National School Health Strategic Plan, 2013/2014- 2017/2018

1. BACKGROUND AND OVERVIEW ..................................................................................... 1 1.1. INTRODUCTION ................................................................................................................ 1 1.2. CONTEXT ........................................................................................................................... 2 1.2.1. International ................................................................................................................... 2 1.2.2. National ......................................................................................................................... 2 1.3. PURPOSE OF THE SH STRATEGIC PLAN ..................................................................... 3 1.4. PROCESS OF DEVELOPING THE SH STRATEGIC PLAN ........................................... 4

2. ANALYSIS ................................................................................................................................ 5 2.1. KEY CHALLENGES .......................................................................................................... 5 2.2. SWOT ANALYSIS .............................................................................................................. 5

3. STRATEGIC FRAMEWORK ................................................................................................ 6 3.1. VISION ................................................................................................................................ 6 3.2. OBJECTIVES ...................................................................................................................... 6 3.2.1. General objective ........................................................................................................... 6 3.2.2. Specific objectives ......................................................................................................... 6 3.3. STRATEGIES FOR ACHIEVING OBJECTIVES ............................................................. 6 3.4. KEY STRATEGIC AREAS ................................................................................................ 6 3.5. PRIORITY SETTING, OUTPUTS AND KEY STRATEGIES .......................................... 7 3.5.1. Health promotion, disease prevention and control ........................................................ 7 3.5.2. Prevention of HIV and other STIS ................................................................................ 7 3.5.3. Sexual and reproductive health and rights ..................................................................... 7 3.5.4. Gender and GBV issues ................................................................................................. 7 3.5.5. Promotion of environmental health in schools .............................................................. 8 3.5.6. School nutrition ............................................................................................................. 8 3.5.7. Physical education ......................................................................................................... 8 3.5.8. Mental health and related needs .................................................................................... 9 3.6. FINANCING THE IMPLEMENTATION OF THE RESULTS FRAMEWORK .............. 9 ii 3.7. CAPACITY BUILDING ................................................................................................... 10 3.8. STRATEGIC RESULTS FRAMEWORK ........................................................................ 10

4. IMPLEMENTATION PLAN ................................................................................................ 25 4.1. INSTITUTIONAL FRAMEWORK .................................................................................. 25 4.2. MONITORING AND EVALUATION ............................................................................. 25

5. CONCLUSION .................................................................................................................... 30 BIBLIOGRAPHY ....................................................................................................................... 31 iii FOREWORD The Government of Rwanda is committed to achieving Education For All (EFA) and improved health status of the population. These are two key targets in the millennium development goals. The Constitution of Rwanda (2003) stipulates that every child has the right to basic health care and basic education. Improved health for children implies safer and healthier lives for a better world. This national SH strategic plan aims at improving the health of all children in school. The school environment is one of the key settings for promoting children’s environmental health and safety as reflected in the national health sector strategic plan as well as in the Rwanda education sector strategic plan 2013/14-2017/18. This national SH strategic plan aims at identifying and mainstreaming key health interventions for improved school health and education. The strategy comprises eight thematic areas:

1. Health promotion and disease prevention and control; 2. HIV, AIDS and other STIs;

3. Sexual Reproductive Health and Rights;

4. Gender and GBV issues; 5. Environmental health; 6. School nutrition;

7. Physical education and sports;

8. Mental health and related needs. The strategy outlines critical issues on health and education linkages that are important towards the improvement of children’s health while in school. The school environment must create an enabling atmosphere for social, cultural and emotional wellbeing that promotes a healthy child- friendly school. This five-year strategic plan will ensure that positive changes in school environment are supported, reinforced and sustained through skills based health education and school health services. It is envisaged that effective and efficient healthy school environment shall ensure access, retention, quality and equity in education. Dr Vincent BIRUTA Minister of Education iv ACRONYMS AIDS : Acquired Immune –Deficiency Syndrome CSOs: Civil Society Organizations ECD: Early Childhood Development EDPRS: Economic Development and Poverty Reduction strategy EFA: Education For All EMIS: Education Management Information System ESSP: Education Sector Strategic Plan FAO: Food and Agriculture Organization FGD: Focused Group Discussion FRESH: Focusing Resources on Effective School Health GBV: Gender Based Violence GoR: Government of Rwanda HGSFP: Home-Grown School Feeding Programme HIV: Human Immune-Deficiency Virus HPV: Human Papilloma Virus IE: International Education MDG: Millennium Development Goals M&E: Monitoring & Evaluation MoE: Ministry of Education MoH: Ministry of Health MINALOC: Ministry of Local Government MINECOFIN: Ministry of Finance and Economic Planning MINEDUC: Ministry of Education MINESPOC: Ministry of Sport and culture MINIJUST: Ministry of Justice MININFRA: Ministry of Infrastructure MINISANTE: Ministry of Health NGOs: Non-Government Organizations OVC: Orphans and Vulnerable Children PE: Physical Education PTA: Parents Teachers Association REB: Rwanda Education Board REMA: Rwanda Environment Management Authority RTP: Rights to Play SBGBV: School Based Gender based Violence SH: School Health SRH&R: Sexual Reproductive Health &Right v STI: Sexually Transmitted Infections SWOT: Strengths, Weaknesses, Opportunities, and Threats TWG: Technical Working Group UN: United Nations UNCRC: United Nations Convention on Rights of the Child UNFPA: United Nations Populations Fund UNICEF: United Nations Children’s Fund USAID: United States Agency for International Development VSO: Voluntary Services Oversees WB: World Bank WFP: World Food Programme WHO: World Health Organization vi

1. BACKGROUND AND OVERVIEW 1.1. INTRODUCTION Rwanda’s Vision 2020 and its EDPRS II aim at developing a knowledge-based and technology- led economy. In this context, Rwanda has planned to achieve Education For All (EFA) and has embarked on reforms to improve every aspect of the quality of education. It is therefore prudent that young people in Rwanda receive resources and opportunities (information, skills, and education) required for them to reach their full potential as skilled, creative and resilient people and also to make informed decisions. Children’s health is improving albeit slowly, as children receive essential life enhancing services such as vitamin A supplementation, de-worming, immunization, prevention of mother to child transmission of HIV, treatment and care of HIV infected children, and more and more children are surviving to school age and enrolling in schools1. It is therefore very important to build upon these gains from early childhood onwards and create health promoting school environments where healthy children will achieve better performance and become active members in promoting health for themselves, their families and communities and the country as a whole. More so: A health promoting school will strive to provide a safe and protective environment, psychosocial care and support, and opportunities for physical education and recreation; A health promoting school will provide skills-based health education with a focus on promoting well-being, preventing health problems, promoting activities appropriate to children’s intellectual and emotional abilities and helping children to make healthy choices and adopt healthy behaviors throughout their lives; A health promoting school engages health and education officials, teachers, parents and community leaders in efforts to promote health with families and communities involved in the school with a special focus on a school/community plan on school health; A health promoting school is one where girls and boys learn in a quality learning environment, ensuring that there are sufficient water and adequate sanitation facilities for both girls and boys, without losing sight of children with disabilities; A health promoting school is a school where students have access to age-appropriate, reliable information on relationships and sexuality and where youth is supported to access prevention and treatment services for HIV including sexual and reproductive health commodities to prevent them from diseases, teenage pregnancies and to give them the opportunity to develop their lives to their full potential; 1 For instance, primary student’s enrollment increased from 2,190,270 up to 2,394,674, and secondary students from 288,036 up to 534,712, between 2008 and 2012 (Education Statistical Yearbook 2012). 1 A health promoting school is one where girls and boys are provided with age appropriate knowledge and skills to prevent communicable disease such as for millions of young people around the world - the biological onset of adolescence – brings not only changes to their bodies but also new vulnerabilities to human rights abuses, particularly in the arenas of sexuality, marriage and child bearing. Millions of girls are coerced into unwanted sex or marriage which predisposes them to high risks of unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) and HIV, and complications which result from childbirth. School health improves health knowledge, attitudes and skills, health behaviors and health outcomes, and improves educational and social outcomes. The well-being of the learners is essential to quality education. For children to develop their full potential through full participation in educational activities and acquire knowledge and skills to become productive citizens who will lead their country to wealth and prosperity, it is important to ensure that all children enjoy a healthy, safe and protected childhood. 1.2. CONTEXT School health lies within the scope of sector policies and international, regional and national strategies. It is aligned and contributes to the achievement of goals of various international commitments and also national laws, policies and sector strategies of Rwanda. 1.2.1. International SH is critical for the achievement of the MDGs, by meeting key targets related to seven out the eight Millennium Development Goals, by helping to eradicate poverty and hunger, achieving universal primary education, promoting gender equality, decreasing under five mortality rate, prevention of HIV and AIDS, and malaria, improving water and sanitation. It also contributes to achieving Education For All (EFA) objectives, by ensuring that by 2015, all children including girls and most vulnerable and disadvantaged children have access to free and compulsory quality primary education and follow it up to the end, Rwanda is committed to fight all socio-cultural factors hindering children learning process, such as illnesses (HIV and AIDS, malnutrition, neglected tropical diseases, etc). Finally, this SH also reinforces the commitments of Rwanda regarding the Convention on the Rights of the Child (1989). As signatory of this convention, the Government of Rwanda is committed to improving the rights of Rwandese children. Specifically, this SH policy concerns the best interests of the child; the right to benefit from special care and education for disabled children; providing access to preventive and curative health care services. 1.2.2. National Regarding the national context, this strategic plan clearly implements the ambitious goals set up by Vision 2020, particularly in pillar 2, human resource development and a knowledge based 2 economy, with improvements in health and education services used to build a productive and efficient workforce. In the EDPRS II, the main health objectives are related to preventing diseases particularly malaria and HIV and AIDS; facilitating access to basic health care, particularly through the reduction of costs borne by the poor and the provision of health information at the community level; ensuring quality improvement of health services; and finally improving the educational environment for girls by providing the necessary facilities such as dormitories and toilets. The national investment strategy aims at providing easy accessibility to primary health care; developing the health insurance scheme; eradicating of malaria; controlling HIV prevalence; controlling tuberculosis and promoting reproductive health2. According to the Government’s 7 year programme, actions like the enhancement of quality education at all teaching levels, upgrading basic Education from 9 years to 12 years that is, 6 years of primary and 6 years of secondary education, giving attention to technical and vocational schools, streamlining learning and teaching of cultural values plus the English language, enhancing an inclusive education programme through increased number of schools capable of teaching the disabled as well as sensitizing parents to take part in their children’s education through their umbrella, Parents and Teachers Associations (PTAs) have to be taken into account. Furthermore, the present SH strategic plan is comprehensively aligned to the priorities established in the Education Sector Strategic Plan, addressing barriers of access to education from vulnerable children, including adolescent girls, children with disabilities, children living with HIV and children from poorer backgrounds. ESSP also focuses on sexual and reproductive health and rights, providing information about HIV and other STIs, prevention, care and treatment of affected students and teachers. ESSP supports the role of sports and physical education, in order to promote healthy bodies and minds, promoting the construction of playgrounds and sports fields; and provision of special counseling, care and support to children with special needs. 1.3. PURPOSE OF THE SH STRATEGIC PLAN The purpose of the SH strategic plan is to provide a detailed roadmap and framework for the effective implementation of the SH policy. The strategic plan seeks to ensure implementation of quality integrated services for all children at school, calling for inter-sectoral coordination of the education, health, nutrition, sanitation, and child protection sectors. SH forms the foundation of basic education programs of MINEDUC, nutrition and sanitation services in MINISANTE and MININFRA, and other agencies and groups. This strategic plan develops an implementation framework, which includes institutional arrangements required to manage and guide this approach. 2 National Investment strategy, 2003 3 1.4. PROCESS OF DEVELOPING THE SH STRATEGIC PLAN National consultations were the major venue through which views from local communities, districts, provinces to national level were sought in the development of both the SH Policy and Strategic Plan. A task force was created and was composed of representatives from the Ministry of Education, the Ministries of Health, Agriculture, Gender and Family Planning, Youth and ICT, Sports and Culture, and Local Government. NGOs and development partners also participated, such as UNICEF, WHO, WFP, UNFPA, Imbuto Foundation, SHE, RTP and VSO. Two workshops were conducted in May 2013 with development partners and government institutions for desk review, key areas for prioritization, definition of the vision and mission, situation analysis and implementation framework for the SH policy, strategic plan and HGSF program. 4

2. ANALYSIS 2.1. KEY CHALLENGES The major barriers to learning for children in Rwanda are poor health, poverty, environmental factors such as inadequate water and sanitation facilities, inadequate school infrastructure, communicable and non-communicable diseases and gender based violence. These factors impact on attendance at schools and on learner's ability to concentrate on school lessons, leading to a high drop-out and repetition rate. 2.2. SWOT ANALYSIS STRENGTHS WEAKNESSES - Political will to strengthen SH policy; - Lack of writing culture; - Community willingness to participate; - Lack of coordination and service - Policy calls for children with disabilities integration; to attend inclusive primary schools; - Inadequate parent-to-child education; - Strong commitment to family planning; - Lack of intergenerational dialogue between - SRH&R developed curriculum and parents, teachers and children about learning material; SRH&R; - General concern exists regarding children - Primary schools generally lack health care with developmental delays, malnutrition or referral services; and disabilities; - Poor attention to personal, home and - Hygiene, water and waste management are school hygiene, water and waste priorities of the Government; management; - Improved higher education institutions - Insufficient water provision in communities could partner to train SH personnel; and homes. - Strong commitment to reduce gender based violence cases, and increase protective services to girls and OVCs. OPPORTUNITIES THREATS - Increasing interest in investing in SH on - Global financial and business recession the part of international donor partners; may limit funds for social development; - Strong consensus among stakeholders and - Possible low/underutilization or inadequate citizens exists regarding the importance of use of mass media for SH; SH. - Cultural barriers and myths. 5

3. STRATEGIC FRAMEWORK 3.1. VISION “All Rwandan school children shall achieve their full development potential, by studying in a healthy environment in child-friendly schools, free from disease, prejudice and violence”. 3.2. OBJECTIVES 3.2.1. General objective To create a healthy, safer and hygienic environment for the school community, so as to ensure effective teaching and learning 3.2.2. Specific objectives

1. To provide preventive and curative services that address needs of school children;

2. To ensure provision of safe water and adequate sanitation facilities in schools;

3. To improve and enhance knowledge of students and teachers about SH, including prevention of diseases, management of disabilities and special learning needs, HIV, GBV, hygiene, nutrition, physical education and mental health;

4. To ensure that children and young people are equipped with the information, knowledge, skills and values to make responsible choices and to achieve their full potential. 3.3. STRATEGIES FOR ACHIEVING OBJECTIVES

1. Advocacy

2. Capacity Building

3. Research on School health issues

4. Integration of school health into education curricula

5. Coordination and collaboration among stakeholders

6. Monitoring, Evaluation and Learning

7. Life skills development and transfer

8. Parents and community involvement/engagement, and ownership 3.4. KEY STRATEGIC AREAS Seven key strategic areas were identified through stakeholder consultations and SWOT analysis. The following areas form the basis of the strategic results framework:

1. Health promotion, disease prevention and control;

2. HIV, AIDS and other STIs; 3. Sexual and Reproductive Health and Rights;

4. Gender and GBV issues 6

5. Environmental health;

6. School nutrition;

7. Physical education;

8. Mental health and related needs. 3.5. PRIORITY SETTING, OUTPUTS AND KEY STRATEGIES 3.5.1. Health promotion, disease prevention and control Output: all school children and youth reached by comprehensive health promotion and diseases prevention and control programs Key strategies:

1. Enabling policy and financial framework for SH;

2. Prevention and early detection of diseases and chronic health conditions;

3. Early identification and management of disabilities and special learning needs;

4. First aid kit at schools;

5. Capacity building of teachers and students on SH;

6. Improvement of M&E system on SH. 3.5.2. Prevention of HIV and other STIS Output: all school children and youth reached by comprehensive HIV and STIs prevention and control programs Key strategies:

1. Knowledge of HIV and STIs;

2. Supportive environment for HIV-positive students and teachers;

3. M&E activities in the context of HIV, AIDS and other STIs. 3.5.3. Sexual and reproductive health and rights Output 1: adolescent and young adults reached by friendly sexual and reproductive health programmes Key strategies:

1. Intergenerational communication and information about SRH&R;

2. Promotion of education on sexual and reproductive health. 3.5.4. Gender and GBV issues Output 1: all school children and youth empowered by existing governance structures on gender 7 issues Key strategies:

1. Management of Gender-Based Violence (GBV) cases;

2. Management of adolescent pregnancies in schools;

3. Follow-up children dropping out of schools (girls in the majority of the cases). 3.5.5. Promotion of environmental health in schools Output: All school children and youth have access to improved hygienic and healthy environments in schools Key strategies:

1. Provision of safe water to the children and staff in the schools;

2. Provision of gender-sensitive sanitation facilities in schools;

3. Promotion of hygiene, including menstrual hygiene management;

4. Operationalization of solid waste management systems in schools;

5. Promotion of environment protection. 3.5.6. School nutrition Output: all school children and youth reached by a comprehensive nutrition programme Key strategies: - Operationalization of Home-Grown School Feeding Programme at schools; - Continuation of other school feeding interventions; - Supplementation of micronutrients; - Promotion of nutrition education. 3.5.7. Physical education Output: all school community members reached by comprehensive physical education and sports programs Key strategies: - Strengthening of physical education and sports curriculum in schools; - Promotion of sport activities to raise awareness; - Provision and management of physical education and sports facilities and equipment. 8 3.5.8. Mental health and related needs Output: all school children and youth with mental health issues and drug addiction receive adequate counseling at schools Key strategies:

1. Provision of basic psychosocial counseling;

2. Strengthening integrated referral system for mental health;

3. Prevention and control of alcohol, tobacco and other drug abuses. 3.6. FINANCING THE IMPLEMENTATION OF THE RESULTS FRAMEWORK The Ministry of Education has been tasked with providing leadership for SH though all concerned Ministries that will contribute through their own budgets, mainly the Ministry of Health. Civil society, faith-based and private sector partnerships and contributions mechanisms and agreements for shared responsibility with Government will be developed. The share of external funding and contribution from development partners to support school health activities is also very important. International partnerships, such as One UN, multilateral and bilateral donors, and international NGOs, are expanding to assist with the development of integrated SH programs nationwide. Table: Costs by key strategic areas (in RwF millions) Source of funding Key areas Total % MoE MoH Other

1. Health promotion and disease prevention 9,598 9.0 541 9,057 -

2. HIV, AIDS and STIs 300 0.4 150 150 -

3. Sexual and reproductive health and rights; 470 0.3 170 150 150 Gender and GBV issues

4. Environmental health 23,255 21.8 23,255 - -

5. School nutrition 71,126 67.0 56,126 - 15,000

6. Physical education and sports 1420 1.3 1,120 - 300

7. Mental health 320 0.3 150 170 - TOTAL 106,489 100 81,932 9,377 15,150 Note: More than 60% of the total budget is for the implementation of school nutrition component 9 3.7. CAPACITY BUILDING An important component of the SH policy and strategic plan refers to capacity building. It standardizes approaches among implementing partners, including at the community level. It is also crucial to build capacity of human resources at central and district levels, to ensure that all implementing actors have sufficient knowledge about this SH strategic plan. A special component of the training refers to the “school health teachers’ training. Pre- and in-service training of teachers should contain all key areas presented in this strategic plan, as a general “school health training”. Each in-training session will be followed by a formative supervision for effective implementation of the policy. These teachers will be responsible of training peer educators, who will then educate other students, especially through the health clubs that will be set up in all schools. The health clubs will include discussions about AIDS, environmental health and hygiene, gender based violence, sexual and reproductive health and rights, nutrition, malaria, mental health, community health, non-communicable diseases, children under five years and immunization and HPV surveillance. 3.8. STRATEGIC RESULTS FRAMEWORK The tables presented below are comprehensive results frameworks which will guide implementation of the SH strategic plan and act as an M&E tool to assess progress towards achieving the objectives of the SH policy. The results chain of the framework is organized into seven strategic objectives (outcomes), which will be achieved over the course of the five- year strategic plan. Output-level results for each outcome contain specific activities, with indicators, targets, timelines and budgets, with the responsible actor identified for each activity. The detailed results framework is the product of a workshop which brought together representatives, from the key concerned Ministries, UN agencies and CSOs. 10 STRATEGIC OBJECTIVE 1: HEALTH AND WELLBEING PROMOTION AND DISEASE PREVENTION AND CONTROL Expected Respo Baseli Activities Indicators Partner Target 2013 2014 2015 2016 2017 Costs results nsible ne 1. To integrate Number of Enabling SH into national policy and Social national policies with MoE 5/11- 6 - 1 1 1 3 - financial ministries policies and integration of framework strategic plans SH for SH

2. To carry out Number of Enhanced health school prevention examination institutions and early of school Healt MoE/ that have New detection children by h MoH, 100 carried out activit 100% - - 50% 50% 800 of health nurses from center WHO, % health y problems neighboring s UNICEF examination and health centers to screen chronic once per year children health conditions To carry out HPV UNICEF, Number of immunization Rotary 100 girls MoH 93% 100% - 95% 97% 99% 3,000 for girls Club, % immunized students three GAVI times a year 11 MoE, To deworm Number of MoH, 100 children every children MoH 95% 100% - 96% 98% 99% 437 WHO, % semester dewormed UNICEF To provide RBC( bed nets for all Number of Global Malar 100 new boarding bed nets Fund, 75% 100% - 96% 98% 99% 3,900 ia % schools distributed WHO unit) admissions To do regularly in- Number of Global Schoo 100 door spraying schools with Fund,WH 75% 100% - 96% 98% 99% 120 l % in boarding IDS O schools Elimination of Number of breeding Global schools with Schoo 100 places of Fund,WH 75% 100% - 96% 98% 99% - no breeding l % mosquitoes in O places schools

3. Early To carry out identificati screening for on and special needs Dev Number of manageme and learning elop school nt of disabilities in Healt MoE, men institutions New disabilities ECDs and h MoH, t of that have activit 100% - 5% 8% 10% 800 and special primary center WHO, Trai carried out y learning schools by s UNICEF ning children needs nurses mod screened from ule neighboring health centers 12 To have a first Number of

4. First aid aid kit MoH/ schools with MoE 30% 90% - 50% 80% 85% 90% 141 at schools available in all UNICEF first aid kits schools To build Number of capacity of 2 teachers and teachers per 100 peer MoE MoH New 100% - 30% 60% 90% 400 school on SH % educators trained 5. Enhanced To set up and knowledge maintain about health clubs in school schools Number of health 100 100 100 (including schools with MoE MoH 65% 100% - 80% - % % % HIV, health clubs ASRH&R, GBV, nutrition, etc.) To carry out Upd

6. M&E regular ate Operationa update data Number of REB/ Annual M& collection MoH EMIS - - - - - l M&E M&E reports MoE report E system tool s Total objective strategic 1 9,598 13 STRATEGIC OBJECTIVE 2: PREVENTION OF HIV, AIDS AND OTHER STIs Expected Respo baseli Activities Indicators Partner Target 2013 2014 2015 2016 2017 Costs results nsible ne

1. To review and Enhanced update knowledge curriculum comprehensiv All Upd Upda about HIV, about HIV and e sexuality schools ate te AIDS and AIDS and education MoE, 100 REB - to - curri curri 100% - other STIs STIs through a curriculum UNFPA % implem culu culu comprehensiv updated and ent m m e sexuality implemented education curriculum To produce Dev Number of and elop schools with REB/ disseminate men IEB/BCC MoE/ MoH/RCH IEC/BCC - 100% - t of 40% 80% 100% 120 materials UNIC C/UNFPA materials mat disseminated EF about HIV, erial and received STIs s

2. Number of Supportive school environme institutions To include nt for who had discussions MoH/ HIV- conducted about MYICT/U positive discussions 100 100 mitigating REB NICEF/U - 100% - 80% 100% - students about % % stigma and NFPA/AR and mitigating discrimination BEF teachers stigma and in health clubs discriminatio n in health clubs 14 To carry out Number of sensitization sensitization MoH/ campaigns campaigns RBC,MYI caring for 100 100 100 REB CT,UNIC New 100% - 100% 180 those affected % % % EF,UNFP by HIV and A AIDS

3. M&E To update M&E school Upd activities M&E school reports ate in the system with including MoH/RBC M& 100 100 context of emphasis on HIV, AIDS MoE - - - 100% - HIV unit E % % HIV, HIV, AIDS and STIs tool AIDS and and STIs s STIs Total Objective Strategic 2 300 STRATEGIC OBJECTIVE 3: PROMOTION OF SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS/GBV ISSUES Expected Respo Baseli Activities Indicators Partner Target 2013 2014 2015 2016 2017 Costs results nsible ne To build capacity of teachers and peer educators Number of about GBV Two

2. Reduced teachers and MoE, (health clubs, MIGE teacher 100 cases of peer UNFPA/G new - 30% 60% 90% 150 trainings, PROF s per % SRGBV educators MO sensitization school trained campaigns, information about GBV kit in health 15 centers) Number of MIGEPR To create and schools OF implement a included in MINALO SBGBV MoH new 100% - 40% 80% 150 SBGBV C, referral system referral UNFPA/G for victims system MO To collect data Number of about pregnant girls quitting Dev girls quitting school due to MINALO All

3. Early elop school and pregnancy school C, concer pregnancie - mec - - - 25 returning to s UNFPA/G ned s managed hani school after MO girls sms delivery Total for objective strategic 3 470 STRATEGIC OBJECTIVE 4: PROMOTION OF ENVIRONMENTAL HEALTH Expected Respo baseli Targe 201 201 Activities Indicators Partner 2015 2016 2017 Costs results nsible ne t 3 4 To set up and maintain rain Number of MININF 1. water schools water REB RA/UNIC 60% 80% - 60% 65% 70% 80% 2,000 Improved harvesting in harvesting EF access to schools adequate Number of MININF To build tap 100 and safe schools with REB RA/ 44% 100% - 50% 70% 90% 2,000 water systems % water to tap water UNICEF schools To improve Number of MININFR Schoo 100 water quality schools with A/ 52% 100% - 65% 80% 90% 1,000 ls UNICEF % and treatment potable water 16 To set up gender-based Number of MININF sanitation schools with 100 REB RA/ 80% 100% - 85% 90% 95% 15,000 facilities in gender-based % UNICEF schools sanitation systems 2. To put in place Number of Improved MININF hand-washing schools with sanitation REB RA/ - 80% - 20% 50% 60% 80% 112 points in all hand-washing facilities in UNICEF schools. points schools To ensure Number of clean MININF schools with sanitation Schoo RA/ 100 clean 60% 100% - 70% 80% 90% 240 facilities at ls UNICEF/ % sanitation school on a WHO facilities daily basis To ensure that Number of children are schools educated about educating MoH/WH 100 3. general body about general REB - 100% - 70% 80% 90% - O % Improved hygiene and body hygiene general oral health and oral hygiene, health including Every school menstrual Number of has sanitary District hygiene schools with pads available MoE Schools, 60% 70% - 25% 40% 60% 70% 1,595 sanitary pads for emergency UNICEF available situations 17 To train and Number of supervise teachers and teachers/learne learners rs in good trained practices MoH/RE 100 including REB 20% - - 30% 60% 90% - MA % cleanliness and proper disposal of waste in all schools To set up waste management systems in Number of schools, e.g. school with MININF MoE 65% 70% - 20% 50% 60% 70% 98 4. eco-san toilets, waste RA Operationa biogas management l solid (fertilizer and waste source of manageme energy) nt systems To train and Number of in schools supervise schools UNICEF, teachers and having WHO, 100 learners on MoE 20% 100% - 30% 60% 90% - teachers and MININF % solid waste learners RA management trained in schools 18 To ensure a healthy learning environment Number of (well schools with school 100 ventilated well- MoE 75% 100% - 80% 85% 90% - s % class rooms, ventilated adequate classrooms number student per 5. class) Protected and improved school Number of To plant tree environme schools with school and gardening REMA 60% 85% - 65% 70% 75% 85% 80 nt gardening and s in schools countrywi trees de 100% To construct Number of of infrastructure schools with newly adequate to MININF infrastructure MoE 20% constr - 20% 50% 60% 70% 130 children with RA to physical ucted physical disabilities school disabilities s Total for objective Strategic 4 23,255 19 STRATEGIC OBJECTIVE 5: PROMOTION OF SCHOOL NUTRITION Resp Expected Indicato Baseli Activities onsi Partner Target 2013 2014 2015 2016 2017 Costs results rs ne ble To provide school meals Number to children in of scho MoA/WFP/ pre-primary, schools 7% 80% - 20% 50% 60% 80% 20,000 ols MoH primary and providin secondary g meals schools To ensure adequate Number Scho human MoA/WFP/

1. HGSFP of staff ols/R 7% 80% - 20% 50% 60% 80% 220 resources at MoH operational hired EB national and local levels Capacity Number building of WFP/UNICE 100 of staff REB - 100% - 30% 60% 90% 11 national and F % trained local staff Number Upd M&E system 100 100 of M&E REB - 100% - ate 100% 15 operational % % reports tool Number

2. Other of school One Cup of schools WFP/UNICE feeding Milk per MoA 4% 50% - 10% 40% 45% 50% 15,000 impleme F intervention Child nting the s continued project 20 Secondary Number School of MIN Feeding schools 100 100 100 EDU REB, District 100% 100% 100% 100% 35,760 Programme(b practicin % % % C oarding g SFP schools) Number of Conduct bi-

3. Reduced schools annual Micronutrie receiving WFP/UNICE 100 100 100 micronutrient MoH 96% 100% - 100% - nts vitamin F % % % supplement deficiencies A (Vitamin A suppleme ntation

4. To Number Enhanced create/strength of school nutrition en school with scho WFP/UNICE 41% 70% - 45% 50% 60% 70% 120 education gardens, as a gardens ols F pedagogical intervention Total for objective Strategic 5 71,126 STRATEGIC OBJECTIVE 6: PROMOTION OF PHYSICAL EDUCATION Resp Expected Indicato Basel Targe Activities onsi Partner 2013 2014 2015 2016 2017 Costs results rs ine t ble

1. A well- To re-orient Life developed curriculum to skills All Upd 100 100 PE/Sport life skills curriculu REB MoE - school - 100% ate % % sequential development m s curriculum and survival. reviewe 21 in place d To train enough Number PE/Sports of 100 teachers in life REB MoE - 100% 30% - 60% 90% teachers % skills oriented trained curriculum To involve Number PTAs/local of communities in schools the with Scho MoE, 100 implementation PTAs - 100% - 30% 60% 90% 400 ols Districts % of the PE/Sport involved curriculum. To organize Number

2. Use of regular of sport awareness rising campaig 100 100 100 activities MoE MINESPOC - 100% - 100% 170 campaigns ns % % % for about health carried awareness education. out 22

3. Schools To provide and Number have maintain sports of sports facilities and schools 100 REB MINESPOC - 70% 30% 60% 90% 850 facilities equipment to all with % and basic education sports equipment schools facilities 1420 Total for objective strategic 6 STRATEGIC OBJECTIVE 7: PROMOTION OF MENTAL AND PSYCHOSOCIAL WELLBEING Ba Expected Indicat Responsi 201 Costs Activities Partner seli Target 2013 2014 2015 2017 results ors ble 6 RWF ne To establish teacher Numbe and peer- r of

1. Students educator schools dealing with counselor with mental s, as focal MoH/W Update 100 operati REB - 100% - 100% 100% - health points, to HO tool % onal issues are assist counsel assisted students ing with system mental health issues 23 To set up Numbe referral r of 2. mechanis schools Operational ms with Ne Update 100 referral between operati schools MoH - - 100% 100% - w tool % health health onal school facilities referral and system schools

3. Alcohol, Numbe Raising tobacco or r of awareness other drug schools campaign WHO/W 100 abuse particip MoH - 100% - 100% 100% 100% 170 s about FP % managed at ating in drug school level campai abuse gns Setting up Numbe REB/sch MoH/M monitorin r of ools ental g schools health mechanis with unit ms to monitor 70 Update 100 100% - 100% 100% 150 rehabilitat ing % tool % e children system with drug/alco hol abuse Total For Objective strategic 7 320 TOTAL GENERAL 106,489 24

4. IMPLEMENTATION PLAN 4.1. INSTITUTIONAL FRAMEWORK The SH strategic plan implementation will require a solid implementation effort from all involved parties, representing a diversity of organizations. Significant inputs in terms of financial and human resources will be required to support SH interventions in each of the seven health priority areas. It is therefore important to put in place a solid governance structure to enable smooth and effective implementation under the coordination of the MoE. The SH policy and its strategic plan implementation will be governed by both political and operational structures. At the political level, a Steering Committee composed of a core group of decision makers in key ministries and partners will meet quarterly to provide overall leadership and guidance on the implementation of the strategic plan and the achievement of the SH policy actions. SH in Rwanda is the responsibility of the Ministry of Education along with the support of line ministries, different governmental and non-governmental agencies including local and international organizations, UN agencies (WFP, UNICEF, UNFPA, WHO, FAO), USAID projects, the private sector and other health and education sector implementing partners. Collaboration among all stakeholders is a key for the successful implementation of SH strategies and activities at national, district and community levels. The work of the Steering Committee will be supported by an SH Technical Working Group, chaired by MINEDUC and composed of technical staff from key ministries/institutions, UN agencies, and NGO’s. The TWG will meet on a regular basis to agree upon specific actions and to report to the Steering Committee on progress and plans. Under the technical working group, the cross-cutting program unit at MINEDUC will be responsible to implement SH program activities. At decentralized levels, the implementation of this SH strategic plan will require a very high degree of coordination. SH committees will be established at district, sector and cell levels, to oversee and implement related activities at their levels of administration. At the school level, a school health committee will be created to supervise and implement all activities carried out in schools. 4.2. MONITORING AND EVALUATION M&E is an integral part in the development of SH strategic plan. The objective of M&E plan is to assess achievements against goals defined during the elaboration of a SH strategy or activity. It includes indicators that measure either impact or processes during and after the period of implementation. Special studies like surveys and surveillance studies can be developed and implemented at certain point of time to measure what the strategy has achieved. M&E increases accountability and is a key information source to ensure policy makers are sufficiently informed and able to reflect and analyze performance. It also enables to gather lessons learned to improve 25 future strategic plans’ development and implementation. Given the always increasing focus on results by the GoR, the establishment of robust monitoring and evaluation mechanisms for SH strategies is of great importance. Rwanda has a well-established and functional system at the national level for M&E. However, the system has not yet been adequately decentralized to the district, sector and community levels. Decentralized routine monitoring activities such as data collection and reporting from the school level up to the national level needs to be strengthened. The quality of the data collected at decentralized levels will influence the quality of SH strategies M&E activities. An important part of the implementation of this strategic plan will be to generate research findings and lessons learned to be shared across ministries. Those data will inform the evidence-based decision making process of policymaking, advocacy, and program evaluation. In addition to a surveillance system, sub-strategy will define formative research needs to be conducted in specific SH areas. Performance review should be conducted on an annual basis as part of the monitoring process with both internal and external partners’ evaluators working together on agreed performance indicators to assess progress. The main purpose of the joint review will be to assess progress made in the sub-sector, identify challenges with explanations as well as identify solutions. It is important stakeholders perform this review jointly to enable standardization of the approach used by the different implementing partners and reduce transaction costs. Results will be used to inform on the progress of the implementation of the SH strategic plan as well as collect lessons learned for future strategic plans. 26 4.2. MONITORING AND EVALUATION FRAMEWORK Indicator Frequency of Source of Method of Responsible collection information collection / tools Extent of integration of health education across the Annually REB FGD REB curriculum Classroom time devoted to each topic area and its Annually REB FGD REB distribution across years No smoking policy in school ground or at school Annually Schools Observations School functions /checklist Availability of prevention interventions such as Quarterly Schools Observations School Mosquitoes nets supplied and their use encouraged /checklist Availability of protective equipment for sports and Quarterly Schools Observations School physical education /checklist Extra curricula programs (sports, music dance and Annually REB FGD REB drama) Increased availability and promotion of healthy foods Quarterly Schools/PTAs EMIS School Clean and well maintained buildings and ground, free of Annually REB FGD REB dangerous materials Adequate light and ventilation in the classrooms and Annually REB FGD REB dormitories 27 Indicator Frequency of Source of Method of Responsible collection information collection / tools Facilities for social interactions and quiet work Annually REB FGD REB Safe facilities for sports, physical education and other Quarterly Schools/PTAs EMIS School recreation Availability and accessibility of safe drinking water Quarterly Schools/PTAs EMIS School Clean, functioning and adequate toilets/latrines for both Quarterly Schools/PTAs EMIS School boys and girls. Availability of hand washing facilities School facilities catering for the needs of pupil with Annually REB FGD REB physical disabilities Extent and nature of student involvement in decision Annually REB FGD REB making Proactive programs to reduce bullying and violence Quarterly Schools/PTAs EMIS School Proactive programs to enhance a positive psycho-social Quarterly Schools/PTAs EMIS School school environment Peer support programs Annually REB FGD REB Nature and extent of parental involvement encouraged Quarterly Schools/PTAs EMIS School by the school Frequency and nature of health promotion programs for Quarterly Schools/PTAs EMIS School school staff 28 Indicator Frequency of Source of Method of Responsible collection information collection / tools Involvement with local community leaders in promoting Quarterly Schools/PTAs EMIS School health (for example, preventing cigarette sales to minors) Frequency and nature of involvement of government, Annually REB/MoE FGD Mineduc non-government, community and commercial agencies with school Frequency of teacher-parent meetings and health issues Quarterly Schools/PTAs EMIS School discussed at those meetings First aid and other support for those with chronic disease Annually MoE/MoH/REB EMIS Mineduc (for example asthma) Screening according to MoH Health guidelines Quarterly Schools/PTAs EMIS School Referral for those with complicated illness (including Quarterly Schools/PTAs EMIS School those with a drug addiction, mental health problem, social adjustment difficulties) Counseling and conflict resolution for staff-staff, staff- Quarterly Schools/PTAs EMIS School student and student- student problems 29

5. CONCLUSION While this SH sstrategic plan has identified seven school health priorities to focus on through 2018, it cannot achieve the desired outcomes alone: it should be integrated in all institutions’ main strategic plans and efforts. This strategic plan provides a broad operational framework for SH planning and coordination of all stakeholders, enabling the creation and maintenance of child-friendly schools. Furthermore, the implementation of this strategic plan implies the provision of a minimum package of health services to the school community. Capacity building of teachers and peer educators, creation of comprehensive school health clubs, curriculum reviews, and having an operational M&E system are also essential steps to achieve the SH objectives. 30 BIBLIOGRAPHY African charter on the rights children Millennium Development Goals (MDGs) Government of Rwanda. Economic Development and Poverty Reduction Strategy 2013- 2018-Kigali/Rwanda Kanyoni M, Gishoma D, Ndahindwa V (2011). Prevalence of psychoactive substance use among youth in Rwanda. School of Public Health, Kigali/Rwanda MIGEPROF (2013). Gender Based Violence in Primary and Secondary Schools in Rwanda. MINECOFIN (2000). Rwanda Vision 2020, Kigali MINEDUC (2011). Education Management Information System Report MINEDUC (2011). Integrated Early Childhood Development Strategic Plan 2011/12- 2015/16 MINEDUC (2013). Education Sector Strategic Plan 2013/14-2017/18 MINISANTE. Health Sector Strategic Plan III, Ministry of Health-Kigali/Rwanda UNESCO, UNICEF, WHO, World Bank and International Education (2002). FRESH, a holistic approach to school health for the prevention of HIV and AIDS and improve learning outcomes, 2002, ED-2002/WS/8. UNCRC (1996). United Nations’ Convention on Rights of the Child UNICEF (2004). The state of the world’s children. New York. WHO (2003). Physical school environment document II WHO (n/d). The World Health Organization’s Information Series on School Health Document 2 The Physical School Environment an Essential Component of a Health- Promoting School environment document II. 31 ANNEX: COORDINATION CHART MINEDUC MINISANTE MINAGRI SH High-Level Steering Committee SH Technical Working Group Cross-cutting programs Unit SH District Level Committee SH Sector Level Committee SH Cell Level Committee School Health Committee (school level) 32