The Health Promoting Schools Essay Writing Project on “How Do I Use Nutrition to Make My School a Health Promoting School” – collaboration between government and private sector targeting communities faced with poor socioeconomic conditions.

By Nireshnee Reddy, RD (South Africa)

Background

Poverty is prevalent in some parts of South Africa. One of the byproducts of the bitter history of apartheid in the country, many people are currently challenged with basic necessities such as food, water and shelter. Furthermore, the same sectors of the population are challenged by teenage pregnancy, alcohol and drug abuse, and malnutrition amongst other problems. In light of the above and to promote equality in a country embracing democracy, the official concept of health promotion entered the South African health system in 1999. The national policy for health promotion practice in South Africa is based on the principles and approach of the 1986 Ottawa Charter for health promotion. The five action areas of services, policy, environment, community involvement and skills development exist to include promotion of health issues by entities other than health institutions only. For example, the Health Promoting Schools (HPS) component is an example of health action outside the health sector. To ensure success of such initiatives however, requires partnership with the relevant bodies (in this case Department of Education [DOE]) to facilitate entry to schools, and communication and activity with teachers and learners. Partnership is also required between health promotion and nutrition professionals to ensure that the correct nutrition information is being disseminated. One of the outcomes of this five-action-areas approach outside the health sector is the fostering of environmental and community change, rather than individual focus. Learning healthy habits at school may entrench them for a lifetime, and it is well documented that nutrition plays a key role in the prevention and management of several diseases, and provides other benefits, such as improved mental alertness and concentration in the classroom.

Improving nutritional status and learner performance is one of the entry points to a school becoming a health-promoting school. However to achieve this, nutrition education to all relevant stakeholders in the school environment is essential. This includes nutrition education to children to be able to understand and implement the information provided. As students are often not the decision makers in food purchase and preparation, it also requires nutrition education to parents, caregivers, school-feeding program coordinators, and teachers. Nutrition is a component in the South African Department of Education's Life Orientation Curriculum for learners, so this information must be in line with the Department of Health's nutrition education strategies. My work at the South African Sugar Association (SASA) entails nutrition education in partnerships with government or NGOs (non-governmental organizations).

Nutrition education is usually based on the South African Food Based Dietary Guidelines (SA FBDG), amended for the relevant target audience. In my project, "nutrition education in schools" was the system improvement, and the Health Promotion Division of Department of Health and SASA were allied partners.

Project Concept

In 2008, SASA approached the KZN Department of Health, Health Promotion to discuss a possibility of collaboration on the Health Promoting Schools (HPS) Project in the province. A partnership ensued that resulted in the development and implementation of the Health Promoting Schools Project, "How do I use nutrition to make my school a health promoting school?"

Schools that were not yet HPS were invited to participate, as they could they use nutrition as an entry point for their schools to become a health promoting school. Primarily schools that were based in deep rural areas were selected, since they had limited access to nutrition education resources. Most nutrition resource materials available display a large variety of foods when explaining a balanced diet, and for a rural community this was discouraging, as they did not have access to most foods. The objective of this project was, therefore, to educate teachers on how best to put together a balanced diet with their available resources and then how to disseminate this information to their learners and the wider community. Department of Education was supportive of the project because it allowed their teachers to learn a section of the life-orientation curriculum, as well as providing the teachers with a personal development opportunity. The project also supplemented the nutrition education component of the National School Nutrition Programme.

Health Promoting Schools Nutrition Essay Projects 2008-2012

Methodology

Teachers were invited to attend a nutrition education workshop (4 - 6 hours long), which I designed, where they were taught basic nutrition principles based on the SA FBDG and how to incorporate this into their curriculum as lesson plans. This was structured so that they did not feel that the workshop added to their current workloads. The workshop was designed to motivate them to practice these nutrition principles in their own lives, and to be positive role models for their learners. The workshop was facilitated in partnership with a health promoter. The workshop also entailed a section on the definition of a health-promoting school, and provided examples of how nutrition could be incorporated into the five action areas of health promotion, as outlined below:

• Services: Access to credible sources of nutrition information from dietitians, academia and hospitals. Most learners and teachers in rural areas were unaware of dietitians and how to access dietitians in the public health sector.
• Environment: Promoting the nurturing of a vegetable garden at school and using the opportunity to teach children the value of vegetables, as well as the value of physical activity, which is also practiced in caring for a garden.
• Policy: Providing examples of nutrition-related policies, e.g. having a vendor policy at school, hand-washing policy, and food safety policies pertaining to the school feeding program.
• Community: Teaching ways of incorporating the parents, caregivers and wider community into activities that would promote nutrition education. For example, celebrating Nutrition Week and inviting the community to learn from activities, such as poems, plays, and posters, conducted by the students.
• Skills: Teaching relevant nutrition related skills; not only in life orientation but other subjects as well, such as, how to read nutrition food labels and then develop a mathematical exercise from that. Or, teaching about foods from other cultures during history lessons.

During the workshops the teachers were provided with a wide variety of resources on both nutrition and health promotion. They were then requested to encourage their learners to enter into the provincial essay writing project on "How do I use nutrition to make my school a health promoting school?" The motivation to enter was recognition for the school and learners at a provincial prize-giving ceremony. The essay writing component was the feedback mechanism to measure the extent to which information was translated from the workshops to the learners. Reading of the essays at the district and provincial level by the project’s organizing committees was an indicator that the workshops were successful. The marking rubric was designed to favor learners with original ideas on promotion of nutrition in their schools, as well as those who were able to translate the FBDGs into practical application in their own settings. It is worth noting that the large majority of learners who participated in both provinces had no access to the internet for extensive research. The essays were handwritten and original copies submitted.

Conclusion

Apart from the number of people that were reached by the project (teachers, learners, parents/caregivers), a greater achievement was the extent of reach. Many times, teachers expressed their deep appreciation for considering their schools in this project, as they were based in deep rural areas and seldom reached by such projects. The project also reiterated the need for public-private partnerships and the importance of integration of government departments in the country. It was a successful collaboration between SASA (private), DOH (government) and DOE (government). Although nutrition education was present in the curriculum and health promotion activities of various departments, this project reiterated a simple message, "together we can do more".