diseases. Deworming in six of the eight countries is administered by MoH At this stage, the focus might effectively shift from creating the employees. policy environment to implementing the strategies. Further, since NCDs such as obesity and type 2 diabetes are emerging areas of concern in the region, greater policy emphasis on NCDs may Support to MoE SHN and HIV responses prove beneficial. • Ten of the 13 MoEs receive external support for education School feeding is near universal in the 13 countries and territories, sector responses to SHN and HIV. This support is derived from while micro-nutrient supplementation is, very focal. In addition, one- various sources including the private sector; NGOs and UN on-one interviews with coordinators suggest that there may be need agencies. Seven MoEs contract or partner with NGOs to assist in for greater focus on the quality of food consumed by school-aged the implementation of HIV prevention education. Separately, children. In the context of the region's growing epidemic of eight MoEs work with the private sector for support to HIV common NCDs there is opportunity to consider the coverage of prevention education. Guyana is the only country eligible for micro-nutrient supplementation and to assess the quality of food EFA FTI funding; funds are used for SHN activities such as provided through school feeding programs and accessed through provision of water and sanitation in schools. food vendors in schools. There is clear evidence that schools have placed strong emphasis on RECOMMENDATIONS ensuring a hygienic and safe environment with psychosocial support for students in school. This survey did not address the availability of There are potential areas for enhancing or building on the data exercise facilities in schools but this may be an important factor for gathered from the rapid survey. consideration given the emergence of common NCDs in Caribbean school-age children. • First, the survey participants were unfamiliar with some aspects of the education sector response, such as the financial and There is generally a high level of teacher training provided in the budgetary information of programs and the financing of MoE countries of the Caribbean. This typically includes training in life skills HIV/AIDS coordinators, and responses were unclear in some education and in relation to delivering HIV prevention messages. cases. These data may be subsequently collected as part of a Teacher training, however, is primarily provided in-service and not as follow-up exercise, for discussions at future EduCan meetings, a substantive component in preparing teachers pre-service for such as that planned during the 2009 CARICOM Council on teaching careers. This might indicate a need to focus on ensuring Human and Social Development meeting. skilled teachers equipped with sexuality training. • Second, data from this survey may be used to assess trends and evaluate progress of education sector responses to HIV. Most of the data collected in this survey relate to program activities and processes. Therefore, repeat surveys for monitoring progress may be conducted on an annual basis, using a methodology similar to this rapid survey for comparability. • Last, additional qualitative and quantitative information on responses and the extent of activities taking place in- country will improve understanding of the quality, impact and scale of programs, and provide opportunities for sharing experiences and future planning. There are also some recommendations for the SHN and HIV responses in the region that the members of the EduCan may consider: 16 CONCLUSIONS AND RECOMMENDATIONS List of References 5 Beasley M., Risley C., Venkatesh M., Johnson S. (2007) Rapid Situation Analysis of the Education Sector's Response to HIV&AIDS in the Context of School Health and Nutrition in Guyana CARICOM, PAHO and WHO (2005) Report of the Caribbean Commission on Health and Development. CARICOM, UNESCO, and World Bank (2007) Accelerating the Response of the Education Sector to HIV and AIDS in the Caribbean Region: The Port-of-Spain Documents. Global Campaign for Education (2004) Learning to survive: How education for all would save millions of young people from HIV&AIDS. Global Campaign for Education: Belgium. Jukes M., Drake L., and Bundy D. (2008) School Health, Nutrition and Education for All: Levelling the Playing Field. Kelly M.J., and Bain B. (2003) Education and HIV/AIDS in the Caribbean. PAHO, USAID and FHI (2006) Behavioural Surveillance Surveys (BSS) in Six Countries of the Organisation of Eastern Caribbean States (OECS) 2005-2006. Risley CL; Clarke, D; Drake LJ; Bundy DAP. Impact of HIV and AIDS on education in the Caribbean. In Challenging HIV & AIDS: new role for Caribbean Education. Eds: Donald Bundy and Michael Morrissey. (2007). http://www1.imperial.ac.uk/_Resources/(F779E9AE-D756-4320- B611-128BD6ABE40A)/risleyetalimpactofhivoncaribbeanteachers. pdf UNAIDS (2004) UNAIDS 2004 report on the global HIV/AIDS epidemic. UNAIDS (2006) 2006 Caribbean Fact Sheet. Whitman C.V. and Oommen M. (2006) Preliminary assessment of Education Ministries’ capacity to address HIV and AIDS (unpublished). UNESCO and World Bank (2007) World Bank Working Paper No. 137, Strengthening the Education Sector Response to HIV&AIDS in the Caribbean. World Bank and Oxford University Press (2006) Disease Control Priorities in Developing Countries. LIST OF REFERENCES 17 Annexes 6 6.1 Port-of-Spain Action Framework Sector Policy Framework Check Item Comments National HIV&AIDS Strategy Demonstrates the government’s commitment to • has been adopted by the government responding to HIV&AIDS. The inclusion of the • includes education in a multi-sectoral education sector shows the recognition of the approach role of the sector in the response. Addresses sector specific HIV&AIDS issues. National Education Sector Shows how the sector plans contribute to the HIV&AIDS Strategy response to HIV&AIDS nationally. Inclusion in the • has been adopted by the Ministry of education plan (and EFA) indicates how this Education strategy will be implemented. • has been incorporated in the national sector plan Education Sector policy for HIV&AIDS The policy will only be effective if it is owned by • has been adopted by Ministry of the relevant stakeholders, especially the teaching Education unions, and if it is widely known and understood. Addressing curriculum at this stage can facilitate • has been shared with all stakeholders, dialogue and agreement with the community on Greater Involvement of People with sensitive issues that can otherwise slow progress HIV&AIDS (GIPA), and disseminated in implementation. Establishing policy is the • addresses gender, curriculum content, essential first step in an effective response. Input planning issues, and education needs of from GIPA will ensure that the policy reflects the orphans and vulnerable children needs of people living with HIV&AIDS within • includes workplace policy the sector. Workplace policy addresses HIV&AIDS presents major new issues in the • stigma and discrimination in recruitment workplace (the school, the office): recruitment and career advancement and career progression are constrained by stigma • sick leave and absenteeism and discrimination; sick leave policies rarely cope with long-term disease, and encourage • dissemination and enforcement of codes undisclosed absenteeism; codes of practice that of practice, especially with respect to forbid sexual abuse of pupils are rarely enforced; the role of teachers in protecting easy access to VCT, treatment and psychosocial children support. The Public Sector can often learn from • care, support and treatment of staff the private sector in developing a workplace • access to voluntary counseling and response. testing (VCT) ANNEXES 19 Planning and Management Framework Check Item Comments Management of the sector response Mainstreaming the HIV&AIDS response requires, requires: at least initially, mechanisms for involving all • an interdepartmental committee departments (the committee) and for • department focal points who have implementation (the unit). Keys to success are: the HIV&AIDS activities as a specific part of focal points have space in their work program to their job description allocate time to HIV&AIDS; the unit reports to the highest level; the unit is led at the department • a secretariat or unit that supports the director level. The sector can now access financial mainstreaming of the response, and has resources (e.g., MAP, GFATM) often thought to be clear political support exclusive to the health sector. • understanding of new sources of financial support For short to medium term planning, Even where an effective EMIS is unavailable, school use the Education Management survey data can be used to assess the impact of Information System (EMIS) or school HIV&AIDS on the education system. This should survey data to assess: relate district level education data to the geographical pattern of the epidemic, using • HIV&AIDS-specific indicators epidemiological data from the health service. • teacher mortality and attrition data • teacher absenteeism data • district level data For long term planning: The effects of the epidemic have a time scale of • Computer model projection of the decades and impacts, only slowly become apparent. impact of HIV&AIDS on education supply Long term planning similarly requires projection of and demand impact over decades, which is best achieved using • assessment of the implications of computer projection models, such as EdSIDA, which changes in supply for teacher combine epidemiological and education data. recruitment and training Projection allows for the planning of future teacher supply needs and, where necessary, the reform of • assessment of the implications of teacher training schedules. changes in the size of the school age population and the proportion of orphans and vulnerable children for education demand 20 ANNEXES Prevention Framework Check Item Comments Achieve Education for All Completion of education is a social vaccine vs. HIV&AIDS. Prevention curriculum requirements: The aim is to develop knowledge and protective • formal and non-formal, within the behaviours: start before risky behaviours have national curriculum become established; match content to the • begin early, before the onset of sexual development stage of the child; use teaching activity methods which establish skills, values and practices to help children protect themselves. Use • use grade- and age- specific content of a single carrier subject (e.g., social studies) is • develop participatory teaching methods often more realistic than more complex • include a life skills approach approaches (e.g., spiral, diffusion). Failure to involve the community in this potentially • use a carrier subject sensitive area is one of the major causes of delay • teach in the context of school health in implementation. (e.g., FRESH) • ensure community ownership and support Teacher training in HIV&AIDS Preventive education is more frequently taught prevention requires development of: as part of in-service training than pre-service. • pre-service training and materials While it is necessary for both, new teachers may be more readily trained in the participatory • in-service training and materials methods that are required to teach the subject. • messages and approaches that help Teacher training institutions frequently overlook teachers to protect themselves the benefits of helping teachers to protect themselves. Complementary approaches: An holistic approach is essential for effective • peer education prevention. Peer education is particularly important for reinforcing active learning by • Ministry of Education has input to youth. IEC strategies ensure consistent messages community IEC strategies in the school, home and community. Building on • Ministry of Education coordinates with existing NGO programs speeds up the response. NGO prevention programs and GIPA to Early and effective treatment of STIs is effective provide consistent messages in reducing HIV transmission; youth need access • Ministry of Education assists Ministry of to condoms to translate learned behaviours into Health in promoting youth-friendly practice. clinics for the treatment of sexually transmitted infections (STIs) and condom distribution ANNEXES 21 Orphans and Vulnerable Children (OVC) Framework Check Item Comments Barriers to education are removed: Achieving EFA enhances access, including for OVC. • achieve Education for All School fees, in particular, may prevent OVC from • abolish school fees accessing education. Abolition provides partial relief, but fees are often substituted by levies (e.g., • develop a mitigation strategy to avoid for textbooks, PTA, uniforms). Social funds offering informal and illegal levies subsidies through schools, PTAs or the community • subsidize payment of informal levies can help overcome these barriers. The Education System helps maintain Ensuring that OVC are able to attend school is only attendance: the beginning: they also require support to remain • offer conditional cash (or food) transfers in school. One effective method is to offer • provide school health programs, caregivers cash (or food) transfers that are including psychosocial counseling conditional upon attendance. OVC have typically suffered severe shock, and benefit from school health programs based on the FRESH framework. The Education Sector works with Long term care, support and protection of OVC are other agencies providing care, typically the mandate of social programs under support and protection: Ministries of Welfare or Social Affairs. In practice, • MinEd coordinates with NGOs NGOs are often most directly involved in these • MinEd coordinates with Ministry of programs and offer an immediate point of entry. In Welfare/Social Affairs both cases, it is important that the Ministry of Education Department ensures that education system programs are complementary to these activities. 22 ANNEXES 6.2 School Health, Nutrition and HIV/AIDS in the Caribbean Region Questionnaire A. IDENTIFICATION: 1. Your Name: 2. Title/Affiliation: 3. Name of Country: 4. Highest administrative divisions of country: No. of Regions: (specify the number) These are known as: Provinces / Zones / Districts / other (please circle or specify) 5. Next highest administrative divisions of country: No. of Regions: (specify the number) These are known as: Provinces / Zones / Districts / other (please circle or specify) B. POLICY PLANNING AND MANAGEMENT Please indicate ‘Yes’ or ‘No’ for each of the following. In some cases you will be asked to fill in a blank with additional information. YES NO 1. Has your country been endorsed for funding through the FTI? (If yes, please provide policy document.) I I 2. Does the Ministry of Education (MoE) implement a Sector-Wide Approach (SWAP)? (If yes, please provide policy document.) I I 3. Does the MoE have an education sector policy? (If yes, please provide a copy.) I I 4. Does the MoE have an education sector strategy? (If yes, please provide a copy.) I I 5. Is there a national School Health & Nutrition (SHN) policy? (If yes, please provide a copy) I I If yes, is it implemented by the Ministry of Health? If yes, is it implemented by the Ministry of Education? If yes, which schools are involved? (primary, secondary, and private, public) If yes, when was it implemented/accepted? 6. Is there a SHN unit in the Ministry of Education? I I If yes, is there a full time coordinator/manager of the unit? Is the unit free-standing? If not freestanding, is the unit a part of a directorate? If yes, which directorate? 7. Does your SHN program involve a number of donors? I I If yes, which ones? (Please attach a list) 8. Are there SHN and/or HIV&AIDS coordinators/focal points at the sub-national level of the SHN HIV/ SHN HIV/ education delivery system?(Nomenclatures may vary from country to country) (Yes/No, If Yes) AIDS AIDS Zonal? Provincial/Regional? District? Sub-District? Learning Facility? 9. Is HIV&AIDS a part of the School Health and Nutrition unit in the Ministry of Education? I I If no, is there an HIV&AIDS unit in the Ministry of Education? ANNEXES 23 Please indicate ‘Yes’ or ‘No’ for each of the following. In some cases you will be asked to fill in a blank with additional information. YES NO 10. Is there an officially appointed HIV&AIDS coordinator/focal point in the Ministry of Education? I I If yes, are the coordinators/focal points full time or part time? Does the coordinator /focal point have an official job description? I I (If yes please provide a copy.) If yes, are they funded by external donor or MoE? 11.Within the Ministry of Education, is there an SHN and/or HIV&AIDS interdepartmental committee? I I If no, how is information shared between MoE staff involved in HIV? If yes, does the committee have clear Terms of Reference? (If yes, please provide a copy of TOR.) 12. Do you have a National HIV&AIDS strategy? I I (If yes, please bring a copy to the EduCan meeting in March.) 13. Do you have an Education Sector HIV&AIDS strategy? I I (If yes, please bring a copy to the EduCan meeting in March.) 14. Do you have an Education sector HIV&AIDS action plan? I I (If yes, please bring a copy to the EduCan meeting in March.) 15. Is the Ministry contracting NGOs to assist in the implementation of its HIV&AIDS educational program? I I 16. In addition to NGOs, does the Ministry work with the private sector to assist in the implementation of HIV/AIDS I I education and outreach programs? 17. Is there a national work place policy? (If yes, please provide a copy.) I I If yes, are HIV&AIDS issues addressed? If no, do you have an Education Sector HIV&AIDS policy that includes workplace regulations? (If yes, please provide a copy.) I I 18. Is there a national policy of free primary school Education For All (EFA)? I I 19. Has the Ministry of Education or any other authorized agency undertaken any impact projections/assessment I I of school health and nutrition initiatives on supply and demand in terms of attaining their EFA goals? (If yes, please provide a copy of the report.) 20. Does the MoE collect data at least annually on health-related attrition and absences of teachers? I I If yes, at which levels are data collected? Zonal? Provincial/Regional? District? Sub-District? School? 21. Does the MoE keep data on Orphans & Vulnerable Children (OVCs)? I I If yes, at which levels are data collected? Zonal? Provincial/Regional? District? Sub-District? School? 22. Do OVCs have to pay school tuition/fees? I I What other fees do OVCs have to pay? 23. Is there any program of conditional transfer of funds? I I If yes, is it to: Relatives or Caregivers? Schools? 24. Are there any affirmative action programs to boost the enrolment or attendance of school-age/school girls? I I 24 ANNEXES C. SCHOOL ENVIRONMENT Please indicate ‘Yes’ or ‘No’ for each of the following. In some cases you will be asked to fill in a blank with additional information. YES NO 1. Is there a national policy that promotes a safe, child-friendly school environment? I I 2. Is there a national policy requiring that schools provide psychosocial support for students? I I 3. Is there a national policy requiring that schools provide safe, potable drinking water? I I 4. Is there a national policy requiring that schools provide hand washing facilities? I I If yes, does this include provision of soap? I I 5. Is there a national policy requiring that schools provide separate latrines for boys and girls? I I 6. Is there a national policy requiring that schools provide separate latrines for students and teachers? I I 7. Is there an annual sanitation survey conducted in all schools? I I 8. Is there an established school hygiene and cleaning regimen that includes: I I Scheduled rubbish removal? I I Maintenance of school buildings and facilities in all schools? ˆ I I D. HEALTH EDUCATION AND CURRICULUM Please indicate ‘Yes’ or ‘No’ for each of the following. In some cases you will be asked to fill in a blank with additional information. YES NO 1. Is there a national health education curriculum? I I If yes, can it be adapted to individual districts/regions/provinces? 2. Is health education taught as a separate subject (i.e. not embedded in another subject)? I I If yes, what is the name of the subject (i.e. health, life-skills..etc)? If no, what is the carrier subject? 3. Is nutrition education taught in schools in any form? I I If yes, is it taught in primary schools? If yes, is it taught in secondary schools? If yes, at what age is nutrition education introduced into schools? Is nutrition education offered in non-formal education? 4. Is hygiene education taught in schools in any form? I I If yes, is it taught in primary schools? If yes, is it taught in secondary schools? If yes, at what age is it introduced into schools? Is hygiene education offered in non-formal education? I I 5. Is dengue prevention education taught in schools in any form (i.e. knowledge based, life-skills, peer education, etc.)? I I If yes, is it taught in primary schools? I I If yes, is it taught in secondary schools? I I If yes, at what age is dengue prevention education introduced into schools? I I If yes, is dengue education taught in non-formal education and in out-of-school settings? 6. Is there a program of peer education within the education sector? I I (If yes, provide some manuals, guidelines, etc. that are used for this.) If yes, is it operational in primary schools? If yes, is it operational in secondary schools? 7. Are there student-led youth groups which have the support of school administration officials to meet on I I school grounds to raise awareness of HIV/AIDS? 8. How many tertiary institutions (universities) exist in the country? I I Of this number, how many have institutional HIV&AIDS policies? (Number) (Please provide copies) ANNEXES 25 Please indicate ‘Yes’ or ‘No’ for each of the following. In some cases you will be asked to fill in a blank with additional information. YES NO 9. Are there training materials for tertiary (university) level HIV&AIDS education? I I If yes, has there been an impact assessment? 10. Do students in tertiary (university) level education have access to on-campus HIV/AIDS testing and counseling? I I 11. Is HIV&AIDS prevention education offered in schools in any form (i.e. knowledge based, life-skills, peer education, etc.)? I I IF NO, LEAVE QUESTIONS 9-12 BLANK AND SKIP TO QUESTION 13. If yes, is it offered in primary schools? If yes, is it offered in secondary schools? If yes, at what age is HIV&AIDS prevention education introduced into schools? If yes, is HIV&AIDS prevention education taught in non-formal education and in out-of-school settings? 12. If HIV&AIDS prevention education is taught in schools, is it embedded in another subject (a “carrier� subject)? I I If yes, which subject/s? 13. If HIV&AIDS prevention education is taught in schools, have you adopted a life-skills approach at the: I I Primary level? Secondary level? Within non-formal education? 14. If HIV&AIDS prevention education is taught in schools, is the HIV&AIDS educational program linked to other I I related topics such as reproductive health, substance abuse, domestic violence, etc? (If it is not taught in schools, leave blank.) If yes, which topics? I I The following questions refer to teachers and teacher training. Please indicate ‘yes’ or ‘no’ for each question. 15. Does the teacher training curriculum include school health and nutrition? I I 16. Are teachers given health education training? I I If yes, is this done during pre-service training? If yes, is this done during in-service training? 17. Are teachers trained in the approach of delivering effective life-skills education to children? I I If yes, is this done during pre-service training? If yes, is this done during in-service training? 18. Are teachers given HIV&AIDS training? I I If yes, is this done during pre-service training? If yes, is this done during in-service training? 19. Are teachers taught to protect themselves from HIV? I I If yes, is this done during pre-service training? If yes, is this done during in-service training? 20. Do teachers have access to counseling concerning HIV&AIDS? I I 21. Are there training materials about HIV&AIDS for the: I I Primary level? Secondary level? 22. Are data collected on the number of teachers trained and the quantity of training material received I I by learning institutions? If yes, at which levels are data kept: Zonal? Provincial/Regional? District? Sub-District? School? 26 ANNEXES E. HEALTH AND NUTRITION SERVICES Are these services provided for school-aged Administered by*: NO. OF REGIONS children? (Tick ‘yes’ or ‘no’ and, if yes, indicate the number of regions within which MoH STAFF the service is offered.) Also indicate if the TEACHERS services are administered by teachers or Ministry of Health (MoH) staff* and whether Are data collected annually Where are data held? indicators of service provision are collected indicating numbers of (Zone/ Province and, if yes, where these are retained. students receiving service? /District etc.) YES NO YES NO 1. Vaccinations I I I I 2. School feeding I I I I 3. Hearing and sight 3. Hearing and sight examinations I I I I 4. General medical examinations I I I I 5. Deworming program (i.e. providing deworming tablets) I I I I 6. Reproductive health (i.e. pregnancy, STIs) I I I I 7. Dengue prevention I I I I 8. Iron supplementation program (i.e. providing I I iron tablets) I I 9. Micronutrient (providing Vitamin A capsules) I I I I * Note that if teachers conduct the examinations (with or without supervision by MoH staff) then tick the ‘Administered by Teachers’ column. The aim is to identify which programs are teacher led, even though it is often normal practice for MoH staff to be nominally responsible for the activity and of course for the referrals to MoH facilities. F. FINANCES Give amounts in local currency only: $1 = date THIS YEAR LAST YEAR 1. What is the Ministry of Education budget? (local currency) 2. What is the budget of the MoE allocated to School Health and Nutrition? 3. What is the budget of the MoE allocated to HIV&AIDS? 4. What is the proportion of national versus external financing of SHN and HIV&AIDS activities? (in percent) ANNEXES 27 G. SUPPLEMENTAL QUESTIONS 1. Who finances the HIV&AIDS Coordinator (e.g. the MoE, the MoH, NAC, etc.)? Please explain. 2. What percentage of school aged children are currently taking an HIV&AIDS course? 3. Who are the external donors who support the Education Sector with financial resources? 4. Name any practices/activities that you have heard of in the Caribbean region that you would like to learn more about as an example of “good practice.� This is not asking for examples solely from your country; the idea is to find out what practices/activities may be highlighted throughout the region as good practice in order to contribute to information sharing. H. Does your ministry participate in regional or sub-regional activities regarding SHN and/or HIV&AIDS? Please attach a list naming the institutions and the activities. I. Below, please elaborate further about anything that is not covered in the questions above. Add additional pages if needed. 28 ANNEXES 6.3 Education Sector HIV/AIDS Coordinator Network (EduCan) List of HIV Focal Points Name Institution Country/Territory Email 1 Maureen Lewis Ministry of Education Antigua and Barbuda lenorelew@hotmail.com Sports and Youth 2 Glenda Rolle Ministry of Education,Youth, The Bahamas grolle54@yahoo.com Sports and Culture 3 Hughson Iniss Ministry of Education,Youth Barbados hinniss@mes.gov.bb Affairs and Sports 4 Patricia Warner Ministry of Education and Barbados Human Resource Development 5 Carolyn Codd Ministry of Education Belize hflebelize@gmail.com 6 Thomas Holmes Ministry of Education Dominica hthomas54@hotmail.com 7 Patrick Thompson National AIDS Directorate Grenada nad@spiceisle.com 8 Arthur Pierre Ministry of Education & Human Grenada pynters@yahoo.com Resource Development 9 Sharlene Johnson Ministry of Education Guyana svj95@yahoo.com 10 Christopher Graham Ministry of Education and Youth Jamaica edhivaids@yahoo.com Joint British and Dutch overseas 11 Patricia Beard aidsresearch@anguillanet.com Territories (Anguilla) Joint British and Dutch overseas 12 Sandra Fahie Department of Education fahiesandra@yahoo.com Territories (Anguilla) 13 Ruby Thomas Ministry of Education St. Kitts and Nevis ruthalithom@gmail.com 14 Sophia Edwards-Gabriel Ministry of Education St. Lucia sofie_edwards@yahoo.com 15 Abner Richards Ministry of Education St.Vincent and the Grenadines messiahyahweh@yahoo.com 16 Muriel Gilds-Muller Suriname rofa@cq-link.sr 17 Patricia Downer Trinidad and Tobago pat_downer46@yahoo.com Ministry of Education ANNEXES 29 Caribbean Education Sector HIV and AIDS Coordinator Network (EduCan) EDC Caribbean Office, c/o UNICEF, United Nations House Marine Gardens, Hastings Christ Church, Barbados www.educan.org Education Development Center Inc. (EDC) 55 Chapel Street Newton, MA 02458-1060, USA www.edc.org The Partnership for Child Development Department of Infectious Disease Epidemiology Imperial College Faculty of Medicine St. Mary’s Campus, Norfolk Place London W 1PG, UK www.schoolsandhealth.org www.child-development.org The World Bank 1818 H Street, NW Washington, DC 20433, USA www.worldbank.org UNESCO Kingston Cluster Office for the Caribbean 3rd Floor, The Towers 25 Dominica Drive, Kingston 5 Jamaica www.unesco.org/kingston